VA touts successful first EHR go-live: ‘A lot of things worked’

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After the pandemic and other challenges forced multiple delays, the Department of Veterans Affairs is declaring its initial go-live of the highly-anticipated electronic health record a success.

VA deployed the new EHR, which is based on Cerner’s Millennium platform, to the Mann-Grandstaff Medical Center in Spokane, Washington, two weeks ago. The initial go-live is part of a 10-year, multi-billion EHR modernization effort, which VA anticipates will run through at least 2028.

“Today I’m happy to report that the first installment of this new system went extremely well,” Pamela Powers, VA’s acting deputy secretary, told reporters Monday afternoon. “As we transition to the new health record in Mann Grandstaff and nearby rural clinics, veterans receive seamless care. No veteran’s treatment suffered as we moved to the new system.”

In the first five days, VA employees in Spokane used the new system to place more than 23,000 orders for clinical tests, medications and admissions, Powers said.

“Our team works. Our processes work. Our methodologies work. Our strategies work,” John Windom, executive director of VA’s Office of Electronic Health Records Modernization, said. “Our plans work, and we can take this to the enterprise. We look forward to doing so.”

VA also deployed the new EHR to the West Consolidated Patient Account Center, a patient billing center in Las Vegas. About 100 employees work at the CPAC support billing in Spokane, and they’re now also using the new Cerner system, Laura Kroupa, chief medical officer for VA’s EHRM Office, said.

The pandemic forced VA to reexamine how many staff could be on the ground in Spokane during the system cut-over, though those preparations came in handy when a snow storm in the area knocked out the power the night of the go-live, Kroupa said.

“Normally in a situation like this we would have a big command center with everyone all in one place. We separated into rooms and kept track of who was in each room,” she said. “We had two different command centers at Mann Grandstaff, one was across the street at the Cerner training center. We had another one at the Doubletree hotel there in Spokane because we needed more space for social distancing.”

Roughly 96% of the Spokane users had received training on the Cerner platform before the go-live. Much of the training went virtual during the leadup to the initial go-live, which Kroupa said will largely continue as the pandemic persists.

Problems had plagued the Defense Department’s initial EHR rollout in 2018, with end users submitting tens of thousands of trouble tickets to the DoD help desk.

Yet VA said it took DoD’s lessons to heart. Most of the trouble tickets that did come in came from users who needed access to an additional function on the new Cerner platform, for example.

“We had very few tickets from an infrastructure and end user device perspective,” Dominic Cussatt, VA’s deputy chief information officer, said. “We were seeing in that first week after we went live the IT infrastructure tickets were remaining in the single digit numbers, which is exceptional. That exceeded our greatest expectations. For a couple days we were able to get the total open infrastructure and end user device tickets down to zero.”

“There were no major critical IT issues that happened during go live and the system seems to be performing well a couple weeks out,” he added.

VA and Cerner stood up a 24/7 support desk to help field incoming trouble tickets and project future problems. Other staff members are on site or available virtually to help end users in Spokane.

“We’ve had adoption coaches and clinical support on the ground in Mann Grandstaff and at the western CPAC, but we’ve also provided virtual adoption coaches to over 800 users across the country who are supporting the effort,” Kroupa said. “We’ve also had some virtual support for Mann Grandstaff as well. We’re continuing to assess how we can be safer and continuing to assess what makes sense virtually and what doesn’t.”

Kroupa said she and her team are seeing some of the usual challenges that naturally come during any large-scale change-management exercise.

“Change is difficult, and it takes some time for staff to be able to understand all those changes and to feel comfortable with all those changes,” she said. “We’re seeing the normal adoption curve. We’re already seeing that they’re going from ‘I don’t know what button to push; I’m not sure what to do next,’ to ‘Why does this work this way, and why did we make this change?’ [They’re] asking more questions about the standardized workflows that were put together.”

An after-action group will collect feedback from Spokane end users and will report its findings. Those findings will inform future EHR deployments, Windom said.

“We continue to assess our risk portfolio, our methodologies and our strategies, and we will refine them, especially as we move to the entire enterprise with deploying this solution,” he said. “I can tell you a lot of things worked.”

Spokane is a relatively small facility and supports roughly 24,000 veterans, according to VA.

Members of Congress have been supportive of VA’s EHR modernization efforts, even as the pandemic and development and training challenges have pushed back the initial go-live in Spokane twice. Still, some of members of Congress are skeptical the recent go-live portends success for the rest of the VA enterprise, and they’re anxious to see how a deployment at a larger facility will go.

They’re also concerned about the potential for confusion among veterans as their facilities receive the new Cerner platform and patient portal.

Powers said more than 2,200 veterans have created accounts for the new patient portal through Cerner’s new system. As VA deploys the EHR to medical facilities around the country, veterans who visit the facilities with the new system will transition away from the My HealtheVet platform and to Center’s patient portal.

The department said it’s actively communicating with veterans about the change. Veterans who are Spokane patients and visit VA.gov today will be automatically sent to the new patient portal.

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