McDonough acknowledges productivity concerns with VA’s new EHR

Veterans Affairs Secretary Denis McDonough told Congress he still believed the department could meet its initial $16 billion, 10-year budget and timeline for implementing Cerner’s Millennium electronic health record suite, despite multiple delays and problems with the modernization effort at its first go-live site.

VA last week announced a three-month pause to review the status of the electronic health record modernization program, which the department deployed to its first site last fall in Spokane, Washington.

“If our review shows anything to suggest that the current deployment of the system or the contract requires us to move forward even if our practitioners are not able to use it to help vets or it’s not increasing outcomes for our vets, then I’ll be the first one back up there to say this thing is not working and we need to re-look [at] the whole thing,” McDonough told the House Veterans Affairs Committee Thursday.

“I don’t think that’s what we’re going to find, but if we do find that then I’m going to be the first one up to there to say to you that this is not working,” he added.

At the time of the initial go-live last fall, VA said the deployment went well. But members of Congress documented a series of challenges with the EHR, prompting concerns as VA initially planned to deploy the electronic record to a second hospital next month.

The department said an initial review of the Spokane go-live prompted its decision to pause and launch a more detailed analysis.

“We’re seeing productivity declines bigger than I would have anticipated, but importantly also continuing longer than I would have anticipated,” McDonough said.

Lawmakers on both sides of the aisle agree the review is necessary. In letters to McDonough, members said clinicians in Spokane struggled to use the new platform to fill prescriptions, leading to mistakes that, in some cases, negatively impacted patient care.

“The doctors and the nurses in the Veterans Health Administration and the veterans they serve are the customers,” said Rep. Jim Banks (R-Ind.). “The Office of Electronic Health Records Modernization (OEHRM) is the implementer. When VHA is not very clear about what it needs or when OEHRM does not listen, the results have been very poor.”

McDonough agreed VHA clinicians should have a prominent seat at the table in developing the requirements for the EHR, suggesting the modernization program couldn’t succeed unless the staff in Spokane believed in the platform.

“At the end of the day, this is about service provision and outcomes for the vets,” he said. “That has to be what drives it, and the best proxy for that right now is making sure that our practitioners, clinicians, doctors … and nurses understand what it means and see its benefit. If they don’t, we’re going to be in this box for a long time.”

Both Banks and Rep. Matt Rosendale (R-Mont.) said VA’s budget and rollout schedule needed an overhaul.

Rosendale went as far as to suggest VA should compensate Cerner based on its performance and its ability to meet specific metrics.

“When we have time frames that have been delayed over and over again and they have not met those benchmarks, in the world that I live in, you don’t get compensated for a job that has not been completed,” he said.

‘A unionized workforce is a strong workforce’

Thursday’s hearing was McDonough’s first time testifying before Congress since his confirmation to VA, and members of the House committee peppered him with a long variety of questions.

Reps. Conor Lamb (D-Pa.) and Elaine Luria (D-Va.) said VA facilities in their districts have been slow to implement the president’s January executive order, which repealed three policies from the previous administration and restored official time and collective bargaining for federal employee unions.

“I come at this with a strong belief that the best way we will serve the mission of the VA, taking care of the veterans, is by taking care of the people whose job it is to actually take care of them,” Lamb said. “The impression we’re left with is that the VA on the ground is dragging their feet in implementing President [Joe] Biden’s executive order.”

McDonough hinted at announcements and other steps “in the next days and weeks” to implement Biden’s order and promised to look into challenges at local VA facilities.

“A unionized workforce is a strong workforce. Collective bargaining is a powerful tool for a strong workforce, and the evidence of this is manifold, but in the VA the evidence of it is the performance over the course of the pandemic,” he said.

“At the end of the day, I’ve made a commitment in taking this job that I will make every decision based on whether that decision increases access and improves access for veterans,” McDonough added. “I see questions around labor-management relations in that same framework, and we’ll be making sure that we both make those decisions and then implement them consistent with empowering a workforce that is our number one asset.”

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