The Department of Veterans Affairs will not deploy its new electronic health record to additional sites over the next six months, after a recent strategic review found a wide array of problems at the first go-live site in Spokane, Washington.
It’s the most definitive statement VA has provided publicly to date about the path forward for the EHR modernization since it launched a strategic review of the massive project back in March.
Senators were frustrated but subdued when they discussed the state of the EHR modernization program at a hearing last week with VA Secretary Denis McDonough, who said he was confident the department could turn things around.
VA returned to Capitol Hill Wednesday, this time without McDonough, but with representatives from Cerner, the lead contractor on the project.
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Committee members were noticeably more frustrated, if not agitated at times.
The current EHR at the Mann-Grandstaff VA Medical Center in Spokane still has bugs, said House Veterans Affairs Committee Ranking Member Mike Bost (R-Ill.), and the department has “a plan to make a plan to fix the system.”
“I’m not interested in shoveling more money into a flawed program just to keep the paychecks flowing,” Rep. Matt Rosendale (R-Mont.), ranking member of the technology modernization subcommittee, said Wednesday afternoon. “Last week Secretary McDonough assured the Senate that the technology is fundamentally sound. We’re going to find out. The proof is in the performance. If the army of crackerjack management consultants, and the tiger teams, and the advancement teams, and the adoption coaches and the change management experts cannot make headway with the situation in Spokane, then the reason is probably pretty simple. The software just isn’t any good, folks. Either that, or it isn’t good for the VA.”
The department is optimistic it can set a new deployment schedule by the end of the calendar year, Carolyn Clancy, VA’s assistant undersecretary for health for discovery, education and affiliate networks, told the House subcommittee.
Clancy, a longtime VA career official, most recently served as the department’s acting deputy secretary until earlier this week, when Donald Remy was sworn into the position permanently.
The department will review the state of physical and IT infrastructure, leadership, staffing and other factors at each of its facilities. Those facilities that are at “the greatest state of readiness” will deploy the new EHR next, Clancy said.
This approach will force VA facilities to think about preparing for the EHR sooner rather than later, she added. The department doesn’t yet know how many sites will go live with the new system at once or which specific sites might go next.
“Now, our big challenge is how do we restore confidence and competence at Mann-Grandstaff, and how do we develop a readiness checklist and a training plan that can be a repeatable process and incorporate what we learned? The hope is, for example, when we finally get to a second deployment that goes a lot more smoothly than Mann-Grandstaff, but it probably won’t be flawless,” Clancy said. “We will learn from that and continue to improve.”
VA is also “starting from scratch” on a new, independent lifecycle cost estimate for the EHR modernization, a point that seemed to satisfy committee members. That estimate may take another year to complete, Clancy said.
The strategic review highlighted training failures, data migration problems and ultimately, patient safety concerns at the initial go-live site.
Mann-Grandstaff is safe for veterans due to “extraordinary staff efforts,” Clancy assured committee members. Patient safety teams have been on the ground at Mann-Grandstaff for four-to-six weeks and will stay there until all challenges have been resolved, she added.
In hindsight, Mann-Grandstaff was not prepared for go-live last October, Clancy acknowledged. Staff at the facility expressed concerns about the deployment, which Clancy said she learned after the fact.
“From my conversations with the leadership of OEHRM, they believed that it was important not to keep delaying the initial deployment, that we would learn a great deal, and they didn’t expect it to go well,” she said. “That is not an unreasonable expectation, because almost all private sector systems we spoke with told us that the initial deployment is always really challenging — really, really challenging — painful was the other word that was used. I would have to surmise that they believed that we should get on with it and learn more, because this is how we actually deploy systems like this on the ground. I don’t think they expected the reaction they got either from the people in Spokane or, frankly, the people in senior leadership positions in the department.”
Cerner also acknowledged the difficulties and said they were common in large commercial EHR implementations. Brian Sandager, Cerner’s general manager, said the company could have done a better job explaining the system’s long-term benefits to VA employees, and he wants the department to set clearer requirements and performance metrics.
Not everyone, however, is convinced.
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“I have major concerns about the amount of money that continues to flow out of Washington, D.C., to Cerner without having a fully functional facility in Mann-Grandstaff, and I continue to hear that we’re going to be introducing it to other areas,” Rosendale said. “I’m not convinced yet. I’m not a believer, folks. We have major problems up there. We have billions of dollars that have been sent out. You haven’t convinced me yet. Sorry.”
VA on Wednesday did not detail its new governance structure, which will ultimately manage the EHR project going forward.
VA Deputy Secretary Donald Remy will lead the EHR modernization. Wednesday was his third day on the job, Clancy said, and the department is still briefing him on the new management structure.
The deputy secretary will have a “far more active role than some of my predecessors,” she said.
Still, Clancy spoke often about the “organizational silo” where the EHR project was previously managed, which included the department’s responses and interactions with the IG.
Auditors sent their recommendations and report findings to VA, expecting the department’s acting deputy secretary and undersecretary for health would respond.
OEHRM responded instead, which David Case, VA’s deputy inspector general, said was “extremely uncommon.” The IG himself contacted the VA acting deputy secretary to confirm OEHRM’s responses.
“I thought the initial response from the [OEHRM] executive director more or less said, ‘We’ve got this, and we’ll follow up in a year,'” said Clancy, who served as the acting deputy secretary at the time. “I didn’t think they were serious responses.”