True costs of troubled VA EHR project are ‘no longer clear,’ appropriators concede

House appropriators say they’re still flying in the dark as they try to allocate funding to the Department of Veterans Affairs for its massive, 10-year electronic health record modernization program — one year after VA went live with the new system at its first site last October.

Congress so far has appropriated more than $6 billion for the VA EHR since 2018, including roughly $2.6 billion in fiscal 2021.

The department did not spend all of the 2021 funding, VA Deputy Secretary Donald Remy told members of the House Appropriations Subcommittee on Military Construction and Veterans Affairs on Thursday.

At the same time, the department asked for nearly $2.7 billion for the VA EHR project for fiscal 2022, and it stands by the request.

But subcommittee members say the annual requests are tough to swallow — when they ultimately have no clear idea what the final price tag for the project will be.

“I understand that any funds that we appropriate in the final fiscal 2022 bill will support the preparation work for go-lives that will occur at sites one or two years from now, and we’re obviously committed to ensuring that VA moves forward with executing this transition in the most efficient manner possible,” Debbie Wasserman Schultz (D-Fla.), chairman of the House subcommittee, said. “I want to remind VA that funds for this program have been appropriated with a three-year period of availability. But given the delayed status of the rollout and the outdated cost estimate, it’s really no longer clear what level of funding is truly necessary to support the program in FY22 and beyond.”

VA recently contracted with the Institute of Defense Analyses to develop an independent cost estimate for the massive EHR initiative. That process is supposed to uncover how much VA will need to spend on the IT and physical infrastructure upgrades necessary to support the new health record.

According to its inspector general, the department had previously underreported the costs of making physical and IT infrastructure upgrades needed to support the VA EHR by as much as $5 billion.

But the new cost estimate will take a year to complete.

In the meantime, House members are questioning what VA will do with the funds it already has but hasn’t fully spent — and what it will do with the funds Congress is poised to appropriate for the rest of the current fiscal year.

“If you haven’t executed on last year’s $2.6 [billion], would it not be fiscally irresponsible for us to allocate an additional $2.7 [billion], which obviously would not be executable either?” said Rep. Sanford Bishop (D-Ga.).

The department originally planned to use 2021 funds to deploy the VA EHR to facilities in the Pacific Northwest and Midwest, but it temporarily paused those previously-planned rollouts after its strategic review found a wide array of ongoing problems at the Mann-Grandstaff VA Medical Center in Spokane.

Remy said VA will use those funds for upcoming deployments next year.

“We recognized it would be more fiscally prudent to obligate when we know we’re actually going in, and that’s going to happen in the first quarter or second quarter of 2022,” he said.

The department is still evaluating which specific sites in the Pacific Northwest and Midwest will be ready to deploy the VA EHR in 2022 and 2023 — and when exactly those rollouts will occur. It’s still developing a timeline and schedule for the remaining facilities, Remy said.

The subcommittee’s members had a difficult time containing their frustration over the situation, even as they acknowledged VA’s current leadership team is still relatively new and inherited a troubled program.

Remy has been on the job since July and is the department’s principal leader for the VA EHR modernization initiative.

“Regardless of what happened before and regardless of how long I’ve been here, I’m here now,” he said. “And what I want you all to know is that means I own it all.”

Subcommittee members peppered Remy with questions about the program’s costs, timeline and the patient safety issues that occurred at the first go-live site in Spokane, Washington, last fall.

The department stands by the 10-year timeline, which puts VA at deploying the new EHR to nearly 150 sites by 2028.

“In talking to other enterprises that have rolled out similar systems, what I understand occurs is after you have these stumbles early on, things become much more efficient in the later years and you’re able to deploy at a much more rapid pace,” Remy said.

In his written testimony, Remy said VA had resolved 146 of the 148 technical issues the department uncovered from the Mann-Grandstaff deployment.

“The remaining two issues continue to be monitored by VA and require joint decisions with DoD,” the testimony reads. “VA continues to prioritize user feedback to inform ongoing evolution of the product and successful rollout at future sites.”

Wasserman Schultz and Rep. John Carter (R-Texas), the subcommittee’s ranking members, said they both wanted to hold monthly hearings with the department on the VA EHR rollout.

“Secretary Remy, we are on your team, but we have to start moving the ball,” Carter said.

As Federal News Network has previously reported, patient addresses weren’t migrated correctly from the old electronic record to the new one, meaning VA clinicians at Mann-Grandstaff had to double check veteran data to ensure their prescriptions went to right places.

In other instances, data failed to migrate or didn’t transmit properly when passed from one module in the new EHR to another, prompting close calls with VA patients.

Remy said the department has since organized patient safety concerns from Mann-Grandstaff into nine categories, and the team evaluates the root causes of those issues as they arise.

“But really, how did this happen? Missing patient medical records, problems with medications…” Wasserman Schultz said. “I don’t really understand what you just said, and with the nine categories that’s not an answer that gives me clarity.”

Remy said VA teams were putting measures in place to ensure patient safety problems didn’t happen again. But his answers didn’t satisfy the subcommittee’s chairman.

“I can appreciate that you inherited a mess and that you are in the middle of sorting through the morass, but unfortunately your responses to our questions about patient safety really aren’t detailed enough,” Wasserman Schultz said. “I realize you probably are doing the best you can to answer them.”

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