With deployments ramping up next year, senators seek more transparency on VA EHR

2022 will be a busy, and pivotal, year for the Department of Veterans Affairs as it ramps up deployments of its massive, multi-billion-dollar electronic health record program to more sites across the enterprise.

To help them keep an eye on the project, almost every member of the Senate Veterans Affairs Committee joined the panel’s leadership in introducing new legislation earlier this week.

“The VA, and consequently our nation, has invested a great deal of time and money into the VA Electronic Health Record Modernization program,” Sen. Jerry Moran (R-Kan.), ranking member of the Veterans Affairs Committee, said in a statement. “The potential benefits of this program are tremendous, but we have to get it right. This legislation ensures the VA is providing the proper transparency throughout the EHRM implementation to better allow this committee to conduct oversight during the deployment process to ensure veterans receive the care they deserve and hold the VA accountable for taxpayer dollars.”

The bill matches legislation that a bipartisan group of House members introduced earlier this year. The VA Electronic Health Record Transparency Act would require that VA regularly report on the costs, schedule and performance of the EHR modernization effort until the entire project is complete.

VA has said it would be difficult for it to comply with the requirements in the new legislation, because it’s currently conducting an independent cost estimate for the entire EHR project. That estimate is supposed to take about a year to produce.

Both the House and Senate are clearly reacting to a series of inspector general reports from earlier in the year, which found the department had previously underreported the costs of making physical and IT infrastructure upgrades needed to support the EHR by as much as $5 billion.

Senators are hopeful that a new VA chief information officer will influence more success with the EHR initiative in 2022. The president nominated Kurt DelBene, a longtime Microsoft executive, to be VA’s new CIO.

The department has had its fair share of CIOs, and since 2009, it’s had more acting CIOs than permanent ones. The average tenure of an acting CIO is more than 10 months, including one who lasted almost two years, according to analysis from the House Veterans Affairs Committee.

The Senate VA Committee easily advanced DelBene’s nomination on Wednesday by voice vote.

DelBene, if confirmed, wouldn’t directly lead the EHR modernization initiative, though he will oversee the IT infrastructure upgrades needed to support the new record. VA named a new EHR modernization program manager as the lead for the initiative, along with a “functional champion” from the Veterans Health Administration and a dedicated deputy CIO.

But during his nomination hearing, senators clearly wanted to know what DelBene will do to put the EHR modernization project on track.

“The infrastructure that the system builds on top of is the responsibility of the OI&T department, and I certainly want to have excellence there,” DelBene told senators last week. “But I think there’s also an opportunity for me to take the learnings that I’ve had from the private sector and figure out how do you use those to make sure you have success in the project overall?”

DelBene spent a brief stint in the Obama administration, where he served on the team trying to overhaul the troubled Healthcare.gov website.

“Wading in and trying to fix the Affordable Care Act website was not glamorous work,” Sen. Patty Murrary (D-Wash.) said at DelBene’s nomination hearing last week. “If anything Mr. DelBene signed up for a very tough, high-stakes job in a politically charged environment. But he kept his head down, he did the work and he delivered, because millions of families were counting on him. This is what we need to see at the VA.”

DelBene said when he arrived to the Healthcare.gov project, the team had too many top priorities.

“When you get into an organization that isn’t functioning as well as it [should], everything is priority one,” he said. “Yet you can’t do everything as a first priority at the same time. You have to strictly say these are the things we’re going to get accomplished in this order. Then you have to have transparency with stakeholders and with external organizations say, ‘Look is the stuff we’re not going to get done for now, and we know why and we’ll explain why that’s not getting done. But this is the stuff you can count on us delivering to you right now.’ A lot of that is what we take for granted in the commercial space as how you function, but it’s something that we can bring to the health records project and all the projects in the VA.”

VA, of course, is no stranger to that problem. The department has an incredibly long list of IT modernization projects. On top of the EHR modernization, the department has been trying to overhaul its decades-old financial management system and find a suitable replacement for a medical supply chain system.

The to-do list has only grown longer as Congress has piled on new veterans initiatives that require IT upgrades. A bipartisan group of House members and senators have introduced legislation, which is designed to help VA and Congress keep better tabs on IT projects with costs over a certain budgetary threshold. The Senate VA Committee cleared the VA IT Reform Act on Wednesday.

DelBene is hopeful that using a concept of “ruthless prioritization” on VA’s daunting IT to-do list will be successful, if he’s confirmed.

“It’s not just the opportunity to transform the VA into a world class technology organization, but it can also be an example of how we do that for all of government,” he said. “It doesn’t need to be a case where people say, ‘We do this in the commercial sector; why can’t we do this in government?’ We can do all this in government too.”

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