Several senators took a skeptical view today over the Department of Veterans Affairs’ (VA’s) Electronic Health Records Modernization effort (EHRM), raising questions on the need for better IT infrastructure, scheduling systems, and leadership structure.

Does VA Have the IT Infrastructure to Handle EHR?

While the EHR modernization effort is separate from the IT department at the VA, senators raised their concerns about the underlying IT infrastructure at a hearing of the Senate Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies.

“Interoperability with legacy systems remains a challenge across the board for new VA IT systems. We are currently watching VA struggle to implement changes to the GI Bill that resulted in IT challenges,” said Sen. John Boozman, R-Ark.

Sen. Brian Schatz, D-Hawaii, asked about reports last fall about shortfalls in IT infrastructure at VA facilities slated for early testing of EHR, and questioned if EHR funding would need to increase to include new IT infrastructure to support the software.

“The carryover [budget] from [fiscal year] 2018 allowed us to cover what we perceive to be about a $70 million expenditure for infrastructure upgrades that were unplanned for things like end-user devices. We have been working hand-in-hand with the CIO such that there is a joint strategy,” said John Windom, executive director of the Office of Electronic Health Record Modernization at VA.

However, the unexpected expense concerned Schatz, who noted that carryover funding may not always be available.

“On a year-over-year basis, are you able to absorb the needs for new infrastructure, or are you just pushing this out to the right, and as you delay contracting … you sort of book that in the current year as savings, plow it into infrastructure, but we’re going to be left with a $2-3 billion infrastructure bill on the back-end,” the senator asked.

Windom assured the senator that his close working relationship with VA CIO James Grferer meant that his office was sharing challenges with the Office of Information Technology, which adds the challenges into their budget request. Schatz pushed back, however, asking for a back-of-the-envelope number for necessary IT infrastructure costs based on already surveyed sites.

“We have not been to every site to assess what deficiencies may exist, but as part of our deployment strategy, we are going to be out front enough to make sure that we understand whether there are funding needs,” Windom responded.

“I don’t want you to wait until you’re 100 percent sure to tell us. If you’re at 98 percent sure that this looks like it’s going to be more money … We don’t want to find out last minute at one of your quarterly reports,” responded Schatz.

DoD vs. VA – Who’s In Charge?

While senators praised the goal of interoperability between systems at the Department of Defense (DoD) and the VA, they also raised concerns over how the two agencies can cooperate in a governance structure.

“The secretaries [of DoD and VA] committed back in September to create a joint governance structure, but that still hasn’t happened, and we’ve known since the Cerner contract back in May that this process will be impossible without an entity at the top of the food chain to make the final decisions,” said Sen. Jon Tester, D-Mont.

VA officials noted that the department is conducting an assessment of potential joint governance structures to replace the Interagency Program Office, the topic of a House hearing back in September, and that the report will be completed around the end of February. However, James Byrne, general counsel and acting deputy secretary at VA, defended the current governance structure.

“We do have a governance construct in place … that is working,” Byrne said. He noted that the current structure is “allowing us to move forward, undistracted,” but that they were examining other solutions, with an arbitrator structure top of mind.

“A purple person, who we all agree would make decisions when there is a dispute between DoD and VA., and that’s … not somebody from DoD or somebody from the VA,” Byrne described. “We’re looking for the recommendation that that is the right solution, and we’re still seeking names and looking for that person right now,” he added.

Tester emphasized the importance of a stronger joint governance structure for the project, gravitating towards the idea of a “purple person.”

“VA is no small partner here, but DoD can steamroll the VA if they want,” said Tester. “They’ve been down the road, so I think they have some experience that the VA doesn’t have, and they could say ‘we know better than you,’ unless you have somebody who’s able to look at it from both perspectives,” said Tester.

What is the Schedule for Scheduling Reform?

Another major issue that emerged during the hearing was concern over efforts to improve the scheduling system at the VA.

“The wait time crisis that was brought to light in 2014 revealed tragic deficiencies in caring for our nation’s veterans, and the need for a modern, functioning scheduling system at the VA, and five years later, I am fearful that we are not closer to a solution,” said Sen. Tammy Baldwin, D-Wis. She pointed to recently canceled pilot programs and the decision to implement a Cerner scheduling system that has not been tested at any VA medical center as her main concern.

Byrne described the department’s plan for the Cerner scheduling module as “rolling it out simultaneously with the overall rollouts of the EHR-M system.”

“Our intent is to deploy the scheduling piece separately to the appropriate facilities. The timeline for that has yet to be fully fleshed out because we have not developed fully our execution strategy, but we expect that to start shortly after we receive IOC [Initial Operating Capability] milestones in March of 2020,” said Windom.

“10 years is too long. You’re going to have to figure out a way to do that much more rapidly,” said Sen. Boozman.

Sen. Steve Daines, R-Mont., echoed the sentiment, expressing his disappointment with the long timeline of the EHR project as a whole.

“Enterprise solutions with a 10-year timeline and a $16 billion price tag – that is a recipe for disaster. That is a recipe for not spending tax dollars wisely. But the people who are hurt most by that are our veterans,” said Daines.

“My understanding is that it will be well before 10 years that the scheduling solution will be across the United States,” clarified Byrne. “We’re doing a dual effort. As the EHRM rolls out within the various medical centers, we’ll implement the scheduling solution, but there’s a separate effort in other locations to do the same. I won’t say it’s going to be in four or five years, but that is certainly more likely than nine years.”

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