The Department of Veterans Affairs’ (VA) Electronic Health Records Modernization (EHRM) program has been under fire in recent months after two VA Office of Inspector General’s (OIG) reports revealed program missteps and underreported, unreported, or unknown program costs. In response, the VA pledged to provide a full lifecycle cost estimate of the program – which Congress wanted to see within 90 days – but a VA official said today that the cost estimate will take at least 12 months to complete.
The Subcommittee on Technology Modernization of the House Committee on Veterans’ Affairs held a legislative hearing today to discuss a number of bills, including the VA Electronic Health Record Transparency Act of 2021. This bill, introduced by Chairman Frank Mrvan, D-Ind., would direct the VA secretary to submit a report on the costs of the EHRM program “not later than 90 days after the date of the enactment of this act,” and every 90 days thereafter until “180 days after” the VA secretary claims the EHRM program has been fully implemented.
However, the bill’s initial 90-day window caused concern for Paul Brubaker, acting principal deputy assistant secretary at VA’s Office of Information Technology, who said that may not be enough time for VA to complete a cost estimate.
“The department supports this bill if amended to address several concerns. Our primary concern is depending on when this legislation is passed, the initial 90-day reporting timeline may not allow sufficient time to complete EHRM’s independent cost estimate that we’re kicking off later this month,” Brubaker said in his testimony. “We anticipated, once launched, this effort is going to take 12 months to complete.”
That answer troubled Chairman Mrvan, who said he would rather see cost estimates sooner than “sometime next year.”
“I find it concerning that three years into a $16 billion program, VA is unable to account for actual expenses related to the project,” Chairman Mrvan said. “Can you explain to me why VA feels it would take so long to accurately account for these costs?”
Brubaker explained that as a result of the two VA OIG reports, the agency needs to take the time to “understand the end-to-end costs and all the additional support costs that go into the definition of crafting an independent cost estimate, as well as a lifecycle cost estimate.”
“When that first cost estimate was scoped, it wasn’t scoped adequately,” Brubaker said. “What we’ve done is we’ve consulted a number of experts, as a result of those IG reports and contracted with an FFRDC [Federally funded research and development center], the Institute for Defense Analysis, to make sure that once and for all, we actually capture all of these end-to-end costs and can present them to the committee as requested.”
Another panelist at today’s hearing, Patrick Murray, director of National Legislative Service at the Veterans of Foreign Wars, said his organization could not support the EHRM program advancing to other parts of the country until a full cost estimate is available – which means the program could take another year until it’s deployed elsewhere.
“We’d like to see the full costs realized. We’d like to make sure that all the items, the work items that are necessary, are at least identified and begin to get knocked out,” Murray said. “Again, we don’t want to see that this very critical program is facing hurdles and roadblocks, simply because, you know, they’re trying to put some new server system in an unventilated closet that will overheat and not work. Those are things that can easily be taken care of, if they’re identified, if they’re properly funded, and put in the work request to take care of them ahead of time.”
Initially, VA estimated the entire program would cost $10 billion over 10 years, including $4.3 billion in IT infrastructure costs. However, one of the VA OIG reports revealed the $4.3 billion estimate is “not reliable,” as it did not account for $2.5 billion in “critical program-related IT infrastructure upgrade costs.”
Additionally, the program underwent a strategic review that VA Secretary Denis McDonough launched in March, after the first EHRM deployment at Mann-Grandstaff VA Medical Center in Spokane, Wash., ran into problems. McDonough said many employees voiced concerns regarding the EHRM program and the Cerner Millennium system it runs on, including confusion over receiving duplicate prescriptions for patients.
Although the VA OIG reports revealed “significant deficiencies” in training for the new EHR program at Mann-Grandstaff VA Medical Center, McDonough said the challenges are not the employees’ fault, nor those of the EHRM technology. McDonough called the missteps in the OIG reports “extremely disappointing,” but told members of Congress on July 14 that he hopes a new approach to the program will get VA’s efforts “back on track.”
“We understand they’re going to be hurdles, but what we want to see is once those hurdles are identified: lessons learned,” Murray said. “We want to see what issues were identified and what [is] being done to correct them as they continue to move on, to make sure that we’re not repeating the same things in each deployment… that would be something that we would be encouraged to see as long as we’re making continual progress in this multi-year project.”