The Department of Veterans Affairs (VA) has faced a troubled rollout of its Electronic Health Records Modernization (EHRM) program, including underreported costs, deficiencies in training, and diminished employee morale. But VA’s recently installed CIO says the agency is coming to grips with those problems and looking for better performance in coming expansions of the program.
Kurt DelBene, who took over in December as VA’s Chief Information Officer (CIO) and Assistant Secretary for Information and Technology, acknowledged during a Feb. 17 call with reporters that the agency could have done a better job in areas such as training. But he also made clear that the rollout itself is “an enormous” task that’s bound to come with lessons learned along the way.
“At its heart, I think that it was always going to be a challenging rollout because electronic health record systems are difficult things to deploy, generally speaking,” DelBene said. “I don’t think there’s anybody in the industry [who] wouldn’t say that.”
The new EHRM program aims to provide a seamless experience for veterans as they transition from receiving care from the Department of Defense (DoD) while on active duty, to receiving care at VA facilities. However, replacing an EHR system that was developed by the VA in the 1980s is not a simple task.
DelBene explained the EHR system that is being replaced – the Veterans Health Information Systems and Technology Architecture (VistA) – “tailored itself deeply to the way that the VA works in particular.” He emphasized the transition for VA clinicians early on “was going to be disruptive.”
VA Office of the Inspector General reports revealed just how disruptive it was, finding “significant deficiencies” in training for the program at the first EHRM deployment site: Mann-Grandstaff VA Medical Center in Spokane, Wash. The OIG reports also found worsened employee morale as a result of the EHRM program and employee concerns about the Cerner Millennium system it runs on.
The Road Ahead for EHRM
DelBene acknowledged the VA’s missteps at the first EHRM launch site and said the agency “could do better in terms of training” going forward.
The assistant secretary also explained that getting the balance right between workflow changes and system changes “is really, really difficult and we could have done a better job there as well.”
“I think our level of preparedness overall for Mann-Grandstaff could have been stronger. And I also think that the clear criteria that we should meet before we go live could have been crisper,” DelBene said.
Neil Evans, a VA physician and the former acting CIO of the agency, said the DoD also “struggled with some of their early sites” with their Cerner rollout, but their lessons learned “are now paying dividends as they’re rolling out.” The DoD has now deployed the same EHR solution at over 50 percent of their sites, according to Evans.
“Transitions are hard and the first place you go, there are going to be lessons learned,” Evans said. “A lot of this is that we’re still relatively early in this transformation journey and … coming at this with a learning mindset and applying lessons learned as we move forward.”
DelBene is hopeful as the VA looks ahead to its next deployment site in Walla Walla, Wash. The VA has “done a lot better job in terms of getting those criteria set and established,” as well as “being collaborative with the clinicians,” he said.
“I feel particularly good about where we are right now with Walla Walla. But again, we’re going to look and see if anything changes that would require us to move that,” he added. “We are on track, but we’re going to make sure that we’re responsive to the stakeholders when we make those decisions along the way.”
Laura Prietula, the new deputy CIO for the EHRM program, said the VA is also establishing a deployment assurance team within the DCIO group. Prietula said the deployment assurance team will be focused on ensuring VA sites have a deep understanding and awareness of the EHRM transformation – from a local IT perspective and the overarching VA IT community.
“This is not just a simple technology implementation,” Prietula said. “And so we want to make sure that the facilities are also ready for those changes from their own process perspective, not just, ‘Are you ready to receive the system?’ So, we’re working very, very closely with the facilities, and we’re setting up different practices for change management all around.”
“I think the actual transformation is going to be as much about change management and people systems and how those come in good alignment – how we work comes in alignment with how the system works – and both are going to adapt to get us to a good place,” DelBene said.