Incomplete IT Systems and Lack of Training Cause EHR Delay, VA OIG Says

Shortcomings in crucial IT systems and staff training caused the launch delay of the electronic health records modernization (EHRm) effort at the Department of Veterans Affairs, David Case, deputy inspector general at the Department of Veterans Affairs, told a House panel today.

The House Committee on Veterans Affairs Subcommittee on Technology Modernization was searching for answers about the cause of the delay of the Spokane, Washington go-live of EHRm and why they were not notified prior to the Feb. 10 delay announcement.

A concern voiced by Rep. Susie Lee, D-Nev., was VA’s lack of communication on the seemingly sudden decision to pause the launch.

“Despite being briefed by the VA on Jan. 17, the subcommittee was not made aware of these [training and interface] issues. That is hardly the transparency that we’ve been asking for,” she said. “I know that these concerns were communicated to the program office in real time. Further, these concerns were communicated to the VA leadership at least starting on Feb. 4. So, my question is why was Congress left out of the loop?”

In a preview of two forthcoming OIG reports, Case confirmed Lee’s suspicion that VA was aware of dilemmas that could stunt the go-live well before the Feb. 10 announcement. His testimony included several findings about VA’s knowledge of EHRm red flags:

  • VA knew in July 2019 that not all capabilities would be ready for March 2020 deployment;
  • VA mitigation strategies did not address patient care concerns;
  • As of Jan. 9, a backlog of 21,155 community care consults remained;
  • Only 30 percent of the IT infrastructure needed was completed as of October 2019;
  • Only half of medical devices were connected as of February; and
  • Some contracts for critical infrastructure upgrades had not been awarded as of February 2020.

Based on information gathered from meeting with VA, Rep. Jim Banks, R-Ind., confirmed that as of November 2019, he was aware that configuration and design decisions needed to be made, interfaces needed to be built, testing and training needed to be completed, and VA needed authorization from the Department of Defense (DoD) to move forward with the go-live. He urged for more communication with the public about these delays.

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“Since the go-live delay was announced, there have been numerous high-level conversations and briefings behind closed doors. However, the public deserves to know what is happening,” he asserted.

Committee Chairman Mark Takano, D-Calif., raised further concerns with personnel changes at the VA that could hinder EHRm progress.

“We also need to ensure stable leadership is in place to make this $16 billion project a success. There have been recent changes at the top. The VA deputy secretary is the accountable official for the electronic health record modernization program under law…yet that position is now vacant, and a successor has not been nominated,” he said.

VA witnesses explained to Takano that Secretary Robert Wilkie has always made the ultimate decisions for EHRm governance and has subsumed the deputy secretary’s task order and financial obligations.

Melissa Glynn, assistant secretary for enterprise integration at VA’s Office of Enterprise Integration, also assured the committee that some steps have already been taken to improve EHRm’s pitfalls. The agency has completed critical infrastructure updates, migrated terabytes of data, is preparing to launch a joint data initiative with DoD, and is currently testing a new centralized scheduling solution.

More work, however, needs to be done. According to Glynn, 20,000 hours of training are needed before the go-live launch which can only be completed once the finished build is available.

VA is preparing for a new launch date in July 2020, confirmed Executive Director at the Office of EHRm John Windom. He said that VA will deliver the new schedule for go-live prep in a March 10 deliverable to Congress.

For now, Richard Stone, executive in charge at the Veterans Health Administration, said that more interfaces are expected to be completed in March, the complete build can be expected in April or May, and then the VA will complete six weeks of training and two week of operational assessment before launch.

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