The Department of Veterans Affairs (VA) is set to resume deployments of its Electronic Health Records Modernization (EHRM) program this summer, but members of Congress and the Federal government’s chief watchdog agency are not confident that this time around will be different from the last.
During a Senate Committee on Veterans’ Affairs hearing late on Wednesday afternoon, senators and an official from the Government Accountability Office (GAO) expressed their skepticism surrounding the EHRM program, which the VA has spent at least $9.4 billion on to date.
Carol Harris, director of information technology and cybersecurity at GAO, said the current EHRM effort represents he VA’s fourth attempt at replacing the legacy system, which “so far, has been fraught with major issues.”
“Users of the new EHR system are generally dissatisfied, and this needs to be addressed before deployments resume,” Harris testified. “VA is well aware that its users are unhappy with the system.”
Harris cited examples from GAO’s new report issued on Wednesday, which found that the VA had partially implemented seven leading practices for change management, and did not implement one.
For example, the report found that while the EHRM program has analyzed VA’s readiness to implement the new system, its data found that users were not ready for such a change.
At the Walla Walla and Columbus deployment sites, survey results showed that staff had indicated low scores for the knowledge of how to change, and the ability to implement the change on a day-to-day basis.
Program officials said they were taking action to provide user support in response to the concerns; however, they did not conduct another assessment before deploying the system, the GAO report finds.
“Had they done so, they would have seen that users were still not ready, which was ultimately reflected in the post-deployment survey data,” Harris said. “We made seven recommendations to VA regarding their change management activities, and until they are fully implemented, future deployments will likely be at risk of similar challenges.”
Nevertheless, VA officials noted they have made improvements to the EHRM program during their “assess and address” pause, which the agency announced last October. They also pledged their commitment to the continuous evaluation of sites before deployments resume in June.
“As improvements continue to be made over the next months, VA will continually evaluate the readiness of upcoming deployment sites as well as the EHR system itself to ensure success,” said Neil Evans, acting program executive director for the EHRM Integration Office (EHRM IO). “It’s important to take the time now to get things right to provide a strong foundation for an accelerated deployment schedule later as the project proceeds.”
Dr. Evans noted that, as of this month, it’s been more than 200 days – or six months – without a complete EHRM system outage.
Additionally, he said last month’s update to the system included three critical pharmacy enhancements, with more on the way. He also noted the VA has addressed usability issues and enhanced training regarding order management in the system.
Even so, Harris was not pleased with the VA’s progress and noted the agency could do more to address system issues.
“VA did not adequately identify and address EHR system issues,” she said. “VA has not conducted an independent operational assessment of the new system, and as of January, did not plan to do so.”
Sen. Patty Murray, D-Wash. – whose state includes the first deployment site of Mann-Grandstaff VA Medical Center in Spokane, Wash. – agreed with Harris, and expressed her hesitancy to provide more funding for the program until all issues are addressed.
The VA acquired Oracle Cerner’s Millennium EHR platform in 2018, and the Federal contract for the program’s work in coming years is set to be renewed in May.
“Despite how much funding has been provided, this system is by no means living up to our promise to care for our veterans,” Sen. Murray said. “The continued patient safety risks are totally unacceptable.”
“I want to be candid here, because at the end of the day, what I care about is getting this right for our veterans, and I do not believe that more money is what is going to solve this problem,” she added. “And I’m not sure it makes sense, Mr. Chairman, to continue to fully fund the budget request for this system until I can see that the system is working and not putting our veterans in harm’s way. That responsibility is on both the VA and Oracle Cerner, and both entities need to step up.”
“In short, our patience is running thin,” committee Chairman Jon Tester, D-Mont., said. “If we’re back here, even three months from now, still talking about the same old stuff, then we’ve got some issues.”