Department of Veterans Affairs (VA) Secretary Denis McDonough has called the recent VA Office of the Inspector General’s (OIG) reports highlighting the Electronic Health Records Modernization (EHRM) program missteps “extremely disappointing,” but told members of Congress on July 14 that he is proposing a new approach for the program he hopes will get VA’s efforts “back on track.”
McDonough has completed the strategic review of the EHRM program, which he 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, such as confusion over receiving duplicate prescriptions for patients.
“I heard from another clinician that help with the new platform wasn’t always easy to find, even when you asked for it,” McDonough said during a Senate Committee on Veterans’ Affairs hearing on Wednesday. “When she called the Cerner help desk, the person on the other end of the line told her he had just started a week prior. In other words, she had more experience using the platform than the person who was supposed to help her navigate it.”
Although 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.
“Most challenges were not breakdowns of the technology, nor of the great people at Mann-Grandstaff who did the best they could in the worst of circumstances and implemented this program in the heart of a pandemic, dutifully shared findings that improved the system, and ensured that our veterans were safe despite the challenges they faced,” McDonough said. “Instead, the missteps were ours at VA and Cerner.”
However, McDonough emphasized that VA is still committed to the Cerner technology, which he believes “is sound.” Instead of putting the blame on the technology, McDonough said “really what we face here are management and structural changes, governance changes, and those are on me.”
The Path Forward
Now that VA has identified issues with the EHRM program, McDonough said he is optimistic it can solve them with a “reimagined” approach to the system.
The first step, McDonough said, is “establishing a unified enterprise-wide governance effort,” led by the VA deputy secretary. This effort will be led by Donald Remy, who the Senate confirmed as VA deputy secretary this afternoon. By bringing key clinical technical acquisition and finance leaders together, McDonough hopes everyone who is involved in the EHRM program “will work in concert with one another from day one.”
The second step is to shift from VA’s previous site-by-site deployment of EHRM to an enterprise-wide readiness and planning approach.
“This means that we will deploy the program based on evidence of readiness, evidence of which sites are most trained and technologically ready for it,” McDonough said, adding that will set “each new site up for success.”
The last major step, according to McDonough, is to create a “fully simulated testing and training environment,” for veterans and providers to learn how to use the EHRM system and evaluate it before deployment, “not during or after.”
“We can and will get this effort back on track,” McDonough said. “That means building an EHR system where veterans are able to access their records in one place from the first day they put on their uniforms to the last day of their lives. A system that empowers vets to receive care anywhere, whether it’s from DoD, VA, or community providers, without worrying about cumbersome paperwork or potentially harmful gaps in records. A system that helps providers understand injuries that veterans suffered 50 years ago so they can provide those vets with the best care possible today. That’s the end goal.”
New IT Budget Estimate on the way
One concern senators had for McDonough involved the inaccurate price tag for the EHRM program’s IT infrastructure costs. Previously, VA estimated the entire program would cost $10 billion over 10 years, including $4.3 billion in IT infrastructure costs. However, a recent VA OIG report said 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.”
When asked about the inaccurate cost estimates, McDonough said VA has taken the “beginning steps” to provide a full lifecycle cost estimate of the program, as the OIG report recommended. This cost estimate will include all infrastructure and IT costs related to the project, including those attributed to VA’s Office of Information and Technology (OIT) and the Veterans Health Administration (VHA) based on the recent OIG findings.
Additionally, he pledged a commitment to provide all projected infrastructure and IT costs to the committee for the remainder of the EHRM program.
“We’re getting to the bottom of the facts, we’re going to deploy based on the facts, I will continue to report regularly to you on those facts,” McDonough told senators. “I won’t run an organization that withholds information from Congress or the IG, so if I find that to be true there will obviously be consequences.”