[Ed. note: This story has been updated to include a statement from Cerner.]

In August 2020, the U.S. Department of Veterans Affairs went live with the first component of its Cerner-developed electronic health record at the VA Central Ohio Healthcare System in Columbus.

Two months later, it rolled out the new EHR at the Mann-Grandstaff VA Medical Center in Spokane, Washington.  

The moves represented major progress for the multibillion-dollar Electronic Health Record Modernization project, which had faced numerous delays due to COVID-19 and other factors.   

But that advancement was short-lived: The initiative has now had numerous setbacks, with leadership repeatedly brought to testify before congressional committees and numerous watchdog reports zeroing in on budgetary problems and training concerns. 

Throughout it all, Healthcare IT News has continued to cover the department's efforts. Read on for a recap of the initiative's headway so far and to find out more about the VA's newest plan announced just this past week.  

The Mann-Grandstaff response  

In March 2021, Rep. Cathy McMorris Rodgers, R-Washington, wrote a letter to VA leadership describing the complaints she had heard about the new system at Mann-Grandstaff and asking for an investigation.

McMorris Rodgers cited alleged problems with patient safety, such as veterans getting the wrong prescription, and with the Cerner patient portal.  

In response to these and other concerns, the VA said it would undertake a strategic review of the program and would pause other go-live activities in the meantime.  

What the review found  

That 90-day review revealed multiple outstanding issues, as VA Secretary Denis McDonough told the Senate Committee on Veterans Affairs in July.  

The issues identified involved patient safety, productivity, governance and management, cost, patient portal experience, testing, data and change management.  

Lawmakers were not impressed.  

"Frankly, I for one am fed up with the amount of taxpayer dollars we're spending on this program without any demonstrated benefits to veterans or VA medical staff," said Sen. Jon Tester, D-Montana, during one hearing.  

Although McDonough had said the agency would stay the course with Cerner, he also said it planned to reimagine its approach.  

That same week in July, Cerner executives told the House Veterans' Affairs Subcommittee on Technology Modernization that the company was "committed to getting this right."    

Meanwhile, VA Assistant Under Secretary for Health for Discovery, Education and Affiliate Networks Dr. Carolyn Clancy said the agency would stop further deployments until next year.  

The Office of Inspector General reports  

Throughout this process, the VA OIG has released several reports flagging issues with the project.  

In May, for example, it found that the agency had underestimated the cost of the initiative by billions of dollars.  

Another report, published in July, focused on unreliable IT infrastructure cost estimates, while a third from that same month pointed to training deficiencies.  

And a fourth, which came down in November, said the scheduling system needs work.  

What now?  

VA has continued to push the project along. Leaders have regularly appeared before congressional committees, facing pointed questions around funding and patient safety.  

In September, the agency allocated $134 million to Cerner to go toward deployment activities at the Louis Stokes Cleveland VA Medical Center and the John D. Dingell VA Medical Center in Detroit.  

The following month, it partnered with the Institute for Defense Analyses to provide an analysis and full cost estimate of the initiative.  

And in November, the White House announced its nomination of former Microsoft executive Kurt DelBene as chief information officer and assistant secretary for information at the VA. If confirmed by the Senate, DelBene could take an active role in the modernization efforts.  

That isn't the only new role at the agency focusing on the project. Just this past week, the VA announced a retooled plan that included a revised EHR management structure, a strengthened Office of the Functional Champion, a new deputy chief information officer for EHR and a newly established program executive director for EHR Integration position. 

That latter position will be filled by Dr. Terry Adirim, currently serving as the acting assistant secretary of defense for health affairs. The VA also announced that it planned to go live in Columbus in March 2022, with another deployment tentatively scheduled for Walla Walla, Washington, that same month.  

Altogether, 11 more deployments are on the calendar for 2022, wrapping up with the facility in Portland, Oregon, on November 5.  

In addition, the agency released a "comprehensive lessons learned" progress update, reflecting on the strategic review and establishing a new path forward.  

"We will do everything we can to get electronic health records right for Veterans and our health care staff, with patient safety being the key driver and non-negotiable," VA Deputy Secretary Donald M. Remy said in a statement.   

"I have incorporated the lessons learned I received during my recent meetings with our team at Mann-Grandstaff VA Medical Center in Spokane, Washington, into this new way forward," he continued. "Under my direction, VA is refining EHR governance and management structures to establish additional rigor and oversight.  

"VA, in coordination with our partners, the Department of Defense and EHR vendor Cerner, will continue to update and refine the EHR implementation process to ensure it delivers the excellence veterans expect and deserve from VA," he added.

"Cerner has and will maintain onsite support at Mann-Grandstaff. We remain committed to Secretary McDonough, the providers and staff, and veterans," said Brian Sandager, general manager and senior vice president of Cerner Government Services, in a statement sent to Healthcare IT News after initial publication. ​"Cerner will continue partnering with VA to gain access to the site, ensuring the program continues to move forward successfully.

"Given last week’s announcement, Cerner shares VA's sentiment that the new governance and leadership will positively impact the program. We are on a path to deliver world class healthcare for our nation’s veterans and look forward to advancing our partnership and additional deployments in 2022," Sandager said.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.