During a hearing in front of the Senate Committee on Veterans Affairs this past week, VA Secretary Denis McDonough said that a review of the agency's electronic health record modernization effort revealed multiple outstanding issues that must be resolved.  

"The mission of EHRM has always been to create a platform that seamlessly delivers the best access and outcomes for our vets and the best experience for our providers," said McDonough.  

"VA's first implementation of the Cerner Millennium … did not live up to that promise, either for our veterans or our providers," he continued.  

WHY IT MATTERS  

McDonough outlined the findings of a 12-week review of the EHRM program initiated after the first implementation of Cerner's Millennium platform at the Mann-Grandstaff VA Medical Center in Spokane, Washington, this past October.  

He relayed several anecdotes about issues at Mann-Grandstaff, including incidents of duplicate prescription orders and difficulty with support from Cerner.  

When one clinician called the customer 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," he said.  

"The strategic review illuminated a broad range of issues and affirmed many stakeholder concerns," said McDonough in written testimony submitted to the committee. The initial issues identified included:   

• Patient safety. Although staff took immediate action on clear issues, McDonough said stakeholders lacked clarity on the broader definition, nature and number of patient safety issues related to the new EHR implementation. 
• Productivity, with a significant decrease post-implementation compounded by the COVID-19 pandemic.
• Governance and management. McDonough during his testimony pointed to the siloed nature of the project. "Moving forward, VA is effectuating a unified, enterprise-wide governance that incorporates the perspectives of key clinical, technical, acquisition, and finance leaders, among others," he said in written testimony.
• Cost, schedule and performance. Not only were cost estimates off by billions of dollars, as outlined in OIG reports, but key performance indicators for the project were not effectively created, maintained or managed. 
• Patient portal experience, which McDonough described as "fragmented" for veterans.
• Testing: "Clinical and interdisciplinary workflows were not tested prior to 'go-live' in a manner that effectively reflected a real-world environment," said McDonough in written testimony.
• Data, with gaps remaining in the ability to manage data between the VA's legacy VistA EHR and Millennium, along with the Department of Defense, to ensure seamless information-sharing.
• Change management and training. Employees need to both understand and have effective support in completing the key functions of their roles within the new system.  

McDonough said the VA is taking specific steps to address each of these issues.  

Overall, he said, the VA is "reimagining our approach to Electronic Health Record Modernization."   

"Prior to deploying to additional sites, VA will also improve our organizational structure and governance to become more responsive and effective as well as invest in training and change management capabilities to better prepare the workforce for the Cerner solution to be implemented at their individual locations," he said.  

VA committee members voiced their displeasure at the rollout thus far.  

"Most people would use the words 'alarming' or something far worse," said Chairman Sen. Jon Tester, D-Montana, in opening remarks.

"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," he continued.  

"I share your exasperation on this topic," said Ranking Member Sen. Jerry Moran, R-Kansas.  

"It's exasperating because the potential benefits that can accrue from this effort are tremendous," he added.  

"It's potentially cost saving, I suppose, but more importantly it's the ability of the Department of Veterans Affairs to care for veterans."  

THE LARGER TREND  

The VA's electronic health record modernization project has faced numerous, high-publicized stumbling blocks.

After the initial rollout at Mann-Grandstaff, McDonough said the agency would pause efforts to go forward at a second site until a review had been conducted. Numerous OIG reports followed, which Moran characterized at the hearing as "damning."   

Although McDonough said the agency would stay the course with Cerner, it's not yet clear what the future looks like for the project.  

ON THE RECORD   

"You will see us pursue a surge of activity in the coming weeks and months, intently focused on veteran experience, patient safety and employee engagement," said McDonough in written testimony.  

"Successful deployment of a modern EHR is essential in the delivery of lifetime, world-class health care and benefits for veterans, as well as to set the standard for U.S. healthcare writ large, and we will get this right," he said.

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