- Over the past six months, VA has awarded Cerner three task orders, conducted a Current State Review of VA initial operating capability (IOC) care sites, and established 18 EHR councils to support the development of national standardized clinical and business workflows for the federal agency’s Cerner EHR implementation.
Office of Electronic Health Record Modernization (OEHRM) Executive Director John Windom reported on these and other VA activities during a November 14 VA technology modernization subcommittee hearing.
Since June, VA has awarded Cerner task orders related to data migration and enterprise interface development, functional baseline design and development, and IOC deployment.
As part of the data migration task order, Cerner will provide data migration planning refinement, analysis, development, testing, and execution services to VA.
“Cerner will provide commercially available registry selected by VA for IOC as well as details and updates on the progress of IOC data migration and enterprise interface development,” clarified Windom in written testimony.
For Cerner’s functional baseline design and development task order, the health IT company will provide project management, workflow, training, and change management services to VA. Additionally, Cerner will maintain communication with stakeholders about the EHR Modernization (EHRM) efforts.
Finally, as part of the IOC deployment task order, Cerner will provide project management, IOC planning and deployment, test and evaluation, pre-deployment training, go-live readiness assessments, and other deployment support to the federal agency.
Windom also updated the subcommittee on a Current State Review of the Cerner EHR implementation completed in October 2018.
“VA reviewed final reports analyzing the Current State Review in October 2018 and discovered there are infrastructure readiness areas that are in better state than initially forecasted and areas that require slightly more investment due to the age of the infrastructure,” stated Windom.
“However, there were no unexpected major needs or significant deviations from the current projected spend plan,” Windom added.
In late September, VA held a Model Validation Event to convene Cerner representatives and members of VA’s EHR councils for discussions about national and local workflow development.
“There was a series of working sessions designed to examine Cerner’s commercial recommended workflows and evaluate the current workflows used at VA medical centers,” said Windom. “This allows VA to configure the workflows to best meet the needs of our Veterans, while also implementing commercial best practices.”
Cerner has also completed an assessment of the 70 percent of capabilities VA’s Cerner EHR system and DoD’s MHS GENESIS EHR system have in common.
“The remaining 30 percent are capabilities VA requires to meet the unique needs of Veterans,” Windom said. “The assessment revealed MHS GENESIS has an 84 percent alignment to commercial best practices. This indicates DoD has high adoption of recommendations and system configuration, which are generally in alignment with commercial best practices.”
Windom also reported VA and DoD are making efforts to coordinate their deployments by maintaining an emphasis on transparency. VA is working to achieve transparency through integrated governance within and across agencies.
Currently, OEHRM comprises five boards including the OEHRM steering committee, OEHRM governance integration board, functional governance board, technical governance board, and legacy OEHRM pivot work group.
“The structure and process of the boards are designed to facilitate efficient and effective decision-making and the adjudication of risks to facilitate rapid implementation of recommended changes.”
DoD and VA have established an interagency workgroup to review use cases and collaborate on best practices for business, functional, and IT workflows. The workgroup is also focused on meeting interoperability objectives.
“VA and DoD’s leadership meet regularly to verify the working group’s strategy, and course correct, when necessary,” clarified Windom.
Over the past few months, VA has also begun leveraging efficiencies to ensure the implementation project runs smoothly.
For example, the department has revised language in VA’s Cerner EHR contract to improve trouble ticket resolution based on DoD’s own experience with resolving trouble tickets.
Additionally, VA has implemented an effective change management strategy.
“Understanding a significant factor of the program’s success relies on effective user adoption, VA is deploying a change management strategy to support this transformation effort,” stated Windom. “The strategy includes working with end-users, beginning with VA medical center leadership, managers and supervisors, and clinicians, to provide the necessary training.”
Finally, VA has established 18 EHR councils to support the development of national standardized clinical and business workflows for VA’s EHR solution.
“The councils represent each of the functional areas of the EHR solution, including behavioral health, pharmacy, ambulatory, dentistry, and business operations,” said Windom. “VA understands a fundamental aspect in ensuring we meet the program’s goals is engaging frontline staff and clinicians.”
About 60 percent of all EHR council members will be clinicians working in the field, while the other 40 percent will be VA Central Office personnel.
“As VA implements its new EHR solution across the enterprise, certain council members will continue to evolve depending on the current implementation location,” Windom said.