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VA EHR Optimization Efforts a Concern for Congress

A House subcommittee is seeking a GAO study of the EHR optimization efforts underway or planned at VA.

- The Department of Defense (DoD) isn't the only federal agency in the midst of a major EHR modernization project, with the Department of Veterans Affairs (VA) also working to upgrade its current EHR technology known as the Veterans Health Information Systems and Technology Architecture (VistA). And it is the latter that is raising concerns among members of Congress.

EHR optimization at VA

In a letter to the head of the Government Accountability Office, Representatives Will Hurd (R-TX) and Robin Kelly (D-IL) of the Committee on Oversight and Government Reform Subcommittee on Information Technology asked the federal agency to study the VA's EHR modernization project of VistA.

"Given the significance of VA's electronic health record information system to the performance of its health care mission, and in light of VA's repeated attempts to modernize VistA, the Subcommittee is requesting information on the efforts to modernize VistA," wrote Hurd and Kelly.

"In particular, we would like to receive information on the history of VA's efforts to modernize VistA, including the costs and results of the efforts, the key contractors that have been involved, and the work that these contractors performed," the letter continued. "In addition, we ask that the study determine VA's current plans and estimated costs for modernizing VistA."

The request for a GAO study followed a criticism of VA's previous work on EHR optimization in concert with DoD on the abandoned joint integrated EHR (iEHR) and by itself on the VistA Evolution following DoD's decision to seek a commercial EHR replacement to its AHLTA EHR.

READ MORE: State Department Considering Commercial EHR Implementation?

"However, these efforts, just to name a few, have not produced the kinds of modern systems and capabilities that Congress mandated. Moreover, VA has recently indicated that it may be pursuing yet another modernization initiative," wrote the leaders of the subcommittee.

As part of a $1.1 trillion spending bill passed earlier this year, Congress carved out $71.4 billion for VA with a significant portion tied to improvements to its VistA EHR platform. The funding, however, comes with a series of catches.

First, VA must submit requests to the Committees on Appropriations in both the House of Representatives and Senate when a given IT project increases or decreases in cost by $1 million. Second, the VA Secretary must also receive the approval of these committees to move forward with IT-related projects as well as associated costs.

As for the VistA Evolution project itself, the Consolidated Appropriations Act of 2016 requires VA to submit a report to Congress spanning nine areas:

(1) the status of and changes to the VistA Evolution program plan dated March 24, 2014 (hereinafter referred to as the ‘‘Plan’’), the VistA 4 product roadmap dated February 26, 2015 (‘‘Roadmap’’), and the VistA 4 Incremental Life Cycle Cost Estimate, dated October 26, 2014;

READ MORE: First DoD Site Completes Go-Live of New GENESIS EHR System

(2) any changes to the scope or functionality of projects within the VistA Evolution program as established in the Plan;

(3) actual program costs incurred to date;

(4) progress in meeting the schedule milestones that have been established in the Plan;

(5) a Project Management Accountability System (PMAS) Dashboard Progress report that identifies each VistA Evolution project being tracked through PMAS, what functionality it is intended to provide, and what evaluation scores it has received throughout development;

(6) the definition being used for interoperability between the electronic health record systems of the Department of Defense and the Department of Veterans Affairs, the metrics to measure the extent of interoperability, the milestones and timeline associated with achieving interoperability, and the baseline measurements associated with interoperability;

READ MORE: Oregon Health System Preps for Epic EHR Implementation

(7) progress toward developing and implementing all components and levels of interoperability, including semantic interoperability;

(8) the change management tools in place to facilitate the implementation of VistA Evolution and interoperability; and

(9) any changes to the governance structure for the VistA Evolution program and its chain of decisionmaking authority…

Also drawing interest on the Hill is the schedule for DoD's EHR implementation later this year. The federal agency's Office of Inspector General published an audit that stated the timetable for completing DoD Healthcare Management System Modernization (DHMSM) by December 2016 "may not be realistic."

"While the DHMSM program office has identified risks and mitigation strategies," the IG report read, "it is still at risk for obtaining an EHR system by the December 2016 initial operational capability date because of the risks and potential delays involved in developing and testing the interfaces needed to interact with legacy systems, ensuring the system is secure against cyber attacks, and ensuring the fielded system works correctly and that users are properly trained."

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