- VA anticipates the Cerner implementation will be less troublesome than the Department of Defense’s (DoD) MHS GENESIS implementation, according to testimony from VA Secretary David Shulkin given at a recent House Appropriations subcommittee hearing.
“We’re using [DoD’s] lessons to make sure that our contract reflects the issues that we’ve learned, but also that we’re going to have a smoother implementation,” Shulkin told congressmen.
Shulkin testified VA is pleased with its 2019 budget, which includes 88.9 billion in discretionary funding and 109.7 billion in mandatory funding.
“I do believe it provides the resources necessary so that we can continue the modernization work that we’re doing at VA,” said Shulkin.
Much of the budget will go toward funding the federal agency’s EHR modernization efforts. In November 2017, Shulkin requested Congress redirect $728 million from its current budget to allow VA to sign the contract with Cerner and start the implementation project. All told, the Cerner contract will likely cost VA about $10 billion.
“The discretionary budget reflects an increase of 6.8 billion or an 8.3 percent increase over the 2018 request,” Shulkin noted.
“I’m proud that our 2019 request for infrastructure is the largest in the last 5 years,” he continued.
The large budget request will help to “advance the implementation of a single, accurate lifetime health record” for veterans, Shulkin said. House Military Construction and VA Appropriations Subcommittee Chairman and Representative Charlie Dent (R-PA) questioned whether VA anticipates experiencing the same glitches and technical problems DoD has come up against with its own Cerner system at its initial operating capability (IOC) care sites.
“I am confident we made the right decision here,” Shulkin maintained. “Congress has been asking us for now 18 years to find a way to get our systems to work together with the Department of Defense. That will certainly be achieved with this.”
Shulkin cited VA’s December 2017 decision to launch an independent interoperability assessment as one example of the federal agency’s commitment to ensuring the EHR implementation runs smoothly. The strategic pause allowed the MITRE Corporation to provide VA with recommendations to improve national interoperability language contained in the EHR contract award.
“I’ve asked for a pause until I can make sure I have the interoperability with community providers,” said Shulkin. “Since 36 percent of veterans now receive care in the community, I think that’s essential to do.”
Dent also pointed out that many of the problems DoD has experienced during its MHS GENESIS launch stemmed from resistance among clinicians to engage in EHR use.
“Don’t you expect more serious user resistance with the VA?” Dent said.
Shulkin stated VA aims to prioritize clinician engagement in its own implementation to ensure providers are comfortable and willing to integrate EHR use into daily clinical and administrative processes.
“I’ve done two previous electronic health record implementations — never on this scale of course — nobody’s done anything on this scale,” said Shulkin. “But if you don’t have involvement from your clinicians you might as well not start in the beginning.”
“That is the absolute key,” he emphasized. “So having this be driven through our clinical leadership and our clinicians is going to be the factor that’s going to be successful.”
Shulkin noted that most VA care providers have been utilizing EHR technology for a long time and will be able to advise VA officials about how to effectively promote clinician engagement with the new Cerner system.
“We’re doing these one VistA instance at a time and involving our clinicians is going to be critical,” stated Shulkin.