VA Pauses EHR Implementation Until Strategic Review Completed

The Department of Veterans Affairs (VA) has paused its upcoming Electronic Health Record Modernization (EHRM) rollout until the agency completes its strategic review and reports the results to Congress, according to VA officials at a recent House Subcommittee on Technology Modernization hearing.

Columbus, Ohio, was poised to be the following EHRM implementation location, but the agency will put the implementation on hold until future notice.

The announcement came soon after new VA Secretary Denis McDonough’s initial one-month EHRM assessment and separate lists of concerns from Representative Cathy McMorris Rodgers (R-Wash) and the Government Accountability Office (GAO).

The agency said the inspection will consist of a complete EHRM program evaluation to ensure success for all impending EHR deployments.

Less than a month ago, VA announced it was conducting a strategic review of the EHRM system to increase EHR productivity and clinical workflow optimization at Mann-Grandstaff VA Medical Center in Spokane, WA, and future go-live sites.

“I’m concerned about starting something until we have all the kinks worked out,” Matt Rosendale (R-MT), of the House Veterans Affairs Technology Modernization Subcommittee, said at the Wednesday hearing. 

“I want to make sure. Do I have your commitment not to start any Columbus go-live activities until after the strategic review has been completed and shared with this committee?” Rosendale asked.

“Yes, you have that commitment,” responded Carolyn Clancy, MD, acting VA deputy secretary.

VA leaders said the agency would provide progress updates to Congress throughout the strategic review. It also reaffirmed its commitment to its EHR vendor, Cerner.

“Cerner supports the decision by the U.S. Department of Veterans Affairs to conduct a strategic program review,” Brian Sandager, general manager of Cerner Government Services, said in an emailed statement to EHRIntelligence.

“Our number one priority remains the Veterans we serve and delivering solutions that drive the transformation of care across the VA. We are proud of the significant milestones we have achieved including one of the largest health data migrations in history and the deployment of a new joint Health Information Exchange between DOD, VA and their community partners,” Sandager continued. 

VA hired a new chief acquisition officer and senior IT adviser to bring “fresh eyes” to the EHRM program and review EHR requirements, Clancy added.

“The strategic review covers a full range of program areas, including productivity and clinical workflow optimization, a human-centered design effort to understand what veterans want to see from VA’s patient portal and a sandbox environment that will allow employees at future implementation sites to conduct interdisciplinary, team-based rehearsals of these workflows in the new EHR solution,” Clancy said.

The review will further examine EHR workflow optimization, the patient portal, data syndication, and the revenue cycle, per VA. It will also track specific EHR task time and analyze user experience.

According to Robert Fisher, MD, Mann-Grandstaff director, clinicians in Spokane have identified nearly 250 patient safety issues since the October go-live. Some clinicians have also stopped sending trouble tickets due to the high number of cases, Rep. Frank Mrvan (D-IN) said.

“They have grown disillusioned with the incident ticket process,” Mrvan said. “They do not feel the issues are being addressed and tickets are being closed without explanation. Because of this, we’re hearing that staff have, to some degree, stopped creating tickets. They are developing their own workarounds and sharing them with their peers outside of the VA’s incident management system.”

Clinicians and VA administrative staff ultimately want to leverage the Cerner Millennium software to access patient medical records on one streamlined workflow. However, optimism is wavering for lawmakers.

“I think the Cerner EHR has to perform better than VA’s current EHR to be worthwhile,” maintained Rep. Jim Banks (R-IN). “Do you agree that the Cerner EHR has to meet a very high bar in terms of performance within VA, and what happens if it doesn’t?”