- VA has started upgrading IT infrastructure at each of its care sites in preparation for the Cerner implementation expected to begin as soon as contract negotiations are finalized, Federal News Radio reported.
The federal agency will collaborate with VA Office of Information and Technology (VAOIT) on 18 projects in 2018 — including the Cerner EHR implementation slated for completion in the next 10 years.
“[We want to] get very crystal clear on what we’re going to deliver, particularly in a world in which we don’t have infinite resources,” VAOIT Executive in Charge Scott Blackburn told the news source at AFCEA Bethesda’s Health IT Day. “Typically at the VA, we get distracted by shiny objects, so if things come up, we can talk about what the trade-offs are that we’re going to make so that we can deliver on what we say we’re going to deliver.”
While contract negotiations are still underway, VAOIT has started installing new fiber, ports, switches, computers, and monitors at VA care sites to support the new commercial EHR.
“We can’t take the brand new engine and stick it on the Model T and expect it to do something different than the Model T did,” said VAOIT Executive Director for Information Technology Systems Migration John Short.
The Cerner implementation should begin in about six months, and VA plans to improve all existing infrastructure prior to the implementation so new users can adjust to the system uninterrupted by upgrades.
“One of our plans is to make sure that that before a new EHR gets deployed to a new site, that we’ve already deployed the infrastructure upgrades there,” stated Short. “We don’t want the cabling, the fiber and the switches to be occurring while a user is trying to learn a new system.”
In addition to upgrading IT infrastructure, the federal agency is also creating data migration and clinician workflow plans for the new Cerner system. VA must migrate health data from about 130 different iterations of VA’s homegrown VistA EHR.
“We are migrating 30 plus years of data to the Cerner data center,” Short said. “We’ve already created the data migration plan. We’ve already done little piece tests of the data migration plan as part of the contract negotiations, so that Cerner Corporation knows how to come back and propose to us how they will do that.”
VA is also looking to improve many of its patient-facing applications — such as HealtheVet — by utilizing application programming interfaces (APIs).
“The way I’m envisioning the future is if people want to go to My HealtheVet or Vets.gov, it’s going to end up going back to the same place,” said Blackburn. “They still go to the URL that they’re familiar with, and whether they’re going to be on a Cerner system or some kind of VistA based system for their experience, they still click.”
VA intends to set up an environment to encourage outside vendors to develop and test new APIs. Additionally, VA has asked the public to recommend new applications that could potentially serve veteran patients.
“We want veterans to have that very same choice about the experience that they have with VA products, services [and] IT applications,” said VA Enterprise Program Management Office Deputy Assistant Secretary Bill James. “[We’re] flipping that whole relationship around so veterans are empowered and that we service their needs, as opposed to us dictating a digital relationship.”
The Cerner implementation will begin in the Pacific Northwest to mirror Department of Defense (DoD) EHR modernization efforts. DoD recently completed its own Cerner implementation in the Pacific Northwest — MHS Genesis — in October.
VA will maintain VistA until the new system is in place to ensure veterans visiting eastern care sites can still benefit from an EHR system over the next decade.
“We have to make some very strategic, targeted investments to maintain the state-of-the-art nature of VistA, things like scheduling systems, whatever that might be to keep that going,” said Blackburn. “Maintaining two large systems for 10 years is going to be a challenge.”
The Cerner implementation is expected to top out at $10 billion. In an effort to limit unnecessary spending, VA will track DoD rollouts and implement its own system where there are already IT experts on location to assist with implementation and train medical staff.
The DoD Cerner implementation is being put on hold for the next eight weeks due to persistent problems, according to Politico.
The rollout has been stalled due to complaints about clinician workflows. A DoD spokesperson said that halting the project will enable Cerner and DoD to get the implementation back on track and address issues with provider dissatisfaction.