VA to continue pause on Cerner deployment for six more months

The Department of Veterans Affairs is continuing its pause on the deployment of its $21 billion electronic health record modernization effort for at least six months, a top official testified in a House hearing on July 21.

Dr. Carolyn Clancy, an assistant undersecretary for health at VA, told lawmakers on Wednesday that by the end of the calendar year a new deployment schedule will be in place – one that is different from the planned geographic progression that was initially developed for the project.

Clancy said the VA would conduct a review of the IT and physical infrastructure "at every facility in our system" and "subsequently deploy based on which sites are in the greatest state of readiness." Clancy was in charge of the project as acting deputy secretary at VA until just a few days ago when Donald Remy was confirmed and sworn in to serve as the agency's No. 2 official.

Rep. Mark Takano (D-Calif.), chairman of the House Veterans Affair Committee, noted at the hearing that lawmakers had sought to hear from a witness from the VA's Office of Electronic Health Records Modernization (OHERM), but none was made available.

The planned six-month pause comes after a 12-week "strategic review" conducted at the behest of VA Secretary Denis McDonough that looked at problems with the initial go-live of the Cerner electronic health record system at the Mann-Grandstaff VA hospital in Spokane, Wash., in October 2020. Multiple oversight reports identified issues with training and aging infrastructure that hindered the adoption of the new system and may have placed VA patients at risk.

Clancy also told lawmakers that VA planned to arrange for an independent estimate of the entire lifecycle cost of the 10-year project, which was initially tabbed at $16 billion but has ballooned to $21 billion based on a review of needed physical infrastructure upgrades that were not included in the overall cost of the project when it was first budgeted.

"We are starting from scratch," Clancy said about the cost estimate, adding that the production of a full lifecycle cost estimate "will take close to a year."

Leaders of the House Veterans Affairs Committee are hoping to make cost transparency a requirement of the project. Takano and Rep. Mike Bost (R-Ill.), the ranking member of the committee, introduced a bill on Wednesday to consolidate cost accounting for the project and to keep Congress apprised of ongoing expenditures. Rep. Frank Mrvan (D-Ind.), the chairman of the Subcommittee on Technology Modernization, is also sponsoring the Electronic Health Record Transparency Act.

Takano is also looking for clarity on changes to the project's governance structure. As revealed in oversight reports and as discussed at the hearing, the Veterans Health Administration lacked a decisive role in making decisions about clinical workflows and developing training in advance of the go-live at Mann-Grandstaff.

Takano surfaced a management issue from the back-and-forth of one of the inspector general reports in which reply comments submitted by OHERM Executive Director John Windom were flagged by the IG as not responsive to the content of the report and were subsequently withdrawn by more senior leaders at VA.

"I thought the initial response from the executive director more or less said, 'We've got this and we'll follow up in a year,'" Clancy said. "I didn't think they were serious responses."

Clancy added: "I think the program office thought that they had full responsibility for the deployment and the buck stops here… I don't know if it was genuine misinterpretation, but they responded to questions and recommendations made to others more senior than they, as if the recommendations were made to the OHERM, and which was not appropriate. So, I appreciated the heads up from the inspector general and we worked through that."

Clancy promised VA would share a revised governance and management structure with lawmakers in the near future and offered a preview at the hearing.

She said that "in its essence" the new structure involving OHERM, the Office of Information and Technology and VHA "will work very closely and report to the deputy secretary, in terms of how things are going to get done." Clancy added that "the deputy secretary will have a far more active role than some of my predecessors in terms of insisting on jointness and transparency across the different components."

VA Deputy Inspector General David Case, who also testified at the hearing, is withholding judgment on how a new management structure will help to correct some of the issues his office identified.

"So at this point we understand the aspirations, but we don't know the details on how it's going to occur," Case said.