VA seeks full 2022 funding for health record project, despite six-month pause

House appropriators are concerned that the Department of Veterans Affairs is seeking to fully fund its program to switch from its homegrown Vista system to Cerner's commercial electronic health record in 2022, despite having unspent funds from fiscal year 2021.

Implementation of the 10-year Electronic Health Record Modernization (EHRM) program was halted this year over concerns about patient safety and the adequacy of training at the initial deployment site of Mann-Grandstaff VA Medical Center in Spokane, Wash. VA Secretary Denis McDonough instituted a "strategic review" in March that wrapped in July during which deployments were paused.

With the review completed, VA is hoping to continue deployment across Veterans Integrated Service Network 20, which includes Mann-Grandstaff and other sites in the Pacific Northwest and Alaska, as well as in VISN 10, which includes Michigan, Ohio and Indiana.

At a hearing on Thursday, held almost one year after the go-live date, VA Deputy Secretary Donald Remy said the agency was seeking the $2.66 billion for the program for FY2022 included in the Biden administration's budget submission, even though there is money left over from FY2021 because the FY2021 appropriation for the program is good for three fiscal years.

"I believe that our plan to roll out and deploy at sites at VISNs 10 and 20, our need to provide infrastructure support to make sure that all of our sites are going to be ready when we deploy this system to those locations, our recognition that right now as we do our current state readiness reviews, we have intentions to roll out into other VISNs later in the year – with all of those things together we believe that the appropriation is necessary to get the work done," Remy said.

Rep. Debbie Wasserman-Schultz (D-Fla.), who chairs the subcommittee that funds VA, was skeptical.

"Obviously asking for more money when you aren't able to spend the money you have and you have a three-year window to do so would not be helpful," she told Remy at the hearing.

Part of the funding issue for lawmakers is that VA's initial cost estimate of $16 billion for the 10-year program has proved to be unreliable, because it didn't take into account physical and IT infrastructure upgrades needed at VA sites before the bandwidth-hungry Cerner application could be deployed. A pair of agency inspector general reports found that VA underestimated physical infrastructure costs by $2.6 billion, and IT infrastructure costs by $2.5 billion, elevating the total program cost to more than $21 billion.

A new cost estimate, "will include all of the components that need to be included that the IG identified that should have been included in defining the cost associated with our Electronic Health Records Modernization program," Remy said. That cost estimate will take about a year to produce, he said.

The House Veterans Affairs Committee is also seeking clarity on cost estimates. The bipartisan VA Electronic Health Record Transparency Act of 2021 would require VA to deliver cost reporting to Congress every 90 days. VA supports the measure in principle, but the department wants some flexibility on reporting times and clarification on other reporting requirements, according to a statement presented at a subcommittee hearing Oct. 7.

Leaders of the Appropriations subcommittee on Military Construction, Veterans Affairs and Related Agencies are also looking for more frequent updates on the status of the EHRM project – panel chairwomen Wasserman-Schultz told Remy to expect to be summoned for monthly updates.