Lawmakers balk at $350M addition to VA's health record deal

The $16 billion, 10-year electronic heath record software upgrade at the Department of Veterans Affairs is barely out of the starting gate, but lawmakers are already worried about management and budgeting missteps that could put the project over budget and behind schedule.

The project's leader, former Navy Captain John Windom, tried to put the best face on the nascent project at a Nov. 14 House hearing, but members of a special subcommittee of the Veterans Affairs Committee formed to oversee the massive IT implementation clearly were worried about issues of accountability and transparency.

"Over the last 20 months we've succeeded in every milestone that we've encountered or desired to achieve," Windom said. "I've seen nothing but unity in pursuit of this mission amongst the entities that are alleged to have been fractured over the years. They have come together. I don't know if it's the stars aligning, but the stars have aligned."

Windom said that priority from VA Secretary Robert Wilkie and the fact that Windom himself has a direct line to James Byrne, the acting number two at VA, were key reasons for what he characterized as the early success of the project.

At the outset of the hearing, Rep. Jim Banks (R-Ind.), who chairs the subcommittee, expressed concern that Windom had only recently factored in the cost of the VA personnel working in a program management capacity to the overall Electronic Health Record Modernization budget projections – an addition of $350 million over 10 years.

"We need to have highly qualified subject matter experts to grade the implementation efforts of Cerner," Windom said. "Those people cost money."

At the same time, Windom noted that the EHRM office, which he leads, has been effectively downsized from its original projection of about 700 full-time employees down to an expected 269. Part of the reason for this, Windom said, is that the Veterans Health Administration and the Office of Information and Technology have been generous in providing experts to the Cerner project.

Windom also said the "full infrastructure plans" for the Cerner implementation were presented to staff on Nov. 13, and that the state of technology at the VA sites "revealed no showstoppers." That means, according to Windom, VA showed "similar and same deficiencies that [Cerner has] seen in a commercial implementation."

Project CTO John Short drilled into the details on the infrastructure front, telling the panel that VA wanted to complete computer and peripheral refreshes at most locations about six months ahead of Cerner implementations, although that time frame will be tighter at the initial operating capability sites in the Pacific Northwest.

Most VA computers, Short said, "are five years old and need to be replaced," and the EHRM project is being integrated with OI&T contracts, "so we don't have additional administrative overhead for those."

Travis Dalton, Cerner’s president of government services, admitted that "we learned some hard lessons with DOD," when implementation of the Cerner software under the MHS Genesis project at military hospitals in the Pacific Northwest was deemed "unsuitable for use" in a DOD report. Obsolete computers and networking gear caused some, though by no means all, of the problems with the rollout of the new software.

"We're doing a lot of things differently here," Dalton said, "engaging with sites early and often…activity we're doing here we didn't do with DOD."

Other issues that are likely to reappear as oversight of the project goes on include the level of data and system integration between the VA system and MHS Genesis.

Windom offered some early examples of where overlap will happen. For instance, DOD and VA will use the same web address to access the online system, and public key infrastructure certificates were recently issued for the shared URL. DOD and VA will also share a patient identity management system.

Banks also expressed concern about the ability of VA's Cerner system to share data with providers outside the DOD-VA system.

"Community interoperability is a very real problem and for $16 billion, VA had better solve it," Banks said."

Rep. Phil Roe (R-Tenn.), the chairman of the full committee, recommended the panel conduct oversight check-ins every 90 days over the life of the project and urged his successor to reconstitute the subcommittee for the next Congress.

Rep. Mark Takano (D-Calif.) is the presumptive chair of the House VA Committee in the next Congress. Current Ranking Member Tim Walz won his race for governor of Minnesota.