VA health record go-live pushed back to July

The Department of Veterans Affairs is delaying a planned initial deployment of its $16 billion electronic health record project by four months but promises added functionality at the go-live date.

VA was scheduled to deploy the commercial Cerner electronic health record software on the March 28 at the Mann-Grandstaff VA Medical Center in Spokane, Wash. Agency head Robert Wilkie announced the delay earlier this month -- just a few days after the firing of Jim Byrne, the deputy secretary and the official tasked under law with heading up the project.

The VA had planned to begin training staff at the Spokane site the week of Feb. 10 on a system that was estimated to be 75% to 80% complete. That plan changed with the results of testing and, apparently, objections from end users -- the VA clinicians expected to use the system. The revised schedule has Cerner going live in Spokane in July 2020, but with closer to 100% functionality.

Additionally, multiple VA officials including the project manager John Windom stated that the overall 10-year project plan and the 18-month implementation plan for full functionality at the Spokane site have not been altered.

Testifying before the House Veterans Affairs Committee, Wilkie said that two key interfaces for sharing data with community health providers and for supporting veterans who use multiple VA facilities to receive care throughout the year were not ready.

Dr. Richard Stone, acting head of the Veterans Health Administration who testified at two Hill hearings on Thursday, explained that overall development was the key sticking point.

"There [are] about 1,000 work processes that need to be written. Those are substantially completed. But once you finish those work processes, you've got to set that electronic medical record into a number of interfaces that plug into the rest of the system," Stone told the House Veterans Affairs Committee. "There are 73 interfaces, 19 are completed as of today, and that is why we are delayed."

Stone also explained that the initial go-live date did not include online prescription refills -- a service in the legacy Vista health record system that was used 11,000 times per month by veterans at Spokane. In the interim, VHA had planned to set up a call center and manually input prescription refills. Stone said he hoped to be able to include that capability in the July go-live to avoid having veterans use a call center in the short term.

At an appropriations hearing the same day, Rep. Debbie Wasserman Schultz (D-Fla.), the chairwoman of the subcommittee that funds VA, expressed surprise at the delay and anger at the lack of advance communication about the issue between VA and Congress.

"Either you were surprised yourself, or you were less than appropriately communitive or truthful with Congress," Wasserman Schultz said to a panel of witnesses.

Stone explained that the end of the second round of integration validation testing known internally as IV2 was the point at which the major communities -- clinical, purchase care, pharmacy and financial -- at VHA would weigh in.

"All said, we're not ready," Stone said. He added: "This is high-risk stuff. This is not a surprise to VHA."

Stone also said that a year ago, VHA had expressed concern about the development methodology and training schedule to Byrne when he was acting deputy secretary.

"The iterative process of building just-in-time and training on products that are similar to your product doesn't work for VHA," Stone said.

Infrastructure shocks

At both the appropriations hearing and the House Veterans Affairs Committee hearing, lawmakers drilled in on the $1.1 billion budget request for infrastructure that included in the fiscal year 2021 budget request -- an increase of $853 million over 2020.

According to multiple officials, the process of reviewing VA facilities revealed just how ill-prepared the agency was to onboard a commercial health care system that requires 1 gigabit internet connectivity.

"I'm spending millions and millions of dollars building closets right now to house equipment because the facilities -- some of which are 100 years old or older -- cannot accept the kind of infrastructure that we need to get these programs online," Wilkie told the House Veterans Affairs Committee.

"When you see some of [the closets], you'd be truly shocked," said Jon Rychalski, VA's chief financial officer.

Rychalski explained that some of the increase in spending was an accounting measure to move the infrastructure improvement spending out of the Office of Information and Technology (OI&T) and house it in the Electronic Health Record Modernization budget.

Rychalski also teed up the possibility of moving some of the sustainment and replacement costs for gear acquired to support the health record modernization project rather than have that cost be borne by OI&T, the VA's centralized CIO shop.

"We're looking actually at a different model where we shift to sustainment of certain things being borne by the user, how we have a working capital fund," Rychalski said. "We're looking at various models of how to fund sustainment and then the refresh going forward. As it exists today, today, OI&T would, but I'm not sure that that'll be the case going forward."