Lawmakers press VA officials on EHR modernization, workforce

Officials with the Department of Veterans Affairs touted progress on the agency's 10-year, $16 billion electronic health records modernization push, but appropriators still have concerns about the multi-billion-dollar project.

At a Feb. 26 House Appropriations subcommittee hearing, Chair Rep. Debbie Wasserman Schultz (D-Fla.) called achieving interoperability with the Department of Defense's health records system "this committee's top priority."

Rep. Will Hurd (R-Texas) called the cost and length of the project "outrageous." The $16 billion includes a $10 billon contract with Cerner and $6 billion in infrastructure upgrades and project management support.

At the hearing, Richard Stone, the executive in charge of the Veterans Health Administration, testified that VA's 131 unique versions of Vista, the VA's homegrown EHR management system, is slowing down the integration. Stone also said that Cerner has mapped all of the data from all the different versions for the transition.

"This is not simply about bringing an electronic medical record to life," he said. "This is about moving from a highly disjointed system without data integration to one that is fully data-integrated and therefore interoperable."

VA Secretary Robert Wilkie admitted the department has "had hiccups" in the testing of the system. "But we should have hiccups," he said.

Hurd said this was "probably the first time I've ever been encouraged" by progress on the project.

"Once you map the data, having this move from one system to another should be quick," he said. "Now it's about … how can you take some of that data that's probably localized and put it into the cloud? That transition, depending on the size of the dataset you're dealing with, may take some time."

Hurd said that his next questions for VA concern specifics on the timeline for implementation.

"They've identified the problem, they're rectifying their problem, they should be able to understand how long it will take to rectify that problem," he said. "I can't give a time, but I know it can be done in less than 10 years."

VA vacancies

Democrats voiced concerns about the impacts of the Trump administration's changes on federal agency workforce rules as well as the thousands of job vacancies throughout the VA.

Rep. Chellie Pingree (D-Maine) raised  issues about the implementation of the VA Accountability Act, passed in June 2017 to make it easier for the agency to fire employees. She questioned an "overzealous interpretation" of the law that lacks quantitative measures of personnel performance and "negatively impacts veterans."

Wasserman Schultz also mentioned concerns about the persisting vacancies at the VA, noting that 17 percent of leadership positions -- including the deputy secretary and the undersecretary of health -- that oversee the health record modernization are occupied by acting officials.

Given the roughly 45,000 total vacancies at the VA, Wilkie testified, "I'd be lying to you if I said I'd fill them all." Instead, he said he would instead focus on filling positions "where we have the greatest need," noting that the Senate recently confirmed James Gfrerer as assistant secretary of information and technology.

Also on the workforce front, Wilkie said that the agency had implemented the executive order to curtail official time, calling the previous policy a "disservice to veterans." Federal unions have sued the Trump administration over this move.