Contractors still looking for leadership on joint health record project

A top executive of the company charged with steering the adoption of commercial health record technology at the Department of Veterans Affairs said that governance between VA and the Department of Defense remains a concern.

Plans to create a body with authority to settle disputes and guide joint implementation of the Cerner Millennium health record software across the two departments are stalled.

"I think we do need that joint decision-making authority. We are operating effectively. I believe that. We are getting things done. But there comes a point where you have to have that joint capability," Travis Dalton, president of Cerner Government Services, said at a June 4 hearing of the Subcommittee on Technology Modernization of the House Veterans Affairs Committee.

Richard Crowe, executive vice president of Booz Allen Hamilton, which is providing program management support to VA on the health record modernization contract, said there was time to get the right construct into place.

"It's not necessarily inappropriate to take some time and pause to think how you want to have this structure come together from a governance standpoint," he told lawmakers.

Already, contractors have been taking a lead role in coming up with solutions to solve pressing interagency concerns. Rep. Susie Lee (D-Nev.), who chairs the subcommittee, cited a contractor-driven plan to allow for VA users to access the Cerner system and expressed concern that contractors were adopting "workarounds" for governance issues that should be handled by VA and DOD officials.

David Waltman, a Cerner executive who formerly served as chief information strategy officer for the Veterans Health Administration and led the project to modernize the home-grown health record system Vista, said that the access problem was complicated and doesn't represent a failure of leadership.

"I don't think progress was impeded specifically by a lack of joint governance. This was a very complex decision and a process that required a lot of input from within VA" and with various stakeholders,  he said.  Waltman noted that the process was also affected because VA is considering a move from the Common Access Card used by many federal agencies to the U.S. Access card from the General Services Administration.

Ranking member Rep. Jim Banks (R-Ind.), who was the founding chairman of the committee when it launched in 2017, wanted to know what was accomplished by months of debate about the DOD and VA using a single instance of the Cerner system, as opposed to using two separate but integrated and interoperable versions.

"If the single instance is going to be more effective in the long run … what's the downside?" Banks asked.

Waltman indicated that VA and DOD participants in the project are beginning to come to terms with some of the constraints of using a common system, and the extent to which that system can be customized, and that the benefits of a single instance "far outweigh the challenges" and "limitations" posed by having to adopt certain language and interfaces and displays required by the use of a single system.

"Not every process or every workflow is identical between the departments. However, I think what folks realized that much of the differences between the departments are external even to the [electronic health record], and so in terms of both departments understanding that we're starting with a commercial baseline and there's a configuration band … in which the system can support variability between workflows and requirements of the departments and do so successfully in one system," Waltman said. "That took a while for people to explore and understand."