VA looks to boost health record spend to modernize infrastructure

The Department of Veterans Affairs is pitching Congress on a massive spending increase on its electronic health record project even as the first "go-live" date looks to be delayed by at least a month.

VA's switch to a commercial electronic health record system across its nationwide enterprise is one of the biggest IT projects in government history. It involves replacing more than 130 distinct instances of its homegrown Vista software with the Cerner Millennium system – the same product currently being implemented by the Department of Defense. The massive project is budgeted at more than $16 billion over 10 years, and it includes a $10 billion contract with Cerner, an estimated $6 billion in hardware upgrades and at least $500 million in program management.

The Cerner software was set to go live on the March 28 at the Mann-Grandstaff VA Medical Center in Spokane, Wash., but VA Secretary Robert Wilkie informed key members of Congress that the launch would be delayed after conducting a "deep dive" review of the project in the wake of the dismissal of James Byrne, until recently VA's deputy secretary and the official in charge of the health record project.

VA is seeking an 82% increase in 2021 spending on the project, which would bring the budget line for the project to $2.627 billion, up from a planned spending level of $1.5 billion in 2020.

The increased budget for next year doesn't necessarily mean the price tag for the entire project will go up. VA is proposing to speed up the tempo of rollouts of the electronic health record software, and it is also pursuing the installation of Cerner scheduling software -- not initially planned as part of the health record acquisition -- to all medical facilities by the end of calendar year 2024.

"Assuming too much risk with reduced funding in the early years of implementation introduces potential additional risk to contract costs in the out-years," the agency stated in its budget justification.

The biggest increase comes with infrastructure -- VA is seeking a 260% increase in funding for hardware, networks, ID management and security and other associated items. The demands of the Cerner software appear to be revealing the age and fragility of VA systems.

"A thorough enterprise-wide technology analysis revealed that 96 to 100% of [end-user devices] should be replaced to work with the new EHR solution," the budget justification stated.

The budget documents indicated that the tech refresh will ideally precede the Cerner software integration by at least six months.

Most VA hardware is more five years old, and local networks are too congested by older VOIP phones to deliver the bandwidth required by the Cerner software. Spending on interfaces to legacy VA systems including Vista is more than doubling from $40 million in 2020 to $86 million sought for 2021.

Those legacy connections and network configurations are proving more complex than initially supposed, according to multiple sources familiar with the reasoning behind the delay.

Paul Cunningham, VA's chief information security officer, testified at a Feb. 12 hearing of the Technology Modernization subcommittee of the House Veterans Affairs Committee (HVAC) that he'd only learned of the go-live delay the day before and characterized the decision as "tactical."

"I've long said that getting it right is far more important than hitting a date on a calendar, and if there needs to be a delay to get the system to a place where veterans lives are not at risk and the VA staff are ready to use it, then that's the right thing to do," subcommittee chairwoman Rep. Susie Lee (D-Nev.) said at the hearing. "However, I'm concerned that as we move closer to the go-live date, we have been told repeatedly that there were no show stoppers in the implementation, that testing was going great and things were on track. I get that in software development and testing conditions can change rapidly, but I require that the VA be as transparent and accountable for its actions."

The Feb. 12 hearing was about information privacy and not about the health record implementation, and VA declined a request from Republicans on the committee to add a witness to speak to the delay. Another HVAC hearing is planned to address the delay, Lee said.