Watchdog: pause on VA's $16B electronic health records project might be needed

The Government Accountability Office wants the Department of Veterans Affairs to postpone new installations of the Cerner electronic health record while the agency irons out the most serious system problems. The recommendations are included in a report released Feb. 11.

GAO notes that the initial go-live of the electronic health record in Spokane, Wash., took place last October with most of the most serious problems closed or temporarily solved with workarounds. VA officials then reported that the launch was a success. However, the report states, new problems -- known inside VA's Office of Electronic Health Records Modernization as critical severity and high severity test findings – will likely crop up. GAO said VA needs to deal with those findings in advance of subsequent deployments.

"If VA does not close or appropriately address all critical and high severity test findings prior to deploying at future locations, the system may not perform as intended," the report states. Recommendations for executive action include delaying "of Electronic Health Record Modernization to postpone deployment of "the new EHR in new locations until all existing open critical severity test findings are resolved and closed, and until any additional critical severity findings identified before planned deployment are closed."

VA is in the early stages of a 10-year effort to replace its homegrown electronic health records system Vista with a commercial product from Cerner, which is also being used at the Department of Defense. The VA program includes $10 billion in software costs and $6 billion in infrastructure upgrades, although the tally for new equipment and additional bandwidth is expected to climb.

In reply comments, made under the signature of former acting VA Secretary Dat Tran and dated Jan. 25, the VA concurred "in principle" with GAO's recommendations, noting that as a rule the agency "already resolves and closes all existing open critical severity test findings prior to the deployment of the EHR in new locations."

The agency also asked GAO to reframe their recommendations to reflect their policy to continually address defects as they come up, and objected to the language calling for VA to "postpone deployment" in new facilities until such issues are closed out.

The VA is planning to deploy what it calls capability set 1.1 to locations in the Pacific Northwest and Midwest through fiscal year 2022. Another big test is coming with the first deployment of capability set 2.0 – a full suite of tools needed to manage the largest hospital complexes – in Seattle in the fourth quarter of FY2021.