VA needs more time on scheduling software

As part of its electronic health records modernization plan, the Department of Veterans Affairs is going to adopt Cerner's scheduling system but it's going to take longer than they thought, it was revealed a House hearing Sept. 26.

The decision to go with Cerner isn't much of a surprise: VA adopted the Cerner Millennium system on a sole-source basis in 2017 to support interoperability with the Department of Defense health system that is using the same commercial software.

However, the move uproots a test of a rival commercial system in VA's Columbus, Ohio, facility, which officials said was yielding improvements. That trial is going to be scrapped as the contract supporting it expires in June 2020. Columbus will be used as a testbed for the Cerner system – with rollout scheduled for next April, around the same time that VA plans to be piloting the overall Cerner health record in the Pacific Northwest. The sequencing left some lawmakers on a key subcommittee of the House Veterans Affairs Committee scratching their heads.

"Despite being six months out from beginning system implementation, the plan seems to be in very rough shape," said Rep. Susie Lee (D-Nev), who chairs the Subcommittee on Technology Modernization. "This includes cost, which VA has said won’t be finalized until November." 

VA previously announced plans to accelerate the implementation of the Cerner Scheduling Solution across the department ahead of the 10-year Cerner Millennium deployment. However, as Lee noted in her remarks, the time frame for putting Cerner scheduling in place has been extended from three years to five.

The history here is complicated. Clinical scheduling woes at the Department of Veterans Affairs first hit the public eye in 2014, when it was revealed that officials at the Phoenix VA were keeping two sets of books to make it appear that wait times for veterans seeking medical appointments were shorter than they were.

In the wake of that scandal, VA cast around for new scheduling solutions to replace the native scheduling modules in its home-grown health record system Vista.

One of these solutions was in the form of a $624 million contract awarded in 2015 for commercial health record provider Epic's Medical Appointment Scheduling System (MASS) program. Lockheed subsidiary Systems Made Simple was also on that five-year contract.

There was another effort to update Vista from within – the Vista Scheduling Enhancement product designed to replace Vista's code-heavy screens with a visual interface modeled on Microsoft's Outlook – that was rolled out in 2017, before VA's decision to adopt the Cerner Millennial system.

Dr. Michael Davies, a senior advisor at the Veterans Health Administration, estimated that VA spent $17 million on the pilot and $2.5 initially on the $624 million contract to plan for roll out MASS nationally. Davies also noted that it took six months for the trial to show a positive effect on wait times and other factors.

Rep. Conor Lamb (D-Pa.), said the fact that VA sunk costs into a trial of one commercial tool before adopting another "drives a little bit of the skepticism that you may be perceiving."

John Windom, executive director of the Office of Electronic Health Record Modernization, said that the Columbus facility was chosen in part because of infrastructure upgrades that were instituted to support the MASS test and because the Epic contract is expiring in less than a year.

"Scheduling is clearly a parameter and an element of the contract we awarded to Cerner," Windom said. "We will be modifying the contract because the deployment of scheduling separately is a new scope item, but is a scope well within the capability set that exists in the contract."

The committee is still waiting on a VA cost estimate of that modification, which VA officials said is coming in November.