Veterans Affairs

VA leaders optimistic on July go-live date for new health record

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The leaders of the $16 billion electronic health record refresh at the Department of Veterans Affairs say they're optimistic that they'll hit a revised go-live date for their first installation of the new, commercial system at Mann-Grandstaff VA Medical Center in Spokane, Wash.

The planned March 28 go-live date for the Cerner electronic medical record was pushed back because of development issues.

Dr. Robert J. Fischer, director at Mann-Grandstaff, said he was grateful for the delay at a March 5 hearing of the subcommittee of the House Veterans Affairs Committee that is charged with oversight of the health record modernization project.

"I think my staff had a large sigh of relief when we were able to slow this forward progress in order to dot some of the I's and cross the T's as both Cerner and VA learn about initial implementation in a large federal health care system," Fischer said. "There's just not a ton of experience with initial implementations in an agency our size -- so we both have to be willing to learn -- and we're are learning."

VA officials said they can't deliver a detailed schedule revision for the implementation of the project until March 10, but a few upcoming milestones were described in testimony.

Dr. Robert Stone, who heads the Veterans Health Administration (VHA) on an acting basis, said that the software build that includes completing interfaces that connect Cerner systems with the VA's own systems, will be completed in April or May. After that, VA needs six weeks of training and two weeks of operational assessment to determine whether the system is ready to go live.

Stone said that he believed in the schedule but cautioned that for each milestone, "there is a gate that my answer could change." He added: "Am I optimistic? Absolutely, because I've got great partners here. But there are gates that must be met in order to sustain that optimism."

Rep. Susie Lee (D-Nev.), who chairs the Subcommittee on Technology Modernization, wanted to know why Congress wasn't informed earlier about the potential for delay, whether lagging infrastructure improvements posed a threat to the viability of the system or to patient safety and "why VA didn't realize earlier that its commitment to a stripped-down first-capability set would be problematic."

Specific answers on the timeline weren't forthcoming from VA officials, but Fischer explained that his staff began to filter up their concerns based on feedback from "super users" -- staffers who volunteered to take an early look at the Cerner system.

"They had expectation about what they would see in the training build, and they simply didn't see it. And they provided that feedback, and I sent that up my chain," Fischer said.

That feedback, received before a training launch set for Feb. 10, helped convince decision-makers to tap the brakes on the Cerner deployment.

Stone noted that the Department of Defense had to delay the go-live of its own Cerner health record system "in order to do the operational readiness testing that we have now demanded."

Hidden infrastructure costs?

Infrastructure woes continue to dog the project. Deputy Inspector General David Case noted that "critical physical and IT infrastructure upgrades have not been completed … in line with VA's own timelines."

The IG's audit team found that "as of February 25, 2020, contracts had yet to be awarded for some critical physical infrastructure upgrades." The Office of Electronic Health Records Modernization had set a goal of completing all physical and IT infrastructure upgrades six months ahead of any go-live date.

The physical infrastructure piece of the puzzle may contribute costs not addressed up front in the $16 billion estimate for the program -- which included a $10 billion contract with Cerner, $4.3 billion for infrastructure costs mostly in the realm of hardware and software and just under $2 billion for program management.

The Office of Electronic Health Record Modernization requested $1.181 billion for infrastructure in fiscal year 2021, up from $327.9 million in 2020 -- a 260% increase.

Additionally, the VHA put a request for an additional $456 million in its non-recurring maintenance budget line in its 2021 budget. Spending on needed physical infrastructure upgrades, including a switch to modern telecom cables and the air conditioning and ventilation of telecom closets, comes out of that budget.

Stone noted that since the dismissal of Jim Byrne as deputy secretary, "deconflicting those pieces of financial responsibility" fall to Melissa Glynn, assistant VA secretary for enterprise integration in the Office of Enterprise Integration.

Case said the office of inspector general "is not aware of any VA estimate for these costs at the current time" but added that once facility assessments requested by VHA are completed at the end of March, "VA may have a better idea of gaps between the current and necessary future state of facilities nationwide and be able to develop informed cost estimates."

About the Author

Adam Mazmanian is executive editor of FCW.

Before joining the editing team, Mazmanian was an FCW staff writer covering Congress, government-wide technology policy and the Department of Veterans Affairs. Prior to joining FCW, Mazmanian was technology correspondent for National Journal and served in a variety of editorial roles at B2B news service SmartBrief. Mazmanian has contributed reviews and articles to the Washington Post, the Washington City Paper, Newsday, New York Press, Architect Magazine and other publications.

Click here for previous articles by Mazmanian. Connect with him on Twitter at @thisismaz.


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