The VA first launched its new electronic health record (EHR) system over 19 months ago — some in Congress would describe these as long, problematic months.

Nevertheless, progress has occurred since the VA joined with DoD in a joint contract to modernize its EHR system in 2017. The massive $16 billion project raised lots of concerns with lawmakers after decades of attempts by both departments to develop a joint interoperable health record that never materialized.

The VA conducted its first launch of the new system in the fall of 2020 at Mann-Grandstaff VA Medical Center in Spokane, Wash. Due to concerns about patient safety, training, employee morale, and other deployment issues, the VA secretary paused the electronic health record modernization (EHRM) project for a year to mitigate problems before future deployments. The department used the time to refine governance and management structures, and to resolve deployment issues at Mann-Grandstaff.

With the reset complete, the VA resumed deployments this year. The VA EHR deployed March 26 at the Jonathan M. Wainwright Memorial VA Medical Center in Walla Walla, Wash., and April 30 at the VA Central Ohio Healthcare System in Columbus, Ohio.

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The additional deployments have sparked more concerns and a myriad of questions from Congress, watchdog groups, and veterans’ organizations – including lingering concerns that the VA has not fully resolved all the problems since its first launch at Mann-Grandstaff. The VA has been working diligently on Capitol Hill and with stakeholder groups and the media – and, more importantly, with veterans and VA employees – in recent months to alleviate some of these concerns.

Most massive technology projects, including health record system rollouts, face some glitches or setbacks. Correcting flaws and incorporating lessons learned are part of the journey. The VA’s EHRM project is no exception. The department has fully backed the project, starting at the very top with the secretary and his leadership team — assuring Congress, veterans, and VA employees that the VA “remains steadfast to getting this right” as a model for transformative health innovation.

“This electronic health record rollout is an important step in our progress toward a single instance of medical record connecting VA, the Department of Defense and the Department of Homeland Security’s U.S. Coast Guard that will provide patients with seamless care from active duty to VA status,” said Dr. Terry Adirim, program executive director of VA’s Electronic Health Record Modernization Integration Office. “With each VA site that adopts this system, we gain momentum. The lessons we carry forward from site to site are refining our rollouts and improving end-user experiences.”

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However, significant problems continue, tracing back to the project’s inception.

A DoD and VA Office of Inspector General (OIG) joint audit in May found even though both departments took action to achieve interoperability by acquiring Cerner Millennium, deploying the EHR system at 49 DoD locations and one VA health care facility, and launching the Joint Health Information Exchange, they did not take all the actions needed to achieve full interoperability. For example, they did not:

• Consistently migrate patient health care information from the legacy system into the new system to create a single, complete patient record.
• Develop interfaces from all medical devices so patient information could be uploaded to the new system.
• Ensure users were granted limited access to the new system to a level necessary to perform their duties.

The audit also highlighted oversight and funding issues with the DoD-VA Federal Electronic Health Record Modernization Program (FEHRM) Office. The FY 2020 National Defense Authorization Act required the joint office to take a more active role in developing and implementing a plan to achieve interoperability. The program office’s primary role up to this point had been facilitating discussions in disputes or providing direction. The office director told inspectors more resources and authorities from DoD and the VA would be needed to meet the legislative mandate.

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Last month, the House Veterans’ Affairs Subcommittee on Technology Modernization held a hearing for the VA EHRM executive director and the VA OIG to provide updates on the system. The VA reported the Cerner EHR was successfully implemented at half of the U.S. sites and that lessons learned from DoD rollouts and deployments at Mann-Grandstaff were used in the Walla Walla deployment and the then-upcoming launch in Columbus.

The OIG highlighted outstanding issues from its first five reports released after the Mann-Grandstaff launch. Of the 38 recommendations centering on production, record content, employee training, and preparation for the new system and implementation deficiency issues, the VA has closed out only 14.

Since last July, the OIG has published five more reports highlighting concerns about medication management, workflow errors, interoperability problems, insufficient user training, and frustration among employees over the handling of problem tickets and resolution of reported problem areas.

Many subcommittee members also shared their frustrations with VA and OIG witnesses during the hearing. Like previous hearings, many lawmakers and advocacy groups left with more questions and a desire to dig deeper into the issues.

“It is clear this program has a long way to go,” said subcommittee chair Rep. Frank Mrvan (D-Ind.). “The VA and Cerner must fix these problems as soon as possible. This system can’t fail because at the other end are the people who put their lives at risk for their country.”

The subcommittee’s ranking member, Rep. Matt Rosendale (R-Mont.), insisted he will not support future deployments of the EHR system. He wants to see existing issues resolved and a fully functional system at the Mann-Grandstaff site before the next project launch.

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Cerner and the VA are poised to deploy the system to nine more VA Medical Center sites this year:

• June 11: Oregon (Roseburg, White City)
• June 25: Idaho (Boise)
• July 16: Alaska (Anchorage)
• Aug. 27: Washington (Puget Sound)
• Oct. 8: Michigan (Battle Creek, Ann Arbor, Saginaw)
• Nov. 22: Oregon (Portland)

No doubt VA’s EHRM project will continue to be scrutinized in the coming months as authorizers and appropriators hold hearings and watch closely the deployment of the system throughout the year.

MOAA and our Military Coalition and veteran service organization partners continue to track progress and work with the VA and Congress to keep the EHRM project moving forward. Stay tuned here for future updates on this important effort.