Despite recent scrutiny over program missteps and complaints from frontline staff, the Department of Veterans Affairs’ (VA) Electronic Health Records Modernization (EHRM) program plans to deploy the EHRM program at a second location in Columbus, Ohio, in February 2022, VA Deputy Secretary Donald Remy told lawmakers today.
Over a year ago, the VA launched the first EHRM deployment at Mann-Grandstaff VA Medical Center in Spokane, Wash., but paused deployment at other planned sites to conduct a strategic review of the program and address the problems that arose in Spokane.
These problems, exposed by VA Office of the Inspector General reports, included underreported costs, “significant deficiencies” in training for the new EHR program, and concerns from employees regarding the EHRM program and the Cerner Millennium system it runs on.
Problems Continue in Spokane
Members of the House Committee on Veterans’ Affairs Subcommittee on Technology Modernization expressed their concerns during today’s hearing over the existing problems in Spokane, which were recently reported in a new survey conducted of Mann-Grandstaff personnel from VA’s National Center for Organizational Development.
“The results of this report are extremely concerning,” Chairman Frank Mrvan, D-Ind., said of the new survey. “They show that people at Spokane VA and its associated clinics are demoralized and unhappy. The vast majority of respondents express that their morale and job satisfaction have worsened because of the Cerner implementation.”
Specifically, the survey found that 83 percent Mann-Grandstaff employees said that as a result of the Cerner medical record implementation, their morale has worsened, and 80 percent said their level of burnout has worsened. What’s more, is 62 percent of the employees said the EHRM has made them question if they want to continue working at Mann-Grandstaff.
Despite these new numbers, Remy said VA’s goal is to deploy the EHRM program at another location in Columbus, Ohio, in February 2022.
EHRM Deployment Heads to Ohio
Remy, who Secretary Dennis McDonough tapped in July to oversee the department’s troubled EHRM program, said the new site in Columbus, Ohio, already has testing and training set up for deployment.
“I want to make sure that everyone understands the distinction between deployment and go live,” Remy explained. “Because when we deploy the system, we’re still in the early processes of making sure that we have training and testing, authentication, and user engagement and adoption before we flip the switch and have the system go live at a location. But it is our intent to deploy in February.”
Many members of Congress expressed their concern over VA’s planned deployment at a second location, amid Spokane’s roadblocks and not having the recommendations from the strategic review fully implemented.
“It seems this decision has been made without demonstrating tangible improvements in Spokane, without putting forward quality metrics, and seemingly without the VA meeting its criteria to move forward,” Ranking Member Matt Rosendale, R-Mont., said. “It seems the veterans’ administration is trying to close off or ignore the problems at Mann-Grandstaff and try to have a do-over, and that is very problematic.”
Rep. Rosendale also called for VA to reduce the program’s spending until significant improvements are made, noting that the VA’s full lifecycle cost estimate of the program will not be available for a year. Until then, “no one will know actually what the true cost of this program is,” he said.
Rep. Cathy McMorris Rodgers, R-Wash., whose district encompasses the people of Spokane, agreed with Rep. Rosendale and wanted to ensure her constituents would be made a priority amid the second deployment.
“Mr. Remy, you know, there’s a sense that you’re moving on. There’s a sense that you’re moving on to Columbus and that you’re done at Mann-Grandstaff,” Rep. McMorris Rodgers said. “The staff are tired, they’re frustrated, and today the electronic health record is making their job harder, not easier.”
Remy assured Rep. McMorris Rodgers that he is committed to making Mann-Grandstaff a priority and that it “will continue to receive treatment” as they deploy in Ohio as well.
“Our teams are already in place to try to help those who are there understand that we’re here for them, with them, while they’re using this system, even if we deploy and when we deploy it at other locations,” Remy said.
Remy also noted that he will be going out to Mann-Grandstaff in a couple of weeks to “get to some of the root cause here and make sure I understand it.”
The Path Forward
Despite the EHRM program’s challenges, Remy is confident the VA “will get this effort back on track,” and emphasized three key points on what the VA is doing to move forward.
“First, that we’re learning from the implementation mistakes of the past. Second, that the Cerner system works, and I believe we properly positioned it for success. And third, that we’re bringing together all relevant stakeholders to ensure an effective EHRM deployment,” Remy said.
Remy emphasized that the problems do not lie within the Cerner technology, as the Cerner EHR system has been deployed in over 35 countries, 27,000 private provider facilities, 5,900 hospitals, and is currently being implemented at Department of Defense sites.
The deputy secretary asked the obvious question of why the Cerner system won’t work at the VA if it has been successful for others.
“I think it will work at VA,” Remy said in response to his question. “But I got to say; we’re making a big change from a system that allows for site-by-site differences in how staff do their jobs to one that will provide standardized workflows across the enterprise. This change, I believe, will benefit veterans and providers over the long run, but it is a difficult transition one that goes beyond just the technology of the system itself.”
“By making these changes and others that I’ve outlined in my written testimony, we can we will get this effort back on track,” Remy continued. “We’ll build an EHR system that allows veterans to access their health care records in one place from the first day they put on their uniforms to the last day of their lives. Because as Secretary McDonough has stated, this is a must-do, not a can-do for vets and providers alike.”