Byrne Says Aging Health IT Infrastructure Complicates VA EHR Rollout

May 21, 2019 - James Byrne, acting deputy secretary at the Department of Veterans Affairs (VA), told a Senate panel that the aging health IT infrastructure at VA facilities might complicate implementation of his agency’s electronic health record (EHR) modernization effort.

Byrne said his department has identified “limiting features” that could impact the timeline and cost of the EHR implementation.

Among those are the communications closets, which house IT systems and devices at VA facilities. “We don’t yet know what these communications closets look like in our various facilities,” Byrne told the Senate Veterans’ Affairs Committee during his May 16 confirmation hearing.

Despite these limiting features, Byrne remains “pretty bullish” about meeting the timeline and cost targets of the EHR implementation, which is expected to take 10 years and cost $16 billion, up from an original $10 billion estimate.

“I’m not going to make any promises that we are going to accelerate it, but 10 years seems like a long time to me. We are setting up the foundation and governance for the EHRM [EHR modernization] execution. When we rollout the IOC [initial operating capability], we are going to get a much clearer picture of our ability to accelerate this rollout across the country,” he noted.

READ MORE: VA’s IT Management Lapses Could Jeopardize EHR Modernization

For the IOC, the VA plans to test the Cerner EHR system at three sites in the Pacific Northwest in the second quarter of 2020. These sites are Mann-Grandstaff VA Medical Center, VA Puget Sound Healthcare System—American Lake and Seattle Divisions, and the West Consolidated Patient Accounting Center.

The VA said that the preparatory work began in the fall of 2018, which is helping it identify ways to optimize the scheduling, refine configurations, and standardize processes for future locations. The department plans to go live with the EHR system at all VA sites by 2028.

“We are on track to executive the IOC next year, but we are planning ahead. Simultaneous with the rollout of the Cerner project, we made the decision to rollout the scheduling tool in a dual track across the country. So, the scheduling capacity will be done across the VA well in advanced of the rollout of the Cerner EHR product,” Byrne said.  

In January, the VA decided to cancel its $600 million contract with Epic to use its scheduling system, opting instead to use Cerner’s scheduling system so that it would integrate with the Cerner EHR system. It also put the scheduling system implementation on the fast track.

Byrne explained that the VA is keeping costs down by using a just-in-time system for purchasing equipment. “Instead of buying technology now and having it sit in a warehouse for six months, [the VA] is waiting to buy the equipment later on.” As a result, the VA is “under-running” in terms of funding, he noted.

Lawmakers' Bill for Third-Party Oversight of VA EHR Project

READ MORE: Lawmakers Blast DoD Officials Over EHR Implementation Delays

Some lawmakers have expressed frustration over the timeline and expense of the VA’s EHR project.

In the House, Rep. Will Hurd (R-TX) criticized the price tag and timeline for the EHR project as “outrageous,” during a Feb. 26 hearing of a House Appropriations Committee panel.

In the Senate, Sen. John Tester (D-MT) and Sen. Marsha Blackburn (R-TN) have introduced a bill that would set up a third-party oversight committee to monitor the VA's EHR project implementation.

The oversight committee would be separate from VA and the Department of Defense (DoD). The 11 committee members would include medical professionals, information technology and interoperability specialists, and veterans currently receiving care through the VA.

The committee would be responsible for analyzing VA’s strategy for the EHR implementation project, developing a risk management plan, touring VA care facilities throughout the system launch, and ensuring veterans, VA employees, medical staff, and other participants have a way to offer feedback during the project.

In introducing the bill, Tester said that “new electronic health record system is too important to veterans’ health care for the VA to get wrong. Our bill will create another layer of accountability and oversight of the process to make sure the VA rollout does right by the nine million veterans who will rely on this system.”

Blackburn added: “A crucial part of giving our veterans better care is improving the way DOD and the VA organize their health records. The EHR Advisory Committee will be entirely devoted to ensuring the implementation and transition is done as smoothly as possible.”