- Rep. Will Hurd (R-TX) said the $10 billion price tag and the 10-year timeline for implementation of the Department of Veterans Affairs’ EHR modernization program are “outrageous,” during a Feb. 26 hearing of the House Appropriations Committee’s Military Construction, Veterans Affairs, and Related Agencies subcommittee.
Addressing VA Secretary Robert Wilkie, Hurd said: “I would welcome your feedback on how implementation is going and hopefully the answer that the completion of this is not going to be 10 years and $10 billion.”
Wilkie responded that this is the current projection for completion of the EHR modernization program. “The key for me is interoperability: the ability of the VA to see the entire health record of the veteran. We have had some hiccups, but we should have hiccups.”
Hurd said: “I’m supportive of this program. I think most people here are supportive of this program. However, why is it taking so long to map one record to the other? Have we completed that data mapping?”
Richard Stone, the executive in charge of the Veterans Health Administration, said that Vista, the VA’s legacy EHR system, has 131 instances.
“What that means is that there are 131 datasets that go back decades that must be not only data mapped, but also combined into a single instance before we can migrate the data over into the Cerner product. This is not simply bringing an electronic medical record to life; this is about moving from a highly disjointed system without data integration to one that is fully data integrated and therefore interoperable,” Stone said.
“The vendor has mapped all of the records for the transition. But there is another piece to this. One of the problems we saw at the Department of Defense is the issue of user acceptance, especially in their initial go live. Part of user acceptance is change management. This is more than simply fielding the electronic medical record,” Stone added.
Wilkie stressed that EHR interoperability is vital to combat opioid addiction and mental health issues among veterans.
“The reason that the electronic health record modernization is so important is interoperability. Say a veteran comes to the VA and we give him 30 Tylenol 3, then that veteran goes into the private sector to his local doctor and that doctor gives him something to sleep. Under this EHR modernization process, the local doctor will punch that information into the record, so that now a warning goes up at the VA that we have a veteran who is at risk for abuse, addiction, or something worse, and it allows us to intervene,” Wilkie said.
Subcommittee Chairwoman Debbie Wasserman Schultz (D-FL) also expressed concern about the high price tag. She noted in her opening statement that the nuclear-powered aircraft carrier USS Gerald R. Ford, which was commissioned in 2017, cost less than the EHR modernization program.
She stressed that “implementing and improving VA’s electronic health record system and executing Congress’ mandate for full interoperability with DOD’s systems has been this committee’s top priority for several years.”
In his prepared statement, Wilkie said that the VA is “committed to a timeline that balances risks, patient safety, and user adoption while also working with DoD in providing a more comprehensive, agile, and coordinated management authority to execute requirements and mitigate potential challenges and obstacles.”
“Throughout this effort, VA will continue to engage front-line staff and clinicians, as it is a fundamental aspect in ensuring we meet the program’s goals. We have begun work with the leadership teams in place in the Pacific Northwest. OEHRM [Office of Electronic Health Record Modernization] has established clinical councils from the field that will develop national workflows and serve as change agents at the local level,” he concluded.