VA’s IT Management Lapses Could Jeopardize EHR Modernization
The Department of Veterans Affairs’ history of IT management problems could jeopardize its $10 billion EHR modernization program, warned Carol Harris, director of IT management at the Government Accountability Office.
Source: VA
- The Department of Veterans Affairs’ (VA) history of IT management problems could jeopardize its $10 billion EHR modernization program, warned Carol Harris, director of IT management at the Government Accountability Office (GAO).
The VA has failed to fully implement more than half of GAO’s recommendations designed to fix problems with the department’s IT management, Harris told the House Veterans’ Affairs Committee’s technology modernization subcommittee during an April 2 hearing.
“VA has long struggled to overcome IT management challenges, which have resulted in a lack of system capabilities needed to successfully implement critical initiatives. In this regard, VA is set to begin deploying its new electronic health record system in less than 1 year and questions remain regarding the governance structure for the program,” Harris observed in her written testimony.
“If the department continues to experience the challenges that we have previously identified, it may jeopardize its fourth attempt to modernize its electronic health record system,” Harris stressed.
The latest attempt by VA to modernize its EHR system is its $10 billion EHR modernization program, which will be based on the Cerner EHR platform and will take ten years to implement.
READ MORE: Lawmaker Calls VA EHR Modernization Cost, Timeline ‘Outrageous’
The three other VA attempts to modernize its EHR system involved upgrades to the legacy Veterans Health Information Systems and Technology Architecture (VistA). These efforts resulted in “high costs, challenges to ensuring interoperability of health data, and ultimately did not result in a modernized VisTA,” she observed.
Source: GAO
Interoperability Office Left Out of EHR Modernization Plan
In terms of its most recent EHR modernization effort, the VA has not implemented the GAO’s recommendation to define the role of the Interagency Program Office — set up by Congress to oversee EHR interoperability at the VA and Department of Defense — in the governance plan, Harris related.
The VA and DoD leadership had approved a role for the Interagency Program Office that included providing expertise, guidance, and support for DoD, VA, and joint governance bodies as the departments acquire and implement interoperable EHRs.
But the VA has not provided GAO with documentation supporting these actions and how they relate to the VA’s governance plans for the new EHR system. Also, the Interagency Program Office role described by the VA does not appear to position the office as the single point of EHR interoperability accountability that Congress envisioned, Harris testified.
“We continue to monitor the department’s governance plans for the acquisition of the new electronic health record system and its relationship with the Interagency Program Office,” she said.
READ MORE: Investment Needed in Health IT Infrastructure for VA EHR Program
Earlier this year, the VA admitted that its aging healthcare IT infrastructure was not currently up to the task of handling the new Cerner system.
VA General Counsel and Acting Deputy Secretary James Byrne told a Senate panel that additional investment would be needed to upgrade the IT infrastructure to make it ready for the EHR modernization program.
In the fiscal year 2019 budget, the VA is spending $412 million on infrastructure readiness, including end user devices, testing activities, and interfaces for the new EHR system.
Inadequate IT System Plagues VA’s Family Caregiver Program
The GAO also found that the VA’s Family Caregiver Program has not been adequately supported by an effective IT system. The program offers caregiver services such as a monthly stipend, training, counseling, referral services, and expanded access to mental health and respite care.
VA officials told GAO that the IT system, the Caregiver Application Tracker, was designed to manage a much smaller program and had limited capabilities.
“Outside of obtaining basic aggregate program statistics, the program office was not able to readily retrieve data from the system that would allow it to better assess the scope and extent of workload problems at VA medical centers,” Harris related.
The officials were also concerned about the reliability of the data in the IT system. The difficulty of accessing workload data made it hard for the office to monitor the program and identify workload problems or make needed modifications.
GAO recommended that the VA replace the program’s IT system, and the department concurred. However, the IT system has yet to be replaced due to challenges related to implementation. .
GAO also dinged the VA on cybersecurity lapses. While the VA has established numerous security controls, it had not effectively implemented key aspects of its IT security program, such as access controls, patch management, and contingency planning.
"Fully implementing all of GAO’s recommendations would help VA ensure that its IT effectively supports the department’s mission," Harris concluded.
