Politico

$16B veterans' health project hits major snag

Veterans Affairs Secretary Robert Wilkie insisted last week that the Trump administration is “on track” with a $16 billion project to connect medical records for the military and vets.

But that’s not exactly the case — the project faces significant delays and unanticipated headaches, according to three sources with detailed knowledge of what will be one of the largest technology contracts in federal history.

Promoters of the flagship Trump administration project say it will create a model for better-coordinated care for the whole United States, setting up a digitized health care record for millions of current and future veterans from the time they join the military. It’s a massively complex bureaucratic and technical undertaking, however, and a host of glitches have surfaced since the VA contract was signed last year, raising doubts in Congress about whether it can achieve its lofty goals.

Those problems are creating the first major hiccup for the project. Its promised March 2020 rollout at three VA medical centers — one in Spokane, Wash., the others in the Seattle area — is almost certain to be partially or completely delayed until October, the sources said.

In an op-ed published in military newspapers last week, Wilkie said the Trump administration is “working to deliver a win for veterans that prior administrations could not: a unified electronic health record (EHR) solution” that “will give [Pentagon and VA] doctors instant and seamless access to veterans’ full-service health records and history.”

Partly at the urging of President Donald Trump’s son-in-law Jared Kushner, the VA decided in 2017 to sign a no-bid contract with Cerner, which the Defense Department signed up with two years earlier to replace its homegrown records system. Three members of Trump’s Mar-a-Lago Club also have been involved in the effort — at first trying to block the Cerner contract because one of them, physician Bruce Moskowitz, didn’t like its software. A cache of 2017 emails released Thursday show that the VA officials in charge of the project humored the Mar-a-Lago group while bristling under their suggestions.

The Pentagon’s project had gotten off on the wrong foot at four Pacific Northwest bases that year. Initially, the system lost prescriptions and made it difficult for clinicians to log on, leading terrified doctors to fear harm to their patients, as POLITICO reported at the time.

Worried the same might happen to the VA project, its congressional overseers repeatedly have urged the agency to slow the project rather than risk compromising veterans’ health care, so they are not entirely dismayed by news of the likely delay.

“I have said to the VA, time and again, that we’d rather get implementation right than to rush to meet a deadline,” said Rep. Susie Lee (D-Nev.), chairwoman of the House Veterans’ Affairs Technology Modernization Subcommittee, in an interview. “If they are not ready to meet the highest standards of care, a delay might be required and that’s what should happen.”

The VA recently decided to split the initial implementation into two blocks, one that might go live in March and April, and a second in October, according to two sources with knowledge of the plan. But this would require the VA to offer limited Cerner software to clinicians during the first phase, they said, and it would require the first phase to start at the understaffed and cramped Mann-Grandstaff Medical Center in Spokane. So the agency may hold up the whole project until October.

In a statement to POLITICO, the VA declined to say whether it would push the launch date. The VA “is continually evaluating its path forward based on lessons learned from the Department of Defense and commercial implementations,” the agency said. “We are considering our options.”

A Cerner spokesperson said the VA was “finalizing their [rollout] strategy” and “already ahead of where other clients would typically be at this point in implementation. We are confident we are on the track.”

“It is my understanding that VA is considering delaying the go-live at one or more of the initial Cerner cites,” said physician and Rep. Phil Roe (R-Tenn.), ranking member of the full committee that led oversight of the project for years. “If delaying the initial go-live date is needed to ensure that implementation is ultimately successful and patient care is enhanced rather than disrupted, then I fully support it.”

The project has been dogged by the inability of the Pentagon and VA to agree to a joint oversight board. The Pentagon has yet to give the VA authority to link its network to the current VA record system, decades-old VistA, which is key to implementation, a congressional staffer said.

A new office called the Federal Electronic Health Record Modernization Office was supposed to handle that and other coordination matters, but the office isn’t up and running yet, although the two agencies agreed to set it up last September. They recently notified Congress of the appointment of Neil Evans, a senior VA health care official, as interim leader of the office, with Pentagon health official Holly Joers as his deputy.

The various problems expected in the initial phase of the electronic records project — partial functionality of key clinical software, the need for clinicians to toggle between different software systems, and the enormous task of installing new IT hardware in the first three bases — has some congressional critics worried about the project’s direction.

“Is it going to be something better than what they currently have in VistA?” asked a second congressional source, referring to the VA’s current software, which the agency developed in-house over the past 35 years. “That’s our concern.”

At a subcommittee hearing July 25, ranking member Jim Banks (R-Ind.) said the VA team had not provided answers to many questions Congress has asked about how well the system is going to work, including how data will flow between the two systems during the 10 years in which Cerner will replace VistA across the VA.

“I am skeptical that all the technical constraints are known and there aren’t more intractable difficulties waiting to be discovered,” he added.

The VA recently trumpeted the transfer of records from VistA to the Cerner data center as a major first step in the project, but far more complex tasks, such as uploading the records into Cerner’s system and making them usable for VA providers, remain, observers said.

“They have physically deposited the record on the Cerner side of the firewall, but they can’t do anything with the records,” a former VA official said, who compared the situation to having received a large encrypted file in an email.

The VA’s statement said it was “on track” in transferring the data.

Lee and Banks also had questions about how long the VA planned to have physicians use the Joint Legacy Viewer, a discreet software program that allows a clinician to view older VA and Pentagon patient data.

The cumbersome viewer was one of the reasons the VA cited for moving to a single “seamless” heath record with the Pentagon to begin with, Lee noted. “It’s not clear how it fits into the long-term interoperability strategy, that is, how long it will be needed,” she said.

The VA said that two Cerner platforms — one with software used for patient encounters, the other with historical data and analytical tools — as well as the Joint Legacy Viewer will all be available on different “tabs” on the same terminal for clinicians, at least initially.

At the July 25 hearing, senior VA medical adviser Thomas O’Toole acknowledged the “challenge” of “complex clinical scenarios” where veterans are seen in different facilities and clinicians must call up multiple screens to safely review a patient’s data.

“We’re trying to identify those workflow processes in advance so clinicians know what to expect,” he said.

Article originally published on POLITICO Magazine

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