Lawmakers balk at cost-overruns, transparency issues with VA's $21 billion health record program

At a Senate hearing last week, Veterans Affairs Secretary Denis McDonough noted deficiencies in training including the lack of a real system available for use by clinicians in advance of the go-live date for a new, integrated health care software system.

Blue Signage and logo of the U.S. Department of Veterans Affairs

The Senate voted 91-8 to confirm Donald Remy to the post of deputy secretary at the Department of Veterans Affairs on July 15. Remy comes in as the agency looks to pivot past two adverse oversight reports about the cost and performance of the Electronic Health Record Modernization Program (EHMR).

Under statute, Remy is tasked with supervising the project of replacing the agency's homegrown health record system Vista with a commercial software system from Cerner – the same product being installed across the Department of Defense.

The VA's effort is now expected to cost more than $21 billion over 10 years – up from the VA's earlier estimate of $16 billion due to higher than reported infrastructure modernization costs. One day before Remy's confirmation, the Senate Committee on Veterans Affairs heard from VA Secretary Denis McDonough about plans for salvaging the EHRM program after a rocky rollout last October in the Mann-Grandstaff Medical Center in Spokane, Wash.

At the hearing, McDonough praised the VA medical staff, noting deficiencies in training including the lack of a real system available for use by clinicians in advance of the go-live date.

"The missteps were ours at VA and Cerner," McDonough told lawmakers.

McDonough pledged to develop a "fully simulated testing and training environment so veterans and providers can properly evaluate and learn the system before it goes live, not during or after" and to make sure physical infrastructure is prepared to accommodate the demands of the Cerner system before installation begins. That means the rollout schedule, designed to track DOD installations of its Cerner-based system across the continental U.S., will change.

The initial schedule "was a mistake," McDonough conceded.

"One, we're off kilter with DOD now anyway geographically. Two … we're not in a position to adequately prepare for the structural and maintenance requirements and, as a result, ended up not being as transparent with you all as we should have been in that process."

Transparency and accountability were big issues for lawmakers in the wake of a July 8 report from the VA Office of Inspector General that stated data that didn't reflect well on efforts to train clinicians was finessed to make it seem that end users were more proficient on the Cerner system than they actually were.

"OIG concluded that [Office of Electronic Health Records Modernization] leaders removed and altered data prior to submission and provided incomplete and insufficient results of OEHRM's assessment of training," David Case, the deputy inspector general at VA, told lawmakers. "Presently, the OIG is conducting an administrative investigation and informed VA leaders of this matter."

So far, however, no one at VA has been fired for withholding information from OIG or from omissions in cost data supplied to Congress that lowballed the overall cost of the program, according McDonough.

Regarding the suggestion from the inspector general that data on user proficiency was deliberately altered, he said: "Obviously, there will be ramifications for that."