VA launches strategic review of beleaguered $16B Cerner EHR project

Dive Brief:

Almost five months after its first site deployment, the Department of Veterans Affairs is launching a systemic review of its multi-billion dollar EHR modernization project, following years of delays and controversy.
Secretary Denis McDonough, the Biden administration's new VA head, said on Friday he is launching a strategic review of the rollout, which should take no longer than 12 weeks. The project overall will not be paused.
VA said Cerner is not to blame for the review of the $16 billion, decade-long contract, but it was difficult to prioritize while manuevering among COVID-19 headwinds. For its part, the Kansas City-based EHR vendor said it supports the move.

Dive Insight:

VA's ongoing analysis of the only site operational with the new EHR, the Mann-Grandstaff VA Medical Center in Spokane, Wash., precipitated the need for a schedule shift, the agency said. Mann-Grandstaff went live in October last year, the first site to cross the finish line in a project that's been plagued by delays, management turnover, growing spending and operational issues since it launched in 2018.

"After a rigorous review of our most-recent deployment at Mann-Grandstaff VA Medical Center, it is apparent that a strategic review is necessary," McDonough said in a Friday statement, though he added the agency "remains committed" to Cerner's EHR and the delay isn't the vendor's fault.

"Cerner supports the decision by the U.S. Department of Veterans Affairs to conduct a strategic program review," Brian Sandager, general manager of Cerner Government Services, said in a statement. The project includes one of the biggest health data migrations in history and a new health information exchange shared between the VA, Department of Defense and private sector partners.

The review won't extend beyond three months, and will focus on areas for additional productivity and fixing any speedbumps in the clinical workflow at Mann-Grandstaff and upcoming go-live sites. VA will also research targeted improvements to the system's patient portal, data syndication and revenue cycle.

The next site scheduled to go live with the new system is the Columbus, Ohio VA Healthcare System, though go-live-related work will be temporarily suspended and the order of subsequent deployments might be shuffled following the review, according to the VA.

But the review, partially due to issues managing the massive project amid the pandemic, is not a pause. Just this week, VA awarded Cerner task orders to continue work on future sites, and non-go-live-related activities will continue for Columbus, too.

By April last year, VA had already twice delayed the launch of the project, meant to give the agency's outdated health IT infrastructure a much-needed facelift by migrating its health data from a customized VistA platform to a unified Cerner EHR, and streamline data sharing between the VA, DOD and Coast Guard.

The VA Inspector General published a report that month outlining myriad problems with the new system's implementation, which is costing the government an additional $6.1 billion over the original $10 billion price tag for the contract, which was awarded to Cerner without competitive bidding.

VA OIG said the agency hadn't prepared properly for the project, and its hospital and outpatient facility network needed their own back-end infrastructure updates before they could host a new EHR. That ill-preparedness resulted in delays and faulty EHR implementations, OIG said.

On top of that, the pandemic was another stressor, causing the agency to push back its implementation schedule once again in April after an initial usability-related pause in February last year.

Just last month, the Government Accountability Office recommended further delaying the project until ongoing problems could be addressed. GAO cited several critical IT infrastructure and training problems that could result in a ripple of failures across the migration, and instructed VA to stop the rollout beyond Mann-Grandstaff.

Rep. Cathy McMorris Rodgers, R-Wash., sent a letter to McDonough on Wednesday alleging she'd received reports of "dangerous and unacceptable delays" in healthcare services, including prescription filling.

"I am hearing an increasing number of complaints and pleas for help coming into my Spokane and Coalville offices," Rodgers, who represents the district where Mann-Grandstaff operates, said.

According to the current schedule, the entire VA network, including 170 hospitals and more than 1,000 outpatient sites, should be live with the new system by 2028.