|Photo: Department of Veterans Affairs, afagen Flickr, licensed under CC BY-NC-SA 2.0|
Two Cerner executives testified before the House Veterans’ Affairs Subcommittee on Technology Modernization on Wednesday regarding the VA’s electronic health record modernization efforts.
The $16 billion program, which initially rolled out Cerner’s Millennium platform at Mann-Grandstaff VA Medical Center in Spokane, Washington, has faced watchdog and congressional scrutiny as it has gotten off the ground.
During his testimony Wednesday, Brian Sandager, senior vice president and general manager of Cerner government services, said the vendor takes its responsibility to veterans, servicemembers, taxpayers and Congress seriously.
“Continued success of VA’s EHRM program will require transparency and an unwavering dedication to do what is right for veterans and the VA providers who passionately serve them,” said Sandager in a statement.
“They have waited far too long for a seamless care experience, and we are committed to getting this right,” he said.
WHY IT MATTERS
This past week, VA Secretary Denis McDonough testified in front of the Senate Committee on Veterans Affairs to outline the findings of a three-month review of the program, which the VA initiated in response to concerns from lawmakers and VA staff.
“I must say that while the report proposes some bold changes, it raises more questions than it answers,” said Committee Chair Frank Mrvan, D-Indiana, during the House hearing.
“This report highlights how VA failed the employees of Mann-Grandstaff and its associated clinics,” said Mrvan. “I want to applaud and thank the frontline leaders and staff at those facilities. It is because of their heroic efforts, in truly unheard-of circumstances, that no veterans were harmed during this transition.”
During the hearing, Mrvan also announced his plans to introduce the VA Electronic Health Record Transparency Act of 2021, which mandates complete accounting and reporting of all expenses relating to the EHRM project.
Other lawmakers voiced misgivings about continuing to expand the project.
“Until the Cerner system is shown to be absolutely safe in Spokane and fully functional, it must not be rolled out anywhere else,” said Ranking Member Matt Rosendale, R-Mont.
“It has to improve operations, not grind them to a halt. It has to improve the delivery of healthcare, not put our veterans’ health at risk. The strategic review is an elaborate explanation of the problems, but the solutions are far and few between,” he continued.
Rosendale suggested that Cerner’s software might not be a good fit for the agency.
“I’m not interested in shoveling more money into a flawed program just to keep the paychecks flowing,” he said. “Low standards and low expectations do not belong in the Department of Veterans’ Affairs.”
Cerner’s Sandager, who was joined by Cerner Vice President of Government Services Avi Vaswani, drew attention to some of the successes of the implementation and pledged to address existing challenges.
“During my time as CIO, it became apparent that success starts from the top, establishing a clear governance process and expectations allow an organization to remain agile and iterative to identifying and resolving issues,” Sandager said in his written testimony.
“We have not done a good enough job articulating to VA end users why this transformation is so important for Veterans, and we will partner with VA to change this,” he added.
Sandager said that wait times are trending down, as is time spent in the EHR per average encounter. Nearly 70% of veterans are seen within 15 minutes of their scheduled appointment time, he said, and urgent care patients are seen within 13 minutes of their arrival.
He also flagged the modification of nearly 300 opioid prescriptions based on Cerner EHR alerts, leading to alternative treatments for those at higher risk of opioid use disorders.
At the same time, he acknowledged existing challenges with the patient portal, RevCycle and end user training and adoption. The company has added a real-time chat feature to the patient portal, he said.
“Is the Mann-Grandstaff Medical Center safe?” pressed Rosendale.
“As a nonclinician, I would have to defer to the VA on that,” said Sandager.
“While the road ahead may be difficult, we must remember why we were given this opportunity,” said Sandager during the hearing.
“This isn’t about Cerner. It is about the veterans, service members and their families for generations to come, whose lives will be made easier because we did what it took now to get this right,” he said.
“I may be the cynic on this panel, but I’ve got major concerns about the amount of money that continues to flow out of Washington, D.C., to Cerner without having a fully functional facility at Mann-Grandstaff,” said Rosendale.
“I’m not convinced yet. I’m not a believer, folks,” he continued.
“We’ve got major problems up there. We’ve got billions of dollars that have been sent down and you haven’t convinced me yet. Sorry,” he said.
THE LARGER TREND
McDonough had initially told Congress that the VA would pause the rollout of the new EHR during the 12-week review. In the meantime, the VA Office of Inspector General released numerous reports about the project, which one senator called “damning” this past week.
McDonough then said the department would stick with Cerner for the modernization, albeit in a “reimagined” fashion.
ON THE RECORD
“Our Cerner associates are committed to working quickly and effectively to identify meaningful requirements that meet the needs of our nation’s veterans, while enabling us to continue deployment of the new system and ensuring improved end-user adoption and patient safety,” said Sandager in written testimony.