WASHINGTON—The rollout of VA’s new electronic health record system has been delayed to at least July due to a lack of technology infrastructure and issues surrounding employee training.

According to legislators, issues with a timely implementation were apparent as early as December, but VA officials kept the problems under wraps for two months.

As late as last November, VA officials were assuring legislators that the system was on track to be operational at its first scheduled site—the Mann-Grandstaff VAMC in Spokane, WA—in March. On Feb. 10, however, VA officials told Congress that they would need to push implementation back to July.

Getting the system up and running in Spokane is the first step in a decadelong rollout of a system designed to replace VA’s current legacy EHR with one compatible with DoD.

While legislators have repeatedly told VA they don’t want the department to rush into the massive IT project until it is fully prepared, lawmakers are demanding more transparency from the agency going forward.

The House VA Subcommittee on Technology Modernization took up the issue last month.

“When the subcommittee investigated what happened between Nov 20 and Feb 10 when the secretary told me it was delayed, it’s become clear that there were issues with the direction the VA was headed,” declared Rep. Susie Lee (D-NV). “As early as December, facility staff who participated in testing were expressing concerns about the project development. … Despite being briefed by VA on Jan. 17, the subcommittee was not made aware of these issues. That is not the transparency we were looking for. Why was Congress left out of the loop? Did VA think the concerns identified by staff were not serious and could be fixed in two months or less?”

According to Lee, subcommittee staff traveled to Spokane to interview hospital staff involved in testing of the new system. “Testing staff was confronted by a system that was not what they expected and a frustrating training process,” the congresswoman said.

The VA Office of the Inspector General is currently preparing two reports on the delays in Spokane. As of last month, both were in draft form and had been sent to VA leaders.

“The first report finds that patient care could be put at risk, particularly given missing key [EHR] capabilities,” explained David Case, deputy inspector general. “Mann-Grandstaff estimated a 30% productivity drop lasting approximately 18 months after go-live. But we found the facility’s mitigation plans were flawed.”

The second OIG report finds that VA’s deployment schedule was unrealistic when it came to upgrading facility infrastructure prior to rollout.

“Facilities need physical infrastructure such as cabling and cooling systems and IT infrastructure [as well as] user devices like laptops,” explained Case. “This was a key lesson learned from DoD’s experience. This work should have been done before Nov 2019.”

Instead, investigators found that all VA’s priority telecommunication rooms and data centers still needed upgrades and that, as of February, some contracts for critical upgrades had yet to be awarded. By January, Spokane facilities had only received about half of the medical devices they needed to go live.

“OIG applauds VA’s decision to delay deployment given the state of readiness,” Case added. “Patient care is put at risk when a system is rolled out with gaps in important capabilities and what we see as inadequate mitigation strategies.”

VA officials said the possibility of a delay was built into the decision-making process. A meeting of VA leadership on Feb. 10 had been planned as a sort of circuit breaker in case things were not ready for a March go-live. When VA saw that the rollout would cause issues for which no mitigation strategies existed, they delayed implementation.

Sigh of Relief

Robert Fischer, MD, Mann-Grandstaff VAMC director, told legislators that he and his staff “breathed a huge sigh of relief when we were able to slow this forward progress so we could dot the i’s and cross the t’s.”

Asked if the four-month delay would be sufficient, Stone said it should be but that there is always the possibility of further delays.

“We’re expecting a large number of interfaces to come online in March,” he said. “Then we’ll finish the build in May. Then we need six weeks of training and two weeks of end-to-end operational assessment. At each one of those [steps], there’s a gate where my answer could change.”

The challenges surrounding the EHR rollout has spurred some legislators to call for an overhaul in VA’s IT management. The VA IT Reform Act of 2019, which passed the Senate VA committee in February, would require the VA Secretary to provide Congress with annual reports on VA’s IT projects with budgets of $25 million or more. The reports would include, among other things, descriptions of project benefits, life cycle costs and key milestones, as well as any budgetary discrepancies. The draft bill also clarifies the role of VA’s Chief Information Officer, requiring VA to ensure that its IT management policies address the role of CIO in regards to strategic planning, technology workforce, IT planning, IT investment management, and emerging technologies. It would also require the VA chief information officer to oversee the migration of VA IT systems to cloud computing services and to keep Congress appraised of that effort.

“I’ve said all along that this electronic health record system is far too important to our veterans for VA to get wrong,” declared Sen. Jon Tester (D-MT), co-author of the bill. “Moving forward, VA must establish stable leadership to provide sufficient accountability and robust oversight of this process.”