Non-Clinical Topics

Congress Seeks More Oversight of VA EHR Program

by Sandra Basu

April 14, 2018

WASHINGTON — Legislation under consideration by Congress would increase oversight of VA’s adoption and implementation of its forthcoming electronic health record (EHR) system.

The VA announced last year that it would adopt the same Cerner EHR system as the DoD had chosen. When some interoperability concerns were raised, however, moving forward with a signed contract was delayed.

Then—VA Secretary David Shulkin, MD, told lawmakers last month that the agency is conducting a few more reviews before moving forward but that the expectation is that a contract would be in place “hopefully soon.”

The bill under consideration, HR 4245, would require VA to submit to Congress several EHR project management documents 30 days after enactment of a new law and also to provide quarterly updates. Any contract, order, agreement or modification to the program would have to be submitted to Congress no later than five days after award or modification.

The VA also would have to notify congressional committees about milestones or delays of 30 days or more; equitable adjustments or change orders exceeding $1 million; loss of clinical or other data and breach of patient privacy, among other things.

“Our intention is not to micromanage the implementation of this record,” explained House Committee on Veterans Affairs Ranking Member Rep. Tim Walz (D-MN). “Our intent is to make sure that, on something this big and this costly and this important, that there is ownership for everyone—that the VSOs are included. …This is going to be critical.”

Rep. Ann McLane Kuster (D-NH) said the bill seeks to ensure that the committee receives the information it needs to conduct proper oversight of the 10-year, $16 billion project.

“I think I speak for all of us when I say we have been advocating for an interoperable electronic health record since we were first elected to Congress. Finally, the solution is in sight,” she said.

Still, she said the “next challenge will be to ensure VA stays on schedule with its installation and implementation, stays within the budget and causes the least amount of disruption to patient care.”

Calling the EHRM program “a potential game-changer for VA,” House Committee on Veterans Affairs Economic Opportunity Subcommittee Chairman Rep. Jack Bergman (R-MI) said, “EHRM is as transformational as it is big and expensive, and Congress needs to keep a watchful eye on it.”

Mutually Agreeable

The bill was discussed at Bergman’s subcommittee hearing last month.

Fred Mingo, director of program control for VA’s EHRM Program Executive Office, said the agency supports the legislation and that “transparency is important to the success of the EHRM program.”

“The EHRM executive office would like to work with the committee to develop a mutually-agreeable timeline to brief staff on these project management documents,” Mingo said.

The VA does not support another EHR bill, HR 3497, however, that would require a pilot program establishing a secure, patient-centered portable medical records storage system for VA healthcare system patients to store and share records of their individual medical histories, he pointed out.

“Doctors have been reluctant to accept plug-in electronic devices from patients because of network security and compatibility issues with electronic health records,” he explained, adding that the legislation “would take resources away from the VA’s current efforts to establish a single electronic record that is interoperable with DoD and community providers.”

Also testifying at the hearing was Louis Celli, Jr., the American Legion Veterans Affairs and Rehabilitation Division director, who told lawmakers that his organization also opposes HR 3497.

“We believe that this and so much more is already incorporated in the pending EHR contract,” he said, adding that his organization supports HR 4245.

“The contract that VA has negotiated with Cerner Corporation will fundamentally change the course of American medical history by providing government standards for electronic health record communication and transferability, health maintenance and patient access, supply chain management, consults, follow-ups and much, much more,” Celli said.

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