Non-Clinical Topics

VA Examines Ways to Lessen Care Disruption During EHR Implementation

by Sandra Basu

December 11, 2018

WASHINGTON—Clinician input will play an important part in decisions that need to be made regarding VA’s new EHR, VA officials assured lawmakers last month.

VA has established 18 EHR Councils with participation from VA medical professionals to help in decision-making. The councils represent several fields, including behavioral health, pharmacy, ambulatory, dentistry and business operations, according to VA.

“[These are] primarily comprised of clinicians in the field to enable the configuration of national standardized clinical and business workflows,” explained VA Office of Electronic Health Record Modernization Executive Director John Windom.

Windom made his comments at a hearing held by the House Committee on Veterans’ Affairs Subcommittee on Technology Modernization during which lawmakers wanted an update on VA’s implementation of the new EHR that will replace VA’s VistA.

“At some point next year, implementation will begin in earnest in Spokane and Seattle. The structure is mostly in place, but there are an enormous number of dots to connect. High-level organizational questions are still not settled. The workflow councils have a series of meetings spanning much of next year in which to hash out how the system should be configured,” said Subcommittee Chairman Rep. Jim Banks (R-IN).

He pointed out that VA has more than “1,200 distinct decisions to make often necessitating coordination with DoD.”

VA signed a contract in May with Cerner to replace VA’s legacy VistA over the next 10 years with the new system that DoD also has adopted. Since then, Windom said that the agency has taken several steps toward implementation, such as establishing its Office of Electronic Health Record Modernization.

He also told lawmakers in his written statement that VA’s approach involves deploying the EHR solution first at initial operating capabilities sites to identify challenges and correct them. VA is also learning lessons from DoD’s IOC sites to reduce potential risks during its own deployment of the system, he said.

Cerner Corp. president of government services Travis Dalton told lawmakers that the company has “learned hard lessons” from DoD’s initial implementation. As a result, Dalton said Cerner is engaging with the VA implementation sites “early and often.” He said the company is “getting regular design reviews and making sure it is understood what those decisions are that are being made.”

Productivity Issues

Meanwhile, lawmakers had several questions. House Committee on Veterans’ Affairs Chairman Rep. Phil Roe, MD (R-TN) wanted to know how VA will deal with a “productivity hit” that is expected during the initial transition at its first sites.

“There have been discussions at the VA about designing the Cerner implementation to limit the productivity hit to 10%. Do you think that’s possible?” he asked.

Laura Kroupa, MD, acting chief medical officer of the VA Office of Electronic Health Record Modernization, responded that the agency is “making active plans to mitigate the loss in productivity that will occur during training and go live.”

She said a committee headed by VHA is reviewing various strategies, including using its telehealth capacity to see patients while clinicians at the IOC sites are being trained. Another option is ‘looking at temporary staff to help treat patients while the staff at the sites are involved,” Kroupa noted.

“We are looking at how we can use community resources, if there is a decrease in capacity,” she said.

The chairman of the House Committee on Veterans’ Affairs, Rep. Phil Roe, MD, (R-TN), suggested that having personnel immediately available to help when a clinician is having trouble with the system is what will work best.

“That will stop a lot of the decrease in productivity,” Roe emphasized.

Meanwhile, Rep. Mike Coffman (R-CO) said that neither DoD nor VA “has taken the lead” to ensure the establishment of an integrated EHR and that “one of them has to have ownership for it.” He said that this is what led to “failures and problems in the past.”

“One of them has to call the shots,” he said.

Windom said that VA Secretary Robert Wilkie has encouraged his office to look at efficiencies between the agencies and that he “feels good” about the working relationship VA has with DoD.

The agencies recently signed a joint statement pledging to “implementing a single, seamlessly integrated electronic health record that will accurately and efficiently share health data” between the two agencies and ensure interoperability with their “networks of supporting community healthcare providers.”

“What I can tell you over the past 20 months is that we have succeeded over every milestone that we have encountered or desired to achieve. I’ve seen nothing but unity in pursuit of this mission amongst the entities that are alleged to be fractured over the years. They have come together,” Windom said.

He added that it is important to “have disagreements” and “healthy tension” because this is what “keeps them” on their toes.

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