WASHINGTON—The rollout of VA’s new medical scheduling system has been delayed an additional two years, with the end date being pushed from 2023 to 2025, VA officials announced last month.
VA had separated implementation of the new system from its larger Cerner-developed electronic health record system rollout in an attempt to fast-track what it sees as a high-priority fix. The announcement followed on the heels of the release of a VA Inspector General report detailing critical problems in previous efforts by VA to fix its scheduling system and address long wait-times for veterans seeking appointments with VA providers.
In 2014, VA launched its VistA Scheduling Enhancement project, which was designed to replace its cumbersome and outdated appointment scheduling system. Six months after that launch, VA issued a proposal for its newly designed Medical Appointment Scheduling System. Over the next few years, VA changed plans several times about which system to prioritize developing. Eventually VSE was rolled out to most VA sites nationwide, while MASS was piloted at the VAMC in Columbus, OH. Rather than characterizing it as a replacement, however, VA began referring to VSE as a short-term solution with MASS being a long-term fix.
When VA signed a contract last year for a Cerner-based EHR system, which includes its own built-in scheduling module, plans to roll MASS out to other sites were scrapped. Currently, the Cerner scheduling module is set to replace MASS, VSE and the current VistA legacy scheduling system. While the full EHR has a 10-year rollout timeline, the scheduling component was separated and fast-tracked for a quicker rollout.
The recent OIG report found that the VSE project was flawed from the start, with VA leaving users out of the development process, resulting in a number of functionality and usability issues. “VSE did not change the functionality of the VistA scheduling system, just the look of the screens,” explained Larry Reinkemeyer, assistant IG for Audits and Evaluations, in testimony before the House VA Subcommittee on Technology Modernization last month. “Essentially the screen would resemble what you’d see in your Outlook calendar. However, users were required to toggle back and forth between VSE, VistA and the EHR, effectively negating any time savings. Insufficient testing during the development phase led to unidentified deficiencies, and, once they were identified, contractors failed to address them.”
Legislators were concerned that the same problems that affected the VSE system will be replicated in the Cerner scheduling rollout, with the recently announced two-year delay only strengthening those worries.
“I am concerned that VA made assertions to Congress before it had any actual analysis of user needs, cost or benefits,” declared committee chair Rep. Susie Lee (D-NV). “Despite being six months out from beginning system implementation, the plan seems to be in very rough shape. This includes cost, which VA has said won’t be finalized until November .”
Lee also wondered aloud why VA was choosing to begin Cerner implementation in Columbus—the same facility where it had piloted the MASS system. “Just months after the successful completion of one scheduling solution, VA is going to scrap it and implement another,” she noted.
Several members of the committee questioned why VA would pull the plug on MASS, which could represent a fallback option. if there are problems with the Cerner system.
John Windom, head of VA’s newly-established Office of Electronic Health Record Modernization, defended VA’s decisions, explaining that, while MASS was successful, it made sense to have the scheduling component developed by the same company as the full EHR.
“We paid for the Cerner licenses as part of the EHR contract. It made business sense to not duplicate that payment by installing another system,” Windom explained. “Sticking with a platform where software updates would be facilitated by a common solution made sense.”
As for the delay, Windom said that the three-year development track had been created prior to VA doing the comprehensive research needed to create an integrated rollout schedule.
VA officials also testified that they were attempting to avoid the problems found in the VSE development by including users into the rollout process.
“We’re going to sit down with every single provider and make sure they understand what their old system looked like and what their new system will look like,” explained Michael Davies, MD, senior adviser to the deputy undersecretary for health access. “Keep in mind that in the old system we didn’t really have a schedule. We had a data collection system where each provider had multiple schedules. In Columbus, there was an average of six profiles or grids or schedules for every day that someone came into work. We’re translating that into one Outlook-based schedule where you can see your work from beginning to end. The providers need to be involved in how their time is deployed.”
Asked whether the VSE report along with VA officials’ testimony at the hearing was a cause for concern, Reinkemeyer said that it was. “Essentially it boils down to having a discipline in place to manage the system you’re developing,” he explained. “You have to be able to balance the agility that you want with the discipline to ensure that cost analysis, business cases, testing—all of the required elements are in place. Is there sufficient discipline to ensure that all of the key components of that system are managed and there’s visibility and oversight over all of those functions?”