Roger Baker, a former assistant secretary of Veterans Affairs for Information and Technology, shared six reasons why he thinks the VA's $16 billion Cerner EHR rollout is rocky, according to a July 26 article published by Federal Computer Week.
- Most government programs of this scale fail.
Programs that do succeed after encountering a lot of issues often take twice the amount of time it was supposed to and twice the original cost estimates. Additionally, the VA has not provided evidence it is implementing recommendations from the Government Accountability Office or from health systems that underwent large-scale EHR transitions, Mr. Baker said. - The VA has historically struggled to launch large-scale programs.
In the last 20 years, the VA has struggled to launch many programs. To mitigate these risks, the VA developed the Office of Information and Technology. The OIT is responsible for large-scale program rollouts. However, the EHR modernization program isn't managed by OIT. - Oversight is split between several offices.
The EHR modernization program's management doesn't solely fall under the Veterans Health Administration or the OIT, which has created accountability concerns. A clear accountability process may improve the success of the program, or at least decipher who is responsible for the program's rocky ride. - The focus is on keeping up with the Department of Defense.
The driving factor for replacing the current EHR with Cerner is to improve interoperability with the Defense Department, which is rolling out its own Cerner EHR simultaneously. Improved design elements for the staff, such as increased quality of care or reducing the costs of care, isn't the primary factor. - The VA's current EHR is among the best.
A 2014 and 2016 Medscape survey found the VA's EHR, CPRS/VistA, was the most highly rated by clinicians. In the same survey, Cerner was rated toward the middle of the rankings. From a change management perspective, the new EHR is going to be more difficult to use than the one staff is currently using. - Lack of transparency.
The VA isn't being completely transparent with the numerous problems it's encountering, Mr. Baker said. The message to Congress and the public is, "Remain calm, all is well." To deal with the reality of the state the rollout is in, the VA needs to be honest with lawmakers, the public and itself if it wants a chance at success.
A Cerner spokesperson told Becker's that time spent in the EHR per encounter at the VA is down 30 minutes per patient, and nurses' average time spent in the EHR is under seven minutes. Wait times are also trending down, with 70 percent of veterans seen within 15 minutes of their scheduled appointment time and urgent care patients being seen within 13 minutes of arrival, which is 40 percent faster than before the go-live.
"Cerner takes our responsibility to Veterans, service members, taxpayers and congress seriously," Brian Sandager, senior vice president and general manager of Cerner Government Services said in a statement provided to Becker's. "We were honored to be asked to join today’s hearing. The 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. They have waited far too long for a seamless care experience, and we are committed to getting this right."