Where the VA, Cerner EHR rollout stands: 11 updates in the past 21 days

The Department of Veterans Affairs' $16 billion plan to modernize its EHR with Cerner has had a bumpy ride. Recent reports have showcased what went wrong as lawmakers express concern over the rising costs. 

Here are 11 updates on the rollout in the last three weeks:

1. VA Secretary Denis McDonough confirmed June 30 the VA will continue to work with Cerner for the EHR rollout after wrapping up a 12-week review. He has expressed a commitment to use Cerner so that active duty military members and veterans have their files on the same system.
   
   
2. Several lawmakers voiced their concern about the budget management of the project at a July 1 House Veterans Affairs Technology Modernization Subcommittee meeting. They stated concern over the possibility the VA was diverting funds from healthcare initiatives to other projects.
   
   
3. The Government Accountability Office said in a July 1 testimony before the House of Representatives that it "made recommendations aimed at helping the department to achieve its goals related to these efforts. However, if the department continues to experience the challenges that we have previously identified and does not take actions to address our recommendations, it may jeopardize its ability to effectively support the [modernization of its EHR and financial IT systems]."
   
   
4. The cost was originally budgeted at $10 billion, then got a 60 percent increase to $16 billion. Now it could need a bump of $2.5 billion to account for IT infrastructure updates, a July 7 Office of Inspector General report found.
   
   
5. The VA did not approve Cerner's training content or training delivery. Spokane, Wash.-based Mann-Grandstaff Medical Center leaders said training did not provide opportunities to test proficiency in various clinical scenarios, a July 8 OIG report said.
   
   
6. Cerner said the training domain was a close copy of its new EHR version, but the OIG said Cerner's current EHR offerings did not closely match the VA's version. Giving the VA a different version hindered VA staff's ability to utilize the EHR, the July 8 report said.
   
   
7. The OIG found that the VA is supposed to complete ongoing assessments of Cerner's work on training. The VA frequently identified "recurring deficits in meeting project deadlines, staffing, management and quality of products" while working with Cerner, the report said. Despite consistently reporting deficiencies with Cerner, the VA's contracting officials scored Cerner's performance as satisfactory, the minimum level required to keep from breaking the contract.
   
   
8. The VA Office of Electronic Health Record Modernization's director of change management, a Cerner counterpart and a Cerner executive had frequent meetings that continued at the time of the OIG's inspection. The director of change management said there were "actions taken to address Cerner's inadequate performance with training, but the OIG was not able to confirm whether those actions led to substantive changes in contractor performance given that Cerner continues to work on training through a no-cost extension to the contract."
   
   
9. The OIG said the VA OEHRM is required by law to share training evaluation data, but the data was withheld.
   
   
10. Mr. McDonough emphasized in a July 14 hearing before the Senate VA Committee that the hiccups the rollout has encountered were not the fault of the VA's hospital staff, but the missteps of VA and Cerner leadership.
    
    "Most challenges were not breakdowns of the technology, nor of the great people at Mann-Grandstaff who did the best they could in the worst of circumstances, implemented this program in the heart of a pandemic, dutifully shared findings that improved the system and ensured that our veterans were safe despite the challenges they faced," Mr. McDonough said. "Instead the missteps were ours, at VA and Cerner."
    
    
11. Senators expressed several concerns about Cerner's role in the rollout. For example, it disrupted the VA's billing operations because the Cerner program doesn't have an "effective revenue cycle function." There are still many parts of the claims and payments process that require manual entry, Mr. McDonough said in a written testimony.
    
    "I hope Cerner’s watching this," said Jon Tester, D-Mont., chair of the Senate Veteran Affairs Committee. "If Cerner's not up to making a user-friendly electronic medical record, and, in fact, what's transpired here is we're going in the opposite direction, then they ought to admit it and give us the money back so we can start over."