Concerns Mount for VA EHR Implementation, Patient Safety

At a recent House of Representatives hearing, subcommittee members noted a lack of clarity in the Department of Veterans Affairs (VA) responses to questions regarding the agency’s ongoing EHR implementation.

Rep. Debbie Wasserman Schultz (D-FL), chairwoman of the House Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies, asked VA deputy secretary Donald Remy what specific steps the agency has taken to address EHR implementation-related patient safety concerns highlighted in several reports over the past year.

Remy, who was confirmed by the Senate in July, responded that the VA had organized patient safety concerns into nine domains: order management; administration of medicine; pharmacy; suicide risk; tracking and documentation; identity; ambulatory care; referrals and consults; and roles, positions, and privileges.

Remy noted that as the agency hears patient safety concerns, it catalogs the information into those domains, “examine the root cause, and make sure that [the problems] don't recur."

Wasserman Schultz was not satisfied with Remy’s answer.

"That's not an answer that gives me clarity,” she said. "I can appreciate that you inherited a mess, and that you are in the middle of sorting through the morass, but unfortunately your responses to our questions about patient safety really aren't detailed enough.”

"I think it's going to be helpful for us to have another hearing that specifically focuses on patient safety, where we can have a panel of witnesses from the VA that can provide us with more detailed answers to the questions on how it's happened and how you're going to fix it, because that's what an oversight hearing is all about," she continued.

Members of the subcommittee also questioned Remy about health IT infrastructure issues related to the EHR implementation. A recent VA strategic review of the EHRM (EHR Modernization) project revealed that the agency estimates that it will require $6 billion in additional funds for infrastructure-related costs.

Rep. David Valadao (R-CA) called for examples of these health IT infrastructure issues, and asked Remy to explain how the VA is planning to “get ahead of them.”

Remy said that the issues are "both physical and technological.”

“We've already started the process of making sure that our facilities are ready to receive this new electronic health records program,” he said. “We don't want to have a circumstance where our technology equipment is tucked away in a closet and not in a position that it can be effective and it can be maintained.”

When asked how the VA misjudged the cost of infrastructure upgrades for the EHRM by such a large margin, Remy replied that "there was an examination and a recognition that there needed to be infrastructure investment, [but] that infrastructure investment may not have been enough at the time to make sure that we were ready, and that's one of those lessons learned."

Rep. Charlie Crist (D-FL) asked Remy whether the VA would update the subcommittee on any future cost overruns, and Remy assured him the agency would do so.

"We want to make sure you have the information you need to exercise your oversight responsibilities to the VA," he said.

VA officials noted at a legislative hearing earlier this month that the department has brought in an independent body to provide a cost estimate for the EHR implementation. VA estimates it will be 12 months before it receives a full lifecycle estimate for the EHR implementation project.

Wasserman Schultz expressed frustration that the new cost estimate is not set to be ready for a year.

"We obviously want this program to be successful, but it's difficult for us to appropriate funding for a program when no one is certain how much it will cost," she emphasized.

She urged VA to "take whatever steps possible to expedite this new estimate and to provide us with the updates along the way, because that's going to be critical for us to do our jobs as appropriators."

Wasserman Schultz suggested that the committee receive monthly briefings on the EHRM to track progress.

Rep. John Carter (R-TX), the committee's ranking member, agreed with this proposal.

"We need to stay on top of this," he said. "We've been doing this for 20 years, and we haven't rattled your cage as much as we need to.”