Former CIO Calls for VA Secretary to Rethink EHR Implementation

While the federal government has committed $16 billion to the Department of Veterans Affairs (VA) EHR implementation project so far, officials must consider whether the health IT will improve clinical quality for veterans, according to a Federal News Network op-ed written by Ed Meagher, former VA Deputy CIO.

The electronic health record modernization (EHRM) project, which aims to connect VA, Department of Defense (DoD), and Coast Guard health records, has faced a plethora of roadblocks since its inception. Challenges include inaccurate cost estimates, delays, and patient safety concerns at EHR implementation pilot sites.

Meagher said that replacing VA’s legacy Veterans Information System Technology Architecture (VISTA) system with the proposed Cerner EHR implementation is “a self-inflicted wound that if allowed to proceed will fester, degrade, and ultimately critically damage the VA’s ability to meet its mission.”

Meagher noted that Denis McDonough, VA secretary, sits at perhaps the most obvious yet challenging inflection point for an incoming cabinet secretary.

If McDonough goes through with the EHRM to completion, the new system will at best replace half of VISTA’s functionality at huge additional costs, Meagher said.

“These costs will not just be in financial terms,” Meagher emphasized. “The impacts on employee productivity, effectiveness, and morale have been enormous and will continue to grow exponentially if the secretary decides to proceed with this program.”

On the flip side, if the secretary stops the EHRM program now after years of work and investment, the government will face multiple lawsuits and harsh criticism from stakeholders, he said.

Meagher outlined several points for McDonough to consider as he solves this “epic conundrum.”

First, he noted drawbacks to leveraging a system from a private EHR vendor and emphasized the importance of keeping veteran care at the center of all health IT decision making.

“You are responsible for the health and care of over 9 million veterans,” he wrote. “Is it better for veterans if the VA controls the critical systems that support these men and women or is it better for the veteran if you turn that control over to a for-profit, commercial entity that must support the needs of more than 27,000 non-VA commercial facilities around the world?”

Next, he called for McDonough to appreciate VISTA and protect the system as an alternative to the EHRM. Meagher said that the notion VISTA is an old “legacy” system in need of replacement is false. Instead, it is a safe and reliable system that needs updating and modernization.

Meagher suggested that McDonough fully fund and staff the VISTA program office to protect it from those that might seek to deprive it of needed resources to eliminate it as a viable health information exchange alternative.

Additionally, the VA should call on an independent, scientific organization to conduct a modelling simulation of the proposed system to prove that it can support both DoD and VA’s needs, Meagher noted.

Next, he wrote that McDonough must engage with VA providers to understand concerns regarding the EHR implementation.

“Forcing a system on them, especially one that reduces their productivity, burdens them with non-medical administrative tasks, reduces their confidence in the safety of the system and impacts their ability — in any way — to provide the level of care that they have come to expect using VISTA will ensure ethical, medical and professional rejection,” he wrote.

Ultimately, Meagher called on McDonough to not let the years of work and investment into the EHRM keep VA from jumping ship on a project that will “inevitably fail.”

“The very best advice I can offer you is that in this moment, it may appear that staying the course is your best option and that halting this multi-billion-dollar juggernaut would seem like failure and a waste of money and the efforts of many dedicated and committed people,” Meagher said. “That is not the case. It would be an act of courage and fulfillment of your pledge to always put the veteran first.”