VA Initiates Independent Cost Review for EHR Implementation

After a series of reviews earlier this year revealed that the Department of Veterans Affairs (VA) underestimated health IT costs for its Electronic Health Record Modernization (EHRM) program, the department has announced that it is bringing in an independent body to provide a cost estimate for the EHR implementation.

VA has contracted the Institute for Defense Analysis (IDA) to conduct the review, Deputy CIO Paul Brubaker told lawmakers on the House Veterans’ Affairs Committee during a legislative hearing on October 7.

IDA will begin its review later this month and VA estimates it will be 12 months before it receives a full lifecycle estimate for the EHR implementation project, Brubaker said.

Earlier this year, the VA came under fire after Office of Inspector General and Government Accountability Office reviews found that the department underestimated costs for the EHRM project by billions of dollars.

In July, the VA announced that it had paused its EHR implementation through the end of this calendar year to ensure enterprise readiness at the next go-live after reports revealed cost inaccuracies.

“When that first cost estimate was scoped, it wasn’t scoped adequately,” Brubaker explained to lawmakers at the hearing. “The issue that we had initially is that we weren’t capturing all of the costs according to what would be a standard lifecycle cost estimate definition — we were only looking at those that were specifically related to deploying the EHRM technology,” he said.

“We have consulted a number of experts as a result of those reports and contracted with IDA to make sure that once and for all, we actually capture all of these end-to-end costs and present them to the committee as requested,” he continued.

The VA has also created an IT investment review board, which Brubaker said has already established “a number of significant criteria designed to get all of us much-improved fidelity over cost estimates.”

“We’re building the IT investment management processes and the governance in order to get you that baseline fidelity that will drive transparency and accountability,” Brubaker continued.

Inaccurate cost estimates are not the only issue that VA has faced in three years of its EHRM project; another OIG review published in July found issues regarding EHR training at the project’s pilot site, Mann-Grandstaff VA Medical Center in Spokane, Washington.

At a House hearing when the VA announced the pause on the EHR implementation in July, Carolyn Clancy, MD, VA undersecretary, addressed the EHR rollout’s shortcomings and discussed next steps for the EHRM project.

Clancy explained that the VA will pursue technical-only deployments of Cerner health IT at previously planned sites in Veterans Integrated Service Networks (VISNs) 10 and 20. This will allow the VA to ensure enterprise readiness without interfering with veterans’ care or frontline employees’ clinical workflows, she stated.

Clancy noted that the agency will also accelerate technical infrastructure upgrades for the EHR implementation. Additionally, Clancy said the VA will establish a test and training environment to evaluate system functionality.

“This will enable us to evolve our processes, training, and change management – and test our approach to build evidence-based confidence in the success of our next deployment before we ‘go-live’ again,” she said in the hearing testimony.