EHR Performance and Execution Issues Result in VA EHR Pause

New Department of Veterans Affairs (VA) Secretary Denis McDonough told the House Veterans Affairs Committee that the agency’s Electronic Health Record Modernization (EHRM) system would undergo a 12-week strategic review due to a lack of quality EHR performance and execution.

"We're seeing productivity declines bigger than I would have anticipated, but importantly, also continuing longer than I would have anticipated," McDonough said during his first testimony as VA secretary.

Last week, VA deployed a strategic review of the new EHR system to increase health IT productivity and clinical workflow optimization at Mann-Grandstaff VA Medical Center in Spokane, WA, and future go-live sites.

The announcement came on the heels of McDonough’s initial one-month EHRM assessment and separate lists of concerns from Representative Cathy McMorris Rodgers (R-Wash) and the Government Accountability Office (GAO). The agency said the inspection consists of a complete EHRM program evaluation to ensure success for all impending EHR deployments.

The Congresswoman penned a letter to VA regarding concerns about the EHRM system after receiving several patient safety complaints from individuals at Mann-Grandstaff.

In the letter addressed to McDonough, McMorris Rodgers said Mann-Grandstaff patients reported “dangerous and unacceptable” delays in prescription filling, along with patient portal issues. Mann-Grandstaff staff members also reported EHR training shortcomings.

Following three separate implementation delays since November 2019, VA launched the EHRM system at its initial location at Mann-Grandstaff in October 2020 and the West Consolidated Patient Account Center in Las Vegas, NV.

"What I want to make sure is that we have success learning from our clinicians and practitioners on the ground in Spokane such that they become advocates as we go to Columbus," said McDonough.

"At the end of the day, this is about service provision and outcomes for the vets…. The best proxy for that right now is making sure that our practitioners, our clinicians, docs, and nurses understand what it means and see its benefit,” McDonough explained. “If they don't, then we're going to be in this box for a long time.”

Although EHRM is a Cerner-based EHR system, Representative Jim Banks (R-Ind.) of the House Subcommittee on Technology Modernization said VA might rely too much on the EHR vendor to manage non-EHR health IT.

"Cerner is an EHR company," Banks clarified. "It cannot and should not be expected to integrate all of VA systems or fulfill every technological need."

Banks also told McDonough that VA needed an implementation timeline and cost estimation “revamp” after the agency increased its spending estimate due to health IT infrastructure issues at certain VA medical facilities.

McDonough added the Veterans Health Administration should aid in the evaluation process.

"As a general matter, I think that we just need more jointness in the execution of the program so that … the VHA customers have not only a big seat at the table, but also an ability to sit with people at their shoulder, to test and to run this thing," McDonough said.

The VA secretary said he does not believe the review will "fundamentally change the underlying program in Spokane." However, McDonough said "if we find something that tells us, well, there's something more fundamental going on here, I'll come to you guys with complete candor and transparency and say, 'This is what we found. This is what we need to do.'"

Columbus, Ohio, is the upcoming EHRM implementation location, but VA said it might revise upcoming deployment locations due to the evaluation.

According to VA, the review will inspect EHR workflow optimization, the patient portal, data syndication, and the revenue cycle.