US GAO Recommends VA Pause EHR Modernization Project

The US Government Accountability Office (GAO) recommended the Department of Veterans Affairs (VA) should postpone future deployments of its new Electronic Health Record Modernization (EHRM) system.

GAO said VA should postpone future deployments until “any resulting critical and high severity test findings are appropriately addressed.”

Following three delays since November 2019, VA launched the EHRM system at the Mann-Grandstaff VA Medical Center in Spokane, WA in October 2020.

Along with Mann-Grandstaff VA Medical Center, the Cerner-led project deployed at the medical center’s four associated community-based outpatient clinics and the West Consolidated Patient Account Center in Las Vegas, NV.

GAO said VA is making implementation progress, developing the system, completing end-user training, and resolving system test findings.  However, VA had not fixed all critical severity test findings and high severity test findings. These risks could result in system failure, significant cost increase, implementation schedule disruption, and patient safety issues.

GAO found 17 critical severity tests and 361 high severity tests that were open since September 2020.

“As a result, VA was at risk of deploying a system that did not perform as intended and could negatively impact the likelihood of its successful adoption by users if these test findings were not resolved prior to initial deployment,” GAO explained.

When VA deployed EHRM at Mann-Grandstaff VA Medical Center, there were no open critical severity test findings and 306 of the 361 high severity test findings were closed. Forty-seven of the 55 high severity test findings had workarounds, seven were associated with future deployments, and one was identified during the initial deployment.

VA’s actions mirrored the implementation of the agency’s October recommendations, GAO wrote.

For example, GAO observed a risk related to misaligned and incorrectly formatted outpatient pharmacy prescription labels. The agency said that risk could result in unusable pharmacy labels. GAO recommended VA work with Cerner to reconfigure label automation and work with the pharmacy teams to fix printer configuration.

Wildfires occurring in initial deployment site areas also posed a risk. Wildfires in deployment areas could impact VA facilities and would result in potential reschedule.

“Nevertheless, as the department moves forward with deployment of additional capabilities at new locations, VA will likely identify new critical and high severity test findings,” GAO concluded. “If VA does not close or appropriately address all critical and high severity test findings prior to deploying at future locations, the system may not perform as intended.”

VA said it “concurs-in-principal” with the agency’s findings and recommendations and it will deploy an action plan to address the agency’s recommendations.

“OEHRM is taking every precaution to deliver an effective system for our clinicians and users and remain committed to getting this right for our Veterans,” wrote VA. “In addition, OEHRM is prioritizing the safety of the OEHRM program office and VAMC staff while endeavoring to remain agile during an unpredictable COVID-19 environment.”

In January, leaders from the VA EHRM project faced scrutiny from the department’s unions and internal groups, according to a POLITICO report.

These issues ranged from the system’s patient data sharing capabilities, questions surrounding leadership, and a lack of a warning regarding the initial EHRM launch in Spokane, WA.

While the initial EHRM implementation was considered an early success, reviews and interviews from those inside the deployment showed real concerns over the project design and VA’s oversight.

The new Cerner patient portal drew concern because more than 2,000 veterans have already created accounts. John Windom, executive director of VA EHRM Office, told POLITICO, VA is reviewing the portal. Members of Congress and veterans service organizations said the new solution would confuse VA patients due to a lack of familiarity.

VA leaders also expressed concern over the system’s patient data sharing capabilities, highlighted by its “data syndication.” VA leaders told POLITICO the assessment should have occurred years ago.

Furthermore, an outside consultant said EHRM leadership was incapable of receiving feedback from VA employees and called those leaders “simultaneously bloated.”