The VA publicly announced Dec. 1 the release of a comprehensive review and plans for moving forward with its electronic health record (EHR) program. The move came just ahead of a Senate Veterans’ Affairs Committee hearing, where VA Secretary Denis McDonough gave testimony on the current state of the VA.
Shortly after taking office earlier this year, McDonough ordered a strategic review of the EHR. The new governance and organizational structural changes outlined in the report reflect the rigorous approach the VA is taking to mitigate problems rising from its initial deployment of the EHR at Mann-Grandstaff VA Medical Center (VAMC) in Spokane, Wash., last year. The plan positions the department for future deployments through early 2024.
“We will do everything we can to get electronic health records right for veterans and our health care staff, with patient safety being the key driver and non-negotiable,” said VA Deputy Secretary Donald M. Remy. “Under my direction, VA is refining EHR governance and management structures to establish additional rigor and oversight. VA, in coordination with our partners, the Department of Defense and EHR vendor Cerner, will continue to update and refine the EHR implementation process to ensure it delivers the excellence veterans expect and deserve from VA.”
New Position, New Council
The new management structure includes a program executive director (PED), a position reporting directly to Remy. Dr. Terry Adirim, who currently serves as the acting assistant secretary of defense for health affairs, will soon assume the duties of the new position. The position will provide effective management and program oversight to improve project integration, communications, and clarity of roles and responsibilities for all stakeholders engaged with the program.
The strategic review identified an urgent need for channeling data-driven decisions through a single governance body for incorporating stakeholder inputs and ensuring increased transparency and risk-management in the program.
A new governance structure establishes an EHRM (electronic health record modernization) Integration Council led by the PED. The council includes representatives from across the VA. The PED also will work with the Federal Electronic Health Record Modernization office to ensure interoperability between DoD and the VA with the Cerner system.
Additionally, the VA has put in place mechanisms to mitigate problems like the ones experienced at VAMC Mann-Grandstaff. A site readiness checklist and operational metrics will help the VA evaluate access times, appointment information, prescription data, revenue collection, clinical productivity, care coordination, system and network performance, and veteran engagement to effectively evaluate risk, make decisions, and determine the success of future deployments.
Congress and media reports have been critical of the $16 billion project because of its hefty price tag and unknown life-cycle costs, calling for the department to implement more management, oversight, and metrics. During the Dec. 1 hearing, McDonough reaffirmed his commitment to lawmakers in keeping them informed on EHRM progress and program milestones.
“While the strategic review highlighted many challenges, it also identified opportunities to build upon, such as the standardization of clinical content developed by the national councils, which included local and national participants,” McDonough stated in written testimony, calling the system a “first for VA in moving toward standardization across VAMCs.”
McDonough intends for the VA to use the momentum of the strategic review to shift toward a veteran-centered approach, continue to find opportunities, and make improvements at Mann-Grandstaff VAMC as well as future sites.
A ‘Game Changer’
VA’s modernization of its EHR system is one of the most complex and transformational undertakings in its history — an enormous project by any health care system standard.
In a briefing to veteran service organizations prior to the release of the report, MOAA asked Guy Kiyokawa, VA’s new assistant secretary for enterprise integration and a former deputy director at the Defense Health Agency, what puts the VA on the right trajectory with this new EHRM approach based on his experience with DoD EHRM?
“Accountability was central,” he said, adding that “the main game changer for DoD was establishing a EHRM Integration Council — something the VA did not have but has included in the new governance structure. The council helps to improve communication and puts the right processes and mechanisms in place for holding stakeholders accountable.”
Kiyokawa also made clear the VAMC Mann-Grandstaff problems are not that dissimilar to DoD’s experience early in its EHR rollout.
VA’s tentative EHR deployment schedule is an ambitious one, starting in March 2022 and running through all of 2023. MOAA will provide periodic updates on the EHRM project as the VA restarts; stay tuned for more information in MOAA’s weekly newsletter and at MOAA.org.
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