***VIDEO FILE INCLUDED*** As 2020 Rollout Nears, Chairwoman Lee Addresses Concerns Surrounding VA Electronic Health Records Modernization Efforts
Washington, D.C. – U.S. Rep. Susie Lee (Nev.-03), chair of the House Committee on Veterans’ Affairs, Subcommittee on Technology Modernization, led a hearing yesterday on the joint implementation of electronic health record systems by the U.S. Departments of Veterans Affairs (VA) and Defense (DoD).
When a servicemember transitions from active duty to civilian life, their health records should move with them from DoD to the VA health care system. The goal of the Electronic Health Record Modernization (EHRM) project is to modernize VA’s electronic record system while also improving and optimizing the transition to the VA health care system. The hearing was the most recent in a string of hearings held by the Subcommittee on Technology Modernization to oversee the implementation of EHRM.
The hearing focused on ensuring that VA is ready to roll out the new system in 2020. Numerous challenges, including joint leadership and accountability at both agencies continue to be a concern for Chairwoman Lee, as VA and DoD have yet to create a permanent office to jointly manage the project. In addition, VA has significant work it still needs to do on development, testing, and training, creating very real concerns that the EHRM program will not be ready for its scheduled March 2020 rollout.
Chairwoman Lee outlined these concerns in her opening remarks, while emphasizing that the most important goal is the successful implementation of EHRM without compromising veterans’ health care:
“Today, the Subcommittee continues its oversight of the Department of Veterans Affairs’ implementation of the Electronic Health Record Modernization program. We have reached a critical juncture in the implementation – we are now a little more than four months from the planned go-live in Spokane, Washington, on March 28, 2020.
“Over the last 18 months, many activities have occurred in support of this effort. I commend VA for approaching this as more than just an IT upgrade. It is an opportunity to modernize the way VA provides healthcare to veterans and has the potential to improve healthcare outcomes throughout our nation. However, many questions remain about VA’s readiness to operate the Cerner Millennium system in a clinical environment.
“As I have said since I became chair of this Subcommittee – the most important thing is that VA get this right, not that it hits an arbitrary deadline. I am concerned that VA has not given itself enough time to fully test the system, nor have they allowed time for all users to adequately train on it.”
Chairwoman Lee pointed out that the goal of the EHRM is to establish one single record that follows servicemembers from when they enlist in the military, perform their service, and transition to civilian life. As of now, a veteran who has been treated at both VA and DoD would have to request separate records from each agency to obtain their full medical records.
Chairwoman Lee asked VA Office of Electronic Health Record Modernization officials if there is a plan in place to resolve this issue. The following exchange is between Chairwoman Lee, Chief Technology Integration Officer Mr. John Short, Chief Medical Officer Dr. Laura Kroupa, and VA Deputy Secretary Mr. James Byrne:
Chairwoman Lee - “We’ve heard that a patient who has been treated at both the VA and DoD would have to request their records separately from the two departments due to restrictions caused by data ownership policies, is that accurate?”
Mr. Short - “I believe that is accurate, ma’am. I will take that full question for the record to validate it for you.”
Chairwoman Lee - “This is concerning because the goal of Congress is to establish one, single record that follows servicemembers from when they enlist in the military, perform their service, transition to civilian life, and for the rest of their lives. If a portion of the veteran’s health records is held by DoD and another is held by VA, is that really a single, unified record?”
Hon. Byrne - “As I understand it, it is all in an enclave right now. It was ingested from DoD and we’ve had some records that we’ve ingested from Department of Veterans Affairs. The ability of the record to go to a Department of Defense health care provider, and then back into the enclave, and then back into a VA facility for care, and back in again—that’s the interoperability component of the enclave that I understand we should have a capability of doing. Granted that is challenging. That is a capability that we intend to have if we do not have it already.”
Dr. Kroupa - “There is a lot of law and regulation around what each agency can release. I think that’s where there has been a lot of discussion over how to adjudicate that and who has providence over different parts of the record.”
Chairwoman Lee - “To me, if a patient needs to go to both the VA and DoD to get their complete record, we are not meeting the goal of the system. So it sounds like there are some issues.”
Dr. Kroupa - “And I can tell you we’ve had discussions with Dr. Evans about what might be some possible ways to improve that. Those laws and regulations were never written in a time when we had the same instance of an electronic health record. We are going into a new era here.”
Chairwoman Lee - “To the extent that there needs to be a change in laws and regulations, obviously we would like to understand exactly what needs to happen so we can be of assistance and expedite that.”
BACKGROUND: Before the August recess, the Subcommittee held two hearings on the implementation of the electronic health records (EHR) systems at the VA and DoD. On June 4, 2019, the Subcommittee examined the implementation from the perspective of the three prime contractors for the VA and DoD programs, Cerner, Leidos, and Booz Allen Hamilton. On June 12, the Subcommittee heard from the VA and DoD directly about the implementation and had an opportunity to address key concerns—especially joint governance and infrastructure. Additionally, the Subcommittee held a hearing on Sept. 26, 2019, on the future of VA scheduling and the Cerner Scheduling Solution. On Oct. 30, 2019 the Subcommittee, in conjunction with the House Armed Services Committee, held a roundtable to discuss the state of EHRM at both DoD and VA.
In June, the House of Representatives adopted three amendments introduced or supported by Rep. Lee to improve EHRM implementation by clarifying and enhancing the role of the VA and DOD Federal Electronic Health Record Modernization (FEHRM) joint program office responsible for EHR implementation. The amendments would create specific implementation milestones to ensure accountability and provide greater assurance that clinical and patient needs of our veterans guide the EHR implementation.