Chairwoman Wasserman Schultz Statement at the Update on VA’s Electronic Health Record Modernization Implementation Hearing

2021-10-21 10:13

Congresswoman Debbie Wasserman Schultz (D-FL), Chair of the Military Construction, Veterans Affairs, and Related Agencies Appropriations Subcommittee, delivered the following remarks at the Update on VA’s Electronic Health Record Modernization Implementation Hearing:

Today we welcome Deputy Secretary Donald Remy from the Department of Veterans Affairs, who leads the effort to modernize VA’s electronic health record system.

The Deputy Secretary, who was recently confirmed in July, can shed light on challenges VA has faced implementing the new health record system and findings from the recent Strategic Review of the program. He can also speak to how VA intends to improve the rollout process moving forward.

In 2018, VA began a historic, nationwide transition from their longstanding electronic health record system, VistA, to a new system developed by Cerner that is interoperable across VA sites and with the Department of Defense’s health record system.

The new EHR will put VA and DOD on a single system, meant to improve Veterans’ health care experiences by eliminating the need to transfer records as servicemembers transition from active duty. Clinicians from both departments will be able to view, update and securely exchange patient data in the new system, as well as share information with providers in the communities where Veterans live and receive care.

This transition requires significant time and effort from VA staff and is an extremely complex undertaking.

We are holding this hearing today because it is critically important that VA get this transition right, for Veterans, their families, and for the clinicians who provide the care that millions nationwide rely upon every day.

While an electronic health record system is, at its core, simply software, it is really much more than that in practice. An electronic health record is a tool for clinicians to make their very difficult jobs easier and to inform and improve health care delivery and outcomes for our Veterans.

At the end of the day, this whole undertaking is about improving patient care.

The last oversight hearing on this topic held by our subcommittee was in February 2020, after significant programmatic delays and poor communication from VA on the status of the stalled EHR rollout process.

Since that hearing, there have been some significant developments. VA’s first, and thus far only, ‘go-live’ with the new EHR system took place at Mann-Grandstaff VA Medical Center in Spokane, Washington one year ago this month, in October 2020.

This was the first of what is expected to be more than 150 ‘go-lives’ at VA sites nationwide by 2028.

VA had originally planned to ‘go-live’ with the new EHR system at three sites in 2020 and 11 more sites in 2021, but there have been multiple setbacks to the timeline. At this point, VA is more than one year behind their initial schedule.

Unfortunately, the first rollout at Mann-Grandstaff has been more difficult than expected, with serious concerns raised by staff, Veterans, and external stakeholders.

Complaints of lost productivity from clinicians and of inadequate training on the new system have persisted since last October. The Government Accountability Office (GAO) recently briefed our staff on findings from interviews with Mann-Grandstaff end users, which showed predominantly negative views of the new EHR system among clinicians and medical staff, with specific concerns on the quality of training provided.

Perhaps more concerning are the reports of potential patient safety issues from clinical staff, such as missing information from patient medical histories, which could lead to treatment errors. While there have been no reports of patient harm at Mann-Grandstaff, this is not a concern to be taken lightly.

In March, one of the first actions that Secretary McDonough took after arriving at the VA was to pause all additional ‘go-lives’ and conduct a top-to-bottom Strategic Review of the EHRM program, including an analysis of the problems at Mann-Grandstaff.

I applaud the Secretary for taking this step. The Strategic Review was a useful and necessary exercise that identified many recommendations to improve the rollout.

I understand VA is now taking steps to implement those recommendations into the rollout plan for future go-lives. This includes improving clinician training, focusing on change management, and incorporating medical staff from VHA into the planning process.

I expect that we will hear from the Deputy Secretary today about what VA found during the Strategic Review and what steps VA has taken to implement the recommendations to ensure that future go-lives do not repeat the same mistakes.

Regarding funding, Congress has provided a total of more than $6 billion to VA for this effort since 2018. Our House-passed FY22 bill included an additional $2.64 billion for the program, with three-year availability. This robust investment would allow VA to move forward with planning and executing more ‘go-lives’ in future years.

Earlier this year, however, the VA’s Office of Inspector General found that the original ten-year $16 billion lifecycle cost estimate for the program excluded nearly $6 billion of additional IT and physical infrastructure costs.

As a result of the Inspector General’s findings, I understand that VA is now undertaking a new cost estimate for the program to incorporate all additional costs.

Given the delayed implementation timeline and the outdated cost estimate, it is no longer clear to us what level of funding is truly necessary to support the program in FY22 and beyond. I ask that VA take whatever steps possible to expedite this new estimate and to provide us with updates along the way. This revised estimate will be critical for us to do our job as appropriators.

Let me close by saying that it is critically important for VA to get this transition right. From our perspective on the appropriations committee, we want to see VA move forward with executing this transition in the most expedient and efficient manner possible.

At the same time, however, we must also ensure that VA’s transition to the new system is not executed in haste simply to meet an arbitrary deadline. Stumbles will happen when undertaking such an ambitious project, but it is necessary to take the time to address any problems before moving forward or else those problems will be repeated.

There is a reason why we have provided funding with three-year availability – to allow VA the time to adjust their approach and to get this right.

I understand that VA is eager to continue moving forward with additional ‘go-lives’ next year but the problems identified at Mann-Grandstaff must also be addressed and accounted for in future rollouts. VA has a responsibility to demonstrate improved progress at Mann-Grandstaff. This progress will help build confidence in the new system among VA staff and Veterans.

Much will be riding on the next set of go-lives and it will be particularly important for VA to be transparent with Congress and the public about the status of those implementations.

We cannot lose sight of the purpose of this whole undertaking, which is to improve health care delivery and outcomes for our Veterans.

Deputy Secretary Remy, I look forward to working with you closely on this and am committed to ensuring that the rollout is executed effectively moving forward.

I am hopeful that with you and Secretary McDonough now in charge, VA will be able to address these problems and improve the rollout moving forward.

I want to express my appreciation to you and Secretary McDonough for your consistent and open communication on this issue with us so far. I hope that we can receive your assurance that VA will continue to have an open dialogue with us in the coming years.

117th Congress