This Week Health

Today: Bill Proposed to Stop VA EHR Rollout

Should the VA EHR Modernization project be stopped?

Transcript

Today in health it A house bill has been put forward to put a stop to the VA E H R modernization project today. Let's take a look at it.

 My name is bill Russell. I'm a former CIO for a 16 hospital system and create, or this week health, a set of channels dedicated to keeping health it staff current. And engaged. We want to thank our show sponsors. We're investing in developing the next generation of health leaders, short test and artist site two great companies. Check them out at this week. health.com/today.

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 All right. I'm getting this article from Healthcare It. and actually somebody forwarded this to me in a direct message, so I appreciate that. Have you come across a story that you want me to discuss or take a look at. Feel free to, uh, direct message it over to me on LinkedIn, however you want to get it to me.

Go ahead and send it over and I will take a look. Uh, healthcare IT News House bill would put a stop to VA e H r modernization legislation seeks to end the Oracle Cerner electronic health record rollout and reinstate Vista. Another bill meanwhile, would only allow new E H R M go-lives after certain clinical certifications.

And so those are the two options. Let's see. Citing billions more to be spent over the next several years by the Department of Veteran Affairs on a new electronic health record system that has been fraught with implementation struggles. Representative Matt Rosendale, Republican from Montana says he wants to stop the rollout of Oracle cer.

EHR system as soon as possible, and then they go Why it matters as he enters his second term, serving as the House Veterans Affairs Committee. Rosendale will now chair the subcommittee on technology modernization legislation legislative, which oversees and has an investigative jurisdiction over the VA's enter.

Technology modernization programs and projects. According to an announcement the VA EHR termination bill introduced last week. Wood within 180 days of passage abolish the EHR Modernization Integration Office. Transfer remaining activities to the Veteran Health Administration or Office of Information and technology, revert all medical centers using the Oracle Ca Cerner EHR to VA's existing EHR platform.

The Veterans Health Information System. I'm not gonna say it this whole thing. So many acronyms in this article gradually wind down the Oracle Cerner contract by preventing the secretary from exercising any options. Rosendale has harshly criticized the VA's new HR since 2021, citing operational inadequacies and the expense of the government funding.

Oracle completed its acquisition of Cerner in June at the cost of more than 28 billion Rosendale said in his VA EHR termination Bill announcement that since 2018, the VA has spent 5 billion on the Oracle Cerner EHR at a handful of its 171 medical centers. Additionally, VA acknowledges that the new system has created unacceptable levels of productivity loss.

Patient safety risk, and staff burnout at these five small and medium sized facilities. He added a separate bill, also introduced last week, the VA Electronic Health Record Modernization Improvement Act by representative Mike Boast. Boss, B O S T, Republican Illinois, chair of the House Committee on Veteran Affairs would only allow additional VA EHR rollouts planned for 2023 with certification.

That improvements were made specifically. Each VA medical center's director, chief of staff and network director would be required to certify that the EHR system has been correctly configured for the site. The staff and the infrastructure are adequate to support it, and it would not negatively impact safety, quality and current wait times according to a fact sheet about what is proposed.

Additionally, the VA and Oracle Cerner could not commence go live preparations. Add additional medical centers until the secretary certifies that the system has achieved 99.9%. Uptime and technical fixes as directed in the contract have been made. There you go. It goes on, uh, from facility to go live in October, 2020 through 2021.

The new EHR failed to deliver more than 11,000 orders for requested clinical services. According to the report, recent systems slowdowns were reported by the Mann Grand Staff Medical Center, which is located in Spokane, Washington. The lag time was caused by an upgrade to the military health system's, Oracle, Cerner EHR Genesis, which shares a database with the VA according to the spokesman reviews report, va Press Secretary, so forth and so on.

Uh, let's see on the record, the Oracle Cerner Electronic Health Record Program is deeply flawed, causing issues for medical staff, imposing significant patient safety risks. Said Rosendale in the statement. Okay, so what is my so what on this? This is always an interesting topic. I come back to this every now and then because, um, you know, doing an EHR implementation is rough and if you put.

Into the news cycle as well as the political points that can be gained by, uh, attacking a, a rollout. This is an impossible job. In fact, I think they were hiring somebody like a year and a half ago to step in and, and fix some of the things that were going on, and I, I said on the. That, that is an impossible job.

I wouldn't take that job if you paid me a billion dollars a year, I wouldn't take that job. It is an impossible job. Can't be done. Uh, what you have to do is, and by the way, some of this stuff is good, by the way. There should be oversight on the costs. The costs are, uh, kind of high for four to five smaller health systems, kind of high, extremely.

But that's the government, right? Um, if I were to do those same five hospitals for St. Joe's back in the day, how much would I have spent? Nowhere near 5 billion. I can guarantee you that the board wouldn't have even approved anywhere remotely close to that. Uh, I think I could do all 16 health systems including, uh, training and physician downtime and whatnot.

Uh, about a billion dollars. Again, that's 16 hospitals and they've done five smaller hospitals than the ones we're talking about. So yeah, they need some cost oversight. This whole idea of having the medical Centers director, chief of staff network director, uh, certify the EHR system, it's been correctly configured, uh, a impossible b uh, they absolutely should be a part of that process.

There should be a process, and everyone knows this. Everyone who's ever done an EHR implementation knows. Right you before you go live, you're going through the medical staff. The medical staff is approving it, and even if you had a central team build, you're still going to the local site and saying, okay, here's the build, here's how it works.

You're doing a bunch of testing all along the way so that they can look at it and say, yes, these order sets work in our workflow, and this workflow actually functions and the information gets from one end to the other. , the orders are getting where they need to get to, so forth and so on. You also have a, a series of checks and tests.

You have automated testing, you have people testing that is happening all along the way, so you should not have, let's see, what do they have? Some ridiculous number of glitches and 11,000 orders for clinical services have been, have been failed to deliver. That shouldn't. Clearly that shouldn't happen, and it shouldn't take you from October to June to figure that out, to be honest with you.

That's kind of an interesting thing in and of itself. So, uh, yeah, and this project needs oversight. It needs cost oversight. It needs operational oversight. Um, and, uh, so, you know, kudos to them for supplying that. Now let's go to what actually is being proposed here. What's being proposed is to actually, um, put a stop to the VA EHR modernization and move them back to Vista.

Okay, here's my take on this. Number one, you have to be able to write off 5 billion, which only the federal government can do. Your health system couldn't do it, but the federal government can do it without blinking an an eye. I mean, they just would not, would not phase them. Hey, 5 billion lost. They'd start pointing fingers.

We would have no idea whose fault it is, and we move on and $5 billion of our tax dollars are just gone. Right? So that's what's being talked about here. Put an end to it. , roll back to Vista and let's stay here. I assume that's what's being talked about. All right. Now, will Vista take you for the next five to 10 years?

That's a good question. I think that question was asked probably about five years ago and answered by, by saying no, and we needed a more modern EHR platform. One that obviously, well, I would. The analysis would say was more extensible, that was more, uh, integrated, that provided with more flexibility and interoperability throughout the entire medical community.

right? So that question was asked five years ago. The answer was no. We need to modernize. We started the modernization. We're getting into it. They're having challenges, and instead of addressing those challenges, they're essentially saying, no, let's roll back. This is akin to your doctor saying, I was better on paper.

I wanna go back to paper. Either the answer to the question was right or the question, the answer to the question was wrong. If the answer to the question was right and that Vista will not take you into the future and you need a modern he. System, then at some point you had to make a decision and they made a decision to go with Cerner.

Cerner is a capable system. , it just has to be implemented correctly. Cerner has its flaws. They all have their flaws, but it just has to be implemented correctly. And again, was Cerner the right choice? I'm not saying it was. I'm not saying it wasn't, but I'm saying it's a capable system that can be implemented correctly and has run health systems for quite some time.

So therefore, you have to put the right processes in place for the go live to be effective. This is where Epic has won the. , right? So at some point, Judy, Carl, the team, stepped back and said, this is gonna be one and lost on our ability to have successful implementations. Therefore, we are gonna be highly prescriptive about how you go about doing these things.

And I think if you hired me today to do this, Say you're gonna gimme a billion dollars. Like I said before, to do this and I'm gonna come in as a cio, I'm gonna have a whole handful of things that I say, look, we're gonna be very prescriptive about how this happens. Yes, we are gonna have those signoffs on the build.

We're gonna have a sign off on the go live. We're gonna have all sorts of sign offs,

but we are also gonna be incredibly prescriptive. We're gonna say this, many doctors need to be trained ahead of time. This many doctors need to be involved in the build process. This many. Nurses need to be involved. Clinicians just in general need to be involved in the build process. The testing needs to have this many clinicians involved in it.

They need to be a part of the build in order to understand the build, in order to be champions for the build and in order to build it correctly. , right? This can't be done by IT staff and handed to the clinicians. That will never work. This has to be done in an effective manner and it's, it un until it gets highly prescriptive the way that Epic has done it for years to avoid this very problem, this will continue to have cost overruns.

It will continue to have challenges like the ones we, we have seen and heard and looked at. so my so what on this is you're gonna hire me tomorrow to be the cio. , you have to be highly prescriptive. You have to tell the federal government, you have to tell the va this is how an effective EHR implementation goes. This is how the build is done. This is how the sign-offs happen. This is how you ensure it is going to go well.

With that being said, expectations have to be set the day you go live. It will not be as productive as Vista. It just will not. These clinicians have been working on Vista, many of them, for the better part of a decade or so. They know the system. It might be inefficient, it might not be as good as a modern system, but at the end of the day, they know it, right?

They know it. They know how to find things. They know how to operate within it. So you have to set the right. Expectations across the board. Set the right expectations for the public, set the right expectations for the va. Set the right expectations for the government and the oversight that you're getting there, and set the right expectations for the people who are actually gonna be using the system and include them in the build process and make sure that they are certifying it as well.

So part of this, I agree with part of it, I don't, the question's been asked and answered, Vista is not gonna take you into the future if that is the case. You are looking at potentially writing off 5 billion and moving in another direction. a decision and a 5 billion mistake that only the federal government can make. 

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