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Home News Implementation of EHRM is 'a $15 billion question'

Implementation of EHRM is 'a $15 billion question'

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During a time when Congress may often seem divided, the Technology Modernization Subcommittee offers a glimpse of what can be accomplished when aisles are crossed to do what is right for the care of our nation’s veterans.

“What I love about serving on this committee is the bipartisan nature of the committee,” said subcommittee Chairman Jim Banks, R-Ind., to The American Legion in a recent interview. “Ranking Member (Conor) Lamb and I have already enjoyed working together and I imagine this is going be a very productive endeavor for both of us moving forward as we provide that type of bipartisan leadership.”

The sentiment of Rep. Conor Lamb, D-Penn., echoed that of Banks. He pointed out the “bipartisan spirit” of the subcommittee — which is made up of three Republicans and two Democrats — and emphasized his belief that caring for America’s veterans is not a partisan issue.

The Technology Modernization Subcommittee was recently formed by the House Committee on Veterans’ Affairs (HVAC) to oversee the Department of Veterans Affairs (VA) $10 billion contract with Cerner for a new electronic health record modernization (EHRM) program. Headed by Banks and Lamb, the subcommittee’s mission is oversight and accountability.

“We are adopting the same electronic health record as DoD so there is a seamless transfer of medical information for veterans leaving the service,” VA Secretary Robert Wilkie said during his first testimony before the Senate Committee on Veterans’ Affairs (SVAC). “We will never have a veteran — as my father was — carrying around an 800-page paper record.”

However, the implementation of Cerner’s EHRM program faces significant hurdles before the planned modernization comes to fruition.

“This is an enormous contract and undertaking by VA and to implement the modernization of electronic health records which is significant to every veteran in America,” Banks said. “At the same time, it’s a substantial investment by the American people and an initial $15 billion contract.

“Dr. (Phil) Roe (HVAC chairman) created this subcommittee in hopes we can provide oversight at the very beginning of the process … rather than waiting for it to become a disaster and to get involved with oversight at the beginning in hopes that it never does (become a disaster). That’s the proper role of the House of Representatives — to provide that oversight.”

A similar program was scrapped and deemed a loss in 2013 to the tune of approximately $1 billion in taxpayer dollars. The creation of the subcommittee, in part, is a consequence of that failure. Banks praised Roe for his leadership in seeing that EHR modernization was deserving of more oversight.

“Creating a new subcommittee to dive deeply into oversight issues of the Cerner contract. I give him a lot of credit for that foresight,” he said. “What happened in prior years with failed initiatives are all part of the justification for what we find ourselves doing today.”

And in order to avoid a repeat of 2013, said Lamb, the subcommittee will “ask hard questions of the people who are accountable and make sure that they have what they need and that they understand their own responsibilities.”

Among Banks’ and Lamb’s concerns, is the high turnover rate at the Interagency Program Office (IPO). The IPO was created by Congress in 2008 to ensure interoperability between VA’s and the Department of Defense’s health records systems.

“I’m extremely concerned,” said Lamb to The American Legion. “I’m concerned about turnover at the VA across the board, for this project, which is incredibly expensive, and important to the health of our veterans, but also for any number of issues affecting veterans’ health care. Anyone who’s been in the military knows you need people in positions of leadership. They have to be in there leading every day to make sure the mission is accomplished and we’re clearly seeing that that’s not the case right now.”

Banks stressed the importance of continuity in the leaders tasked with implementing EHR modernization.

“The turnover is among the most concerning issues here,” said Banks. “Without continuity of leadership this will never go well. Continuity of leadership is critical in ensuring EHR modernization is successful in the end.”

Banks noted his visit to facilities where EHRM and MHS Genesis were implemented were extremely valuable.

“The lessons learned on the DoD side are very important for the VA to pay attention to and learn from,” he said. “Lots of concerns from both of them about training issues, about clinical workflows, and the uniqueness of our VA sites, that they have the flexibility to implement their own nuances that are important to a particular facility. My hope is that Cerner and the VA are paying close attention to the concerns of leaders who are on the ground and that’s a very important aspect of all this that the subcommittee is going continue to work hard on to make sure that we do.”

Another obstacle facing EHRM is time. The initial agreed-upon timeframe is 18 months.

“I don’t know,” Banks said when asked if it’s enough time. “We’ve travelled to Seattle and met with leaders there at the implementation sight and that’s the $15 billion question. We certainly don’t want to pressure VA to act within a certain timeframe if they need more time. We want them to take their time to get it right, learn from the mistakes of MHS Genesis on the DoD side.

“If that means slow-walking this further, taking more time…I can’t speak for anyone else on the committee, but I think the consensus I’ve heard is that time isn’t the issue here, getting right on behalf of our veteran population is what’s most important.”

“What we ultimately want to accomplish is the end result of an electronic health records system that’s good for the health of the veterans,” said Lamb. “And were going to work to see that this is accomplished.”

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Did you know?

A veteran’s family must request a United States flag.

A flag is provided at no cost to drape the casket or accompany the urn of a deceased veteran. Generally, the flag is given to the next of kin. Only one flag may be provided per veteran. Upon the request of the family, an “Application for United States Flag for Burial Purposes” (VA Form 21-2008) must be submitted along with a copy of the veteran’s discharge papers. Flags may be obtained from VA regional offices and most U.S. Post Offices.