Twice so far this year, the Department of Veterans Affairs has delayed the launch of its massive $16 billion electronic health record system. Now, the Inspector General says the department's plans are failing.
The new system, intended to create a universal electronic health record for troops and veterans has been a multi-year project for VA and the Pentagon. But this is just the most recent version in a track record of past failures to overhaul the records systems for both federal agencies that have met delay after delay and billions of dollars already spent.
VA delays launch of massive $16B electronic health record system over coronavirus
Problems implementing the Military Health System (MHS) Genesis were outlined in recent reports from the VA Inspector General, including that VA expects the system to cost another $6.1 billion more than the initial $10 billion 10-year contract with Kansas-based Cerner Corp. That contract was awarded without competitive bidding.
"There are tremendous costs and challenges associated with this effort," one of the reports said.
Of that additional $6.1 billion, about $4.3 billion is for infrastructure, including IT equipment. VA has been plagued by outdated IT systems -- some dating back nearly 50 years.
"I will admit that VA has been underfunded on IT efforts," Secretary Robert Wilkie told lawmakers during a Congressional hearing in February.
The reports showed major delays and failures of oversight that could put veteran patients at risk, along with failures to train staff and provide adequate equipment, such as computers capable of handling the new system.
One of the two reports released this week described failures of VA's pilot program for the system, even after the rollout was scaled back from the planned three test sites to just one at the Mann-Grandstaff VA Medical Center in Spokane, Wash.
That report showed that patients' safety could be at risk because the medical center was not prepared to make the switch to the new system.
VA leadership and leaders at the Washington hospital failed to hire and train enough staff to handle the system changes and failed to create a contingency plan to ensure uninterrupted care as the system was tested.
One example the report detailed was that online prescription refills, "the most popular form for refilling prescriptions" at the Spokane medical center where the system was being tested, "was identified as a capability that would be absent when going live ... OIG determined that the multiple workarounds needed to address the removal of an online prescription refill process presents a patient safety risk."
The report also showed that patient referrals to outside community care providers through the Mission Act -- a replacement for the expired Choice program -- were backlogged during the planned transition.
"A significant backlog of 21,155 care in the community consults remained as of Jan. 9, 2020," according to the report.
In VA's response to the reports, Veterans Health Administration executive Dr. Richard Stone said the department was working to fix infrastructure and staffing issues.
"I appreciate the concerns regarding mitigation strategies and capabilities of the new electronic health records system," Stone wrote, adding that as the launch date for the pilot rollout in Washington approached, "Secretary Wilkie received feedback from clinical and technical staff" and "decided to postpone the go-live so the system can provide the greatest functionality ... and VHA staff are confident in providing care with the new system with the least mitigation strategies."
Defense and Veterans Affairs lawmakers have become increasingly frustrated over the years with continual delays and failures to launch.
In February of this year, VA delayed the electronic health record rollout with no notice to Congress, prompting outrage from some lawmakers who said they felt blindsided.
Weeks later at a House Veterans Affairs Committee hearing, Wilkie told lawmakers VA was "on the verge" of delivering the new system, which had been delayed until July.
Less than two weeks later, VA suddenly announced it would delay the EHR launch again, this time blaming the coronavirus pandemic.
"For 10 years we've heard the same assurances," Rep. Hal Rogers, R-Kentucky, told acting Secretary of Defense Patrick Shanahan in a May 2019 House Defense Appropriations subcommittee hearing on the Pentagon's 2020 budget. "It's incredible that we can't get this fixed."
"I don't ever recall being as outraged about an issue than I am about the electronic health record program," Rep. Kay Granger, R-Texas, told Shanahan at the same hearing. "We've spent billions of dollars and worked on it for over a decade."
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VA delays launch of $16 billion electronic health record system
Lawmakers doubt VA and DOD will meet deadline for universal health records