Dive Brief:

• The House Veterans' Affairs Committee's Technology Modernization Subcommittee took aim at the VA's EHR modernization project, an estimated $16.1 billion no-bid contract awarded to Cerner, with many skeptical the agency had overcome its years of problems. The EHR implementation, expected to conclude in March of 2020, has been riddled with roadblocks. 
• Lawmakers seemed troubled primarily with the budget management and the project's fluctuating costs. Committee chairman Rep. Jim Banks, R-Ind., voiced concerns with expensive infrastructural barriers, community interoperability issues and "what seems to be a lack of focus on innovation." 
• John Windom, executive director of the fledgling Office of Electronic Health Record Modernization (OEHRM), sought to assuage the committee's concerns by sharing project milestones and detailing the level of oversight his office has implemented to manage the transition.  

Dive Insight:

The project's problems have ranged from "mundane to esoteric," according to Banks. The undertaking certainly got off to a rocky start after Cerner ran into interoperability issues immediately after signing the contract in June of 2017. That contract, originally priced at $10 billion, was re-estimated at $16.1 billion once the VA remembered to account for staffing.

The snafus haven't stopped since. Genevieve Morris, who served as interim chief health information officer at the newly-created OEHRM, resigned from her post after one month, citing differences in opinion. Last month, in what some might perceive to be a red flag, Cerner subcontracted a coalition of 24 businesses to help with the VA EHR implementation, including Accenture, AbleVets and Leidos, the firm contracted to implement a twin Cerner EHR at the Department of Defense. 

Staffing and leadership issues aside, technical problems remain. Nearly all of the computers at implementation sites in Spokane and Seattle, for example, are reportedly incompatible with Cerner and need to be replaced, according to Banks. 

According to ProPublica, Cerner recently rated its EHR project with the VA "yellow trending towards red." 

"Frankly," Banks said, "The more I learn about the EHR program, the more daunting it has become." 

Considering the unprecedented size of the job, this isn't unexpected. Windom, a recently-retired Navy captain who took the reins at OEHRM after Morris' abrupt exit, called the project a "moving target." 

"It's an extremely dynamic environment, and we hope that efficiencies are gained," he said. "What you can count on me to do ... is be extremely transparent with you." 

To that end, Windom shared recent decisions made to improve efficiencies, including improved coordination with the DoD's implementation of its MHS Genesis EHR system, the adoption of a new change management strategy and trimming fat within the budget, particularly around staffing —  while OEHRM was originally budgeted for 700 people, Windom said he's kept it at 269. 

Asked about how he's handling historic inter-agency fractures that have and may continue to impede progress, Windom was optimistic. 

"I think it's important to have disagreements and healthy tension because that's what keeps us on our toes," he said. "That's what keeps us from entering into group-think, and that's what keeps us in support of our veterans and moving in the right direction." 

But Banks concluded the hearing by warning things won't get any less difficult moving forward. In fact, he said, "there is every indication that they probably will."