The new VA leadership’s plan to implement a Cerner EHR in lockstep with the DoD program is raising concerns among some VA officials and was partly responsible for the sudden departure of the woman chosen to lead the implementation, according to sources within and outside the agency.
The recent arrival of Robert Wilkie, a former Pentagon leader, as VA secretary appears to have raised the military’s influence on the direction of the contract, worrying VA officials who point to the vast difference between veteran services and what the Pentagon offers active-duty troops.
In a speech to the American Legion last week, Wilkie said the two implementations would be “joined from the hip” to make sure patient records could move flawlessly between medical facilities at the two agencies.
Skeptical VA officials note that clinicians in the two systems have different care settings and licensure levels. In addition, the DoD’s Cerner EHR showed major weaknesses during its rollout in the Pacific Northwest last year, creating wariness about it at the VA.
Both agencies have been promising Congress for years to build a system that enables a smooth transition from military to VA medical care. The question dividing approaches now is how single-mindedly to focus on that one issue.
The woman chosen in July to lead the VA’s Cerner transition, Genevieve Morris, asked Cerner for a report on what items DoD and VA had to share for its dual implementation to succeed, as well as what specific differences could be allowed, congressional and VA sources said.
Morris quit Aug. 24 after only five weeks on the job, in part because of a conflict with Wilkie and other officials over the amount of variation in the two versions of Cerner, according to three former VA officials.
At a nomination hearing Wednesday for the VA’s designated chief information officer, James Gfrerer, Sen. Bill Cassidy asked whether the report was still expected and when. Gfrerer said he would investigate.
Morris’ departure followed a mid-August meeting of the DoD and VA EHR teams at which Wilkie confirmed that the two systems would be nearly identical.
Morris declined to comment on her departure. Wilkie issued a statement praising her service and expressing confidence in Windom. A Cerner spokeswoman said the company had “worked closely with VA’s senior leaders and Mr. Windom since program inception.” Cerner officials “have total confidence in Mr. Windom’s leadership which provides program and oversight continuity. We look forward to continuing to work closely together on this transformational journey and in support of better care for our nation’s veterans,” she said.
The ongoing turmoil reflects continued uncertainty over the 10-year, $16 billion VA Cerner conversion, though health IT experts spent 10 months picking over the contract before it was signed in March.
Three members of President Donald Trump’s Mar-a-Lago club with unusual influence in VA matters — Trump friend and Marvel Entertainment chairman Ike Perlmutter, Palm Beach internist Bruce Moskowitz and attorney Marc Sherman — were deeply involved in the reviews.
This spring, for example, a group of hospital CIOs who use Cerner technology were asked to examine the VA contract. John Windom, who led the VA work before Morris and returned to its helm after her departure, once joked to colleagues, “more people have read the Cerner contract than the Bible.”
Yet VA clinicians and informaticists have not been reassured. They aren’t convinced that an system identical to the DoD’s will be workable for the Veterans Health Administration, the ultimate customer.
Everyone attached to the project agrees that “change management” — getting VA clinicians to learn and adapt to the new system — is the biggest challenge. But the new VA leadership seems willing to convince VA clinicians to accept the new system even if they do not necessarily like it.
“There’s a huge change management component, so clinicians will have to go through a substantial, rigorous process to conform their workflows to the IT systems,” Gfrerer testified. If the implementation fails to meet milestones, he said, people may be fired.
Some officials inside and out of the VA are concerned that a single-minded push to have interoperable computers in the two systems could come at the cost of good care at the VA.
Clinical informatics leaders say any major EHR project should first and foremost be aimed at transforming a health care system to better deliver on its mission rather than forcing clinicians to adjust to a particular technology.
The point is salient in this case because most VA clinicians are relatively happy with their current homegrown system, VistA. The DoD, in contrast, was eager to replace its clunky existing system.
At a meeting during a military IT conference in Orlando in July, Morris and Stacy Cummings, who leads the military’s EHR implementation, had a somewhat contentious discussion about the project, according to two former VA officials.
According to a military source close to Cummings, “Stacy believed it was in everyone’s best interest if the DoD and VA solutions were identical; Genevieve seemed to believe VA’s system would operate better if VA was able to be as unique as possible.”
The source reflected the military’s position in adding, “I’m not a rocket scientist on EHRs, but different is bad. I’m not looking for this to be the bleeding edge. I want a system that works reliably well. We aren’t the Mayo Clinic — this is government-run health care.”
At the Mayo Clinic and in other EHR transformations, the IT staff are answerable to clinical leaders. While the VA transition includes councils of clinical advisers, the modernization is currently led by an acquisitions officer.
One way to bridge differences would be to standardize most of the two implementations, while putting a governance council in charge of approving some variations and assuring neither agency strayed outside certain guardrails, said a former VA IT official who spoke on the condition of anonymity.
Another former VA IT officer, Roger Baker, suggested that this may be the only way to make the implementations work.
“VA and DoD don’t like to work together, and they aren’t going to fold to any policy or even law that says they have to work together,” said Baker, who was CIO during an Obama administration attempt to create a single VA-DoD EHR. “If you have a single instance, it will be easier to work together. If you have a single object code, there’s a circle around how much you can change and how much you can drift.”