Senate Veterans Affairs Committee Hearing on VA’s Electronic Health Records Modernization

Good afternoon, Chairman Tester, Ranking Member Moran, and distinguished Members of the Committee. Thank you for your steadfast support of Veterans.

Before I get into today’s important topic, I want to highlight a simmering crisis. Over the last month, we at VA have lost four of our dear colleagues to COVID infection spurred by the highly transmissible Delta variant. We are seeing a surge of infections that has necessitated the deployment of dozens of VA Disaster Emergency Medical Personnel to supplement our workforce—a level of deployment that mirrors prior surges and warns of what’s to come. This underscores the critical need for everyone to be vaccinated, especially our VA personnel, to keep our Veterans safe.

Back to today’s focus, I appreciate the opportunity to update you on VA’s initiative to modernize its electronic health record system.

The mission of EHRM has always been to create a platform that seamlessly delivers the best access and outcomes for our Vets, and the best experience for our providers.

But as many of you, VSOs, members of the press, OIG, GAO, and others have rightly noted, VA’s first implementation of the Cerner Millennium—which occurred in October 2020 at the Mann-Grandstaff VA Medical Center in Spokane, Washington—did not live up to that promise… for Veterans or our providers.

That was exemplified by a story I heard about one of our great pharmacy staff in Spokane. 

A few months into implementation, he began hearing disquieting reports from the mail-in pharmacy team that they were receiving duplicate prescriptions from Mann-Grandstaff.

The issue, it turned out, was that Veterans’ old prescriptions weren’t automatically being cancelled when new prescriptions were sent in.

Recognizing the threat to patient safety, the Mann-Grandstaff team immediately jumped into action—collaborating across VA to create a workaround that eliminated these duplications and made sure that our Veterans didn’t receive more medication than was necessary or safe.

Those efforts were largely successful, but they also demonstrate the lengths to which our staff in Spokane had to go to simply do their jobs and care for our Vets.

On top of that, I heard from another clinician that help with the new platform wasn’t always easy to find—even when you asked for it. When she called the Cerner help desk, the person on the other end of the line told her he had just started a week prior. In other words, she had more experience using the platform than the person who was supposed to help her navigate it.

Stories like that are what led me to launch a top-to-bottom, 12-week strategic review of the EHRM program.

What we found during the review was troubling—a series of breakdowns that led to productivity lapses and patient risks.

Among other challenges, the project was being run in an organizational silo, meaning that some relevant stakeholders did not have a chance to shape it for success. In fact, the IG report from Friday found no evidence that our health care experts at VHA had a defined role in decision-making or oversight of this health care record modernization project.

There was also a distinct lack of testing and training for a real-life clinical environment. For some providers, the first time they used the final program was the day it went live.

Clearly, these findings were extremely disappointing—but the strategic review also provided reason for optimism. Because it also found that we have what we need to succeed, starting with dedicated employees who will stop at nothing to get this right.

Most challenges were not breakdowns of the technology, nor of the great people at Mann-Grandstaff—who did the best they could in the worst of circumstances, implemented this program in the heart of the pandemic, dutifully shared findings that improved the system, and ensured that our Veterans were safe despite the EHR challenges they faced.

Instead, the missteps were ours at VA and Cerner. And now that we’ve identified those problems, we can solve them.

As a result of this strategic review, we are reimagining our approach to EHRM.

First, we are establishing unified, enterprise-wide governance of the effort—led by our Deputy Secretary, whom I know Chairman Tester and Ranking Member Moran are working hard to confirm this week. This structure will incorporate the perspectives of key clinical, technical, acquisition, and finance leaders—thus guaranteeing that everyone who will build this platform, use it, or be affected by it will work in concert to shape it from day one.

Second, we will shift from site-by-site deployment of EHRM to an enterprise-wide readiness and planning approach. This means that we will deploy the program based on evidence of which sites are most trained and technologically ready for it, therefore setting each new site up for success.

And third, we will create a fully simulated testing and training environment so Veterans and providers can properly evaluate and learn the system before it goes live, not after.

By making these changes and the others that are outlined in my written testimony, we can and will get this effort back on track.

That means building an EHR system where Veterans are able to access their health care records in one place, from the first day they put on their uniforms to the last day of their lives …

… a system that empowers Vets to receive care anywhere—whether it’s from DOD, VA, or community providers—without worrying about cumbersome paperwork or potentially harmful gaps in their records.

… a system that helps providers understand injuries that Veterans suffered 50 years ago, so they can provide those Vets with the best possible care today.

That’s the end goal, and I know that many folks out there are concerned that we can’t or won’t get there.

But we can. And we will.                                                           

This strategic review was not a setback, but a step forward.

We are now in an excellent position to move ahead as one unified organization, in partnership with Cerner and DoD, and deliver a EHR system that improves the outcomes for our Vets and the experiences of our providers. And that’s exactly what we’re going to do.

Mr. Chairman, Ranking Member Moran, thank you for the opportunity to appear today.

I look forward to your questions.