House lawmakers on Tuesday warned the Department of Veterans Affairs against ignoring its current health records system as it rolls out a new $16 billion electronic program, saying the VA's 40-year-old system may be needed for years to come.
Citing cost, reliability, user satisfaction and patient safety as measures for selecting an electronic health records system, Republicans on the House Veterans Affairs technology modernization subcommittee said during a hearing there will be "no more blank checks" for a system that doesn't meet standards and called out the VA's new Oracle Cerner Millennium system for poor quality.
Rep. Matt Rosendale, R-Mont., who has introduced a bill that would end the Millennium program if improvements don't come, noted that while the VA's current Veterans Health Information Systems and Technology Architecture, or VistA, program earns high approval ratings from its users, 78% of Millennium users say that system didn't provide quality care.
"We look at the development modernization enhancements being starved out of VistA and hear that we are relying so heavily on VistA -- at 166 of 171 facilities -- and yet we are basically creating a self-fulfilling prophesy of starving that system of the investment it needs," Rosendale said.
The VA signed a $10 billion contract in May 2018 with Cerner to replace its aging VistA program with the same off-the-shelf program selected by the Defense Department, which the Pentagon calls MHS Genesis.
But the rollout across the VA has faced multiple delays and operational pauses as a result of system instability, patient safety concerns, provider frustration and training issues. Last year, the VA announced that planned deployments of the system to Boise, Idaho; Ann Arbor, Michigan; and elsewhere would be delayed until at least this summer.
During the hearing, VA officials said maintaining VistA or upgrading it would not be viable, given its age and cost.
Daniel McCune, executive director for enterprise portfolio management at the VA, noted that VistA was written in a computer programming language known as Mumps that is no longer taught, and 70% of programmers at the VA who know it are nearing or past retirement age.
"VA is fortunate to have dedicated Mumps programmers," McCune said. "We've been able to retain them much longer than a typical workforce ... but we have few options to hire or contract additional ones."
McCune said modernization of VistA, to ensure that it would work for years and be fully integrated with internal and external programs and systems, would require it to be completely rewritten at a cost to be determined.
He added that the VA is not considering upgrading VistA as an option.
"We don't have extra people working on a Plan B," McCune said. "We are fully committed to this until such a time as we need to change course. All of our resources, both our people and our funding, are allocated to a successful Cerner implementation."
In an earlier hearing of the Senate Appropriations defense subcommittee on Tuesday, defense health officials said roughly 75% of all military health facilities will be using the Oracle Cerner MHS Genesis system in the coming weeks. The DoD expects the switch to be complete by 2024.
While the changeover to MHS Genesis has appeared to have fewer problems than the rollout of Millennium at the VA, the introduction at each facility has temporarily reduced access to care, such as reduced pharmacy and laboratory hours, and postponing routine services like mammograms.
As part of the MHS Genesis rollout at facilities, the DoD implemented strict training protocols and reduced patient care at facilities before their "go-live" dates, which may account for a higher level of satisfaction among providers throughout implementation.
DoD officials told Military.com that, before each introduction, the Defense Health Agency deploys trainers to military treatment facilities to teach staff about the system and recommends that sites reduce appointment schedules for six weeks prior, with the exception of inpatient care, labor and delivery, and emergency room services.
"There is a learning curve with the transition," Defense Health Agency spokesman Peter Graves said in an email to Military.com.
"As a resulting of preparing the staffs [sic], operating room scheduling generally reduces to 50% for the first week and typically returns to 100% within three weeks post go-live," Graves wrote.
Outpatient clinics also use scheduling templates for pediatrics, family medicine, internal medicine and specialties at reduced capacity to ensure that providers learn the new program, and they "typically return to full schedules within a month post go-live," Graves said.
Representatives from Oracle Cerner were not present at the VA technology modernization hearing. Company officials said last year they planned to fix the system to ensure stability and improved performance for providers.
While Democrats on the subcommittee also chided the department for the poor rollout of Millennium and dismissing staff concerns over the program, they said it is an imperative that the VA have a modern health records system.
"VA has spent almost 20 years, and according to the comptroller general, $1.7 billion, in failed attempts to modernize VistA. Numerous experts have told this panel that VistA is not a viable long-term solution and must be replaced," said Florida Rep. Sheila Cherfilus-McCormick, a former health care executive who serves as the subcommittee's ranking Democrat.
Editor's note: This story has been updated to correct that VistA is an electronic system.
– Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime