Problems have once again surfaced around the implementation of the VA’s new EHR system, a $16 billion project being built by Cerner for the last three years.

Issues found within the EHR’s scheduling platform “reduced the system’s effectiveness and risked delays in patient care” according to a new report made public last week by the VA Office of Inspector General. It added that the VA was aware of these “significant” limitations prior to installing the system last year in Spokane, Washington and Columbus, Ohio.

Among the problems was the inability to change appointment types, with schedulers having to manually create a new one or ask the provider to submit a new order. They also could not mail appointment letter reminders automatically, a feature that was available on the old system. Additionally, the new system did not have oversight reports that were previously accessible to track and monitor patient wait times, according to Modern Healthcare.

Assessments made the VA’s Office of Electronic Health Record Modernization aware of these performance malfunctions, but they were not fully resolved before the system went live in Columbus. Even more issues arose after the system was installed there but were not resolved before it went live in Spokane. This included missing information for clinics, appointment types and providers; the inability of some schedulers to schedule appointments; and data from the VHA’s old system not being properly or completely transferred to the new one when deployed at both locations. Automatic appointment calls also had to be turned off, because they were providing misleading information.

"Facility staff said it generally took more than a week for Cerner to close help tickets, unnecessarily delaying some patients' care," said the report.

The VA had planned to implement the new scheduling system at all facilities by December, but this idea was pushed back in March when a strategic review of the full program was launched.

VA leaders did not provide scheduling staff with enough opportunity to identify these limitations and lacked a mechanism for determining if Cerner was complying with the timeline requirements of its contract, according to the OIG. It recommended in its report that the VA resolve the issue “as soon as possible, ideally before deploying any more of the new EHR system at future facilities.” It suggested improving training for scheduling; engaging schedulers better in testing and improvements; issuing guidance on measuring patient wait times; tracking help tickets consistent with contract terms; developing a strategy to promptly resolve identified issues; developing oversight of schedulers’ accuracy; evaluating patient care timeliness; and providing guidance to consistently address system limitations.

Launched in 2018, the project is designed to replace the VA’s old EHR system and provide faster and seamless access to care for veterans after they leave military service. Cerner was chosen to complete it and signed one of the largest IT contracts in the federal government’s history. Initially estimated to cost $10 billion, the cost for the project was later upgraded to $16 billion.

The report follows the VA’s announcement last month to conduct an independent cost estimate to determine how much it can expect to spend on the project. The decision was motivated by concerns about the project’s funding, with a report in May estimating that the agency may be short by as much as $2.6 billion for infrastructure upgrades, including electrical work, cabling and heating, ventilation and cooling. Another, in July, found an additional deficit of $2.5 billion for IT infrastructure needs such as system interfaces and end-user devices, according to Nextgov. Together, the two estimate that the VA may be short by as much as $5.1 billion.

In response to the reports, the VA said it would work with the Office of the Inspector General over the next year to improve planning and coordination. The independent cost estimate will take into account these IT and physical infrastructure upgrades. Legislation known as the VA Electronic Health Record Transparency Act was also introduced in July. Under it, the VA must regularly report its EHR expenses until the project is completed.

The COVID-19 pandemic also delayed the project in early 2020, with work resuming in August of that year. Another six-month delay was initiated in July 2021 following training failures, data migration problems, and concerns over patient safety at the site in Spokane.

The system is currently live at Mann-Grandstaff VA Medical Center in Spokane and the VA Central Ohio Healthcare System in Columbus.