Today, the House Committee on Veterans' Affairs, chaired by Rep. Phil Roe, M.D. (R-Tenn.), held an oversight hearing on the Department of Veterans Affairs (VA) electronic health record modernization program.
Below are Chairman Roe's opening remarks from the hearing:
Opening Remarks As Prepared for Delivery
The Committee will come to order.
Thank you all for being here today to discuss VA’s Electronic Health Record Modernization program.
Much has been said and written about the program since June 1st of last year, when former Secretary Shulkin announced his decision to commence negotiations with Cerner. Opinions have been formed, and conclusions have been drawn.
The reality is, even with the contract awarded and work underway, we are at the beginning of the beginning. We all know the broad strokes that led to the EHR Modernization. The VA IT budget is consumed by operations and maintenance costs. VA’s health information system, VistA, is functional but increasingly complicated, while the EHR industry continues to evolve. Also, it is well past time for VA and DoD to achieve seamless interoperability, because servicemembers and veterans deserve a lifetime medical record.
VA leaders were guarded in how much they would discuss during the negotiation. To some extent that is understandable, but it is time to delve into the details.
$15.8 billion dollars over to 10 years, including $10 billion to Cerner, is a staggering number for an enormous government agency. However, EHR software is only a relatively small part of the overall price tag. What exactly does all that money buy?
Everyone here today knows the adage, “If you have seen one VA hospital, you have seen one VA hospital.” Part of the reason for that is for 35 years, VHA has had a culture of creating software to fit any process and a technology platform, VistA, that facilitates it. There is much to be said for local authority in health care, but it seems to have gotten out of control and made the IT landscape ungovernable.
The EHR Modernization is not just a technology project; it will have a major impact on the way VHA operates. That means clinical and administrative workflows. It will also reshape the culture, as VistA has. However, if imposed on the clinicians from the top down, the culture will reject it, and no amount of technological savvy will be able to save it.
If we were creating a veterans’ health care system from scratch, implementing an EHR would be relatively easy. But that is not the reality. Transitioning away from VistA is the most difficult aspect of the EHR Modernization.
VHA and VistA have been built up around each other for decades. Amazingly, even after all these years, the Department does not seem to have a complete technical understanding of where VistA begins and ends. It is not an oversimplification to say the EHR Modernization team may still be figuring out what VistA is up until they day they turn it off, if ever.
The scale is daunting and the ambition is impressive. That is evident. I am interested in the benefit, at the end of the 10 years, to the veteran and the clinician. The lifetime health record has to be worth the potential disruption. The ease of use and the new analytics in the EHR have to be worth the learning curve.
Those things are difficult to quantify, but if the equation does not balance, it will become abundantly clear as soon as the system is turned on in the first medical center.
I believe VA has been realistic about the level of resources needed to manage the EHR Modernization, and by every indication, the EHRM Program Executive Office is building a good structure to do that. But they will need a great deal of help.
The program cannot be seen as just the responsibility of an office in Washington. VA’s senior leaders, VHA throughout the country, the Office of Information and Technology, and every other corner of the Department must be invested in its success.
I especially appreciate all our witnesses agreeing to testify today. It is a large and impressive group, on two panels, including some new faces for the Committee. You all demonstrate an interest in the EHR Modernization’s success.
My colleagues on the Committee and I are committed to doing our part. That is why Ranking Member Walz and I have decided to create a new Subcommittee on Technology Modernization to focus on oversight of the EHR Modernization program as well as VA’s other enterprise modernization projects and programs. The subcommittee will allow a small group of Committee members to focus intensively on these issues and strengthen the work the staff has already been doing. The EHR Modernization is a big bet on the future of VA, and we simply must make sure it succeeds. More details will be available as we constitute the subcommittee in the coming weeks.
I will now yield to Ranking Member Walz for any opening statement that he might have.