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VA prepares for its first Cerner EHR launch

After months of delays, a sizable cost inflation and in the midst of a pandemic, the U.S. Department of Veterans Affairs is ready to start its Cerner EHR roll out.

The U.S. Department of Veterans Affairs is preparing to launch its first instance of a new Cerner EHR this week, an effort two years in the making.

Mann-Grandstaff VA Medical Center in Spokane, Wash., will be the first medical center to go live with the new Cerner EHR.

James Gfrerer, assistant secretary for information and technology and CIO for the VA, and a Marine Corps veteran, said the VA's Office of Electronic Health Record Modernization (OEHRM) spent the last seven months refining details of the EHR launch at Mann-Grandstaff.

"From an [Office of Information and Technology] perspective, we are fully prepared and our release framework, what we do to tabletop and prepare and war game for a release and a go-live like this, has become a very mature and substantial effort," he said. "That said, it is our first go-live, so we'll see how things go."

The launch was originally scheduled for March 28 but was delayed due to the COVID-19 pandemic, as well as the lack of critical infrastructure upgrades at the facility, including additional interfaces between the VA's existing patient record system and the Cerner EHR.

James Gfrerer, assistant secretary for information and technology and CIO, Office of Public and Intergovernmental AffairsJames Gfrerer

Interoperability will make or break the VA EHR modernization project, according to Forrester Research analyst Jeffrey Becker.

"Many attribute delays to the ongoing pandemic," he said. "But in reality, this go-live has been delayed several times before, most recently due to interoperability issues."

The VA implementation of the Cerner EHR is the largest implementation undertaken in years and is being scrutinized by many in the healthcare industry, he said. The VA not only has to make the transition from its existing homegrown Veterans Health Information Systems and Technology Architecture (VistA) platform system to the new Cerner EHR, but it also has to connect the new EHR to the U.S. Department of Defense. The goal is to align the two systems and create a longitudinal patient record for military personnel.

"Interoperability will be more important to this project than it might in other installs because regulators expect the VA Cerner instance to integrate tightly with the DoD Cerner instance," Becker said. "Tighter integration between EHRs is seen as a key component of the solution."

The VA signed its initial $10 billion contract with Cerner in May 2018 to transition the department, which has more than 1,255 facilities serving more than 9 million veterans, from the VA's VistA platform to the Cerner EHR platform. The price tag for the migration jumped to $16 billion in November 2018, just a few months after signing the initial contract. The migration also experienced delays prior to the COVID-19 pandemic, which then forced the VA to rethink and further delay its first launch.

Despite the delays and additional costs, Gfrerer said the VA plans to stick to the 10-year implementation schedule and overall cost estimation of the EHR modernization effort.

Planning for launch

Traditionally, the launch of a new EHR calls for all hands on deck, said Laura Kroupa, M.D., chief medical officer at the OEHRM, during the virtual Cerner Health Conference 2020. The VA's plan to launch the Cerner EHR earlier this year was disrupted by the pandemic, which forced nonessential personnel to work from home and forced the VA to reconsider how to roll out the platform and how to train hospital staff on the new software with so many employees working remotely.

In the beginning, we were bringing the whole army; it was going to be lots of people. Now, we have to think about every single person who goes there.
Laura Kroupa, M.D.Chief medical officer, VA Office of Electronic Health Record Modernization

"In the beginning, we were bringing the whole army; it was going to be lots of people," she said. "Now, we have to think about every single person who goes there, what is their job, where are they going to be able to sit, and how can we make sure we don't overstep our bounds because the last thing we want to do is endanger any of our team members or anyone at the site. It required a whole other layer of thought process to be able to do it."

The VA has migrated the clinical and demographic data of roughly 88,000 veterans serviced by Mann-Grandstaff from VistA into the Cerner EHR in preparation for this week's launch. Once the Cerner EHR is online at Mann-Grandstaff, providers will be able to view and access patient information such as medications, past medical procedures, demographic details and allergies directly within the Cerner EHR, according to a VA news release.

To accomplish a successful launch, John Windom, executive director of OEHRM and a Navy veteran, said the OEHRM team had to accomplish two tasks. First, it had to make sure the staff at Mann-Grandstaff was comfortable with the new EHR. Second, OEHRM had to make sure the current VistA system could integrate into the new Cerner EHR, which the team has been able to demonstrate. Windom said the OEHRM team spent time building interfaces between the two EHRs over the last seven months, which caused the delay of the first launch.

"We've done the appropriate risk mitigation reviews and we'll continue all the way up to the last minute of go-live," Windom said. "After that, we'll be assessing how well we performed, how well the solution is performing in the active environment, and we'll be ready to make adjustments."

After the first full Cerner EHR go-live at Mann-Grandstaff, the VA plans to deploy the EHR at select facilities in Ohio, Indiana, Kentucky and Michigan.

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