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$16B VA electronic health records project hits failures and delays, IG report says

Airman 1st Class Nicholas Ward, 28th Medical Support Squadron medical records technician, scans files prior to scheduled appointments at Ellsworth Air Force Base, S.D., Sept. 6, 2013. (U.S. Air Force photo by Airman 1st Class Alystria Maurer/Released)
April 29, 2020

The Department of Veterans Affairs’ $16 billion project for a universal electronic health information system that would make medical records accessible across all points of care, has run into major delays and failures.

The problems with implementing the health records system, known as the Military Health System (MHS) GENESIS, were detailed in a recent VA inspector general’s report, titled “Deficiencies in Infrastructure Readiness for Deploying VA’s New Electronic Health Record System.”

One of the top findings of the report was that, beyond the initial $10 billion contract to implement the system, the VA now expects the program to cost an additional $6.1 billion to fund. Of that additional cost, $4.3 billion is for program infrastructure, including IT equipment, such as computers capable of handling the electronic health records systems. Another $1.8 billion is needed for program management.

The IG report also determined the infrastructure changes need to be in place at sites at least six months prior to the system’s rollout, to help ensure the system can launch efficiently.

The VA awarded the contract to Cerner Government Systems Inc. without competitive bidding. The IG report determined that Cerner was responsible for conducting the Current State Review, required to assess the conditions of IT systems at each participating facility. Those Current State Reviews assessed the IT infrastructure, but not the physical infrastructure at certain facilities.

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Reviews by Cerner as well as the Office of Information and Technology also failed to note that locations with critical physical infrastructure were vulnerable to unauthorized access to the IT systems.

“The telecommunications room on the second floor of the Mann-Grandstaff VAMC main hospital building houses equipment that serves the campus radiology department,” the IG report noted of its pilot program site, the Mann-Grandstaff VA Medical Center in Spokane, Washington. “This room has a dumbwaiter that, the audit team was informed, was used to move food and dishes between floors. The dumbwaiter is not secured; therefore, unauthorized individuals with knowledge of the campus may be able to access and/or release prohibited items into the dumbwaiter from floors above with the intent to cause damage to IT equipment in the telecommunications room.”

Problems with the system have required delays at both the pilot program site as well as delays in the broader implementation across VA medical sites. The first three waves of sites implementing the health records systems was planned for August, October and November of 2020, but have all been delayed until 2021.

The latest delays are just the latest in years of efforts to implement such health records systems by the VA. In May of 2019, then-acting Defense Secretary Patrick Shanahan received criticism from lawmakers when he projected a four-year delay in implementing the electronic health records system, Military.com reported.

“For 10 years we’ve heard the same assurances” that the electronic health records problem will be solved, Rep. Hal Rogers (R-KY) said during the hearing. “It’s incredible that we can’t get this fixed.”

The last effort to implement an electronic health records system was abandoned in 2013, ending a four year $1 billion effort.

A bill to provide a similar electronic medical records system in a matter of months for immigrants crossing into the U.S., was passed by the House of Representatives in September 2019. The move sparked outrage among some lawmakers who saw it as placing immigrants — including illegal immigrants awaiting immigration hearings — ahead of veterans.