House Panel Unhappy With VA Official's Answers During Hearing on EHR System

WASHINGTON -- Several House members weren't very happy with the answers they got Thursday at a hearing on progress with the new electronic health record (EHR) system being implemented at the Department of Veterans Affairs (VA).

"I can appreciate that you inherited a mess, and that you are in the middle of sorting through the morass, but unfortunately your responses to our questions about patient safety really aren't detailed enough," Rep. Debbie Wasserman Schultz (D-Fla.), chairwoman of the House Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies, said to VA deputy secretary Donald Remy, who was confirmed by the Senate in July. "I realize you're doing the best you can to answer, but we're just not really getting enough detail in your answers."

Remy had been responding to a question from subcommittee member Rep. John Rutherford (R-Fla.) about the patient safety processes being put in place in the EHR system to prevent problems such as drug-drug interactions. "I think it's going to be helpful for us to have another hearing that specifically focuses on patient safety, where we can have a panel of witnesses from the VA that can provide us with more detailed answers to the questions on how it's happened and how you're going to fix it, because that's what an oversight hearing is all about," said Wasserman Schultz.

Remy is one of a long line of VA officials who have appeared before various congressional committees to answer questions about the EHR installation, which officially began in 2018 after 2 decades of discussion, and is already a year behind schedule. At a Senate VA Committee hearing in July, for example, Sen. Jerry Moran (R-Kan.) called the EHR system's modernization program structure "dysfunctional," while VA Secretary Denis McDonough admitted that the VA's first implementation of the Cerner Millennium EHR system, which occurred in October 2020 at Mann-Grandstaff VA Medical Center in Spokane, Washington, did not live up to its promises "either for our veterans or for our providers."

At that hearing, patient safety also was on the agenda: the secretary said that his team "began hearing disquieting reports from ... the pharmacy team that they were receiving duplicate prescriptions. It turned out that the veterans' old prescriptions weren't automatically being canceled when new ones came in."

At Thursday's hearing, Wasserman Schultz tried to dive into yet another patient safety issue, noting that a review of the Mann-Grandstaff EHR installation "cited examples of information that was missing from patient medical records in the new EHR, like current medications, allergies, and other medical history. Those are serious issues that could have real adverse effects on treatment ... It was caught in time and hopefully nothing happened as a result of this problem, but what specific steps have been taken to fix these problems?"

Remy responded that the VA had organized patient safety issues with the rollout into nine domains -- which he listed -- and that "as we hear this information, we catalog [it] into those domains, and we examine the root cause, and make sure that [the problems] don't recur." Wasserman Schultz was not satisfied. "Really, how did this happen? I mean, missing patient medical records, problems with medications; what steps did you take? I don't really understand what you just said, quite frankly, with the nine categories -- that's not an answer that gives me clarity."

Rep. David Valadao (R-Calif.) asked about the $6 billion in additional funds that the VA now estimates are needed to deal with infrastructure issues related to the EHR program. "Can you give us some examples of what these infrastructure issues are and how you are planning to get ahead of them?" he asked.

Remy said that the issues are "both physical and technological ... We've already started the process of making sure that our facilities are ready to receive this new electronic health records program. We don't want to have a circumstance where our technology equipment is tucked away in a closet and not in a position that it can be effective and it can be maintained. We don't want to have a circumstance where you have laptops or telephones or other technology that's out of date."

"How did the VA not anticipate these infrastructure needs at the beginning of the project?" Valadao asked. "We're looking at a pretty sizable oversight here." Remy replied that "there was an examination and a recognition that there needed to be infrastructure investment, [but] that infrastructure investment may not have been enough at the time to make sure that we were ready, and that's one of those lessons learned."

Rep. Charlie Crist (D-Fla.) wanted to know whether the VA would update the committee on any future cost overruns. Remy assured him his agency would do so: "We want to make sure you have the information you need to exercise your oversight responsibilities to the VA." He also told committee members that the VA would finish installing the new system in all its sites by 2028, as is specified in the current timeline.

Wasserman Schultz expressed frustration that the VA is now saying it will take about a year to come up with a new estimate for the cost of the EHR project. "We obviously want this program to be successful, but it's difficult for us to appropriate funding for a program when no one is certain how much it will cost," she said. She urged the agency to "take whatever steps possible to expedite this new estimate and to provide us with the updates along the way, because that's going to be critical for us to do our jobs as appropriators."

Rep. John Carter (R-Texas), the committee's ranking member, agreed with a suggestion from Wasserman Schultz that the committee get monthly briefings on the EHR implementation. "We need to stay on top of this," he said. "We've been doing this for 20 years, and we haven't rattled your cage as much as we need to."

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