Despite an ongoing pandemic, a summer of raging wildfires and a record-breaking pre-Halloween snowstorm that knocked out power just before officials were about to start the cutover, the Veterans Affairs Department is reporting a near flawless deployment of the first instance of its new electronic health record platform.
The VA has been working for close to two years on deploying the first instance of its new electronic health record platform—one of the most difficult projects in both tech and health in even the best of times.
“We went live as anticipated on October 24, Saturday, at approximately 0700. It’s great to report that the system is working as expected—that includes the interfaces, that includes the core electronic health record solution. We’re proud to report we opened for business on the 24th,” John Windom, executive director of VA’s Office of Electronic Health Record Modernization, told Nextgov in an interview Monday.
“We’ve got 75 interfaces in play and, literally, double the capability sets that typical implementations have,” Windom said. “And to have the issues that we’ve had, it’s really phenomenal that we’ve been able to maintain the incident profile at the level we’ve been able to maintain it.”
The cutover process included turning off old interfaces, launching new ones and triple checking the validity of all data and processes in the new system to ensure a safe, seamless continuity of care for patients. By Saturday morning, 1,300 users at Mann-Grandstaff VA Medical Center in Spokane, Washington were using the new system, as well as 100 support staff at the Western Consolidated Patient Accounting Center in Las Vegas and another 800 users at the Tele-ICU—the clinical resource hub for telehealth—based out of Cincinnati.
The initial deployment Mann-Grandstaff was a long time coming. VA has been working on the Cerner Millennium program since 2018, when VA Secretary Robert Wilkie signed a contract with the commercial EHR provider.
The contract resulted in a shift from a multigenerational, in-house built EHR system—VistA—to a commercial system, which would take years to configure and require infrastructure upgrades at all VA medical centers.
VA was rounding the corner on these preparations at the start of the year but officials were told the established training regimen wasn’t enough to prepare clinical staff. In February, officials told Congress they planned to delay the first rollout to the summer to finish developing all the capabilities and get staff complete training.
Officials were planning for a July go-live before the COVID-19 pandemic broke out in the U.S., prompting the VA to initialize its fourth mission—acting as the nation’s backup medical infrastructure. While medical staff were focused on saving lives, the EHR rollout was put on the backburner.
The rollout was restarted in August, with the first go-live scheduled at Mann-Grandstaff on Saturday. The team was able to make that deadline, despite a resurgence of COVID-19 in many parts of the country and raging wildfires impeding progress on the West Coast.
Then, just before shutting down systems at 7:30 p.m. local time Friday, a freak snowstorm slammed into the region, dropping several inches of snow and knocking out power.
“It was the biggest ever snowfall in October,” John Short, OEHRM chief technology integration officer, said during the interview. “It took out the power and left major portions of Spokane” in the dark.
The team had an alternate command center location already prepped at a hotel to use the next morning but started making their way there. The office also had two other command centers up and active during the transition, allowing staff at the primary command station to continue working while moving to the new location.
“We actually cut over two interfaces while we were traveling to the alternate command center,” Short said.
Despite yet another emergency situation, “The cutover went very smoothly,” said Laura Kroupa, OEHRM chief medical officer. “Everything went flawlessly, as far as the cutover goes.”
Of course, no IT transition is perfect, and the team has been receiving help tickets throughout the weekend.
“From a clinical standpoint, everything we’re seeing has been expected,” Kroupa said, noting all the systems were integrated and working as of 7 a.m. Saturday. “Every printer except one worked from the very start, which I think is pretty historic for a new EHR.”
The team did not have stats handy on the number of help desk tickets received over the last three days but said anecdotal evidence suggests a normal IT transition.
“Most of the tickets have been what you’d expect,” Kroupa said. “’I thought I had access to something and I don’t have access to it.’ ‘I don’t have an icon on my desktop that I should have in order to get to something.’ There have been some questions about how to use the system, ‘I don’t remember how to get to this thing.’
“I would say most of what we found over the weekend was making sure user roles were correct and that they knew how to access the system,” she said.
While the team is still sorting through the full scope of the help tickets received, Kroupa could confirm that there were no patient health issues created by the transition.
“The system integrity has worked flawlessly. The interfaces coming together with the core EHR, the technical solution is working. We couldn’t have asked for a better cutover,” Windom said.
Going forward, the team plans to “keep an eye on Mount St. Helens,” an active volcano in the Pacific Northwest, Windom joked, noting Mother Nature’s apparent disdain for VA’s EHR system. “We’ve had a snowstorm, wildfires and a pandemic.”
But while nature was against the program, Windom said support from VA leadership and Congress—including consistent funding—has enabled this apparent early success.
Meanwhile, the Defense Department has been rolling out its own version of the Cerner platform—dubbed MHS GENESIS—developed by the Leidos Partnership for Defense Health. That program also saw delays due to COVID-19 but there have been signs of resurgence, including deploying the platform at four Coast Guard installations in August.
“We’re honored to join VA, DOD and Coast Guard in their mission to provide better health care for service members and veterans,” Brent Shafer, Cerner chairman and CEO, said in a statement Monday. “These federal modernization programs will not only transform care, but they have the power to launch innovations that could shape the future of health care for everyone.”
Travis Dalton, president of Cerner Government Services, noted this rollout combined with other ongoing efforts are creating a new digitized health ecosystem for the department.
“This can help improve health outcomes, create public health infrastructure, enable more effective predictive clinical models and create better informed research critical to solving some of the nation’s most pressing health challenges, such as suicide and the opioid epidemic,” he said in the statement. “Though there is still much work to be done, this go-live, along with the deployment of Cerner’s Centralized Scheduling Solution at Columbus and joint health information exchange are key proof points that EHRM is and will continue to be a success.”