‘Reset’ of VA health records system is much bigger than lost Kansas City Cerner jobs | Opinion

Implementation of the U.S. Department of Veterans Affairs’ new medical records system is in trouble. And I fear Congress is going to kill it before it has a chance to succeed.

The VA is five years into its planned 10 year, $10 billion Electronic Health Record Modernization initiative, built on the Millennium system from Oracle Cerner, formerly based in North Kansas City. This same system (renamed MHS Genesis) is used by the Department of Defense, the U.S. Coast Guard and a few other government departments. The joint health information exchange integrated across these agencies and the VA provides a single health record for service members, veterans and their families, while enabling quick and secure sharing of information for providers.

In April, the VA began a reset focused on fixing issues with its records program modernization, addressing concerns from veterans and staff, and reworking its agreement with Oracle Cerner, resulting in workers losing jobs in Kansas City and nationwide. A recent Politico article highlights concerns from Congress and others. A VA-commissioned assessment last year estimates the program will grow to cost $50.8 billion over 28 years. Multiple members of Congress are racing to increase oversight — or shut down the initiative entirely. It is easy to see the increasing costs and timelines as another government program running off the rails.

I served on the VA records modernization program from Veterans Day 2018 until last month, most recently as an engagement executive for Oracle Cerner overseeing implementations at agency medical facilities in Indiana. I worked alongside dedicated and hardworking people from the VA, Oracle Cerner, third-party partners and veterans trying to wrestle this into being for nearly five years.

I can assure you no one involved in the program is confused about or lacking an understanding of how bad this has gotten. Rather, I believe too many stakeholders are underestimating the severity of the situation. The scale of what needs to happen to deliver successfully for veterans and providers is several orders of magnitude greater than anyone is publicly discussing or proposing.

Biggest implementation ever attempted

First, this is the largest electronic health records system implementation ever attempted. To understand what is fundamentally wrong with the program, please reread that sentence and say it out loud a few times. No one, anywhere, ever, has tried administering a similar program this complex, complicated or challenging. Of course the program is struggling.

Second, this is not about a new system. It is about transforming the VA to operate as a single entity. The old joke within the agency is, “If you’ve seen one VA, you’ve seen one VA.” The focus on implementing the system alone belies what is essential for the program’s success: transforming all VA facilities to operate as “One VA.” Ensuring consistent operations across the agency’s 171 medical centers and 1,113 outpatient sites must be the priority.

This is less a program run amok and more about trying desperately to solve multigenerational, multidisciplinary and cultural problems within an undersized approach. We need to think “Project Apollo” rather than “update a records system.”

Putting a new health records program into place solves many issues, but it also reveals operational gaps and inconsistencies. No software or vendor can force or align disparate operations across facilities. The current efforts to standardize operations nationally, regionally and locally do not appear to effectively address operational gaps and cultural differences within the VA. It is unreasonable to expect any two VA medical centers to operate with common systems and processes if they vary greatly in their operations, services, facilities, staffing, catchment areas or case volumes.

This program must build upon a fundamental operational transformation on a scale no one has proposed yet. I hope the conversations within Congress and the VA quickly turn to look at a “One VA” modernization and all that requires, rather than continued battles over records software, vendors and never-ending scorecards of program management successes and failures.

Our veterans deserve world-class health care. And that requires an effort scaled to ensure our veterans, and those who serve them, are set up to succeed for the rest of this century and beyond.

Harry Cook is a technology executive with a background in enterprise programs, strategic planning, operations and end-user training. He lives in Liberty.