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 Today in Health it, the story is VA halts EHR rollout for review. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health IT at channel dedicated to keeping health IT staff current. I. And engaged. I wanna thank our sponsor for today's Sirius Healthcare. They reached out about this time last year and said, we love what you're doing and really appreciate your mission to develop the next generation of health leaders.

The rest is history, as they say. If you believe in our mission and want to support the show, please shoot me a note at partner at this week, health it.com. Now onto today's story, some projects are hard. Some projects are . Next to impossible to pull off without a hitch, and this is one of those. This is from Healthcare IT News.

The title of the story is VA Will Halt EHR rollout at second site until after strategic review. I. . So here's some excerpts. The US Department of Veteran Affairs will pause the rollout of its Cerner Electronic Health Record until it reviews the program and shares the results with Congress agency officials essentially ask for that at ad hearing.

The VA's committed in partnership with the Department of Defense, the leading American healthcare forward, realizing. . The full promise of a modern integrated record to cultivate the health and wellbeing of those we serve, said Dr. Carolyn Clancy, acting Deputy secretary at the va. During the hearing, Cerner supports the decision by the US Department of Veteran Affairs to conduct a strategic program review, which makes perfect sense.

We are proud of the significant milestones we have achieved, including one of the largest health data migrations in history. And the deployment of a new joint health information exchange between the DOD VA and their community partners. Yeah, that's no small deal. I don't know if they did, you know, the, the typical PAM e migration or if they're doing like a repository where they're pulling the information in as needed later.

The migration itself must have been just. Amazing to build the health information exchange between the DOD and VA would've been interesting as well. I mean, none of these projects in and of themselves are small projects, so I I, I would agree that there's a fair amount of work that's been done here. The agency's strategic review announcement came on the heels of the October EHR rollout at the Mann Grand Grandstaff VA Medical Center in Spokane, Washington, which is the first site.

Right, so the first site's always the toughest, and you always get a lot of feedback after that. First site Complaints include prescription errors and unsatisfactory patient portal functionality along with added stress for providers. What's interesting when we get into the so what here, I'm gonna say you really have to be careful when you're putting complaints together.

So let's just take this list. Complaints included prescription errors. Okay. That's a, that's a red flag. That's a serious problem in unsatisfactory patient portal functionality. Heck, I could go to most major academic medical centers in the country today and make that claim unsatisfactory patient portal functionality.

So I, I would now put that in the same red category as prescription errors along with added stress for providers. Well, of course there's added stress for providers. They're learning a new technology and a new platform. So again, I, I'm not saying that I'm not minimizing the fact that there's an awful lot of stress that comes with changing the environment.

I'm just saying not in the same category as prescription errors. In addition to this, they reported hearing more than 240 patient safety concerns. Again, those go into the red category, patient safety. Number one, the EHR should get nowhere near causing any patient safety related issues. It goes on. A representative from the state of Washington makes the claim that the system is not an improvement, at least not yet.

I doubt I could find any health systems across the country that did their first site and didn't have at least a handful of those quotes, if not a significant number of those quotes that this isn't an improvement over what we had before. So, . Some of this is just understanding the context and taking it out of the political environment and saying, okay, this is our first site.

This is a heavy lift. It is a massive undertaking, and we are going to learn some things in that first site. It is not going to be perfect. All right. It goes on at the hearing on Wednesday. Lawmakers express concerns and they should, because you know the first site should not go well. I'm sure you agree that the go live at Mann Grandstaff did not go as smoothly as we had all hoped.

Of course, we all hope this is a, uh, Democrat from California. Of course, we all hope that these go smoothly. But they are significantly hard implementations. I hope I've said that enough because it sets up the so what? Do I have a commitment not to start Columbus, go live activities until after the strategic review has been completed and shared with the committee, asked another Republican representative from Montana, and of course they said yes, and they should say yes, there should be a review.

I mean, that should be standard practice, obviously. I mean, you do the first site, you do a complete review. And then you analyze that review. You make adjustments before you go to the next site. I, if they were planning to do anything other than that, I would be shocked. As is the case with most healthcare IT news stories, they talk about the larger trend.

The VA's EHR modernization effort has faced numerous slowdowns. Last April, it hit pause on the rollout at manned grand staff. . Saying that the department wanted to prioritize care for veterans before finally going live in October. Still, the Biden administration is looking to support the project with more funding in the future, requesting 2.7 billion this past week for continued VA EHR modernization.

All right, what's my so what on this? Uh, re review is always warranted. As I've said earlier, the first site is always the hardest. You should get better with each site you do. It is not gonna be smooth in Columbus either. If there's any senators or congressmen listening to this, it is not gonna go smooth.

It should go smoother than the previous site, and it should get better. The process should get better. You know, the process to evaluate this, which I think is gonna be interesting, and I'm gonna watch this because if it gets political, that's when I know it's going to. Face serious headwinds, but the process to evaluate this should be pretty straightforward.

Identify the errors, identify the challenges, categorize those challenges and issues. Review similar deployments of the EHRs to determine if those issues are normal and customary. It's hard, of course it's hard. I have to learn a new system versus . Those that are just unacceptable, like the prescription errors or problemless errors or you name it, they have to be categorized because some problems are not the same as others.

Use an outside firm with a volume of data, such as the Class Arch Collaborative. They have a ton of information. What has gone well, what hasn't gone well? They've studied this for the past at least two years, and really collect massive amounts of data. To evaluate a successful go live, bring them in to determine how this is going.

They have a very simple methodology to collect the information and they can evaluate it. Very . Quickly, is this going well? Is it not? Versus all the anecdotal information that flies around with an EHR implementation. The thing to watch though is going to be, is this going to be used as a political football?

This is hard to avoid in most health systems alone. Throw in two political parties that think they can garner a single vote by blaming the other party for anything that is wrong with this rollout. You just have a disaster and this thing is gonna blow up. So keep an eye on this. If it gets political, that's gonna be a problem.

If they handle it like it should be handled by really identifying the issues that are happening, looking for progress and not perfection With each site, look at better training mechanisms, bringing doctors into the process earlier, bringing them up to speed earlier. Better testing. You name it. Whatever they do, look for better with each rollout and then revisit the sites.

Revisit Spokane, Washington in, I don't know, 180 days, see how much progress has been made. Are the doctors still saying the same thing? Are we still seeing some of the errors or have we not been able to correct those? Now we're handling this like a project and not a political . Football. The team that pulls this project off should be given a commendation from the president and awarded a place of high honor in health.

It circles. This is a challenging project to say this is a challenging project, is an understatement. This is a tough project, so hats off to the people who are doing this and I, I wish them the best as they move forward. I think they will get better with each site if they're given the chance to do so.

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