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  Today in Health it, the story is the VA's EHR implementation. This is a halftime show. Essentially, what would happen after the first half of a football game, you'd have these personalities come on who know a little bit more about football than we do, and describe what they saw. That's what I'm gonna do here.

I'm gonna describe what these senators and congressmen are talking about, what they've seen, what the OIG is reporting, and give you a little bit of my color commentary on it. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week Health IT at Channel, dedicated to Keeping Health IT staff current.

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All right. There are several articles around the VA re-imagining their approach to the EHR modernization. Let me give you some of the highlights here. I'm gonna pull mostly from the Healthcare IT News article, and here's just some quotes from this. A strategic review of the initiative has so far found problems with patient safety, productivity, cost, schedule, and performance, frankly.

I for 1:00 AM fed up, said one Senator, gosh, nothing like grandstanding. During a hearing in front of the Senate Committee on Veteran Affairs, this past week, VA secretary Dennis McDonough said that a review of the agency's electronic health record monetization effort revealed multiple outstanding issues that must be resolved.

The mission of . EHRM has always been to create a platform that seamlessly delivers the best access and outcomes for our vets. And the best experience for our providers says McDonough. VA's first implementation of Cerner Millennium did not live up to that promise either for our veterans or our providers.

He continued McDonough outlined the findings of a 12 week review of the EHRM. Program initiated after the first implementation of Cerner's Millennium Platform at the Mann Grand Staff, VA Medical Center in Spokane, Washington this past October. Here's what the findings were around this patient safety.

Although staff took immediate action on clear issues, McDonough said, stakeholders, clarity on the broader definition, nature, and number of patient safety issues related to the new EHR implementation. All right, so patient safety is of utmost importance whenever you're doing these EHR projects. There has to be a funnel for how to escalate those things, how to triage those potential patient safety issues and how to address them immediately.

That process should be very well known, should be very well executed on and should be reported out on an hourly basis, if not a minute by minute basis, depending on the nature of the patient safety issue. That's just a part of . Every EHR implementation. It should be pretty well a standard process productivity with the significant decrease post-implementation compounded by the COVID-19 pandemic productivity.

Here's what I would say to the center and to to McDonough. I would say get over it. Productivity does not go up after an EHR project. You just changed everything. You just changed workflows. You just changed how they interact with a new system. If I took your Apple phone away and gave you a. Google Android phone tomorrow and said, I want you to be as productive tomorrow as you were today.

It would take you weeks, and that is just your silly phone. We are talking about changing everything, changing the entire backend, changing where they . Find things changing, how they search for things, changing how they interact with it, the workflows. So set the right expectations and meet those expectations.

What should the productivity be? Post-implementation, and then measure progress against that metric as you progress from that. Governance and management. McDonough during his testimony pointed that the siloed nature of the project moving forward VA is effectuating. Wow, is that a word? VA is effectuating a unified enterprise-wide governance that incorporates the perspectives of key clinical, technical acquisition, and finance leaders among others.

He said in written testimony, if you're gonna use words like effectuating. That could be part of the problem. Simplify. I agree with you. The siloed nature of things. Governance is so critical to these EHR projects, especially with defining the workflows, defining the data, and the metadata within the EHR.

Yeah. Governance has to be done well and the communication structure has to be very clear. And so clearly governance is key. Stop using words like effectuating and start using words that anyone can understand. Take the lessons from Abraham Lincoln. Cost, schedule and performance. Not only were cost estimates off by billions of dollars as outlined in OIG reports, but key performance indicators for the project.

Were not effectively created, maintained, or managed. That's a problem. That's just needs to be addressed in some way, shape, or form. First of all. We've done a million of these implementations, we should know what the costs are, give or take within five to 10%, and reporting out on this and maintaining the, uh, cost estimates should be basic blocking and tackling for any organization.

Patient portal experience, which McDonough describes as fragmented for veterans. Of course it is. It's fragmented for every patient across the United States. I'm not saying that as an excuse for the life of us. We cannot listen to patients. First and foremost. Instead, we put the clinician experience first and then we build our patient portals around that.

If you want to build a truly patient portal experience, you have to start with the patients in mind. You have to meet with the patients. You have to develop it with the patients in mind and not roll out the same crap we've rolled out for years and now I'm everybody and their brother's gonna send me emails saying, are you kidding me?

Have you ever used the Epic portal? I've used all of 'em. I've used all of them because every health system I go to gives me a different one to use. Case in point, anyway. Next. Next one. Testing clinical and interdisciplinary workflows were not tested prior to go live in a manner that effectively reflected a real world environment, said McDonough in written testimony.

I. Absolutely you, you've gotta put the testing in place. I would say we've gotta look at the number of different test cases that we're going to develop. If each one of these hospitals is run differently, that's a different problem altogether. There should be a uniform set of clinical processes, an agreement on me, how medicine is practiced, an agreement on workflows across all of these.

Hospitals. It's one of the things that you do by implementing an EHR, is that you drive that through conversations. You bring those teams together to drive a common way of approaching your standards of care and closing those care gaps. And if you're not going to do that, if you're not gonna do that hard work and let each one of these hospitals really operate as an independent unit.

And then try to roll an EHR out across that and expect magic to happen. It's just not going to happen. Data with gaps remaining in the ability to manage the data between the VA's Legacy Vista, EHR, and Millennium, along with the Department of Defense to ensure seamless information sharing. Again, this is basic blocking and tackling.

I would think the team, there should be a very . Well-rounded data team that understands how to get the data out of the Vista, EHR, and into the millennium. But I would say you have to set the right expectations. Moving all the data across is very hard to do. And so we start with the Pam e data. Problems, allergies, medications, and immunizations, and we try to get that discrete data across along with the demographic data, and then we go on from there.

A lot of it, quite frankly, ends up staying in the legacy system, going into some sort of legacy repository that gets accessed from Millennium and doesn't actually get ported over to Millennium. If you're gonna port everything over to Millennium, you're gonna end up with quite the mess. Change management and training employees need to both understand and have effective support in completing the key functions of their roles within the new system.

Amen. Amen. Amen. Training is the number one. Most overlooked item in the EHR implementation, and one of the primary reasons for that is 'cause you have to train very expensive doctors and nurses, some of which will choose not to go through the training. And other reason is because the organization will choose not to make the necessary investment around training.

Training cannot be overemphasized. This is changing the underlying structure of all the workflows in the hospital. You have to understand the EHR or it's almost impossible to function in the health system training over and over again. Reinforcement of training. If the implementation at the first health system did not go that well, I would go back in there with training.

I would also look at the customization. What level of customization is available to the clinician so that they can make it work for them in their workflows. These are important aspects of the implementation that need to be done. The rest of this article, quite frankly, is grandstanding by Republicans, grandstanding by Democrats, grandstanding, and positioning by everybody in their brother, most of which have no idea what it takes to implement an EHR.

And since I've done it and many of you have done it, it is almost impossible for these things to come off flawless. I don't care how many of them you have done, there are going to be challenges. Now we can minimize those challenges because we should have great process around patient safety. We should set the right expectations around productivity.

We should have the right governance in place from the get go with the right expectations of what governance is gonna drive across the entire va. Cost, scheduling and performance is basic. Blocking tackling should have been taken care of. The patient portal experience needs to be developed. Around the patient's experience and not the clinician's experience.

Testing is just, again, basic blocking and tackling data, basic blocking and tackling and change management and training needs to be escalated, as well as customization of the environment once it's implemented. We know this from the work that class has done around the arch collaborative, which gives us really the playbook for making sure that a lot of this stuff goes well, at least post implementation.

That's all for today. If a senator or congressman or anyone from the VA wants to call and talk to me about my critique of this and how it can be done better, more than happy to assist in any way that I can. That's all for today. If you know someone that might benefit from our channel, please forward them a note.

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