STATEMENT OF THE HONORABLE MELISSA S GLYNN Ph D ASSISTANT SECRETARY FOR ENTERPRISE INTEGRATION DEPARTMENT OF VETERANS AFFAIRS BEFORE THE HOUSE COMMITTEE ON APPROPRIATIONS SUBCOMMITTEE ON MILITARY CONSTRUCTION VETERANS AFFAIRS AND RELATED AGENCIES FEBRUARY 27 2020 Good afternoon Madam Chairwoman Ranking Member Carter and distinguished Members of the Subcommittee Thank you for the opportunity to testify today in support of the Department of Veterans Affairs VA electronic health record modernization EHRM initiative and deployment of the Cerner Millennium electronic health record EHR solution I am accompanied today by Dr Richard Stone Executive in Charge of the Veterans Health Administration and Mr John Windom Executive Director of the Office of Electronic Health Record Modernization I would like to begin by introducing myself and my role within VA The Office of Enterprise Integration helps guide VA operations inform decision-making and integrate initiatives within the Department and with other agencies In my role I support the Secretary on major transformational initiatives including our supply chain modernization financial management business transformation the MISSION Act and EHRM deployment In this capacity I work closely with leadership in our Office of Electronic Health Record Modernization and the Veterans Health Administration to support implementation activities at the enterprise level Additionally my office is the lead for coordination activities with the Department of Defense DoD which is vital to this joint endeavor Our internal coordination with DoD will ensure seamless delivery of quality health care to Servicemembers Veterans and qualified beneficiaries We have made tremendous progress since our last hearing before this Subcommittee in March 2019 We met critical milestones including site assessments infrastructure upgrades migration of 78 billion health records development of an enterprise interface and the completion of eight national user workshops These workshops spanned nearly 1 500 sessions and over 50 000 cumulative work hours by more than 1 000 frontline clinicians and end users from across the enterprise We established national councils comprised of VA and DoD clinicians technologists and industry leaders to collaborate as we build a single standardized system We received valuable insight from DoD which has brought lessons learned and context to the EHR configuration and by industry advisors who shared commercial best practices Through these workshops we reached consensus on more than 1 300 design decisions and over approximately 900 workflows were standardized to best meet the needs of our Veterans 1 These efforts have moved us beyond mere partnership to support true coordination with DoD We established a joint Federal Electronic Health Record Modernization Office and in Spring 2020 we are poised to deliver a Joint Health Information Exchange together with DoD This will benefit all legacy and modernized VA and DoD health care sites as well as community providers who exchange records with both departments I am proud of our progress and we are continuing to work toward a successful EHR deployment EHRM Deployment VA pioneered the first EHR in the 1980s which paved the way for widespread EHR adoption throughout the U S health care system To achieve greater interoperability with DoD in May 2018 VA awarded Cerner Corporation a contract to replace the Department’s legacy patient record systems with the commercial-off-theshelf solution adopted by DoD A single interoperable solution across VA and DoD will enable the secure transfer of active-duty Servicemembers’ health data as they transition to Veteran status This 10-year modernization effort will create a lifetime of seamless care for Servicemembers and Veterans VA’s health care platform is composed of a highly complex clinical and technical environment delivering Veterans specialty care not typically supported by commercial EHRs with unique requirements that must be configured and properly integrated to ensure continuity of care No other health care organization in the world is attempting something of this scale and complexity and we are committed to getting this absolutely right for our Veterans We selected the Mann-Grandstaff VA Medical Center in Spokane Washington as our initial operating capability IOC site and established a very aggressive and optimistic deployment timeline that also prioritizes patient safety balances risk enhances user adoption and leverages lessons learned from DoD’s deployment During the IOC deployment we are working to identify efficiencies to optimize the schedule hone governance refine configuration and standardize processes for future locations Our immediate focus for our IOC site is readiness of the system to support training After we completed the second Integration Validation Testing IV2 in early February 2020 we identified that additional efforts are needed to configure the system to meet VA’s unique requirements for community care beneficiary travel and others— for which there are not similar requirements elsewhere in modern health care We were able to identify these issues because leadership and clinicians at the Mann-Grandstaff VA Medical Center raised concerns using feedback mechanisms built into our deployment plan This led to a decision on whether to sustain the user training schedule or continue development to move the system build closer to 100 percent complete before conducting training The training event which was scheduled to begin the week of February 10th would have marked the start of ongoing education for the professionals—clinicians providers and VA staff—who will use the new EHR 2 The governance process I established to support leadership oversight provided a check point to validate the beginning of this end user training and the overall implementation timeline with the completion of IV2 Thus reaffirming the timeline for our go-live date was anticipated to occur at this point As the IOC timeline has been expected to occur over many months a re-planned go-live date will still occur during the IOC period It is important to note that we are not adjusting our 18-month timeline for IOC at Mann-Grandstaff We are still operating within the designated time period for IOC We are continuing to build capabilities into the system so that our clinicians and users can train on a more complete EHR interface Congress and other stakeholders have cautioned VA not to rush and deploy a product that would fall short of the quality patient care Veterans expect and deserve We could not agree more that getting it right is more important than meeting an aggressive schedule and we decided to postpone our go-live date at Mann-Grandstaff VA Medical Center Detecting course correction opportunities prior to go-live is at the core of our approach to deploying an EHR solution This approach ensures patient safety security and a functional system for all VA health care professionals Current Status A large-scale EHR deployment follows an iterative model in which new capabilities are added as the system is deployed Though we initially planned to commence user training when the system was 75-80 percent complete our clinicians in the field identified some critical requirements that must be completed prior to go-live at Mann-Grandstaff If not addressed these critical requirements would pose significant risk to preserving continuity of care to our Veterans thus VA will take all precautions to manage this risk to an acceptable level for our clinicians and users and even more importantly our Veterans Therefore we decided to continue development to move the system closer to 100 percent complete before conducting user training We are currently working to have the system closer to 100 percent and expect to validate this milestone in the spring Once we validate functionality of the system we will commence user training with the goal of establishing a new go live phase in July of 2020 Ultimately our EHR transformation success revolves around user adoption By adjusting our training schedule we will be adding additional capabilities originally scheduled to be incorporated after our go live date These capabilities are intended to enhance user adoption improve productivity and efficiency for our field staff and enhance the Veteran experience 3 It is also important to recognize that we are not doing this alone—our VA deployment schedule leverages lessons learned as we deliver a single longitudinal health record at VA and military health facilities EHRM Budget With the support of Congress and the President we have a Fiscal Year FY 2021 budget request of $2 6 billion for our EHRM which is $1 2 billion above FY 2020 This budget request provides necessary resources for full deployment of VA’s new EHR solution at the remaining sites in Veterans Integrated Service Network VISN 20 and VISN 22 Additionally it funds the concurrent deployment of waves comprised of sites in VISNs 7 and 21 This budget will also allow us to continue implementation efforts and nationwide deployment of the simultaneous Centralized Scheduling Solution We are currently testing the Centralized Scheduling Solution at the Chalmers P Wylie Ambulatory Care Center in Columbus Ohio and through our governance process we will validate commencement of user training and our implementation schedule Our intent is to implement this new resource-based scheduling solution across the enterprise on an accelerated timeline and enhance scheduling accuracy This initiative will bring the benefit of a modern resourced-based scheduling system to VA and to our Nation’s Veterans before the full EHR solution is implemented By providing this capability sooner VA will improve timely access to care for Veterans increase provider productivity and enable the adoption of the full EHR solution Because we are still operating within our designated IOC 18-month schedule we do not anticipate a change in funding requirements at this time Should our deployment schedule change such that it impacts our current or proposed budget we are committed to providing Congress with timely notification Closing I would like to once again thank Congress and specifically this Subcommittee for your continued support and shared commitment to our success Because of your support we are able to continue our mission of improving health care delivery to our Nation’s Veterans and those who care for them while being a good steward of taxpayer dollars We are committed to providing the high-quality care and benefits that our Nation’s Veterans deserve and we will continue to keep Congress informed of milestones as they occur Madam Chairwoman Ranking Member and Members of the Subcommittee thank you for the opportunity to testify before the Subcommittee today to discuss our deployment of the Cerner EHR solution I would be happy to respond to any questions that you have 4