ICYMI: Senator Murray Presses VA Secretary on Electronic Health Records Rollout at Mann-Grandstaff VA Medical Center in Spokane – MORE HERE
Senator Murray: “I don’t want to see the new EHR deployed at other sites in Washington until it is fixed and really ready to go”
*** WATCH SENATOR MURRAY’S QUESTIONING HERE***
(Washington, D.C.) – Today, during a Senate Veterans’ Affairs Committee hearing, U.S. Senator Patty Murray (D-WA), a senior member of the committee, pressed Department of Veterans Affairs (VA) Secretary Denis McDonough for solutions and transparency around the ongoing issues at Mann-Grandstaff VA Medical Center (VAMC) in Spokane that have arisen during the implementation of the VA’s new Electronic Health Record (EHR) Modernization program that is currently being piloted at Mann-Grandstaff. These issues have limited Eastern Washington veterans’ ability to receive timely, quality health care.
During the hearing, Senator Murray underscored VA’s responsibility to address the problems that veterans are seeing at Mann-Grandstaff VAMC, and pressed Secretary McDonough for assurances that these issues would be resolved quickly and would not arise at other VA medical centers in Washington state, such as Jonathan M. Wainwright Memorial VAMC in Walla Walla.
Senator Murray pressed Secretary McDonough for concrete steps being taken to address the challenges in Spokane and secured a commitment from him that VA would share clear indicators of readiness before deploying the new EHR program at any other sites in Washington state, specifically Walla Walla.
“I appreciate VA senior leadership’s continued engagement on this issue, but we really need to see corrective actions to put this important program back on track and to get it right for the veterans, families, and staff counting on it. For Spokane VA Medical Center and its clinics, what are VA’s next steps for remedying the existing issues?” Senator Murray asked of Secretary McDonough.
During the exchange Senator Murray asked Secretary McDonough for specifics when he referenced “pressing” Cerner, VA’s contractor overseeing the new EHR program, to, “enhance the presence on the ground in Spokane.”
“What do you mean pressing them? Saying you’d like them to or telling them they have to?” asked Senator Murray, to which the Secretary responded affirmatively, “we’re telling them that they have to.”
Murray then shifted the conversation toward any future deployments of the new EHR, “Almost two years ago, I cautioned the previous Administration against deploying the new EHR until infrastructure and staffing issues were addressed. I don’t want to see the new EHR deployed at other sites in Washington until it is fixed and really ready to go. So to avoid any confusion, for future sites, what indicators is the VA looking for to know when a site is ready and that the deployment won’t disrupt veterans’ care or staff productivity or the morale that we see?”
In response, Secretary McDonough made a commitment to Senator Murray to provide, “[VA’s] dashboard on what we intend to measure as it relates to Walla Walla” before proceeding with the deployment of the new EHR program at Jonathan M. Wainwright Memorial VAMC in Walla Walla.
Senator Murray has been conducting oversight on the EHR rollout at Mann-Grandstaff VAMC for years, questioning then VA Secretary Wilkie about the EHR rollout in September of 2018 and writing a letter in January 2020 to VA leadership expressing her concern on reports of staffing and facility issues at Mann-Grandstaff VAMC, and how those issues could affect the EHR rollout. Following Senator Murray’s concerns, VA initially delayed rollout of the EHR program at Mann-Grandstaff until March 2020.
In July, Senator Murray pressed Secretary McDonough on patient safety in light of reports of veterans receiving incorrect medications, the need for more staff support from VA, and how VA will avoid the issues that have arisen at Mann-Grandstaff VAMC moving forward and at other VA medical centers. Senator Murray has since raised the need to resolve issues with care at Mann-Grandstaff with Secretary McDonough and other VA officials multiple times in private meetings and public hearings.
The long planned restructuring of VA’s EHR system is meant to ease sharing of medical records between the Department of Defense and VA, as well as VA and community providers. It is projected to be completed by 2028.
During the hearing, Senator Murray also raised issues with the restrictive eligibility criteria put in place by the Trump Administration for the Caregivers program, which Senator Murray pushed to expand, which has resulted in 88% of applications between October 2020 and August 2021 being denied. Senator Murray had previously expressed concerns with the new eligibility requirements being too restrictive following the Trump administration’s announcement of them.
A full transcript of Senator Murray’s questioning of Secretary McDonough is below.
Murray: Thank you Mr. Chairman, Secretary, good to see you again. Thanks for being here. As you well know, this summer the VA completed its strategic review of the Electronic Health Record Modernization program. And deputy secretary Remy made a virtual visit to Man-Grandstaff VAMC in Spokane, last month in November. I appreciate the senior leadership’s continued engagement on this issue, but we really do need to see corrective actions to put this important program back on track. And to get it right for veterans’ families and staff who are counting on it. For Spokane VA medical center, and it’s clinic what are VA’s next steps for remedying the existing issues?
McDonough: So the next steps are that – we are – I last talked to Donald about this last night, Donald Remy. We’re Pressing on Cerner to enhance the presence on the ground in Spokane so that people can get a more timely reaction.
Murray: What do you mean pressing them? Saying you’d like them to or telling them they have to?
McDonough: Yeah we’re telling them that they have to.
McDonough: And Donald reported to me last night, he was in touch with Rob Fischer, who is the medical center director there in Spokane. And what Rob said to him is that as of last night the kind of presence that Cerner was manifesting was not what he had been anticipating. And so Donald was gonna tell Cerner today that’s not good enough.
Murray: When do you expect to see that?
McDonough: I don’t know the answer to that question cause he had that discussion today, but I’ll get you the answer. I haven’t talked to him since he had that discussion.
Murray: Any other steps that you’re taking?
McDonough: Well we’re continuing to – we have regular engagement with, through the office of Electronic Health Record Modernization, with the team in Spokane so that we as an institution are making sure that we are taking whatever corrective action we need to take as well. And we’ve obviously restructured the management and governance of the implementation of the project going forward.
Murray: In your testimony, you mentioned that the VA plans to “continue deployments to gain more experience while increasing future site readiness.” That’s a quote. Almost two years ago, I cautioned the previous administration against deploying this new EHR until infrastructure and staffing issues were addressed. I don’t want to see the new EHR deployed at other sites in Washington State until it’s fixed and it’s ready to go. So to avoid any confusion, for future sites, what indicators is the VA looking for to know when a site is ready and that the deployment won’t disrupt veterans’ care or staff productivity or the morale that we see?
McDonough: Yeah, it’s a fair question. Maybe the way to answer this Senator is that in as much as Walla Walla would be the next site in WA, why don’t we come to you with our dashboard on what we intend to measure as it relates to Walla Walla and then you can see our decision making on that.
Murray: Are you at this time moving forward with any other sites in Washington State?
McDonough: What we’ve indicated is that as soon as March we’ll go to Columbus and shortly after that to Walla Walla.
Murray: Ok and you will bring to me what your indicators are before you proceed on that?
McDonough: Yep, yep.
Murray: Great, I expect to see that, all right.
Murray: You were asked about caregivers by Senator Brown, and you know that’s a passion of mine too.
McDonough: Yeah and we have the program because of you.
Murray: As you know the previous administration finalized a rule for the caregivers program that restricted the eligibility criteria for veterans. I heard your answer to Senator Brown. I know what you’re doing about those that have been denied. But he stated 88% of the applications were denied so my question to you is a little different. How is the VA going to fix that unnecessarily restrictive eligibility criteria, so that we don’t continue to see these denials?
McDonough: Yeah I think there’s kind of two big movers in the decision; one is a statutory provision which says the condition the veteran suffers has to have been incurred in the line of duty. Our proxy for that is a 70% disability rating. And we can’t get around that, that’s statutory. Right, we may after looking at this come back to you and say ‘hey can we look at this statute line, this statutory language.’ As I’ve discussed with several of you, the other mover is a determination of the percentage of the activities of daily living that a veteran has to manifest problems with to qualify, having gotten over that first hurdle of the 70% disability. We do have some regulatory flexibility on that question of the percentage of activities of daily living that would be required, once over that 70% hump. That’s what we’re looking at now.
Murray: So you are looking at changing some of that criteria?
McDonough: We are.
Murray: Ok and what’s your timeline on that?
McDonough: ASAP.
Murray: Ok, alright.
McDonough: We may have to do it through rulemaking, we may be able to do it through a clarification. That’s a question really for general counsel. But I am working really closely with the caregiver office with general counsel to make sure we do whatever we can as quickly as we can. And surely in anticipation of the October one date.
Murray: Ok thank you very much.
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