McDonough told Senate lawmakers that a three-month internal review of the electronic health records system found so many structural problems that he cannot continue to deploy it at other hospitals until VA leaders are confident of success. He could not say when the rollout will resume.
“It’s a lot of money you’ve entrusted to us,” McDonough, confirmed in February as President Biden’s pick to lead the agency, told the Senate Veterans' Affairs Committee at a hearing. He called the digital health project a “potential game changer for medicine” that could improve veterans’ health care. But he cited serious “governance and management challenges” that have dogged it from the outset, saying, “That’s on us.”
“We are taking swift and decisive action to incorporate the management rigor and enterprise jointness required for this program to deliver on its intended purpose: seamless excellence in VA care for veterans,” McDonough said. “VA’s first implementation of the [project] did not live up to that promise, either for our veterans or for our providers.”
He said he has ordered an overhaul that will include better training for clinical staff; more reliable testing and oversight of Kansas City-based Cerner, the health technology giant building the system; and a leadership shake-up, the details of which he did not publicly release.
The records project was met with excitement in Congress and the veterans community when Jared Kushner, Trump’s son-in-law and a senior adviser, put it at the top of the list of innovations to federal government technology that the administration could tackle. The president had won in 2016 with veterans’ support, and the agency had relied for years on an antiquated system that badly needed an upgrade. But the agency had a weak record when it came to technology projects.
Trump touted his administration’s effort to merge the medical records of active-duty service members and their files when they leave military service as a long-overdue revolution in veterans’ health care. VA promised that veterans would receive better medical care when physicians could call up patients’ medical histories on their computer with a few strokes of their keyboard instead of relying on faxes to transfer the records from the Defense Department. The entire agency was scheduled to go online by 2028.
But the project confronted turbulence from the start, starting with controversy over a sole-source contract with Cerner, the influence of three Trump confidants who are members of his Florida golf club on Trump’s VA secretaries, and the question of whether, after several failures over 20 years, such a massive project could be successful.
The project has suffered largely from internal missteps, VA’s review and oversight by other watchdogs found. A lack of consultation among project and clinical leaders led to power struggles. Cost estimates ballooned to $16 billion from $10 billion — and are now at an additional $5 billion because VA leaders during the Trump administration did not budget for technology and hospital upgrades to allow the new platform to work.
In recent months, Congress has stepped up bipartisan scrutiny after the rollout at the VA Medical Center in Spokane, Wash., weeks before the November election quickly ran into trouble. Training of the medical staff was inadequate and the contractor’s on-site staff was ill-equipped to troubleshoot problems, the VA review found. Staff productivity plummeted as workers struggled to find patient records, prescribe proper medications and update medical visits in the system.
The Spokane staff filed hundreds of reports of patient safety issues caused by the new system, Sen. Patty Murray (D-Wash.) said at Wednesday’s hearing.
“Patients are not getting accurate meds,” Murray said. “Meds are sent to the wrong address. What used to take a few clicks is now a lot more complicated. Providers are burning out.”
McDonough said he has installed a patient safety team at the Spokane hospital to address the problems because of the potential for harm created by errors with the system.
He said he is not considering abandoning the project or switching contractors.
“I think the technology is basically sound,” McDonough said. “So much of these questions in terms of execution end up being governance and management challenges, and that’s on us.”
But some senators remained skeptical. “I’ve had the impression for some time that there are folks who are milking the cow,” said the committee’s chairman, Sen. Jon Tester (D-Mont.). “There’s been damn little accountability.”
“I hope Cerner’s watching this,” the senator added. “If they’re not open to making a user-friendly health medical record, they ought to admit it so we can get the money back and start all over.”
He told McDonough that the failures were “not all your fault . . . I don’t know if any of it is your fault.”
VA Inspector General Michael Missal’s office has flagged concerns in five reports on the project since April 2020, with more underway. Auditors disclosed last week that the agency’s cost estimates to Congress were unreliable and lacked documentation. A separate report found gaps in staff training in Spokane and apparent attempts by some agency officials to disguise the problems by withholding training evaluation data from auditors and altering other data before submitting it to them.
Senators were galled by the staff missteps in both areas.
“I would hope you would deal very sternly with that type of activity,” Sen. Thom Tillis (R-N.C.) said, echoing calls from others in his party for McDonough to discipline or fire those held responsible. The secretary said he still has not figured out “what went wrong” and who is to blame but added that he plans to find out and hold the employees involved responsible.
VA was scheduled to roll out the new system in Columbus, Ohio, this summer, followed by a hospital in northern Michigan, but those plans are now on hold, McDonough said. He is abandoning a scheduled deployment and instead will evaluate each hospital’s readiness to proceed. He did not say when that would occur.