Becker's Hospital Review

42 CIO / HEALTH IT VA hasn't included all critical stakeholders in $16B EHR modernization, GAO report finds: 7 notes By Jackie Drees T he U.S. Government Accountability Office released a report June 5 claiming that while the Department of Veterans Affairs' deci- sion-making procedures for its $16 billion Cerner EHR rollout have generally been effective, it has sometimes failed to include the input of key stakeholders. In June 2017, VA announced its plans to transition to a Cerner EHR, the same system the Department of Defense was implementing. Since then, VA has delayed the go-live for its EHR system multiple times, most recently postponing it indefinitely to focus its efforts on its COVID-19 response. For its report, the GAO analyzed VA's implementation efforts at Mann-Grandstaff VA Medical Center in Spokane, Wash., where the de- partment planned to deploy the EHR in July 2020 as well as the Puget Sound Health Care System, where it planned to go-live in fall 2020. Seven report insights: 1. To prepare for its planned summer and fall 2020 go-lives, VA estab- lished 18 EHR councils comprising VA clinicians, staff and other experts and held eight national workshops between November 2018 and Octo- ber 2019. VA also held eight local workshops at both medical centers to help ensure the EHR configuration supported local practices. 2. At the workshops, the councils decided how to design the EHR so- ware's functionality to help clinicians and staff complete tasks such as administering medication. 3. While the EHR councils included a wide range of stakeholders from various geographic regions, "VA did not always effectively communicate information to stakeholders, including medical facility clinicians and staff," to ensure these groups were at local workshop meetings, two clini- cians from initial implementation sites told GAO. 4. Local workshop participants said they didn't always know which work- shop meetings they were required to attend because they didn't receive proper information about the session topics, according to the report. 5. Clinicians and department leads from medical facilities that were sup- posed to participate in the workshops also told the GAO that "differences in the use of terminology between VA and Cerner sometimes made it challenging to identify the clinicians and staff that should attend local workshop meetings." For example, some officials didn't think a meet- ing on "charge services" was relevant to their work but later learned the meeting covered topics that involved them beyond billing. 6. VA has not indicated how it plans to describe these future workshops and sessions to ensure critical stakeholders participate but the depart- ment does plan to hold local workshops before implementing the Cerner EHR at future VA medical facilities. 7. GAO recommended that VA improve communication on workshop meeting topics to ensure the EHR modernization program obtains input from critical facility clinicians and staff to consider when making design decisions for the EHR system. n Permanently higher telehealth pay rates under review, CMS says By Laura Dyrda C MS Administrator Seema Verma discussed the pros- pects for extending telehealth coverage and pay rates permanently during a STAT virtual event. "I can't imagine going back," she said during the June event. But it may not be up to her. While Ms. Verma and President Donald Trump have repeatedly touted the gains telehealth has made for CMS beneficiaries during the pan- demic, the federal government has not finalized perma- nent changes that would expand access to telehealth and coverage rates. During the pandemic, CMS made telehealth available to all beneficiaries. Previously, it would only cover telehealth in specific regions and circumstances. The rates were also lower than in-person visits and did not include audio-only visits. One of the reasons telehealth was able to expand so rapidly in the last few months was because of the coverage changes. "People recognize the value of (telehealth), so it seems like it would not be a good thing to force our beneficiaries to go back to in-person visits," Ms. Verma said, mentioning that virtual visits increased 40-fold in some places during the pandemic. However, in a CMS press release on June 9, Ms. Verma also acknowledged the value of in-person visits as healthcare facilities reopen for elective care. "While telehealth has proven to be a lifeline, nothing can absolutely replace the gold standard: in-person care," she said. Ms. Verma also said the government was evaluating wheth- er to permanently pay the same rates for telehealth visits as in-person visits. A permanent nationwide expansion would be up to Congress because current laws limit coverage, she said. n

• Cover