Michael Douglas’ character Gordon Gekko from the movie Wall Street will forever be remembered for his quote, “Greed is good.” He went on to say that greed “captures the essence of the evolutionary spirit.” So can we logically say the same about Change?
I’m drawn to that thought when reading about the Department of Veterans Affairs and its long-awaited decision to replace its electronic health records system. Valued at a whopping $10 billion dollars (with another $5 billion in change management expected by experts, according to Politico), this modernization project will be challenging, to say the least. The sour taste left by the stalled negotiation process with Cerner certainly isn’t helping to launch the project on a positive note, nor is a recent report by the Pentagon that gave a devastating review of the DoD’s new Cerner implementation (a report Cerner President Zane Burke has suggested is “fake news”).
When we wrote about the controversy around having two Mar-a-Lago friends of President Donald Trump “helping” to evaluate the contract, we focused on the issue of who should be involved in the evaluation process. “The VA’s implementation of a new EHR system is a massive undertaking by the largest health system in the country,” says Dr. Neil Kudler, Chief Medical Officer here at VertitechIT. “Not only will this call for technical precision and clinical partnership at the highest levels, but will also demand thorough executive leadership, operational engagement, cultural readiness, and a training and education program specifically designed to meet the needs and varieties of adult learning.”
There are many who say the VA’s Cerner project is doomed to fail. The number one reason… VA clinicians love their legacy EHR VistA. Many have never used anything else and don’t understand the need to change (even though the VA says its necessary for interoperability and information exchange with the DoD).
Politico asked several experts for their opinion. We asked several more (Dr. Kudler, who has served as COO and CMIO at several large medical institutions, and Jonathan Butz, a senior healthcare consultant and the former chief healthcare strategist for VMware).
David Shulkin, former VA secretary: Get VA clinical leadership buy-in. Form a veteran advisory committee (with veterans of all generations) to give input to implementation. Set transparent metrics and measurable outcomes.
Dr. Neil Kudler: Leadership cannot be simply limited to assent; executive leadership from the Secretary on down must be knowledgeable champions of the project. This implementation must be seen as part of the vision of the VA’s efforts to continually improve and provide premier care to our veterans. But leadership is just the ignition; the operational roadmap and those responsible for driving it are the engine of this new machine. From IT to clinical to internal marketing and communications, to name a few, these are the critical people and projects that will bring the EMR alive.
Scott Blackburn, former VA Chief Information Officer: Stay laser-focused initially on 1-3 pilot sites to make sure those are successful before scaling. Go slow to go fast. Make sure VA is getting ahead of infrastructure upgrades at the pilot sites. This needs to start right now. This was one of the lessons learned from DoD.
Jonathan Butz: Focus on patients to ensure there are no gaps in care. Focus on clinicians to earn their support for the change.
Dr.Kudler: Communication of rationale, value, and benefits must be cogent, yet appealing and delivered on a regular and frequent basis. This project must be consonant with the vision of the system and its members and must be communicated outwards. The ‘why’ must not be held close, but shared across the country.
Peter Levin, CEO, Amida Technology Solutions, former VA Chief Technology Officer: We’ll lose years of time and billions of dollars – never mind put patients at risk – if we don’t have measurable, auditable, reliable, and secure clinical data exchange. If you get the data exchange right, nothing else matters (because the clinical components can be aligned and fixed later).
Jonathan Butz: Cerner is an amazing and proven EHR. The VA must ensure flexible records and data exchange and the best way to do that is to leverage the capabilities of the solution with minimal customization.
John Halamka, CIO, Beth Israel Deaconess Medical Center: Implementing an EHR is more about psychology than technology. It’s all change management.
Dr. Kudler: EHRs today are too sophisticated to leave users to their own devices. Train, retrain, and educate all users with systems designed for ready assistance, i.e. sophisticated centralized help desk services.”
Change, like greed, can be good. And bad. Let’s hope the VA listens to the experts (and their own doctors and nurses). Blindly charging ahead could be disruptive at best, and endanger the lives of our veterans at worst. It’ll make the last crash on Wall Street seem tame in comparison.