Roger Baker: Why VA's Electronic Health Record Mega-Project is Failing

The Department of Veterans Affairs currently is reassessing its $16 billion-plus Electronic Health Record Modernization (EHRM) effort. Faced with productivity and patient safety issues in its initial pilot site, further rollouts of the EHRM have been paused by VA Secretary Denis McDonough. And while VA has not yet announced the details of the actions it will take to correct the EHRM program, those actions must include addressing the program's fundamental problems, not just the readily apparent quality and productivity problems surfaced at the pilot site.

Roger BakerFirst, most government programs of the scale of the EHRM fail, for a variety of reasons that the Government Accountability Office has documented in numerous reports. Even those programs that succeed do so after substantial struggles, often more than doubling their original schedule and budget estimates. In its first three years, the EHRM program is clearly on the path to failure. It has missed nearly every deadline it has set, and its budget estimate has expanded from $16 billion to $21 billion. Externally, there is no indication that VA has studied and implemented the various GAO-recommended governance, organization, accountability or execution measures intended to help agencies avoid large-scale failures, or that VA heeded governance and execution advice from private-sector health care systems that had previously pursued EHR transitions.

Second, VA's track record with large-scale systems development and deployment has been abysmal. Over the past 20 years, it has suffered many failed programs costing taxpayers hundreds of millions of dollars. To try to address this track record, VA's Office of Information and Technology, which is responsible for most of the large systems development programs, adopted disciplined incremental and agile program management approaches about a decade ago, resulting in substantially improved results. Unfortunately, the EHRM program is not managed by OIT. Instead, it is being executed by a separate program management organization in the traditional "waterfall" approach that contributed to so many VA failures...