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After a 5-year wait, VA gets a new top medical leader

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After more than a five-year wait, the Department of Veterans Affairs has a Senate-confirmed official leading its health care operations again.

Lawmakers on Thursday voted 66-23 to confirm Dr. Shereef Elnahal as the next VA under secretary for health.

“Now more than ever, the Department of Veterans Affairs needs a steady hand to guide the Veterans Health Administration,” said Senate Veterans’ Affairs Committee Chairman Jon Tester, D-Montana, in a floor speech just before the vote.

Elnahal “has an impressive record of leading health care systems and health agencies,” he said. “But more importantly than that, he is committed to caring for the more than 9 million veterans currently in VA’s care.”

VA’s top health care post had been unfilled since early 2017, when Dr. David Shulkin stepped down from the postion to take over as secretary of the entire department. Since then, the job has been held by a series of temporary, unconfirmed executives.

Over the past five years, officials have convened several panels to find candidates for the post without success.

President Joe Biden nominated Elnahal in March. He currently serves as chief executive officer of University Hospital in Newark, New Jersey.

He received largely positive reviews from Senate Veterans’ Affairs Committee members during his confirmation hearing in April, but his nomination has been stalled since May after Sen. Rick Scott, R-Florida, blocked an attempt to fast-track his appointment over general concerns about Biden’s nominees.

The move drew the ire of Democratic leaders and VA Secretary Denis McDonough, who said Elnahal will provide valuable help with the department’s electronic health records overhaul and ongoing review of medical facility infrastructure.

Elnahal previously served as VA’s assistant deputy under secretary for health for quality, safety and value from 2016–2018. During that time he co-founded the VHA Innovation Ecosystem, which focused on sharing best practices to improve veteran care.

During his confirmation hearing, Elnahal said one of his top priorities for the job will be improving recruiting and retention for clinical care positions at the Veterans Health Administration.

“The sacred health care mission of VA simply cannot be fulfilled without having people to do it, talented healthcare professionals who put the mission above all else,” he said. “So this is a major priority for me.”

With Thursday’s vote, the department now has four of its top five leadership roles confirmed by the Senate. The only vacancy is the under secretary for benefits.

Last week, Biden’s nominee for that post, Ray Jefferson, withdrew his name from consideration after a monthslong wait for action by the Senate. VA officials announced this week they have formed a new search commission to look for potential candidates.

Leo covers Congress, Veterans Affairs and the White House for Military Times. He has covered Washington, D.C. since 2004, focusing on military personnel and veterans policies. His work has earned numerous honors, including a 2009 Polk award, a 2010 National Headliner Award, the IAVA Leadership in Journalism award and the VFW News Media award.

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VA’s $16 billion medical records overhaul could triple in cost

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Veterans Affairs officials announced Wednesday they will delay the planned deployment of the department’s new electronic medical records to sites in Idaho amid concerns the $16-billion project could be endangering veterans and may triple in cost.

Senate lawmakers said the latest postponement — and other promised fixes to the training and deployment process — don’t go far enough to acknowledge the deep-seated problems with the system, some of which may not be reparable.

“For nearly two years, [local employees] have done all they can to provide healthcare to veterans in the middle of a pandemic, and with an electronic health record system that is not delivering,” Senate Veterans’ Affairs Committee Chairman Jon Tester, D-Mont., said during a hearing on the issue.

“We know this program faces very real problems. And we need to work together to make needed improvements without delay.”

But VA officials said they are not abandoning the project, despite growing concerns about its long-term viability.

“We’ve learned from these issues around patient safety,” VA Secretary Denis McDonough said at a separate press event Wednesday. “Our veterans deserve to have access to 21st century healthcare in a way that protects them and enhances their interests.”

The 10-year, $16 billion project was approved in 2017 by President Donald Trump and touted by his administration as a transformational event for the department by putting VA records on the same system as the Department of Defense for the first time. Military officials began using a new records system based on the same software in 2015.

But last week, the VA Inspector General’s office released a new report detailing 149 cases of patient harm, all of which were caused by the implementation of the new Oracle Cerner Millennium records software over a nine-month period at the department’s hospital in Spokane, Wash.

A flaw in the system sent about 11,000 orders to an unknown and unchecked file, where requests for items such as appointments or blood tests went unanswered. In at least two cases, the lost files caused “major harm” to patients.

The report was the latest in a series of negative assessments of the system unveiled by the inspector general over the last two years, several of which have prompted reviews and delays.

One month ago, the department announced plans to delay deployment to sites in Washington and Oregon because “the system hadn’t shown adequate reliability to support the current schedule.”

The latest delay came this week, when VA leaders announced plans to postpone deployment of the records system to sites in Boise, Idaho. That work was scheduled to begin this weekend.

Meanwhile, lawmakers are also scrutinizing the cost of the project after officials said the total over the next 30 years could approach $51 billion, when factors such as system maintenance, care changes and staffing issues are factored in.

“It is $40 billion over the cost estimate VA has been operating under until now,” said Sen. Jerry Moran, R-Kansas, ranking member of the veterans committee. “But until Monday, we were not aware how large that cost overrun truly is.”

VA officials said that those calculations factor in a host of expected costs outside of the software contract, and are not indicative of an over-budgeted endeavor. They also said they do not expect the system to cost more than the $16 billion agreed-upon price tag unless the 10-year implementation timeline is extended significantly.

But they did acknowledge shortcomings in training and adaptation of the software in past years.

Administrators promised that recent corrections — such as establishing new oversight protocols and staff training plans — would keep the project on schedule and produce the robust records system promised to staff and patients.

“We’ve taken sufficient steps to build additional safeguards, knowing where the vulnerabilities are based on experiences we’ve had, to reduce the risk of additional harm or to reduce the likelihood of similar problems occurring and other sites,” Dr. Gerard Cox, VA’s assistant under secretary for health for quality and patient safety.

“I feel like we have done everything possible to reduce the risk to patients.”

Officials from Oracle Cerner have said that many of the initial problems with getting the new system integrated into VA were expected and reparable.

“While I fully appreciate substantial challenges exist – all of which are legitimate and understandable – the fact is that more is working than is not,” said Mike Sicilia, executive vice president of Oracle Corporation, which took over the contract earlier this summer when it bought Cerner.

“There is nothing here that can’t be addressed in reasonably short order.”

Part of that work will be shifting operations to a new cloud-based system, in order to prevent outages and stalls. Officials said they have had nearly 50 such problem events since the first VA site began using the Millennium software.

Lawmakers remain skeptical.

In a statement last week, House Veterans’ Affairs Committee Chairman Mark Takano, D-Calif., said he was “extremely disappointed” with the process so far, including VA’s transparency about ongoing problems.

Committee ranking member Mike Bost, R-Ill., said he has “serious doubts about whether this project should continue, even if the fatal flaws at the initial rollout sites are fixed” because of the ongoing cost and safety questions.

Several other lawmakers have pushed for VA to abandon the project, a move that would cost billions of dollars and leave the department’s medical records systems with an uncertain future. McDonough said he is not considering that option.

“We will get to the bottom of these problems, and make sure that we can realize a modernized electronic health record that draws the full history of our veterans’ service to the country,” he said. “When we realize that potential, we will be able to expand exponentially the benefits for veterans and for the country.”

Leo covers Congress, Veterans Affairs and the White House for Military Times. He has covered Washington, D.C. since 2004, focusing on military personnel and veterans policies. His work has earned numerous honors, including a 2009 Polk award, a 2010 National Headliner Award, the IAVA Leadership in Journalism award and the VFW News Media award.

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VA overhauls patient wait time website, but not policies on other medical options

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Veterans Affairs officials are overhauling their website detailing medical wait times at facilities across the country, but that won’t mean significant changes to private-sector care eligibility for patients worried about access issues.

The new site, which went live Tuesday afternoon, is the culmination of months of behind-the-scenes work in response to veterans’ complaints about deficiencies in the old offering.

VA has been publicly posting wait time estimates for the past eight years, with multiple modifications to the data directed by Congress in recent years.

Officials said the new site changes will make the information more user friendly, with information on waits for various specialties at sites displayed on a single page instead of across multiple links.

They also said sites have begun to calculate average wait items differently, to more accurately reflect delays that patients face in getting care. As a result, the new wait times listed for most sites are expected to increase as compared to the information posted just a few days ago.

But VA leaders in a background call with reporters said the wait times increases are not reflective of increased access problems at VA hospitals.

As a result, they do not expect more individuals to seek community care options based on the new numbers, since specific patient eligibility is considered on a case-by-case basis.

Under current rules, veterans can apply to get private-sector health care if they face significant waits (20 days for primary care, 28 days for specialty care) or travel (30-minute average drive time for primary care, 60 minutes for specialty care) to receive care at a VA medical site.

Calculations for that eligibility are separate from the average wait time data posted online, officials said. Individuals who are interested in private-sector care will still be required to work through VA administrators to check if they qualify.

VA’s Community Care program has been a target of controversy in recent years, with Republican lawmakers lamenting bureaucratic barriers for patients looking to schedule outside medical visits and Democrats warning that shifting too much care outside of veterans hospitals will undermine the VA system.

The website changes also include updated contact numbers for VA facilities and additional information on patient satisfaction.

Leo covers Congress, Veterans Affairs and the White House for Military Times. He has covered Washington, D.C. since 2004, focusing on military personnel and veterans policies. His work has earned numerous honors, including a 2009 Polk award, a 2010 National Headliner Award, the IAVA Leadership in Journalism award and the VFW News Media award.

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