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The Electronic Health Record Modernization Program Did Not Fully Meet the Standards for a High-Quality, Reliable Schedule

Report Information

Issue Date
Report Number
21-02889-134
VISN
State
District
VA Office
Electronic Health Record Modernization Integration Office (EHRM IO)
Report Author
Office of Audits and Evaluations
Report Type
Audit
Report Topic
Electronic Health Records Modernization (EHRM)
System Development and Implementation
Major Management Challenges
Information Systems and Innovation
Leadership and Governance
Recommendations
6
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary

VA is replacing its aging electronic health record system with a new one intended to be interoperable with the Defense Department to give healthcare providers a continuous and comprehensive medical history for veterans. The Electronic Health Record Modernization (EHRM) program is expected to take about 10 years to implement across VA facilities, with projected completion in fiscal year 2028. The Office of Inspector General (OIG) audited the EHRM program’s master schedule as part of its continued oversight of this costly and complex effort and identified reliability weaknesses. The audit team found VA lacked a reliable integrated master schedule consistent with scheduling standards, which increases the risk of missing milestones and delaying the delivery of a system to support prompt quality care to veterans. Schedule delays that extend the program are also likely to result in about $1.95 billion in cost overruns per year and may undermine VA’s other modernization efforts on supply chain and financial management systems. Additional deficiencies included known tasks not being reflected on schedules, no risk analysis, lack of longer-term actions scheduled, and no complete baseline schedule or overall schedule that fully integrated individual project schedules. VA also did not comply with federal regulations when it paid its contractor for deliverables before accepting them (reviewing for compliance with contract requirements). VA concurred with the OIG recommendations for the EHRM program office to comply with internal guidance and develop an integrated master schedule that meets standards, improve stakeholder coordination to ensure activities from all relevant VA entities are included, implement procedures for performing schedule risk analyses, make contract language and program office plans or other guidance consistent, evaluate and modify contract requirements for schedule management to clarify roles for further schedule development and maintenance, and issue guidance to accept deliverables not separately priced before invoice payment.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Open Recommendation Image, Square
to Electronic Health Record Modernization Integration Office (EHRM IO)

The executive director of the Electronic Health Record Modernization Program Management Office complies with internal guidance and ensures the development of an integrated master schedule for the Electronic Health Record Modernization program that complies with standards adopted from GAO for scheduling.

No. 2
Open Recommendation Image, Square
to Electronic Health Record Modernization Integration Office (EHRM IO)

The executive director of the Electronic Health Record Modernization Program Management Office takes action to improve stakeholder coordination in the development of the program schedules to ensure activities from all relevant VA entities are included.

No. 3
Open Recommendation Image, Square
to Electronic Health Record Modernization Integration Office (EHRM IO)

The executive director of the Electronic Health Record Modernization Program Management Office develops procedures for when and how staff should perform an initial schedule risk analysis for the program and conduct periodic updates as needed.

No. 4
Open Recommendation Image, Square
to Electronic Health Record Modernization Integration Office (EHRM IO)

The executive director of the Electronic Health Record Modernization Program Management Office ensures consistency between contract language and program office plans or other guidance identifying the entity or individuals responsible for developing and maintaining the program’s work breakdown structure and integrated master schedule.

No. 5
Open Recommendation Image, Square
to Electronic Health Record Modernization Integration Office (EHRM IO)

The executive director of the Electronic Health Record Modernization Program Management Office evaluates the contract requirements for schedule management and modifies as needed to ensure clear roles and expectations for further development and maintenance of the program’s integrated master schedule.

No. 6
Open Recommendation Image, Square
to Electronic Health Record Modernization Integration Office (EHRM IO)

The executive director of the Electronic Health Record Modernization Program Management Office complies with the Federal Acquisition Regulation and issue guidance to accept deliverables not separately priced before invoice payment.