Banks Asks VA to Adopt Modern Appointment Scheduling System
Congressman Jim Banks (IN-03), Chairman of the House Veterans’ Affairs Subcommittee on Technology Modernization, last week sent a letter to the Department of Veterans Affairs (VA) Acting Deputy Secretary James Byrne urging a decision about adopting a modern appointment scheduling system. Read the full letter here and below:
December 14, 2018
The Honorable James Byrne
Acting Deputy Secretary
Dear Acting Deputy Secretary Byrne:
In the coming days, my understanding is that VA will be complying with the requirement of H.Rpt. 115-929 and announcing a decision as to how the nationwide implementation of a modernized medical scheduling system will be accelerated. I share the Appropriations Committee’s interest that such a scheduling system, meaning one that is resource-based, permits comprehensive veteran self-scheduling, and is accessible on multiple platforms, reaches all Veterans Health Administration facilities as quickly as possible. Without a doubt, scheduling is one of the most archaic VistA modules. These scheduling inefficiencies and a serious lack of internal controls created the environment resulting in the veteran wait list crisis, revealed in 2014. Four years later, a significant infusion of staffing and community care resources has reduced wait times in many states, but VA has only implemented the modest VistA Scheduling Enhancement (VSE), intended to be a temporary improvement.
While all available information indicates VA’s pilot of the Epic Cadence scheduling system in Columbus, Ohio has been successful, my understanding based on testimony from and conversations with Department leaders is that VA’s preference is to implement the Cerner Millennium scheduling package, because it has either already been purchased or a commitment has been made to purchase it. If that is the case, accelerating the nationwide implementation would entail decoupling scheduling from the rest of the Electronic Health Record Modernization (EHRM) program’s timetable.
It is extremely frustrating that previous VA leaders awarded the Medical Appointment Scheduling System (MASS) contract in 2015 to deploy Epic Cadence but stopped and started it repeatedly, at one point announcing that a resource-based scheduling system was unnecessary and VSE was sufficient. When MASS was allowed to proceed, it was structured in an excessively slow and expensive manner, which had the effect of making it appear unfavorable when compared to VSE. Even the companies performing the MASS contract have expressed their opinion that it could be carried out more quickly and at lower cost. It seems if Epic Cadence’s implementation had been unimpeded it could have been nearly complete by now.
Nonetheless, I am encouraged that VA will soon decide on a final course of action. My concern is that the decision be based on an apples-to-apples comparison and its effects be fully explored and communicated. To that end, I request answers to the following questions by the report’s 90- or 150-day deadline, whichever is applicable:
1) Regardless of which scheduling system is ultimately selected, how will its resource-based capabilities be used to increase efficiency, reduce wait times, and make better use of health care resources? What metrics will be put in place, and how will results be measured?
2) How much does the Cerner Millennium scheduling package cost? If it is not severable from a larger software package, how was that determined, and how much does that software package cost? Please separate software licensing costs from implementation costs.
3) How would a decision to decouple scheduling from the rest of the EHRM implementation affect the program’s cost estimate and integrated master schedule, in the initial sites and beyond?
4) How much would it cost to deploy the Cadence scheduling system according to the accelerated timeline contemplated for the Cerner Millennium scheduling package, instead of the original timeline and notional scope of work in the MASS contract?
5) Would there be meaningful schedule differences in an accelerated Cerner scheduling implementation compared to an accelerated Epic scheduling implementation? If so, please compare the two schedules and explain why.
6) Has VA considered publishing scheduling resources in conjunction with its recently launched FHIR server?
Regardless of the decision, I encourage you to retain Epic Cadence in Columbus, Ohio over the medium term. Time and money have already been invested to implement it, and by all accounts it is functioning well. Perhaps more significantly, the MyChart patient portal which was implemented along with Cadence could serve as a valuable interoperability test bed at little or no additional cost. Community health systems in Columbus have already joined VA’s Open API pledge. Given VA’s recent launch of its FHIR server, this is an opportunity to make Cerner data formats and elements available via open APIs to accelerate FHIR-based interoperability services, including scheduling.
Thank you for your commitment to solving this longstanding problem. If you have any questions about this request, please do not hesitate to have your staff contact Mr. William Mallison, Majority Staff Director of the Subcommittee on Technology Modernization at (202) 225-3527 or firstname.lastname@example.org.