The U.S. Department of Veterans Affairs eliminated several electronic health record modernization contracts amid a larger cutback earlier this month. Some canceled work under the Veterans Health Administration’s Integrated Healthcare Transformation program could directly affect system improvements that ensure patient safety.
Veteran-owned businesses
The VHA initially received multiple bids for the potential 10-year, $1 billion transformation support contract in 2020 – and selected companies such as Aptive HTG, HRS Consulting, RB Management Consultants, Sierra7, Titan Alpha and Trilogy Federal to work on the project.
As of this week, all these companies appeared with multiple contracts receiving a “Notice of Termination for Convenience” dated March 4 in a search of all contracts awarded by the VA under the Integrated Healthcare Transformation program since September on USASpending.gov.
The 2006 Veterans Benefits, Healthcare and Information Technology Act requires the VA to use veteran-owned small businesses, both service-disabled and otherwise, for certain contracts.
Aptive Resources is a veteran-owned and woman-owned management consulting firm. Along with Trilogy Federal, Titan Alpha and the others with canceled EHR transformation support contracts, all are service-disabled and/or veteran-owned small businesses.
According to documents obtained by Federal News Network, which broke the story that the VA cut support work for the EHR program on Wednesday, six service-disabled, veteran-owned small businesses were part of the VA’s recent purge of 585 non-mission-critical or duplicative contracts, announced March 3.
Key EHR data integration fixes
A source reportedly told FNN that advisors from the Department of Government Efficiency, or DOGE, and lawmakers who oversee the VA are not communicating about cuts to the EHR modernization program and the affected companies have already been forced to lay off staff.
“The groundwork, and all the other work, is being done by this contract support team,” the source told FNN. “Right now, they’re just trying to do damage control. It’s inevitable, I hate to say this, but when this impacts a veteran, and somebody loses their life, that’s when the fire alarm is going to ring.”
The agency previously said that mission-critical contracts were exempt from the reductions it made earlier this month, and the $900 million saved by canceling this round of contracts is just the first step in the audit of the VA’s nearly 90,000 contracts worth more than $67 billion. The VA said it would redirect savings from the canceled contracts to healthcare, benefits and services to its beneficiaries.
“Among the contract cancellations announced today are those that paid contractors to generate ‘contract deliverables’ for other contractors to fulfill,” the VA had said.
“Other canceled contracts cover administrative services that VA can perform on its own, such as staff mentoring, leadership coaching, preparation of meeting agendas and meeting minutes, as well as services such as ‘executive support’ that involve creating PowerPoint slides.”
Meanwhile, projects such as the VHA’s Healthcare Identity Management Program, which safeguards patient and beneficiary identity data, could be in jeopardy with its VHA Integrated Healthcare Transformation contract included in the purge.
Aptive was unable to discuss the canceled contracts “due to provisions in our contractual agreements,” a spokesperson for the company said Thursday by message. But a case study posted to the company’s website in January details its extensive role in ensuring the integrity of the nation’s largest integrated health system.
Because the VA EHR uses the Department of Defense’s Defense Enrollment Eligibility Reporting System as the authoritative source of identity information and the DoD Electronic Data Interchange Person Identifier as the unique identifier for the shared EHR, data accuracy is essential to correctly identify patients and link clinical records before care is delivered to veterans.
VA’s Master Person Index is a database with more than 75 million unique entries populated from patient and beneficiary databases at VA facilities nationwide.
The company said it was addressing inconsistencies in integrating the VA’s and DoD’s data elements. For example, including both DoD and VHA sites in the provider list has resulted in VHA Message Center orders being sent to DoD providers rather than the appropriate VHA provider, “risking patient safety unless erroneous orders are identified and correctly redirected.”
To correct the patient order errors, VHA contracted with Aptive directly to support all aspects of error identification, resolution, reporting and workflow redesign, the company said.
“There are major differences in the identity data between VA and DoD that must be addressed before data migration,” Aptive said in January.
“Although significant progress has been made in reducing the number of identity issues shared between VA and DoD, tremendous numbers of anomalies remain that will likely require manual analysis, which are beyond the ability of the existing [identity management program] team to successfully resolve according to schedule,” the company said.
Under the extinguished contract, Aptive audited procedures and identified system errors, detailed tracking of data message redirection and corrections, redesigned the workflow to halt potential errors and managed the reporting and tracking of initial data errors and corrections “as required by statute.”
Healthcare IT News reached out to the VA Thursday about the non-mission-critical or duplicative status of Aptive’s and others’ contracts and was asked for specific contract numbers. Details on 82 of the VHA Integrated Healthcare Transformation program awards terminated on March 4 were provided.
The agency said it is reviewing the request for information. When and if it provides comments or clarifications, this story will be updated.
EHR modernization progress incremental
The lack of interoperability between the DoD and VA has been a stumbling block for the EHR system since early predeployment delays in 2020.
In 2022, the VA Office of Inspector General found 149 instances of patient harm related to an element of the Oracle Health EHR known as the “unknown queue.” Incomplete routing information had failed to alert VA clinicians in several cases.
The VA’s watchdog has performed several audits and provided numerous recommendations to prevent, respond to and mitigate the impact of major performance incidents on VA care delivery operations and patient safety over the last few years.
The Government Accountability Office said Feb. 21 that while the VA’s EHR Modernization Program had made incremental improvements to the system during the most recent pause on rollouts, there’s much more to be done to eliminate risks to veterans in the VA’s care. The office added three new recommendations for cost estimating, schedule and system metrics, bringing its total recommendations to 18.
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.