In a budget change proposal (BCP) submitted in early January around the time of Gov. Gavin Newsom’s proposed 2023-2024 Fiscal Year state budget, the California Department of Veterans Affairs (CalVet) requests $2.5 million, with rounding, from the General Fund in FY 2023-24 for “the fourth year of implementation of a new long-term care electronic health record system in the Veterans Homes of California and headquarters.” Implementing a new electronic health record that can be used “across all veterans’ homes” is part of a larger goal to enhance operational effectiveness and maximize veteran service, found in the department’s 2018-20 Strategic Plan. Find Industry Insider — California’s September One-on-One interview with CalVet Chief Project Director and Electronic Health Records Project Director Carlos Chavez here. Among the takeaways:
- The California Electronic Health Record (CEHR) Project formally launched March 18, 2020, when CalVet and Netsmart formally entered into a pact to implement the latter’s LTC EHR solution at all veteran homes and headquarters in a “three-phased approach over a two-year period.” The COVID-19 pandemic, however, “significantly impacted” operations, with limited access to homes to protect residents; statewide emergency telework for state staffers; unavailability of subject matter experts (SMEs); and delays of deliverables. CalVet’s risk and issue management team accepted Issue 62 in April 2020, which “acknowledged the severe effects of the COVID-19 response” on SMEs and especially clinical staff who were unable to participate at the height of the state’s COVID response. The project continued through 2021 with most CalVet headquarters staff on telework. A 2021-22 BCP delivered a “one-time augmentation of $10 million” from the General Fund and enabled the “implementation and go-live of Netsmart’s LTC EHR at the homes.” Two special project reports ultimately detailed progress and ongoing needs, though following the first, project scope was unchanged, albeit with additional time for activities including “discovery, business process alignment reviews, testing activities” between vendor and CalVet, and training. Chavez said in September that it will “ensure uniformity, accountability and reliability across all veterans homes, while improving the levels of care provided to California veterans” and identified its biggest achievement to date as the implementation and rollout of OrderConnect. This, he said, is “a module within our new EHR system that allows CalVet pharmacies to accept electronic prescriptions.” In April 2022, CalVet announced the deployment of e-Prescribe, a new software system to streamline the prescription process for the then more than 1,700 veterans and spouses at eight homes statewide.
- Two business goals in CalVet’s 2021-23 Strategic Plan continue to emphasize the aims of CEHR as providing the highest quality of care and services for veterans and their families, and investing in CalVet’s workforce and enhancing its “operational effectiveness” to do so. The $2.5 million sought specifically includes $1.8 million for the projected payment on CalVet's Netsmart contract; $447,000 for independent project oversight/California Department of Technology (CDT); $195,000 for independent verification and validation from Ten Consulting; and $99,000 for FrameworkERX software licensing for an interface platform, all with rounding. The project has continued despite COVID, deploying e-Prescribe earlier than initially planned as a standalone. However, completing user acceptance testing, data conversion and migration, and addressing “the complexity of the interface configurations” will, per the BCP, “increase the project timeline by an additional 13 months.” Now in its second phase, which will provide “additional functionality” at the first three homes implemented, the project’s third phase will cover 2023-24, with “full implementation with enhancements” at homes in Chula Vista, Barstow, Yountville and Redding. The project is slated to wrap in calendar 2024 with implementation July 1 at the Fresno home. When that happens, CalVet will have a fully paperless electronic health record and standardized health record processing across eight homes; standardized physician order entry; compliance with regulations and accessibility needs including Health Insurance Portability and Accountability Act privacy rules; accurate billing; and participation in the Health Information Exchange.
- CalVet recommends approval of the BCP as submitted, which it notes would result in a one-time increased cost to the General Fund, but it does offer three alternatives. The first would decommission existing EHR solutions including “standalone OrderConnect functionality” and put paper-based processes in place. This wouldn’t cost the General Fund anything but would mean the department would no longer follow Assembly Bill 2789’s mandate that health-care practitioners send and receive electronic prescriptions after Jan. 1, 2022, and would be fined. It would also implement all paper-based processes and invalidate the money and time spent standing up the EHR at the first six homes. The second alternative would apply funds to the existing EHR solutions but wouldn’t complete the CEHR’s third phase. This would mean only six homes would have the new CEHR, information security would be reduced, CalVet would move “further away from CDT’s ‘Cloud First’ policy and Vision 2023,” and there would be an “inability to complete and close out the CEHR project.” The third alternative would discontinue the project and have the homes continue their current operations with paper and some EHR solutions including OrderConnect. This, too, would bring increased cost to the General Fund, wouldn’t complete the electronic health record project, and,, given the increased number of disparate existing electronic solutions, would reduce standardization.
