Implementing a new Cerner electronic health record (EHR) system through the Veterans Administration (VA) system will involve 48 “deployment waves” beginning in 2019 and ending in 2027, according to a Cerner presentation at the HIMSS18 conference in Las Vegas.

In an investor community meeting, Cerner executives said the VA project has boosted the company’s growth expectations, both in the near-term and “core” categories and a “critical part” of the health IT giant’s business which, along with the ongoing rollout at the U.S. Department of Defense (DOD), “need to be successful.”

“I think that VA reflects a slightly higher expectation for core growth as that contract will grow over time and basically offset any flattening that you might expect as that EHR market continues to mature over that time. So that is actually a great bridge for us as we work our way to 2025,” said Cerner CFO Mark Naughton.

Cerner had previously said implementation at the VA would follow the rollout of MHS Genesis at the DOD, which executives said at HIMSS18 has completed the pilot stage and is now in an “optimization” stage—not a pause, argued said Cerner’s federal government senior vice president and general manager Travis Dalton—ahead of full deployment starting in May.

The VA implementation will follow the same path as the DoD rollout, Dalton said, beginning with the Pacific Northwest, which may go live with the Cerner platform in the fourth quarter of 2019.

“We're using a programmatic approach,” he said. “So the hard-earned lessons from DOD are being applied to the VA. The solution that we have in place today for DOD will form the baseline for VA. So about 80 percent of everything that we're going to put in for the VA is already live with DOD. And then the VA in turn for things that they want to implement that DOD didn't, for example, cardiology, they are going to actually create the baseline and then the DOD will benefit from that work.”

Dalton said the new system has resulted in improvements at the first sites to go live, including avoiding duplicate orders. Health IT specialists and physicians involved told a different story to POLITICO, saying technical glitches and poor training caused dangerous errors, slower care, with one saying, “We took a broken system and just broke it completely.”

Cerner’s existing contract with the DOD has been cited as a major reason why it was given the VA contract without going through a competitive bidding process. No deal has been signed, however, over concerns about interoperability with the DOD system, a conversation Dalton said the company welcomes as “the best opportunity to demonstrate Cerner’s leading position as it relates to interoperability in the market” by bringing together the VA’s 130 “disparate” systems.

“We're going to connect the VA and the DOD,” Dalton said. “So seamless record from the time you enter to the time you leave and into the VA system. We're going to connect to the community providers. So we're working closely … with the VA, [PricewaterhouseCoopers,] Harvard, Yale, Stanford, a number of Cerner clients, where we're all going to work with the best interest of our veterans on interoperability.”

The entire project is slated to be completed in 2027, when the final VA care site goes live in its 48^th deployment wave. In contrast, the DOD rollout is expected to be done by 2020 after 23 waves.

As far as contract negotiations go, Dalton said the company is pleased where it stands as Congress begins the appropriation process for the fiscal year 2019. VA Secretary David Shulkin, MD, had said in his own HIMSS speech that contract talks had been stalled over the interoperability issues, leading to “extremely productive” work with the industry.

"This is too big of an opportunity, too big of a contract, too important to our veterans and the country, not to get this right,” Shulkin said.