House VA Committee Chairman, Rep. Mark Takano (D-CA)
WASHINGTON, DC — All upcoming deployments of VA’s new electronic healthcare record system will be halted until at least June 2023, the agency announced. This is in response to continuing issues with the system at its pilot site in Spokane, WA, as well as the handful of sites that followed.
“Right now, the Oracle Cerner electronic health record system is not delivering for veterans or VA healthcare providers, and we are holding Oracle Cerner and ourselves accountable to get this right,” said Deputy VA Secretary Donald Remy, JD. “We are delaying all future deployments of the new EHR while we fully assess performance and address every concern. Veterans and clinicians deserve a seamless, modernized health record system, and we will not rest until they get it.”
In July, VA Secretary Denis McDonough announced that the department was scrapping all deployment plans in the 2022 calendar year. A subsequent VA investigation found lingering problems, as well as new technical and system issues. According to VA, the department is moving to an “assess and address” mode where it will correct ongoing issues, particularly those impacting patient safety, before moving to new deployments.
The department also will send letters to every veteran it believes has been affected by the challenges in getting the system up and running. This includes patients who have experienced delays in medications, appointments, referrals and test results, some of whom may have experienced direct and indirect patient harm as a result of system errors.
While Congress has been frustrated by the continued delays with VA’s $16 billion project, legislators have been more concerned by the cascade of reports from the VA Office of the Inspector General, the Government Accountability Office, and VA itself detailing failures in the new system. Republicans and Democrats in both houses have long urged VA to call a halt to the rollout until all of these problems can be resolved.
Veteran Safety
“I support VA’s plan to further delay EHRM go-lives until the system can be made safe for veterans,” said House VA Committee Chairman, Rep. Mark Takano (D-CA). “Patient safety should be the guiding principle for this program. However, it is clear this program was not given a foundation for success. I have been concerned from the very beginning that the sole-source nature of this contract, the lack of market research, misunderstandings about interoperability and incomplete requirements development under the Trump administration led to the situation VA is currently in.”
Takano’s counterpart in the Senate, Sen. Jon Tester (D-MT) echoed that sentiment.
“The new EHR simply cannot be deployed before its ready for prime time,” Tester said. “When it comes to delivering the quality healthcare our nation’s veterans have earned, we have to hit the mark the first time around. That’s why I’ll continue holding VA and Oracle Cerner’s feet to the fire in fixing system-wide issues so existing facilities and any future rollouts guarantee VA healthcare staff have the tools to provide veterans safe, timely care.”
The EHR pilot was launched at the Mann-Grandstaff VAMC in October 2020. Categorized as a “small” facility since it has fewer than 100 beds, it was considered to be a relatively safe place to kick off VA’s largest-ever IT infrastructure project.
As soon as the EHR went live, staff began encountering problems. Functions that had been simple with the old system were unavailable in the new one and required time-consuming workarounds. Due to incomplete training, there were aspects of the system that were poorly understood. One of those aspects resulted in the redirecting of physician orders into an inaccessible file, where they laid unfilled. The VA OIG eventually found that nearly 150 adverse events resulted from this rerouting.
In its first year and a half of being online at Spokane, the EHR crashed–either partially or in full—over 50 times.
Despite the continuing problems at Mann-Grandstaff, the rollout continued in March 2022, with the Jonathan Wainright VAMC in Walla Walla, WA, also considered a “small” facility. Less than a month later, it went live at the VA Central Ohio Healthcare System, considered a “medium” system, with 100-300 beds. Then it was on to the Roseburg VA Healthcare System in Oregon (a medium system) and the VA Southern Oregon Rehabilitation Center and Clinics, a large system with more than 300 beds.
VA assured Congress that it was learning from mistakes made in Spokane and working with Oracle-Cerner to correct the problems. However, the second-wave facilities also reported issues, and outages continued to occur.
Shortly after being confirmed as VHA undersecretary, Shereef Elnahal, MD, visited the Columbus site and was faced with many of the same complaints from facility staff that had been voiced in the early months of the Spokane rollout.
Next up on VA’s deployment schedule are VAMCs in Boise, ID; Saginaw, MI, and Ann Arbor, MI, before moving back to the Northwest for Tacoma, WA, and Seattle.