WASHINGTON, DC — According to VA, at least one aspect of its new Oracle-Cerner electronic health record (EHR) system is showing demonstrable improvement–a reduction in the number of times the system as a whole has been offline and inaccessible.
As of Nov. 8, 2023, the system had gone six months without an outage and had 100% availability in 10 of the previous 12 months. This is compared to its first year of operation, where the initial pilot site–the Mann-Grandstaff VAMC in Spokane–experienced 48 outages, half of them full system failures.
Despite this improvement, a recent survey of front-line employees at the five sites where the system is live shows only 26% of staff say the system was always online and available when needed.
“Complete nationwide outages have become less common over the past year, but crashes, hangs or errors that affect one facility, one module, or one person are still widespread,” declared Rep. Matt Rosendale (R-MT) at a recent VA Technology Modernization Subcommittee hearing. “Ultimately, it’s the user’s experience that counts, and they are not happy.”
The survey, conducted by KLAS Research, an independent healthcare IT research company, also found that only 10% of staff said that the new EHR enables them to deliver high-quality care.
VA Chief Information Office Kurt DelBene acknowledged that, while the lack of full system outages is a big accomplishment, it does not discount more localized outages and delays.
“To be sure, we’re still experiencing partial system failures that impact the users,” he told lawmakers. “We [call this] incident-free time (IFT) which captures the time that the system performs without significant end-user problems. While it’s improving, it is not yet meeting the surface level agreement of 95% IFT on a regular basis. As of Sept 30, 2023, Oracle has reached this metric only four of the last 10 months.”
Problems like this are to be expected with an EHR that is being changed as regularly and rapidly as VA’s new system, DelBene said. “Systems stabilize when the rate of change made to the software decreases. The rate of change is still very high, resulting in more incidents than we would like.”
Complicating matters is the fact that some of those changes represent the first time that particular functionality has been included in a health IT system.
“VA has requested functionality that has never been implemented commercially, such as the integration of VA’s outpatient mail pharmacy, making VA the first user of this functionality, which also increases incident risk,” DelBene explained.
Rosendale interpreted this on-the-fly innovation less generously.
“Unfortunately, Oracle is using taxpayers’ money for its own research and development mechanism,” he declared. “These companies hold themselves out to be the experts in the field…and yet we’re being used as an experimental lab. And the taxpayers are funding it and the veterans are the ones shouldering the problem.”
In April, VA put a hold on all future deployments until it could address problems at the existing sites. However, the department is still set to deploy the system at the James A. Lovell Federal Health Care Center in Chicago in March. The facility is unique in that it’s jointly operated by VA and DoD, which is nearly finished with the deployment of its own version of the Oracle-Cerner EHR.
Asked how confident VA and DoD were that the EHR would be ready to be deployed at Lovell, Bill Tinston, director of the Federal Electronic Health Record Modernization (FEHRM) Office at DoD, said their confidence was “very high.”
“It’s the highest it’s ever been, and it’s improved every day in the last year because we are working on a daily basis with the leadership team that delivers care at [Lovell],” he said.
He acknowledged that as a joint VA-DoD facility, Lovell presents unique challenges, but noted that the facility has faced those challenges from its creation.
“The problem is different at James A. Lovell,” Tinston explained. “It’s an organization led by the VA that was asked about a decade ago to work in an integrated fashion supporting both VA beneficiaries and DoD beneficiaries out of one common facility. We didn’t equip them with the right IT tools to do that. They use at least three different EHRs trying to create integrated care delivery at that facility. We’re working to solve that problem. We work every day with the director of that facility to make sure we’re solving those problems, and we’re ready for go-live.”