VA Secretary Denis McDonough spoke recently at the Congressional Gold Medal Celebration for the 6888th Central Postal Directory Battalion. About a week later, in response to questions about the agency’s electronic health record rollout, he said his confidence had been shaken. Photo from the Office of the Secretary of Veterans Affairs Twitter feed.
SPOKANE, WA — The VA has paused any further expansion of its new electronic health record (EHR) in reaction to an early draft of a VA Office of the Inspector General (OIG) report documenting negative impacts to patient care caused by the system’s launch in Spokane.
A copy of the draft report was obtained by the Spokane newspaper, The Spokesman-Review, which reported on it on June 19.
According to the article, VHA patient safety experts found 148 cases where flaws in the EHR caused harm to patients, and that Cerner, the manufacturer of the system, knew about the flaw but failed to fix it prior to the system’s launch at the Mann-Grandstaff VAMC in October 2020. The newspaper reported that, according to the draft report, the system failed to send over 11,000 orders for specialty care, lab work and other services, without informing providers that the orders had failed to go through.
Upon release of the story, VA leaders called a halt to the department’s plans to launch the system at other sites in Washington and Oregon until 2023 and delayed a planned June launch in Boise, ID, until July.
In recent months, VA Secretary Denis McDonough has testified at numerous congressional hearings that issues with the system were being resolved and that the EHR was safe to launch at future sites. At a press conference on June 22, McDonough admitted that recent revelations of flaws in the EHR have “shook my confidence in the system.”
“If I had known what I know today when I was appearing before Congress, I would have answered those questions differently,” he declared.
While McDonough was careful to neither confirm nor deny the contents of the draft report, he said that VA was being constantly updated on incidents of patient harm.
“This goes to one of the innovations that we’ve insisted on in the last couple of months, which is a weekly meeting between the OEHR team and the VA Patient Safety team,” he explained. “Those [patient safety] communication and reports should be flagged at all levels. I think that it is now, and I’m gratified by that, and I think it’s impacting the performance of the system at other sites, but we’ll wait to see what the experts say about that.”
Asked what VA’s fallback option is, should the rollout of the Cerner EHR ultimately fail, McDonough said that he was not ready to think about failure yet.
“We’re right now trying our darnedest to make the Cerner option work,” he said. “Because I think we all know that the best thing for patient outcome, for patient safety, for clinician practice and for healthcare objectives has been shown in system after system across the country to be a well-functioning electronic health record. This is the option we had when we arrived. We’re executing as diligently as we can, as transparently as we can. But I’m not ready to answer hypotheticals about if this doesn’t work, what happens next.”
If the final version of the OIG report resembles the leaked draft, it will again place much of the blame on Cerner, which was recently acquired by Oracle in a $28 billion deal. Several previous OIG reports have documented failures by Cerner to address system flaws prior to launch, and failures in the company’s ability to provide to VA staff following the launch.
“[Cerner] has a very generous contract awarded several years ago to provide a workable EHR. And that’s what we’re holding them accountable to,” McDonough declared.
Legislators, who have been clamoring for VA to halt the rollout until all of the system’s problems have been addressed, were more direct in suggesting that the federal government might seek legal remedies if it’s determined that Cerner is in breach of contract.
“During our last hearing on April 26, we requested that VA halt go-lives at Level 1 facilities and subsequently wrote to VA demanding additional information on patient safety risks,” said Rep. Mark Takano (D-CA), chair of the House VA Committee and Rep. Frank Mrvan (D-IN), chair of the VA Subcommittee on Technology and Modernization in a joint statement. “We have already begun discussions with VA on the performance of Cerner and requested an official briefing on the forthcoming report. Once released, we will be reviewing the findings closely in order to determine if there are any contractual or legal repercussions of these draft findings.”
The EHR contract awarded to Cerner in 2018 was originally priced at $10 billion, with the project expected to take 10 years. That number has since ballooned to $16 billion, with an estimated $2 billion that would be added to the final cost for every additional year the rollout is delayed.