Maj. Catherine Anderson, chief nurse for the 915th Forward Surgical Team, uses MC4, an electronic healthcare record system developed by the military, at the Medical Treatment Facility at Contingency Operating Base Basra., December 31, 2009. (U.S. Army/Pfc. J.P. Lawrence)
Maj. Catherine Anderson, chief nurse for the 915th Forward Surgical Team, uses MC4, an electronic healthcare record system developed by the military, at the Medical Treatment Facility at Contingency Operating Base Basra., December 31, 2009. (U.S. Army/Pfc. J.P. Lawrence)
WASHINGTON, DC — A group of Republican lawmakers has introduced legislation that would end VA’s Electronic Health Record Modernization Program. The bill is a response to the frequently delayed and problem-ridden rollout of the department’s new EHR, which the bill’s authors say is fundamentally broken and doing more harm than good to veterans.
Democratic leaders have called the legislation unsound and argued that the modernization of VA’s EHR system is a necessity for the department and its patients.
“The Oracle Cerner electronic health record program is deeply flawed—causing issues for medical staff and posing significant patient safety risks,” said Rep. Matt Rosendale (R-MT), one of the bill’s co-sponsors and the new chairman of the House VA Subcommittee on Technology Modernization. “We cannot continue to further implement this inadequate system at the expense of billions of dollars in government funding. We must hold the VA to the high standard of care promised to our veterans and be good stewards of taxpayer dollars.”
The bill was introduced in the House at the end of January and referred to the House Veterans Affairs Committee, where the legislation’s other co-sponsor, Rep. Mike Bost (R-IL), now serves as chairman.
The rollout of the new Cerner EHR, now branded Oracle-Cerner after Oracle’s acquisition of the company, began after numerous delays at the Mann-Grandstaff VA Medical Center in Spokane, WA, in October 2020. The new EHR was designed to allow easy interoperability with DoD’s own Cerner-developed system—a goal that VA and DoD have had for decades.
Flaws in the system and in the training of employees immediately became apparent and are still being corrected over two years later. Some of these glitches have had a direct impact on patients, including one that left thousands of lab requests sitting unfilled in a digital limbo. Multiple reports have been written by agency watchdogs detailing the flaws and what needs to be accomplished in order to fix them. Since then the system has also been installed at facilities in Walla-Walla, Ohio, and Oregon.
VA paused the rollout last summer and has since put a hold on any future installations until June 2023.
Rosendale and Bost said they believe the hold should become permanent. The text of the “Termination of Electronic Health Record Modernization Program” bill is short and clear. It would:
- Forbid the VA secretary from carrying out the VA EHRM Program;
- Abolish the EHRM Integration Office;
- Forbid the secretary from implementing any new expansion while the program’s termination is ongoing; and
- Require VA facilities that have already installed the Oracle-Cerner system to go back to the VISTA legacy system.
Senate VA Committee Chairman Jon Tester (D-MT) and former House VA Committee Chairman Mark Takano (D-CA.) have gone on record saying that the legislation is not a viable solution, that VA’s EHR needs to be replaced and that ending the Oracle-Cerner project without a viable alternative is misguided.
Those defending the EHR Program, as well as VA and Oracle-Cerner, say the problems with the system can be fixed to the point where the department and legislators would feel comfortable with continuing the installation process.
As a demonstration of the company’s faith in their ability to patch the system, Oracle-Cerner debuted a public-facing website last year that tracks the status of the high-priority issues that have been identified by Congress.
As of last month, the dashboard listed 8 of 20 issues as having been closed, three “in progress,” one “scheduled” and eight “in development.”
Should the effort to terminate the program fail, Bost also introduced legislation that would prohibit the VA secretary from commencing an EHRM Program activity at any facility until VA assured Congress that these issues had been fully resolved. It would also prohibit additional rollouts to any new sites unless the leaders of that facility ensure the secretary and Congress that the infrastructure is in place and the staff is properly trained.
In addition to the 20 areas defined on Oracle-Cerner’s dashboard, the legislation adds the additional objective that the system have a monthly uptime of 99.9% for four sequential months. The system has had major slowdowns or gone offline entirely numerous times since being installed at Mann-Grandstaff. One such slow-down occurred Jan. 23, 2023, when DoD ran an update on its system, which shares a server with VA’s. Bost’s legislation was submitted only a few days later.