VA Electronic Health Record Rollout Unlikely to Resume for a Year After Being Derailed by Problems

The Department of Veterans Affairs said Wednesday it may resume agency-wide adoption of its new electronic health records system next summer, after it was placed on hold in April due to problems involving patient health and safety and frustration among users.

VA officials told members of Congress that introduction of the Oracle Cerner system across 166 additional hospitals could resume in 2024 if the department makes progress on several goals, including a successful rollout in March at the Captain James A. Lovell Federal Health Care Center in Illinois.

The House Veterans Affairs Committee and a House Appropriations subcommittee scheduled hearings this week to receive updates on what originally was supposed to be a $10 billion Oracle Cerner Millennium records system, now used at just five VA sites in the Pacific Northwest and Ohio.

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The department is aiming to build a system that is user-friendly to staff members and veterans, has no negative impact on operations, and performs 100% of the time, Dr. Neil Evans, acting program executive director at the VA Electronic Health Record Modernization Integration Office, told members of the House Appropriations Military Construction, Veterans Affairs and Related Agencies subcommittee.

"The path to restarting is to sustain a positive trajectory. We do not need to get to perfection," Evans said. "On those metrics to exit the reset, we need to see a positive trend improvement in productivity, improvement in user adoption and satisfaction, and improvement in the right direction with regards to technical reliability, which by the way, we're already starting to see."

The system was first introduced in October 2020 at the Mann-Grandstaff VA Medical Center in Spokane, Washington, and its affiliated clinics. Almost immediately, it drew criticism from medical providers for its complexity, but also led to delays in care and safety risks for patients.

Its use was expanded to the VA Walla Walla Health Care System in Washington, as well as medical centers in Columbus, Ohio, and Oregon in 2022.

In November 2022, lawmakers raised concerns that two veterans may have died as a result of the system's complexities -- one who never received a needed medication because of issues with prescription tracking in the system and another who missed a medical appointment but received no follow-up because the system didn't properly record the skipped appointment.

Following reviews by the Government Accountability Office and the VA inspector general that found hundreds of issues with the system, VA leadership decided to halt further deployment until the problems were resolved.

The VA is working with Oracle Cerner, which also provides the electronic health records system MHS Genesis to the Defense Department, to improve operations at the sites where it is being used and to streamline the system to make it more user-friendly and not as complicated to learn.

Among the problems that must be addressed before the system goes live elsewhere, according to VA and Oracle leaders, is "change management" -- alleviating the system's frustration and complexity among users who have spent careers utilizing the VA's current electronic medical record system, Vista.

"They can almost do [Vista] in their sleep," Evans said. "Moving to a different system is a change, a significant change, and that change management, I think, has been one of the larger challenges."

Nonetheless, the system is being tweaked, including 270 changes to make it easier to use, according to officials.

"The feedback around the training, the metrics, were unacceptable and frankly embarrassing," Oracle Global Industries Executive Vice President Mike Sicilia said during the hearing. "You don't have to learn to use many IT systems these days. It should be fairly intuitive. That said, there are specialty workflows ... that do require some training, but I think you'll see us move to a just-in-time or iterative model rather than an extended, elongated training."

VA officials said that with a joint system that allows VA and DoD providers to view both departments' medical records, along with roughly 90% of records at civilian hospitals, veterans are getting the benefits of a comprehensive electronic medical records program.

But lawmakers remain frustrated over the cost, which included a $1.86 billion request in the fiscal 2024 budget.

"This is dangerous on two fronts: People are dying, and it's costing taxpayers money. Not a little bit of money, a lot of money," said Rep. Tony Gonzales, R-Texas, a retired Navy master chief petty officer.

Evans said the VA is committed to the program and will make it work.

"The department is committed to moving forward as part of the federal electronic health record, in partnership with the Department of Defense. ... There is value in doing this together," Evans said.

"I sure hope so," said Subcommittee Chairman Rep. John Carter, R-Texas. "We have been in this for a long time."

– Patricia Kime can be reached at Patricia.Kime@Military.com.

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