Ongoing issues cause delay in VA EHR modernization

The Department of Veteran Affairs (VA) has postponed the Oracle Cerner Electronic Health Record (EHR) implementation until June 2023 after the system has repeatedly failed to meet expectations. 

Rep. Matt Rosendale (R-Montana) has been a critic of the new EHR system stating, “The Oracle Cerner electronic health record program is deeply flawed – causing issues for medical staff and posing significant patient safety risks. 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.” 

Rosendale introduced the VA Electronic Health Record termination bill (HR 608) in late January that would prevent the VA Secretary from carrying out the EHR Modernization Program and: 

• Abolish the EHR Modernization Integration Office 
• Move remaining responsibilities to the Veterans Health Administration or Office of Information and Technology of the Department of Veterans Affairs 
• Revert all EHR systems back to the VA’s original EHR, VistA 
• Stop the Secretary from further EHR implementation or contract option exercising under the modernization program. 

So far, the VA has spent $5 billion to integrate the Oracle Cerner EHR system at only five of 171 medical centers across the U.S. since 2018. 

The VA originally agreed to a $10 billion contract to implement the Oracle Cerner EHR system, but the cost later ballooned to $16 billion. Nonprofit Institute for Defense Analysis estimates the new EHR system rollout would cost $39 billion in 13 years.

Related article: Is it possible to achieve Oracle’s vision for a national EHR database?  

House member proposes alternative bill 

Rep. Mike Bost, R.-Ill., has proposed the VA Electronic Health Record Modernization Improvement Act, which would require VA and Oracle Cerner to “demonstrate significant improvements in the EHR system” before implementing it in additional centers. 

“Specifically, each VA medical center’s director, chief of staff, and network director would be required to certify that the EHR system has been correctly configured for the site, the staff and infrastructure are adequate to support it, and it would not negatively impact safety, quality, or current wait times.”  

Ultimately, the act will “ensure that VA medical centers are confident in their ability to maintain a high level of care before they make the transition to the Oracle Cerner EHR system.” 

Both bills were referred to the House Committee on Veteran’s Affairs on Jan. 27, then sent to its Subcommittee on Oversight and Investigations in mid-February.  

Oracle Cerner’s rocky start 

The VA Office of Inspector General found 149 events of patient harm due to technical errors, per their report published in July 20222, and that from October 2020 through June 2021 the EHR “failed to deliver more than 11,000 orders for requested clinical services. 

Related article: VA slows EHR modernization to rework operational issues 

One of the highest concerns was the EHR’s “unknown queue” which left medical requests in virtual no-man’s-land resulting in two patients’ death.  

The causes were straightforward and preventable. In one case, a man waited on an antibiotic prescription that never came because “the electronic health record provided erroneous tracking information for the prescription,” said Bost and lawmakers. The patient later died from hypoxia.  

In another case, a patient missed an appointment and no one from the hospital attempted to contact the patient to reschedule. His health rapidly declined, and he “returned to the VA urgent care with alcohol withdrawal symptoms” and died shortly after.  

Oracle claims new EHR is better than what VA had before 

If the VA hospital chose to not move forward with the rollout, they would revert to the system they have had since the 1980s, VistA. Oracle Executive Vice President Ken Glueck claims “veterans deserve better.”  

Glueck claims the interoperability issues stem from the fact that VistA was never created to be used with the internet, and to upgrade the system has required varied and detailed attention because “there is no single set of source-code from which to work.”  

He also claims that the rollout will be better now that Oracle took control of Cerner in June 2022.  

Currently, the Oracle Cerner EHR rollout has been delayed until June 2023.