A new patient portal was touted as part of the new federal electronic record rollout at James A. Lovell Federal Healthcare Center in North Chicago, IL. While there is agreement that the EHR is experiencing fewer problems there than at previous sites, some legislators pointed out that problems still exist. VA photo
WASHINGTON, DC — About six months ago, the James A. Lovell Federal Healthcare Center became the sixth VA site to switch to the Oracle-Cerner electronic health record (EHR). The only fully integrated joint DoD/VA healthcare facility, it was an exception to the overall pause that the EHR rollout has been on since October 2022.
The switchover did not come with the same severity of problems seen at previous sites, and VA officials have been lauding the installation as a success, saying it bodes well for future installations, once the rollout recommences, which it is expected to do in 2025. However, legislators have received reports of employee dissatisfaction and argue that the cost of ensuring the Lovell rollout went smoothly cannot be replicated at every VA facility.
“The committee has revisited James A. Lovell twice [since the rollout]. Employees are reporting the same frustration, hypervigilance and burnout that the managers at the other facilities testified about,” Rep. Matt Rosendale (R-MT) told VA officials at a recent VA House Oversight Subcommittee hearing. “They’ve managed to keep the doors open to provide care to the veterans and servicmembers, but only through the support of 100 new staff and [as many as] 100 more on the way. In addition, [they had] 800 experienced users from other military treatment facilities, contractors, and experts, pitching in immediately after the go-live.”
Officials from VA Central Office, Lovell, and Oracle-Cerner presented a unified picture of the rollout as a qualified success. The facility is in North Chicago, IL.
“It’s still too early to declare unequivocal final success, but results have been promising overall,” Neil Evans, MD, acting EHR Modernization Program director, told Rosendale. “There have been no critical patient safety incidents; Lovell FHCC maintained 100% capacity for its emergency room and inpatient bed census; [and] acute medical and ICU have returned to baseline.”
This stands in marked in contrast to other facility rollouts, where it took considerable time for some departments to regain full capacity after the EHR switchover.
As for whether this would be possible without the additional staffing resources, Lovell’s medical director, Robert Buckley, MD, said, “I think it’s necessary for being the first site to go live in a couple of years that we had those resources brought alongside of us to make sure it was successful. We are learning that, over time, the amount of staff that it will take will not be quite as large as was quoted.”
One component that continues to cause problems for all six facilities operating the Oracle-Cerner EHR is the pharmacy module. The system that providers order prescriptions through is currently not in sync with the system through which pharmacists fill the prescriptions. Facilities, including Lovell, have needed to bring on several additional pharmacists to complete the workarounds necessary to bridge this gap between the systems and get veterans their prescriptions in a timely manner.
Oracle-Cerner delivered upgrades intended to fix this problem in February but, after testing, VA found that they did not work as promised. Revised upgrades are now expected to roll out in February 2025.
Asked why there’s been such a delay in fixing one of the most frustrating bugs in the system, Oracle Executive Vice President Seema Verma said, “The way that the [VA] pharmacy operates is very different from what we see at most commercial sites, so it’s required some unique configurations.”
Rep. Mike Bost (R-IL) was less than satisfied with that answer.
“[When] Oracle made their purchase [of Cerner in July 2022,] they came into my office, and they had about three or four executives, a lot of the upper echelon. They said that, if a person tells you in this industry that they can’t fix a problem in six months, they don’t know what they’re doing. Those were their exact words,” he declared. “With the pharmacy [module], you’ve been working on it for 18 months.”
Legislators also are impatient for a revised life cycle cost estimate and are assuming that the project will far exceed the original $16 billion quote.
“Lovell is on track for a 7% staffing increase to mitigate the EHR impacts. Spokane medical center had to increase their staff by over 20%,” Rosendale said. “If the system was rolled out across the whole [VA], based on the current payroll, that would mean between $3.5 to $10 billion [for staff increase]. That’s on top of all the costs to purchase and implement the system.”
Evans testified that, without a deployment schedule, it’s difficult to provide a revised estimate, but that one will be delivered as the department moves toward restarting the rollout early next year.