WASHINGTON, DC — VA recently launched its new electronic healthcare record system in a third region, despite evidence of problems with previous deployments and strong objections from legislators and oversight groups.
VA’s EHR launch at the Central Ohio Healthcare System in Columbus occurred April 30. Reports from watchdog organizations have detailed extensive problems with previous deployments, and a series of system shutdowns have occurred in facilities already using the EHR. At the same time, legislators have been calling on VA to halt the rollout until all of the existing problems with the system are fixed.
Columbus is the third region to get the new Cerner-developed EHR. VA rolled the system out in Walla Walla, WA, in March of this year, and in Spokane, WA, in October 2020.
Over the last year and a half, the problems with the EHR at the Mann-Grandstaff VAMC in Spokane have been heavily documented by VA, the VA Office of the Inspector General and the Government Accountability Office. Problems with integrating the EHR into the hospital have resulted in staff needing to create time-consuming and inefficient workarounds in order to complete basic tasks, most notably in the hospital’s pharmacy.
Active medications have disappeared from the system, while physicians have had trouble getting new prescriptions to go through. This issue was brought into stark relief in April when it was revealed that a veteran was hospitalized with heart failure in the month before after the system failed to renew his medication.
The most recent report from the OIG is a joint audit of DoD and VA EHR interoperability. The DoD acquired Cerner’s Millennium EHR platform in 2015 with plans to roll the system out to all of its facilities by 2023. Hoping that using the same system would result in smooth interoperability between the two departments, VA purchased the platform in 2018, with a plan to roll it out to all of its facilities by 2028.
However, according to the audit, both departments failed to plan effectively for the rollout, and the effects of that failure can be seen most in the integration of patient data into the new system. Cerner’s system has 21 healthcare data domains. As of June 2021, DoD had migrated information for only six and VA only nine.
DoD failed to migrate inpatient and outpatient encounters, as well as patient demographics. Data such as lab results, radiology reports and inpatient and outpatient diagnoses were lacking from both departments.
DoD officials said they plan to migrate the remainder of the legacy patient health data only after the Cerner system has been fully deployed to all 490 DoD healthcare facilities. According to DoD officials interviewed by the OIG auditors, the department did not have an initial plan for migrating the data because they did not have the tool needed to transfer the data and had not determined which data needed to be migrated in the first place.
VA officials say they will migrate five more of the 21 data domains eventually, but could not provide an expected date for doing so. For the remaining seven domains, VA is still determining where in the Cerner system that data can be stored.
The audit also found that the departments did not develop interfaces to connect all of a facility’s medical devices to the Cerner system, and DoD did not ensure that healthcare providers were granted access commensurate with their duties.
Auditors laid these oversights at the feet of the Federal Electronic Health Record Modernization (FEHRM) Program Office, the joint effort by DoD and VA to coordinate the rollout.
“FEHRM Program Office officials limited their role to facilitating discussions when disputes arose between the DoD and the VA and would only provide direction if the departments reported a problem,” the audit states. “Because the FEHRM Program Office limited its role, the DoD and the VA took separate actions to migrate patient health care information, develop interfaces, and grant user access to Cerner Millennium.”
Hard Questions
At a House VA Committee budget hearing last month, VA Secretary Denis McDonough faced hard questions from legislators who wanted to know why VA was continuing the EHR rollout when faced with a continuous stream of reports documenting the system’s failures.
“Last year you assured us that the Cerner system would not be introduced to other facilities until it was fully functional,” Rep. Matt Rosendale (R-MT.) reminded McDonough. “Since that time, we’ve seen 700 patient safety reports, we’ve got 80% of the employees at Mann-Grandstaff [in Spokane] polled and stating that they would rather work somewhere else as a direct result of the Cerner system. They’ve experienced 50 system shutdowns, two this week alone, and the pharmacies have been forced to use dangerous workarounds that contributed to, if not caused, a recent cardiac event and hospitalization of a veteran that could easily have caused their death. Why are you forcing this failed experiment—this multibillion-dollar failed experiment–into other facilities at this time?”
McDonough admitted that the system outages were concerning, noting there had been five since March 3 and that the first was so egregious that it resulted in a letter of apology from the Cerner CEO.
“So I’m very concerned about the expectation of that program. We will continue to hold Cerner accountable to that, particularly these shutdowns,” McDonough said.
As for how VA can move forward when so many problems have been documented in Spokane, McDonough told Rosendale that VA expects to learn from its experiences in Washington.
“If I perceive any of this to be a threat to our veterans, I won’t proceed,” he said. “But, to date, the experience and learnings from Mann-Grandstaff strengthen our ability to go up to Walla-Walla. And the experience at Mann-Grandstaff and Walla Walla will strengthen our ability to go to Columbus.”
He added, “The only reason to do this is if it has clinical value, and it improves outcomes for our veterans. Our clinicians continue to believe that it will, and it does. If it ever stops being the case, I’ll come here and tell you that we’re not going to proceed.”
