VA EHR update: four deaths traced to Oracle Cerner EHR; four safety issues identified by VA EHRM Sprint Team

March 18, 2023 | by

The Senate Veterans Affairs Committee is unhappy. Very unhappy. With good reason. The ongoing problems with the Department of Veterans Affairs (VA) rollout of the Oracle Cerner EHR multiply. There were six instances of ‘catastrophic harm’ attributed to a feature of the EHR modernization program since the rollout, four of which resulted in the death of a veteran patient. According to information given to the staff of Senator Richard Blumenthal (D-CT), one fatality was at Spokane’s Mann-Grandstaff VA Medical Center and the other three died as patients in the VA Central Ohio Healthcare System, launched in April 2022. The nonfatal cases happened to veteran patients in the Inland Northwest (also Spokane).

While Senator Patty Murray (D-WA), the chair of the powerful Appropriations Committee, threatened to withhold further funding for the EHR migration, Senator Jon Tester (D-MT) is not fed up enough to be in favor of terminating the contract, as the House Veterans Affairs technology subcommittee head, Rep. Matt Rosendale (R-also MT), proposed in January in H.R. 608, [TTA 1 Feb] now in the House Subcommittee on Oversight and Investigations. The VA has paid Oracle Cerner $4.4 billion on the contract so far, with a refund of $325,000 paid as compensation for ‘incomplete technology and poor training’. Obligations through the contract are at least $9.4 billion. It comes up for renegotiation on 17 May and VA’s contracting officer, Michael Parrish, has testified he will push for a more favorable contract

The Government Accountability Office is also unhappy. The GAO, which calculated the above obligations, told the committee that the EHR contract “as currently written, has not sufficiently motivated Oracle-Cerner to perform better,” and that the current terms of the contract are “not necessarily in the best favor of the government in this particular case.” The GAO surveyed VA users of the Oracle Cerner EHR and found that only 6% agreed the system enabled quality care. Some of this may be reluctance to change technologies after 40 years of VistA, as Senator Marsha Blackburn (R-TN) pointed out in what this Editor expects is a ‘devil’s advocate’ statement, but there is also a fatigue factor–it’s the fourth attempt at replacing VistA.  Federal News Network 16 March, Spokane Spokesman-Review, Becker’s HealthIT

The VA’s EHRM Sprint Team identified four main issues in the EHR Modernization Sprint Report (PDF) released on 10 March.

1) Unknown queue and related issues (including medications)
2) No show and cancelled appointment orders failed to route to scheduling queues
3) Add Referral button not creating visible external site referral for worklist action
4) Usability issues with the EHR application, allowing providers to order procedure charge codes for imaging without ordering the actual clinical imaging

There were 30 safety issues examined by the team (pages 6-7) of 450 submitted. The report also identified EHR workarounds for VA medical centers that conduct medical research, an issue that surfaced publicly with Ann Arbor Healthcare System in delaying their go-live until 2024 [TTA 1 Mar]. They also examined the Data Collection Workbooks (DCW) process to better ensure consistency with VA standards through moving to a standardized approach. The VA is developing an Enterprise Site Readiness Dashboard for determining if a site is ready to migrate their EHR. Federal News Network 13 March

More VA-Oracle Cerner fallout? Deputy secretary, EHR executive director depart agency

March 3, 2023 | by

EHR Trouble falls with a thud on two senior VA leaders. The Department of Veterans Affairs announced yesterday (1 March) that Deputy Secretary Donald Remy will be stepping down from his post. He will be replaced on an interim basis by VA Assistant Secretary for Enterprise Integration Guy Kiyokawa. This follows the resignation effective 25 February of Terry Adirim, MD, EHR modernization (EHRM) program executive director. Her duties will be taken over, also on an interim basis, by Senior Advisor to the Assistant Secretary for the Office of Information and Technology (OIT), Dr. Neil Evans. The Deputy Secretary position requires nomination by the President and Senate confirmation. The EHRM position is an internal fill.

Both Deputy Secretary Remy and director Adirim were named to their posts in mid-to-late 2021, Dr. Adirim from Acting Assistant Secretary of Defense for Health Affairs. Remy specifically oversaw the EHRM among other duties while Dr. Adirim led the implementation of the Oracle Cerner Millenium EHR that started with an analysis of the failures of the initial tests and the formation of an EHR Integration Council [TTA 3 Dec 21]. But from this ‘go forth and fail no more’, the rethought rollout was fraught with failures, including the 2022  ‘unknown queue’ that created 149 adverse events, a two-day slowdown in both the VA and MHS EHRs in late January 2023, and delayed rollouts to June this year. Perhaps the topper was the chair of the House Veterans Affairs Committee and the chair of the House Veterans Affairs Subcommittee on Technology Modernization co-sponsoring a bill to cancel the Oracle Cerner EHR and return to VistA [TTA 1 Feb]. At the end of February, Ann Arbor Healthcare Center pointed out that VA’s research centers were having specific problems with the EHR cutover that had not been addressed and were cause for further delay, possibly to end of year. Will this change lead to progress with Oracle–or more delay? FedScoop 1 March, 10 Feb. Hat tip to HISTalk 3 March