VA Continues Roll Out of Electronic Health Record Modernization Despite Issues
WASHINGTON — The U.S. Department of Veterans Affairs is continuing to roll out the electronic health record modernization program, despite concerns from some members of Congress and reports which show unresolved patient safety issues.
“Implementing a new electronic health record in any organization is difficult, but implementing one in a health care system as large and complex as VA’s has presented some challenges,” said Randal Noller, public affairs officer at the Department of Veterans Affairs, Office of Public and Intergovernmental Affairs, in an email to The Well News.
The EHRM was implemented during the pandemic to electronically store health information and track patient care to connect VA medical facilities with the U.S. Department of Defense, and other community care providers, and allow clinicians to easily access a veteran’s full medical history in one location.
According to Noller, the VA is currently in the initial operating capability phase, where the first sites that have implemented the EHR are helping to identify what works and what is not working for VA, to apply those lessons learned going forward.
In 2018, the VA entered a 10-year, $10 billion contract with Cerner, one of the largest suppliers of health information technology services, devices and hardware, to create and implement the EHR modernization program.
The EHR was first launched in October 2020 at the Mann-Grandstaff VA Medical Center in Spokane, Washington.
By March 2022, three reports were released from the Office of Inspector General which showed patient safety issues with the VA’s initial roll out of the EHR at the first deployment site, including the system failing to alert providers to patients at risk of suicide, or having the wrong medications mailed to patients.
A total of 21 different medication-related problems were reported by employees at the Mann-Grandstaff VA Medical Center, all still unresolved by June 2021.
In July 2021, the VA released the Comprehensive Lessons Learned Report from the strategic review, which focused on improving the veteran experience, ensuring patient safety, providing enhanced training to frontline employees and building confidence at VA sites.
That report identified that as of November 2021 there were 829 patient safety reports since the EHR went live, with 576 of those tickets directly related to the new system.
Through the report, the VA learned that the patient portal experience was fragmented for veterans at the Mann-Grandstaff location post-Go-Live, as clinical and interdisciplinary workflows were not tested in a manner that effectively reflected a real-world environment.
Other concerns noted in the reports include gaps in governing and managing data between the two EHRs and the Department of Defense.
In one example, staff from the Mann-Grandstaff location in Spokane reported that a veteran was hospitalized with heart failure after his heart medication prescribed prior to the EHR launch had disappeared from the list of active medications when it expired in the Cerner system.
Some of the staff at that facility indicated they were not given adequate training on legacy prescriptions before the Cerner transition.
“We have already made significant progress in many areas, including hiring leaders and staff with the right skills and experience for successfully completing large complex projects, developing site-readiness for deployment criteria, optimizing dashboards to monitor and measure our performance, establishing VA governance bodies for more collaborative decision-making, enhancing training content and delivery and improving communication with our stakeholders and veterans, among many others,” said Noller.
David Case, who serves as deputy inspector general at the Office of the Inspector General for the U.S. Department of Veterans Affairs, attended a hearing on April 26 held by the Subcommittee on Technology Modernization, and said that despite the issues with the EHRM the VA is continuing to prepare for additional roll outs.
According to the VA’s go-live schedule for future EHR deployments, the Jonathan Wainwright Memorial VA Medical Center in Walla Walla, Washington, had a go-live date that was delayed until March 26 of this year.
The VA Central Ohio Health Care System in Columbus, Ohio, was delayed from its March deployment date, but went live on April 30. Other planned rollouts this year include Roseburg and White City, Oregon, on June 11; Boise, Idaho, on June 25; Anchorage, Alaska, on July 16; Seattle and American Lake, Washington, on Aug. 27; three sites in Michigan on Oct. 8; and Portland, Oregon, on Nov. 5.
Case said one of the main barriers to achieving a successful roll out of the EHR is that the VA does not have a reliable budget for improving the IT infrastructure and making additional hires.
“Last summer we had two reports that showed the life cycle for IT upgrades are not reliable, and we agreed to do an independent cost assessment … We don’t know what VA’s plans are or how they will implement their plans over the next 10 years, whether its infrastructure upgrades or IT,” said Case.
“We are looking into bringing in a consultant to evaluate the training as it is now and help identify ways to improve,” continued Case.
Despite Case’s optimism, many members of the House Committee on Veterans’ Affairs believe the VA has not made a great case for continuing the EHR roll out.
“There should be no more go-lives or additional funding until every single one of these has a fix,” said Rep. Matt Rosendale, R-Mont., who serves as ranking member of the House Committee on Veterans’ Affairs Subcommittee on Technology Modernization, during the subcommittee hearing on technology modernization.
“If VA and Cerner had taken action we would not be here,” continued Rosendale.
Rosendale issued a letter on April 8 to the VA Deputy Secretary Donald Remy and Cerner Government Services President Travis Dalton with requests that an interface be established between the Cerner electronic health record and the pharmacy module. Rosendale cited a number of interface issues between the PowerChart and Cerner’s Pharmacy Module.
In the letter, Rosendale said that he was advised by Cerner and the VA that fixing the problem would typically take Cerner roughly two years.
“This must be accelerated. It is clearly necessary to make the EHR system fully functional, and I question why it was not originally part of the Cerner contract,” Rosendale said in the letter.
“Until a true bidirectional interface is put in place, pharmacists at the Mann-Grandstaff VA Medical Center, the Jonathan M. Wainwright VA Medical Center, and any subsequent sites will struggle with a needlessly complicated, time-consuming, error-prone, double-entry process to prescribe medication that saps productivity and puts veterans at risk,” continued Rosendale.
The letter from Rosendale was issued after an Inspector General report from March identified seven fixes that were needed in EHR pharmacy management, such as synchronizing patient records, fixing issues with patient medications from falling off active medications list, or allowing pharmacy technicians to process the refill requests without having pharmacists verify them.
“I have not seen any action on any of these letters,” said Rosendale.
In a separate letter sent in February, Rep. Cathy McMorris Rodgers, R-Wash., called for an immediate delay in the roll out of the Cerner EHR system to the Walla Walla VA Medical Center, based on the issues experienced for more than a year at the Mann-Grandstaff location.
Rodgers also visited the Mann-Grandstaff location to meet with Deputy Secretary Donald Remy on April 25, so that she could firsthand see the complications caused by the new EHR which happened to be down for 45 minutes during her visit.
Sen. Patty Murray, D-Wash., who is a senior member of the Senate VA Committee, also requested a delay on the roll out of the EHR Cerner system before it launched in Walla Walla on March 26.
Murray and some other members of Congress met to review the FY 2023 Budget and FY 2024 Advance Appropriations Request for the VA on Wednesday in a hearing held by the Senate Committee on Appropriations Subcommittee on Military Construction and Veteran Affairs and Related Agencies.
According to Committee members, the VA has requested $301 billion for FY23, a 11.3% increase over FY22, with specifically $1.75 billion for the electronic health record modernization program. Noller said the VA has spent $8.5 billion to launch the electronic health record system.
Murray said during the hearing that Washington state has been used as a pilot site for a number of VA programs, but the EHR has been frustrating, disruptive and even dangerous for patients.
“I am asking you today to reconsider the schedule of the roll out of the electronic health record. We need to continue to fix the issues that have been raised in Spokane, and Walla Walla, and then only return back to Washington state for any new deployments after demonstrating that EHR is ready and successful at different facilities,” said Murray.
Despite the concerns about whether the EHR is ready for a national roll out, the VA and DoD have said they will continue the roll out of the EHRM through 2028.
“Spokane is getting better, it’s not perfect … Walla Walla has not been perfect, but it’s been better … So far, on day 6 in Columbus we are seeing reasonable results, but again it’s early. We will make every decision based on the experience of the learning to-date,” said Denis R. McDonough, secretary of Veterans Affairs, during the hearing.
McDonough noted that since March 3 there have already been 6 outages at Cerner which impacts the VA and DoD.
“I’m frustrated with that,” said McDonough.
Alexa Hornbeck can be reached at [email protected]