‘Fundamentally flawed’: VA providers bemoan new electronic health records system

It’s been six months since the VA paused its rollout of a new electronic health records system but the physicians using it are still filing complaints and raising concerns about patient safety, according to internal messages obtained by POLITICO.

Messages this month from clinicians at Mann-Grandstaff, a Veterans Affairs facility in Spokane, Wash., show deep frustration with the software from Oracle Cerner, the electronic health records vendor, stemming from outages and errors that prevent staff from filling prescriptions and referring patients to other providers. The messages also show providers struggling to access key patient data needed for patient safety.

“The base structure of this system is so fundamentally flawed,” one physician said in a message earlier this month. “90% of my brain power is going to figuring out how to operate this [electronic health records system], which is inverse of any other [EHR system] I’ve ever used.”

The VA announced in April that it would suspend its rollout until it fixed the issues in the facilities using Oracle Cerner’s system — including at Mann-Grandstaff. The rollout is billions over budget and has been tied to at least four veterans’ deaths. Mann-Grandstaff was the first site VA deployed the technology, with a launch just ahead of the 2020 election.

The VA inspector general found that the facility lacked sufficient staffing to handle the transition and didn’t take enough steps to “mitigate known risks,” leading to substantial dangers to patient safety. Cost overruns stemming from the rollout have forced the medical center to reduce staffing, according to the facility’s director.

Mike Sicilia, executive vice president of Oracle Global Industries, said the company is working with the VA to improve the system’s workflow and performance. Sicilia said that “Oracle-owned uptime” has been at 100 percent for 12 of the last 13 months.

Neil Evans, program executive director of the VA’s Electronic Health Record Modernization Integration Office, acknowledged to POLITICO that the system isn’t meeting expectations, necessitating the pause.

Evans noted that recently confirmed VA Deputy Secretary Tanya Bradsher is visiting the sites where the software is deployed, including Mann-Grandstaff, with the goal of hearing more from clinicians.

“When EHR systems are at their best, they are intuitive, responsive, and reliable. Clinicians should never be waiting for the EHR,” Evans said. “It should always be ready for them. It’s a tool that’s every bit as important as the stethoscope — and it needs to be just as dependable. During this period, we are laser-focused on making that goal a reality.”

But problems abound, according to the messages. One doctor wrote that the system has struggled to import lab results, meaning it’s hard to gauge a patient’s condition.

“When I look at a creatinine I must know the last creatinine to make any sense of it. A creatinine of 1.5 may be stable for a patient or could reflect acute kidney injury,” the doctor messaged.

Some called for leaders to see how the system is working for themselves.

“Anyone who makes decision [sic] on these fixes and change requests should be down in the trenches and have a viceral [sic] experience to understand what we are asking,” another clinician wrote. “We are not asking for luxury adjustments honestly. Just to be able to deliver the best care we can for our veterans in the most efficient manner.”

Providers sometimes encountered so many errors that they couldn’t try to fix them all.

“I say this with all seriousness — I cannot call [the service desk] 5 to 10 times per day …” a physician wrote.

Zooming out: Many of the issues the clinicians discuss are similar to those that have been reported. The agency’s inspector general found in a report last year there were 1,134 reports of patient safety events tied to the new system.

An assessment commissioned by the VA from the Institute for Defense Analyses last year found that the initial cost projection from 2018, $10 billion over 10 years, had grown to $50.8 billion over 28 years. More than a dozen officials who have been involved or are intimately familiar with the project previously told POLITICO that the system’s issues include a lack of clinician buy-in, insufficient preparation for deployments and a rushed initial rollout.

The project is under scrutiny from lawmakers on Capitol Hill, with some threatening to end the project altogether.

What’s next: It’s not clear when the agency might resume new deployments. The VA has said it plans to continue its EHR rollout at the Captain James A. Lovell Federal Health Care Center in Chicago in March 2024 despite the pause.

At a House Veterans’ Affairs Committee hearing in September, Evans pledged to publish a schedule the agency will stick to once the program reset ends. The VA has pledged not to restart deployments until it’s confident the system is ready.