VA should admit failure of its new e-health record system

The Department of Veterans Affairs is about to enter its seventh year of attempting to replace its legacy information system architecture VISTA with a commercial-off-the-shelf product based on the Oracle/Cerner legacy system Millennium.

In six years, the VA has spent over $10 billion to install the electronic health records modernization (EHRM) system at five VA hospitals and at several smaller VA clinics, and most recently at the joint Defense Department/VA hospital in North Chicago. The VA has paused further implementations of this system for over a year now while it performs a “program reset.” During this period the VA has continued to pay Oracle-Cerner on average $100 million per month based on its $1.2 billion budget for ongoing support of the five hospitals and their efforts in “fixing what’s wrong” with their product.

Based on the latest communications to Congress, VA currently plans to resume installations beginning in fiscal 2025 despite concerns by members of Congress that the EHRM is “deeply flawed” and the cutting of funding for the program by $600 million and restricting the spending of $300 million more based on meeting schedules, goals and metrics

Despite this skepticism, there does not appear to be even the smallest consideration that this program should be reevaluated, even though the VA has not been able to  show any — even the slightest — benefit to veterans, clinicians or the American taxpayer after six years and $10 billion worth of effort. The best that VA Secretary Denis McDonough could say about the program is that “VA is seeing incremental, but accelerating progress as it addresses the issues that clinicians and other end users are experiencing.”

This decision to move forward, even though every known metric for this system is negative — and many are tragically negative — is incomprehensible.

Start with at least five acknowledged veteran deaths, over 150 documented cases of harm to veterans and the acknowledged exposure of over 70,000 veterans to potential harm attributable to use of the EHRM.

Then consider the following:

• Productivity at the five VA hospitals using the system has fallen by as much as 50%, and the only improvements to productivity at these facilities has been the result of hiring as many as 125 additional staff.
• According to a 2023 user survey the VA initiated at one of these hospitals in Ohio, only 4% of clinicians using the system felt it kept their patients safe, and 71% said that they experienced a great deal of stress having to use the system.
• The VA has not provided a response or a revised budget and schedule to the Institute for Defense Analysis, whose report states it will cost $50 billion and take another six years to complete the system.
• A recent VA inspector general report described flaws in the EHRM pharmacy system that put over 250,000 veterans at risk of medication errors.
• Clinician burnout, early retirements, resignations and requests for transfer to sites not using the EHRM continue to be documented.
• As a direct result of the loss of productivity caused by the EHRM system at the affected facilities, the costs and delays associated with providing outsourced veteran care in the local communities has skyrocketed.

The VA has not provided meaningful metrics to measure progress at the impacted sites, instead using meaningless technical metrics that reveal nothing in terms of clinical outcomes, user satisfaction or improvements in service to veterans. The VA has begun measuring and reporting on improvements in server response time and improvements in overall server up time but refuses to monitor or report on productivity, accuracy, veteran and clinician satisfaction or the actual number of Patient Safety Reports or their resolution rate. Routinely, on notification of a Patient Safety Issue, management acknowledges the report and immediately notifies that no one else need report this issue. This not only skews the statistics but hides the scale, scope and severity of the issue from statistical capture.

The same VA survey from June 2023 of users’ experience at the Columbus Ohio VA Medical Center found that, “The new EHR is failing basic expectations for most users.” And that compared to the Computerized Patient Records System, more time was spent in the new EHR outside of work/clinical hours, and longer amounts of time were required to complete standard tasks, which drove frustration amongst participants.” 

Despite all of this, and much more, and the fact that the VA has not and cannot point to a single benefit to veterans, clinicians, the VA or the American taxpayer that is attributable to this program, they intend to proceed.

Considering all of this, the question that must be asked and that must be answered before proceeding is: Why is the VA continuing to pound this very expensive, very harmful square peg into this very adequately filled round hole?

It defies logic. It defies common sense.

Is this simply a case of egos and reputations getting in the way of doing the right thing for veterans and the American taxpayer?

Is this a case of throwing good money after bad to avoid admitting bad decisions?

Is this a case of a massive and ballooning bureaucracy running amok?

Or is this what happens when political appointees make momentous decisions and then are not held accountable for these decisions?

Or is this what happens when you ignore process and procedures and you undertake initiatives that lack requirements, metrics, competition, transparency and accountability?

The evidence is clear and irrefutable that this system does not meet the needs of veterans, the clinicians who care for them or the VA as a whole. The VA has a best in breed legacy system that is safely, efficiently and cost effectively taking care of 95% of veterans at the 172 VA hospitals in the system.

The arrogance and irrationality of continuing to pursue a failed program when a much better option in every regard exists and is available at a small fraction of the cost and disruption to the wellbeing of veterans must be challenged.

I ask again, why are they doing this to veterans?

Edward Meagher retired after 24 years in government, 26 years in the private sector and four years in the U.S Air Force. He served for seven years as the deputy assistant secretary and deputy CIO at the Department of Veterans Affairs. Meagher divides his time between his own executive consultancy, VETEGIC, LLC and extensive involvement with several veteran focused organizations including his own Service Member Support (SMS) Foundation.

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