VA pauses all future deployments of its new EHR in latest ‘reset’ of troubled rollout

The Department of Veterans Affairs is putting all future deployments of its new Electronic Health Record on hold, until it addresses problems at sites already u...

The Department of Veterans Affairs is putting all future deployments of its new Electronic Health Record on hold, until it addresses problems at sites already using the system, as part of a “larger program reset.”

The agency announced Friday that “additional deployments will not be scheduled until VA is confident that the new EHR is highly functioning at current sites and ready to deliver for veterans and VA clinicians at new sites.”

VA Secretary Denis McDonough said in a statement that the Oracle-Cerner EHR is not yet meeting expectations, and that “we’re holding Oracle Cerner and ourselves accountable
to get this right.”

“This reset period will allow us to focus on fixing what’s wrong, listening to those we serve, and laying the foundation for a modern electronic health record that delivers for veterans and clinicians,” McDonough said.

Neil Evans, acting program executive director of VA’s EHR Modernization Integration Office, told reporters Thursday that the VA will postpone any additional EHR go-lives “until the system is functioning as we expect it to at our current sites.”

“We’ve been listening to our frontline clinicians, specifically our frontline clinicians at the five sites that are live with the new Electronic Health Record, and it’s clear the EHR is not meeting their expectations,” Evans said. “Frankly, it’s not meeting my expectations either.”

The Oracle-Cerner EHR is currently running at five small and medium-sized VA medical centers. Full deployment would bring it to more than 170 VA medical facilities.

Evans said the VA won’t move ahead with new EHR go-lives until the system shows “measurable improvements” at the five sites already using it.

He said those needed improvements will include better clinician and veteran experience, as well as higher reliability and productivity.

“When those criteria are met, the reset period concludes. At that point in time, we’ll release a new deployment schedule and resume deployment activities,” Evans said. “This is, again, something we’re doing because we want to get this right.”

The VA’s “program reset” marks the agency’s third prolonged pause in the troubled Oracle-Cerner rollout.

The agency announced in July 2021 it would put all EHR go-lives on pause as part of a “strategic review” of sites running the new health record.

Last fall, the VA said it would put all new EHR go-lives on hold through June 2023, as part of an “assess and address” period.

“I would argue that what we’re talking about here with this reset is really an extension of that ‘assess and address period’ and how it is different, is the commitment to really do the addressing — that is, the execution focus, and the focus on the field,” Evans said.

Mike Sicilia, executive vice president of Oracle Global Industries, said in a statement that the vendor will “continue to closely coordinate with VA to provide enhancements and updates to the EHR.”

“We support VA’s plan to improve the operation of the EHR at the current sites and take the necessary time to institute governance, change management and standardization changes to ensure the success of future VA deployments, similar to what DoD did a few years ago,” Sicilia said.

The VA, as of late 2022, expected the Oracle-Cerner EHR to go live at 25 additional sites in fiscal 2023.

Given the VA’s EHR reset, it remains unclear what a revised timeline of go-lives will look like, or whether full deployment would stay within a 10-year window as planned.

“We’re going to take the time that it takes to get this right. It is more important to get this right for veterans and the staff who serve them, than to strictly hold to a 10-year timeline,” Evans said. “I believe that if we spend the time to get things right, we may actually be able to rethink some of our deployment strategies, and how we manage this.”

The VA previously planned to resume its EHR rollout in June, at a VA medical center in Saginaw, Michigan, but the agency told clinicians earlier this month that the Oracle-Cerner EHR was “not ready” for deployment, and would be postponed.

The VA also recently postponed the EHR launch in Ann Arbor, Michigan.

Evans said the VA is working with Oracle-Cerner to improve the reliability of the EHR system, and make any adjustments necessary to prepare the system to go live at large VA medical centers.

Five years into the contract, VA is back at the negotiating table, looking to renegotiate the terms of its contract with Oracle-Cerner, with a focus on holding the vendor accountable for system degradations.

The contract the VA signed in 2018 has a five-year base period, with a subsequent five-year option. The deadline to renew the contract is May 16.

“Everything has been on the table as part of our contract negotiations,” Evans said.

Lawmakers have been frustrated by delays in the VA EHR modernization efforts, as well as patient safety issues.

House and Senate lawmakers have introduced several bills, but are closing ranks on one particular bill with bipartisan support.

House VA Committee Chairman Mike Bost (R-Ill.) and Ranking Member Mark Takano (D-Calif.) on Thursday introduced House companion legislation of the EHR Program RESET Act.

The EHR Program RESET Act would prevent the VA from proceeding with EHR go-lives at additional facilities, until performance data from the five current sites already using the system shows improvement.

The RESET Act is led by Senate VA Committee Chairman Jon Tester (D-Mont.) and Sens. Patty Murray (D-Wash.) and Sherrod Brown (D-Ohio).

The House VA Committee’s Technology Modernization Subcommittee also held a hearing last month over whether the VA should remain on its custom-built legacy EHR, VistA, rather than proceed with the Oracle-Cerner rollout.

VistA has been running in some VA medical facilities for up to 40 years, but is familiar to VA clinicians.

Evans, however, said moving the five VA sites using Oracle-Cerner back to VistA on a limited basis “is a really, really, difficult proposition to think through.”

The VA expects to keep using VistA for another five-to-10 years, if not longer, given delays with the Oracle-Cerner rollout, and is migrating instances of VistA to the cloud.

But Evans said VistA doesn’t support the VA’s long-term goal of interoperability with DoD’s health record as well as the Oracle-Cerner EHR would.

“I guess I would say that VistA [Computerized Patient Record System] supports broad interoperability, but not in as sort of a convenient way as Oracle-Cerner does,” he said. “VistA CPRS does perform, from a system performance level and reliability level, in a way that we expect. I’m confident that the users of VistA CPRS are still going to be able to deliver the excellent care to veterans that they deserve, and as we figure out the path forward with regard to the Oracle [Cerner] record.”

The VA last month released its EHR Modernization Sprint Report, which identifies four key issues leading to problems with the Oracle-Cerner rollout, as well as 14 issues with the system that need to be fixed.

Evans told the Senate VA Committee last month that five of the 14 fixes have been partially implemented, and that some of the fixes probably require additional work from Oracle-Cerner.

“The result of that ‘assess and address’ period is that we do have a pretty clear idea of what [the] issues are that need to be addressed, and so I think we’ve made progress in understanding what needs to be done. We need the time and the focus and the energy to execute on that,” Evans told reporters.

The Oracle-Cerner EHR has also experienced several outages throughout its deployment, including a five-hour outage on Monday felt across the VA, DoD and Coast Guard.

Evans said the outage stemmed from a significant upgrade added to the EHR over the weekend, meant to improve database capability and failover capability.

“Unfortunately, when you introduce change, it also introduces the opportunity for things to go not as well as we would hope. The challenges that happened on Monday was an unanticipated aftereffect of that change that had been made,” Evans said. “Downtime is never acceptable, and not something that we want to see, and its impact on users is certainly a problem,” he said.

Evans said VA is working with DoD and Oracle-Cerner to improve the reliability of the system, “including its ability to be a resilient system, where if some of the system fails, there is rollover to another part of the system  there to provide backup, so that the end user does not appreciate a loss of functionality as a result.”

The Defense Department, by contrast, has the same Oracle-Cerner EHR running at 75% of its clinics and hospitals, and is expected to complete its deployment next year, according to its 2024 budget request.

Evans said the VA expects to, much like DoD, troubleshoot problems with its initial EHR rollout and get to a point where go-lives happen at a more rapid pace.

“These EHR projects are always complicated. The DoD had a very similar experience, and found themselves at a point where they needed to essentially reset the program themselves,” Evans said.

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