Recent VA EHR rollout ‘most successful’ so far, but IG outlines recent problems

Top officials at the Department of Veterans Affairs say its latest rollout of a new Electronic Health Record is the most successful go-live to date.

VA officials say they’re building on lessons learned from a rocky rollout of the new Oracle-Cerner EHR that started in October 2020.

Since its first new EHR go-live, VA’s inspector general office has documented instances of the new system contributing to patient harm. The watchdog, in a report released last week, also linked problems with the new EHR to the 2022 death of a veteran in Columbus, Ohio.

Under Secretary for Health Shereef Elnahal told reporters at a press conference on Tuesday that VA’s rollout of the new EHR at Capt. James A. Lovell Federal Health Care Center (Lovell FHCC) in North Chicago has been “the most successful deployment we’ve had.”

“We’re going to watch this closely, and we’re going to be on top of it, not just in the next few weeks, but in the coming months, when we start to roll back the direct support and get to normal operations at Lovell,” Elnahal said. “We’ll be watching closely about what these trends are. We’ll be very transparent when problems arise, and we’ll jump on any issue to fix it.”

The VA remains in a “reset” period and won’t schedule any additional go-lives until sites already using the new EHR return to pre-rollout productivity levels.

Elnahal said the five other VA sites using the Oracle-Cerner EHR are “getting closer and closer” to predeployment productivity levels.

“We’re seeing tickets filed when problems are noticed, with quick action. And we’re seeing patient safety incident tickets filed when problems arise,” he said.

VA Secretary Denis McDonough said the department is closely monitoring the performance of sites using the new EHR to “make sure that everything is in good standing.”

“There’s a reason we’re in reset. And these are hard-learned lessons. We’re going to stay in reset until we are confident that we are making the system work in a way that improves veteran outcomes and improves the provider experience in those five sites before we go live any farther,” McDonough said.

VA’s fiscal 2025 budget request seeks $894 million for the VA’s ongoing rollout of a new Electronic Health Record from Oracle-Cerner. For context, the department received a $1.3 billion EHR budget from Congress this year — $529 million less than what the department requested.

The 2025 budget request doesn’t include any funding for additional deployments. The funding would go toward contract payments to Oracle-Cerner, and infrastructure support for VA sites already using the new EHR.

VA officials, however, say the request funding levels are not indicative that a pause of EHR go-lives will continue through 2025.

“We’re not looking to jumpstart and do any fast movements here,” McDonough said. “I think you see that in our budget request. We’re very eyes-wide-open. We’re trying to make sure that we are rolling forward, consistent with what the experience of our providers and of our veterans at those five important go-live sites tells us.”

A successful EHR rollout at the Lovell FHCC would give the VA an opportunity to move on from problems that have hampered the multi-billion dollar project for years.

As a reminder of those persistent challenges, VA OIG released three reports on March 21, highlighting several problems VA facilities have experienced with the new EHR.

VA OIG, in one report, found a scheduling error with the Oracle-Cerner EHR and “inadequate mental health care” at the VA Central Ohio Health Care System contributed to a veteran’s death.

The IG office found a veteran in his 20’s, flagged as a high-risk for suicide, died from an accidental inhalant overdose about seven weeks after he missed an appointment at the VA Central Ohio Healthcare System in Columbus, Ohio.

The IG office confirmed that a system error in the Oracle-Cerner EHR led to VA staff not following up with the veteran 14 days after he missed a VA mental health appointment.

The OIG found that when the patient missed his appointment, although it was updated to no-show status, the EHR didn’t prompt schedulers to follow up with required rescheduling efforts.

“The OIG concluded that the lack of contact efforts may have contributed to the patient’s disengagement from mental health treatment and ultimately the patient’s substance use relapse and death,” the report states.

The veteran had received mental health treatment from the VA since spring 2018. According to the IG report, the department flagged the veteran as a high-risk for suicide, after a suicide attempt in spring 2019.

Elnahal told reporters on Tuesday that the Columbus VA Medical Center has done a “deep dive” into the IG office’s findings, conducted a root cause analysis, “and have made already significant changes to our processes as we interface with the new Electronic Health Record to prevent this from ever happening again.”

“Every single time this happens, we have to learn from it,” Elnahal said.

It’s not the first death linked to the new EHR. Members of the Senate VA Committee said at a March 2023 hearing they were briefed on “six catastrophic events” related to the Oracle-Cerner EHR, four of which resulted in patient deaths.

VA Press Secretary Terrence Hayes said in a statement that when VA became aware of this veteran’s death, “VA began taking action to reduce the risk of tragedies like this from happening in the future.”

“We have fixed the technical issue and the EHRM system now provides appropriate follow-up reminders to VA staff, and VA is further evaluating and standardizing its current policies and procedures for scheduling mental health appointments,” Hayes said.

“There is nothing more important to VA than providing high-quality mental health care to veterans — especially veterans in crisis — and we are deeply saddened by the loss of any veteran who dies by suicide,” he added. “Patient safety concerns are of the utmost importance to VA, and we fully concur with the OIG’s recommendations.”

VA OIG  found, in a second report, that the new EHR impacted medication and allergy safety checks for veterans who receive care from more than one VA facility.

The VA watchdog released its full report on March 21, but testified before members of the  House VA Committee on its findings in a hearing last month.

VA OIG found the department couldn’t automatically check for drug interactions or allergies when patients at VA facilities using the new Oracle-Cerner EHR later sought treatment at another VA site using its legacy EHR system.

Deputy VA IG David Case told lawmakers that about 250,000 veterans since September 2023 have received medication orders or medication allergies documented in the new Oracle-Cerner EHR.

Hayes said in a statement that “to date, there has been no patient harm identified due to this issue.”

“This issue has been fixed for all new medications prescribed since April 2023, and all historical medications will be corrected by the end of August 2024,” Hayes said. “Many medications have already been updated, and our VA providers are conducting manual interaction checks as needed to ensure patient safety until the issue has been fully resolved.”

Hayes added that, “out of an abundance of caution,” the VA is communicating with VA patients at the affected facilities to encourage them to bring their medications, or medication lists, to all in-person and virtual appointments.

VA, he said, encourages veterans to alert their providers if they visit more than one VA facility, have received care through a non-VA facility, or if they have a specific drug allergy.

“These steps are to support quality care so that VA providers can conduct manual order checks as needed,” Hayes said.

VA OIG, in a third report, warned that scheduling system challenges at VA facilities using the new EHR may be exacerbated at larger, more complex medical centers.

VA OIG states the new EHR provides one scheduling system for patients, providers, and schedulers, and was expected to increase scheduler efficiency and reduce scheduling errors.

While some VA clinicians told VA OIG that scheduling appointments in the new EHR is more user-friendly,  the report found schedulers at the three VA medical facilities that have been using the new EHR the longest billed for more than 13,000 hours of overtime last year.

“Although other reports and this memorandum call attention to the problems experienced during the transition to the EHR scheduling system, VHA staff anticipate that positive outcomes are still achievable if facilities take the time to learn from previous deployments, applying lessons learned to either alleviate challenges or better manage them, thereby decreasing the impact to staff and patients,” the report states.

Hayes said in a statement that VA is developing a standard process, outlining the steps VA staff should take to carry out and improve scheduling efforts.

“VA is committed to addressing all issues with the federal EHR system, including scheduling-related functions. Veterans remain the center of everything we do. They deserve high-quality health care that is safe, timely, veteran-centric, equitable, evidence-based and efficient,” he said.

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