VA employee files EHR lawsuit, claiming lack of accessibility features

The VA launched the new EHR in White City, Oregon in June 2022, but a VA employee says she raised unresolved accessibility concerns before launch.

A Department of Veterans Affairs employee is suing the VA over its rollout of a new Electronic Health Record (EHR), over claims the system is inaccessible to employees and veterans with disabilities.

The lawsuit claims VA’s new Oracle-Cerner EHR doesn’t work with assistive devices, such as screen readers that allow visually impaired users to access information on a computer screen.

Laurette Santos, a licensed social worker who’s worked at the VA for over a decade, is leading the lawsuit, which she filed with the U.S. District Court for the District of Columbia last month.

Santos works as a Visual Impairment Services Team coordinator for the VA Medical Center in White City, Oregon. It’s one of six VA sites currently using the new EHR. Full deployment of the EHR would bring the system to more than a hundred VA locations.

Santos said in an interview that she provides therapeutic counseling to veterans who are experiencing vision loss or blindness.

“Any disability is difficult, but blindness is particularly isolating. My veterans, mostly who are visually impaired or legally blind, are older,” she said Tuesday. “So they’ve experienced seeing, and now they’re experiencing loss, bit by bit, and it’s very difficult for them to transition,” Santos said. “It is critical that they have a bridge from where they are, to where they want to go.”

Santos understands what many of these veterans are feeling. She’s legally blind from a condition called retinitis pigmentosa, which allows her to perceive light, but she’s been unable to read text since 1988.

Santos said she uses the VA’s EHR to gather data from veterans’ medical records — such as their diagnosis, what items they have received from other VIST coordinators, and their particular challenges.

“It could be anywhere to not having a family, to being alone and blind, to lots of medical complications — physical, mental, emotional, combined with blindness,” she said.

Santos relies on the screen-reader software Job Access With Speech (JAWS), which reads out loud the text that’s on a computer screen. Santos said she’s been using JAWS for more than 20 years.

When the VA hired Santos as a VIST coordinator in 2019, her facility was still using the VA’s legacy Computerized Patient Record System (CPRS), which is also called VistA.

VA’s legacy EHR is compatible with the screen-reader technology Santos uses, and allows her to independently perform the essential functions of her job, with only limited assistance from a sighted assistant.

“In my work, JAWS was very effective,” she said. “I could connect with other providers, which is a huge part of health care for veterans — that support of people who work with them to make sure all of their needs are met, such as pharmacy, social work, and primary care. I need access to all of those, I can no longer do that independently.”

StatNews first reported details of the lawsuit last Friday. VA Press Secretary Terrence Hayes told Federal News Network that the VA is unable to comment on pending litigation.

Federal News Network also reached Cerner’s parent company Oracle for comment.

‘They took my eyes away’

The VA launched the new EHR in White City in June 2022, but Santos said she raised accessibility concerns before the launch that the department didn’t resolve.

“My screen-reading software cannot read anything in the Oracle Cerner platform,” Santos said. “I can’t even sign in,” Santos said. “Essentially, they rendered me disabled again. They took my eyes away. My screen reader was my eyes.”

Before the go-live, Santos said Cerner personnel asked her to provide feedback on the accessibility features back in 2019.

“It was requested of me to see how it interacted, which I did. And I immediately told them it doesn’t work. The codes that were written did not even recognize that there was another software in there,” she said.

According to the lawsuit, VA’s contract with Cerner required the EHR system to be compatible with accessibility-related software and assistive technology devices, including screen readers, screen magnifiers and speech recognition software.

Eve Hill, a partner with the law firm Brown Goldstein & Levy, which is representing Santos in the lawsuit, said the VA failed to ensure that Cerner was compliant with Section 508 before entering into the contract for its procurement and after its rollout.

“The fault here legally lies with the VA. Section 508 requires the VA to only purchase, use and develop accessible technology,” Hill said. “Anything since ages ago, when 508 was passed, they have to only buy things that are accessible. And they went and bought the Cerner system without it being accessible. And they might say, ‘We didn’t know,’ but they’re obligated to know.”

The lawsuit claims the Cerner EHR requires users to operate a computer mouse, which Santos and other blind employees are unable to use. The VA was also made aware that all training simulating the Cerner EHR was not Section 508 compliant.

Between November 2020 and November 2021, the VA’s Section 508 Office conducted several audits and found the Cerner EHR was inaccessible.

The lawsuit claims the Cerner EHR has “disastrous consequences” for Santos and her ability to do her job independently.

“I’ve gone through a million feelings, from really being angry to being really depressed and really hurt,” she said. “I knew that I would get what I needed and be a very successful employee, which I was. And then, in a blink of an eye, it was gone.”

Santos says she can no longer independently complete her clinician job duties, such as receiving and making referrals, or placing orders for devices, software, and other items for veterans.  Instead, she must delegate these tasks to sighted employees.

“Delegating such tasks, particularly to non-licensed staff, potentially jeopardizes Ms. Santos’s clinical license,” the lawsuit states.

According to the lawsuit, the VA allows Santos to keep using the legacy CPRS, but in a read-write-only format with assistance from sighted individuals.

“This response does not allow Ms. Santos to independently perform the essential functions of her job, nor has it allowed her to handle anything close to the workload she previously completed,” the lawsuit states.

Santos said the new EHR is also presenting new challenges to veterans with visual disabilities.

“My veterans, consequently, are suffering, because they can no longer interact with this platform, either, and that’s my largest concern,” Santos said. “Yes, this is really frustrating for me, as an employee. But my goal is to be able to provide the veterans that I work with bridges that can help them transition into a different way of living. One of the things that I was able to do with them was let them know, ‘You can do this. We can do this, and I can help you.’ Well, I don’t feel like that anymore.”

“They’re depending on me to be able to do an excellent job and to support them in their endeavors to climb these militants that are theirs right now. And I can’t do it,” she added.

The VA is currently in a “reset” period and has put all future go-lives on the Oracle-Cerner EHR on hold until it addresses persistent problems at sites already using the system.

“I would really like to see them work on the 508 compliance. However, no new codes have been written for 508. They’re busy trying to put out the fires in the rest of the system,” Santos said.

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