The Department of Veterans Affairs has seen hundreds of major problems with the performance of its new Electronic Health Record (EHR) since its launch nearly four years ago, according to a watchdog report.

The VA paused the rollout of the Oracle-Cerner EHR in April 2023, to address persistent performance issues at VA medical facilities already using the new system.

The VA’s inspector general office has linked the new EHR’s problems to instances of patient harm — and in some cases, linked those problems to the death of patients.

In one of its latest reports, the VA’s inspector general office found that between October 2020 and March 2024, the Oracle-Cerner EHR experienced 826 “major performance incidents” — including outages, performance degradations and incomplete functionality.

The IG report found more than half of those major performance incidents — 447 in total — happened after the VA put all future EHR go-lives on hold.

According to the IG’s report, major performance incidents happened as recently as March 2024.

Neil Evans, acting program executive director of VA’s EHR Modernization Integration Office, told the IG’s office that the new EHR has “increasingly stabilized over time, resulting in improvements to the user experience.”

He added that since August 2022, the VA saw three months where the Oracle-Cerner EHR fell short of the contract’s standard for outage-free time.

“While the core federal EHR has stabilized, VA recognizes that the frequency of performance incidents and outages is still a challenge and accordingly, will continue to expend maximal effort to reduce any preventable events,” Evans wrote.

Despite these efforts, Evans wrote that “there will likely still be some level of system disruption, partly due to the number of changes still being introduced to the federal EHR environment by both VA and the Department of Defense.”

“It is a well-established axiom of software development that systems stabilize when the rate of changes made to the system decreases. The rate of change is still high for the Federal EHR, likely contributing to more incidents,” Evans wrote.

Major incidents with the Oracle-Cerner EHR, over the past four years, collectively impacted the new EHR’s performance for 1,909 hours — or nearly 80 days.

In most cases, these EHR incidents led to incomplete functionality. However, VA facilities also saw outages and performance degradation with the platform.

“An EHR system that reliably provides access to patient information is critical to delivering quality health care. However, since VA began implementing the system, many major performance incidents have occurred, hindering clinicians’ access to patient records and increasing risk to patient safety,” the report states. “To counter that risk, VA needs better controls to improve incident management.”

According to the IG report, Oracle Health was responsible for 654 of the major incidents, while the VA was responsible for 172 of the major incidents.

In another recent report, the IG’s office found VA medical providers and facilities are still having problems providing care to veterans using the new EHR.

“During interviews, staff at both medical facilities described the new EHR as a system shock,” the IG’s office wrote.

In a survey, most respondents told the IG’s office that the new EHR contributed to a decrease in staff morale and increases in stress and burnout.

Leaders at the VA Southern Oregon Healthcare System told the IG’s office that implementation of the new EHR remains “the single largest challenge that we have here.”

“In addition, a psychologist within the VA Southern Oregon Healthcare System told auditors that in VA’s recent All Employee Survey responses listed the new EHR as the number one stressor and reason employees were leaving the facility.

A pharmacy employee at a VA medical center in Walla Walla, Washington, told auditors lag times with the new EHR prevented him from meeting expectations of seeing 10 patients per day.

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