VA launches strategic review, considers schedule changes amid concerns with new EHR

This story was updated on Friday, March 19, 2021 at 12:50 p.m. with additional statements from Cerner Corporation and members of Congress. 

The Department of Veterans Affairs will launch a 12-week strategic review of its electronic health records modernization program, the agency announced Friday.

“A successful EHR deployment is essential in the delivery of lifetime, world-class health care for our veterans,” VA Secretary Denis McDonough said Friday in a statement. “After a rigorous review of our most-recent deployment at Mann-Grandstaff VA Medical Center, it is apparent that a strategic review is necessary. VA remains committed to the Cerner Millennium solution, and we must get this right for veterans.”

VA delayed its initial rollout of the Cerner Millenium EHR suite twice last year — once to allow for more training, and then because of COVID-19.

The department eventually launched the new EHR last October to its first site, the Mann-Grandstaff VA Medical Center in Spokane, Washington, and said the deployment was successful.

But the department said its ongoing analysis of the situation in Spokane “precipitated the need for a schedule shift.”

VA was supposed to launch the new EHR next at its medical center in Columbus, Ohio, where the department had previously launched Cerner’s centralized scheduling system (CSS) last summer.

That could change after VA’s forthcoming review, the department said Friday, though it didn’t go into many specifics.

Congress has expressed concern in the past with VA’s deployment schedule, after the department delayed its initial go-live in Spokane but maintained its long-term, 10-year timeline for the entire project.

The department said it will focus on finding additional productivity and optimizing clinical workflow at Mann-Grandstaff and other upcoming sites and looking for more improvements to the patient portal that veterans use, as well as “data syndication and revenue cycle improvements.”

VA’s review comes as Rep. Cathy McMorris-Rodgers (R-Wash.), whose district includes Spokane, raised concerns with the new electronic health record to the new secretary.

“As you decide how to proceed with the Cerner electronic health record, I hope you will keep the real-life experiences of veterans and VA employees in eastern Washington in mind,” she wrote in a March 17 letter to McDonough. “The system is not an improvement, at least not yet.”

She went on to detail how VA clinicians have struggled to use the new platform to fill prescriptions. Some veterans aren’t receiving their prescriptions when needed or are receiving the wrong ones.

“This seems to be especially troublesome when information from veterans’ health records gets mixed up with the Cerner EHR at Fairchild Air Force Base,” McMorris-Rodgers said. “I have one report of a VA doctor who ordered a veteran two medications, but he received 15 erroneous medications. I have multiple reports of prescriptions being delayed, which in one case caused a veteran to suffer withdrawal. These impacts are dangerous and unacceptable.”

Cerner’s patient portal is also confusing for veterans in Spokane, and it seems to be less functional than VA’s own patient portal, McMorris-Rodgers said.

Challenges with the new platform are also driving down employee morale, she added.

“I am hearing from some who are deeply frustrated with the system and are not getting the support they need,” McMorris-Rodgers wrote. “Nurses who go to work every day to serve our veterans should not be driven by to tears because software, which was intended to be an improvement, makes their jobs more difficult.”

Mann-Grandstaff hired additional clinical staff to help compensate for productivity delays that the new EHR might inevitability cause, but McMorris-Rodger said those staffing gains are gone. She said her local VA medical center experienced especially high levels of turnover last year, with the primary care sector seeing a 60% churn in staff.

The chairmen and ranking members of the House and Senate VA committees also described their concerns with the EHR modernization program in a Feb. 25 letter to McDonough.

Richard Stone, VA’s acting undersecretary for health, traveled with a group of leaders from the department  in late January to observe the challenges at Mann-Grandstaff, members of Congress said. Employees at the Spokane hospital, as well as VA and Cerner personnel, have formed “tiger teams”to diagnose and address usability problems with the EHR platform, they added.

McDonough acknowledged VA employees at Mann-Grandstaff had worked especially hard to deploy a new electronic record during a particularly challenging year.

“Our dedicated VA professionals continue to work feverishly on this effort even as we maneuver through the complexities and surges of the COVID-19 pandemic,” he said Friday.

Cerner Corporation said it supported VA’s decision and welcomed the opportunity to review lessons learned.

“Our number one priority remains the veterans we serve and delivering solutions that drive the transformation of care across the VA,” said Brian Sandager, general manager of Cerner Government Solutions. “We are proud of the significant milestones we have achieved, including one of the largest health data migrations in history and the deployment of a new joint health information exchange between DOD, VA and their community partners.”

Leadership on both the House and Senate Veterans Affairs Committees also said they were pleased VA had listened to concerns from veterans and VA employees in Spokane.

The chairmen and ranking members of those committees wrote to McDonough last month, asking him to reconsider the path forward for the EHR modernization program.

“Pausing the rollout of the new Cerner electronic health record is a good call,” Mike Bost (R-Ill.), ranking member of the House Veterans Affairs Committee, said Friday. “This effort could revolutionize VA care, but it is not on the right track today. VA must fix the serious problems in Spokane. VA must also fix the process, strategy and management challenges that led to those problems before moving forward anywhere else.”

The House VA Committee will host a hearing next month on status of EHR modernization, said Frank Mrvan (D-Ind.), chairman of the technology modernization subcommittee.

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