Congress fears VA is ‘moving on’ amid persistent EHR challenges, low employee morale at initial go-live site

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Veterans Affairs employees at the department’s initial go-live site remain frustrated with the new electronic health record — now more than a year after last October’s rollout and three months after the agency’s strategic review uncovered widespread patient safety issues, technical problems, training shortfalls and other budgetary and organizational challenges.

VA said it wouldn’t deploy the EHR to a second site until it resolved the challenges uncovered in the strategic review, putting off future go-lives until at least 2022.

But members of Congress on both sides of the aisle said they fear VA is moving on to the next site before fully addressing still-present problems with patient safety issues, employee morale and productivity in Spokane, Washington.

“What worries me is that these problems keep happening,” Mike Bost (R-Ill.), ranking member of the House Veterans Affairs Committee, said at a Tuesday hearing on the VA EHR. “Some VA leaders still believe that it is all because employees are resistant to change. In other words, they blame the staff. This is inaccurate and unfair.”

The department is eyeing February as its target for deploying the Cerner EHR to the VA facility in Columbus, Ohio.

That doesn’t mean VA will “flip the switch” and go live with the new health record during that time, Deputy Secretary Donald Remy told the House Veterans Affairs Technology Modernization Subcommittee on Tuesday.

“We’ve got the training [and] testing all set up. We’ve already started to socialize and received exceeding favorable feedback,” he said. “But this quarter two, [fiscal] 2022 deployment is the deployment that leads up to the go-live at a later point in time. We’ll be doing this testing. We’ll be doing the training. We’ll have sandbox exercises to make sure that the facility is ready to receive and that we’ve provided them with the tools to be successful.”

But Congress says the data still coming from the Mann-Grandstaff VA Medical Center in Spokane is too troubling to ignore. Members on the technology modernization say they continue to hear about deteriorating employee morale and troubling usability problems with the EHR, many of which Federal News Network reported back in April.

VA’s National Center for Organization Development conducted an anonymous, voluntary survey of Spokane employees back in August and September. Some 833 employees responded, the committee said.

About 83% of employees said their morale has worsened since the Cerner implementation last fall. Roughly 16% said their morale hasn’t changed and 0.7% said it had improved, according to the survey results, which the House committee shared with Federal News Network.

Nearly 63% of employees said the Cerner deployment has made them question whether they should keep working at VA.

Almost 81% said their level of burnout has increased since the EHR implementation, with 18.6% of employees holding neutral opinions and 0.5% saying things have gotten better.

And when it came to their level of confidence in using the EHR to perform their job duties, 61.7% of employees disagreed. Another 22.4% were neutral, while 15.8% of employees said they were confident with the system.

“If any of us had polls like what that survey was we’d quit these jobs, I’ll guarantee it, because those numbers are bad,” Bost said.

Committee Democrats and Republicans questioned Remy about the survey results over and over, calling them “startling,” and “terrible.” They said they’ve spoken with or heard from Spokane employees themselves who expressed frustrations with the EHR.

Rep. Cathy McMorris Rodgers (R-Wash.), who represents employees and veterans in Spokane, said the Mann-Grandstaff workforce has logged more than 61,000 hours of overtime in the last year.

“Mr. Remy, there’s a sense that you’re moving on,” she said. “There’s a sense that you’re moving on to Columbus and that you’re done at Mann-Grandstaff.”

VA staff around the country have been feeling burnout during the pandemic, Remy said. But he acknowledged both the deployment and the pandemic have stressed Spokane employees perhaps more so than their colleagues in other regions.

At the same time, Remy said the survey results concerned him and acknowledged the department had to “tend to them immediately.” He spoke with the Mann-Grandstaff director after the survey results came out and is planning to visit the facility in a few weeks.

“I want the folks there to know we’re not forgetting about them, and we’re not trying to brush them to the side,” Remy said. “We’re hopeful that we’ll be able to make sure that we’re delivering them the tools today and tomorrow to continue the success of the program.”

Patient safety issues persist, productivity lags

Since VA went live with the new EHR last October, employees at Spokane have submitted a total 829 patient safety tickets, including 576 that are directly related to the new health record, Rosendale said.

Remy said VA has a multi-disciplinary team that evaluates each ticket as they come in.

“With these issues that have arisen, we’ve developed solutions,” he said. “We’ve learned lessons from any issue that might arise on how to move forward so we don’t repeat that.”

Rep. Matt Rosendale (R-Mont.), ranking member of the Technology Modernization Subcommittee, was especially frustrated.

“Are you going to tell me in quarter four here that I shouldn’t be expecting to see any of these patient safety tickets problems so that when you introduce this system in Columbus in February everything should be working just fine?” he said. “Is that what you’re trying to tell me?”

“I think things will continue to improve,” Remy said. “I cannot tell you that we will never have another ticket around another patient safety issue.”

Beyond concerns with employee morale and patient safety tickets, members worry VA isn’t restoring lost productivity from the EHR rollout at Spokane fast enough.

For example, VA in August had 164 employee reconciling problems with veterans’ medical data where it was migrated to the Cerner system incorrectly. The department had 181 employees working on those problems a year ago, Rosendale said.

In August, VA saw 57% of veterans within 15 minutes of their arrival to the Spokane facility, compared with 50% a year ago.

“That’s a slight improvement, but anything that’s in the 50s, quite frankly, is unacceptable,” Rosendale said.

The chairmen and ranking members of the House and Senate VA committees say they’re “apprehensive” the department is pressing ahead with future deployments.

The leaders, which include Sens. Jon Tester (D-Mont.) and Jerry Moran (R-Kan.), as well as Reps. Mark Takano (D-Calif.), Frank Mrvan (D-Ind.), Bost and Rosendale, want VA to set specific performance metrics that demonstrate tangible improvements to the Cerner EHR itself.

“It is vitally important that VA and Cerner expeditiously agree on quality and outcome metrics and make them public, along with the supporting data indicating performance on a regular basis,” they wrote in an Oct. 1 letter to Remy. “The metrics should concern usage and performance of the electronic health record system, as well as its impact on operations, safety and quality in the medical centers.”

VA hiring a new executive to oversee daily EHR decisions

The department is still finalizing a new governance structure for the EHR project, which VA Secretary Denis McDonough had highlighted as a pain point from the initial deployment last fall.

The department is creating a new position, an executive that will serve as the go-between with Remy and the VA EHR program office and will oversee daily decisions with the project.

Remy said VA is currently looking for qualified applicants to fill the role now, and the department is searching within and outside government. The ideal candidate will have experience implementing an electronic health record within a large-scale enterprise and will have change management skills, he added.

The department is also considering a new deputy chief information officer solely responsible for the EHR modernization, but Remy said those decisions aren’t quite final.

“I’m not in a position to say what the specific title is, but we plan on making sure that there is someone that’s focused on the electronic health records modernization program within our Office of Information and Technology,” Remy said.

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