System outages and patient safety concerns associated with the Department of Veterans Affairs’ new electronic health record (EHR) have led to top members of the House VA Committee calling for the agency to stop future rollouts.

VA officials told the technology modernization subcommittee Tuesday that the VA medical center in Walla Walla, Washington, experienced EHR outages Monday and Tuesday this week.

In light of these and other recent outages, Cerner officials told lawmakers the company is considering a technical review of the EHR to ensure the system is stable and reliable for future rollouts.

VA deployed the new EHR at two sites so far — one in Spokane, Washington, the other in Walla Walla. A third go-live is planned at the end of the month in Columbus, Ohio.

The agency has plans for the EHR to go live at larger, more complex VA facilities in Seattle and Ann Arbor, Michigan later this year.

However, the subcommittee pointed to several inspector general reports that found the EHR rollout increased “risks for errors” in veteran health care as grounds for the VA stopping all future go-lives until the agency addresses these problems.

Subcommittee Chairman Frank Mrvan (D-Ind.) said EHR medication management issues in Spokane resulted in a veteran’s heart medication “falling off” the list of active prescriptions on his health record, causing him to run out of medication.

Mrvan said, citing an article from the Spokane Spokesman-Review, said the patient was hospitalized after a cardiac episode. He said the incident was “unacceptable,” and that the EHR rollout has put a burden on VA employees.

“Until these issues are resolved, the committee cannot support VA going live with Cerner at larger, more complex facilities,” Mrvan said Tuesday.

Mrvan said the EHR has created an “enormous amount of extra work” for VA employees, which has hurt productivity levels and made it more difficult for veterans to schedule appointments.

“It’s hard to do your job when the systems you rely on aren’t working,” Mrvan said.

Terry Adirim, executive director of the EHR Modernization Integration Office, said the EHR issues are not strictly IT problems, but rather a matter of getting the “right mix of training and change management.”

”As a physician, none of us like our EHRs. It’s just a lot of clicking. The other piece of this too is that people don’t like to change how they do their work that they’ve been doing a certain way over a long period of time. That said, there definitely are issues that need to be addressed, issues that have been addressed and issues that we have continued to address,” Adirim said.

Adirim declined to answer the subcommittee’s questions about the patient’s heart medication in Spokane, citing patient confidentiality, but said the EHR was “working as intended,” and that it is up to physicians to renew prescriptions when they see patients.

“I don’t believe that there’s any evidence that it has harmed patients or will going forward,” she said about the EHR rollout.

VA and Cerner officials told the subcommittee it will take about up to three years to make the code changes necessary to address some of the agency’s requests to change how medication management functions under the new system.

That timeline, however, combined with multiple system outages, have led to lawmakers urging VA to pause future EHR go-lives until these issues are solved.

Laura Prietula, VA’s deputy chief information officer for EHR modernization, said Walla Walla experienced an outage Monday and Tuesday, the cause being “load balancers not being able to control the load.”

Adirim initially disputed Monday’s tech issues as an outage, and told the subcommittee that it was instead a “slowdown.”

“There wasn’t an outage yesterday,” Adirim said.

Patrick Sargent, senior vice president and general manager for Cerner Government Services, said the company is considering doing a technical review of the EHR, in light of these and other recent outages.

“We have made a determination that we need to do likely an independent look at our system, just to make sure we’re not missing something with regard to the stability of the system,” Sargent said.

Sargent said yesterday’s outage was caused by an update to the system, and that the VA has downtime procedures planned for outages to ensure continuity of care.

“Yesterday’s outage pertained to a push we made to the system in the middle of the day, and it brought the system down,” Sargent said.

VA earlier this month investigated a broader outage that brought down all federal Cerner systems across the Defense Department, VA and the Coast Guard.

Adirim said the EHR is a “safe system” that DoD has running at more than half of its facilities across the country.

Given the issues documented at Spokane and Walla Walla, Mrvan said “the risks exceed the benefits,” and said the VA is not ready to roll out the EHR to larger, more complex sites.

Subcommittee Chairman Matt Rosendale (R-Mont.) said there have been 50 EHR outages since the first go live in Spokane in October 2020.

“It is certainly a lot of time when the physicians could not deliver care nor set appointments for the patients,” Rosendale said.

Rosendale said he is “gravely concerned” with the current state of the VA’s EHR rollout, and urged the agency to get to the bottom of these issues before moving ahead with additional deployments.

“There should be no more go-lives or additional funding until every single one of these has a fix,” he said.

The VA announced last summer that would not deploy new electronic health record to additional sites for the rest of 2021, after a strategic review found a wide array of problems at the first go-live site in Spokane.

Committee Chairman Mark Takano (D-Calif.) said the VA continuing with its legacy VistA system “is simply not sustainable in the long term,” but said the VA must ensure its new EHR is not putting an undue burden on its frontline workers or endangering veterans.

“The common theme is that there are issues and the staff working with the new system don’t feel their concerns are being taken seriously,” Takano said.

Sargent, however, said Cerner plans on taking the subcommittee’s concerns about VA patient safety seriously.

“I will give you my commitment that we will work to have zero preventable harm,” he said.

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