VA confidence in new EHR ‘shaken’ following cases of patient harm, McDonough says

The Department of Veterans Affairs, Congress and the vendors behind the VA's new Electronic Health Record are renewing their scrutiny of the EHR rollout.

The Department of Veterans Affairs, Congress and the vendors behind the VA’s new Electronic Health Record are renewing their scrutiny of the EHR rollout.

Denis McDonough told reporters Wednesday that his “confidence has been shaken” over the rollout of the new Cerner Electronic Health Record, following system outages and IG reports documenting risks to patient care.

“I do now know that there are instances of patient harm, and that there could be a range of factors that contribute to that,” McDonough said.

McDonough said he’s communicated his concerns with EHR vendor Cerner, and that the agency and Cerner are addressing issues with the system rollout.

“There’s been some work over the course of the last 10 days, that seems to have had a major impact on that,” McDonough said.

The Spokesman-Review over the weekend first reported that a draft IG report found 148 cases of patient harm following the EHR go-live in Spokane, Washington.

McDonough told reporters he could neither confirm nor deny the existence of the draft VA IG report. However, he said the VA’s patient safety expert team is looking into these cases of patient harm, and that team at this point “can’t rule out that EHR plays a role” in the harm caused.

McDonough said he’s been in close contact with the VA inspector general about its EHR findings, and said he has “gotten smarter on these reports over the course of the last couple of months.”

“The kind of back and forth that we’re currently engaged with the IG on is really, really important to us getting better at what we do. That kind of ability to exchange candid views, including on draft reports, is really important to us getting better,” he said.

McDonough said that he’s also been in close contact with VA Chief Information Officer Kurt DelBene, who’s been leading the agency’s technical team.

The VA recently announced it will push back the EHR go-live at four locations from this year to 2023. These include facilities in the Puget Sound VA Health Care System and Portland VA Health Care System.

The EHR, however, will still go live in Boise, Idaho on July 23 as planned.

It remains unclear when McDonough first learned of the patient harm cases documented by the VA inspector general’s office.

McDonough told the House VA Committee last that the agency wouldn’t proceed with the EHR rollout if he determined that issues with the rollout “create a threat to our veterans.”

“If I had known what I know today when I was appearing before Congress, I would have answered those questions differently,” McDonough said Wednesday.

McDonough said the VA right now is “trying our darndest to make the Cerner option work,” adding that a well-functioning electronic health record will improve patient outcomes, but said the agency wasn’t yet prepared to discuss alternative options.

The VA awarded a 10-year contract with Cerner in May 2018 to replace its legacy VistA electronic health record with the same commercial off-the-shelf platform used by the Defense Department and Coast Guard.

“This is the option that we had when we arrived. We’re executing as diligently as we can on that, as transparently as we can, and working closely, for example, with Congress and the IG, and we’ll continue to do that. But I’m not ready to answer hypotheticals about if this doesn’t work,” McDonough said.

The lifecycle of the contract is currently estimated at $16 billion. Previous IG reports warn those costs may continue to increase in light of schedule delays.

McDonough said several degradations and outages since the second EHR go-live in Walla Walla, Washington have “shook my confidence in the system.”

“They have a very generous contract that was awarded several years ago to provide a workable EHR. And that’s what we’re holding them accountable to,” he said.

Oracle spokeswoman Deborah Hellinger said in a statement Wednesday that since acquiring Cerner two weeks ago, Oracle engineers have been on the ground, “making technical and operational changes, with an emphasis on patient safety, to ensure the system exceeds the expectations of providers, patients, and the VA.”

“We intend to bring substantially more resources to this program and deliver a modern, state-of-the-art electronic health system that will make the VA the industry standard. We have a contractual and moral obligation to deliver the best technology possible for our nation’s veterans, and we intend to do so,” Hellinger said.

House VA Committee Chairman Mark Takano (D-Calif.) and Technology Modernization Subcommittee Chairman Frank Mrvan (D-Ind.) said in a statement Wednesday that the draft VA IG report’s findings were “seriously troubling and contradict what we have heard from VA officials during public testimony,”

“We have already begun discussions with VA on the performance of Cerner and requested an official briefing on the forthcoming report. Once released, we will be reviewing the findings closely in order to determine if there are any contractual or legal repercussions of these draft findings,” the lawmakers wrote.

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