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The Department of Veterans Affairs is postponing the go-live for its new Electronic Health Record at yet another site, as Congress intensifies its scrutiny of the rollout.
Secretary Denis McDonough told reporters in a press conference Wednesday that the agency will not go live with its Oracle-Cerner EHR in Boise, Idaho on July 23 as planned. There are no other scheduled EHR deployments for the rest of fiscal 2022.
“That was a decision made by the project team, in consultation with all of our expertise at VHA,” McDonough said.
Terry Adirim, the executive director of the EHR Modernization Integration Office, told the Senate VA Committee that the agency made the “go/no-go decision” for the Boise VA Medical Center on Wednesday.
“Today, we made the decision that the system just wasn’t in a place, because of latency, as well as other pieces that were not in place for us to be confident that we could have a successful deployment,” Adirim said.
Adirim said the decision came from the Boise VA Medical Center director and Veterans Health Administration’s leadership.
More broadly, Adirim said her team informed McDonough that the EHR is not yet ready for deployment at larger, more complex VA facilities because of system stability issues.
“We wanted to give Cerner more time to address those issues before going to the larger medical centers,” Adirim said.
The Boise decision marks only the latest EHR postponement decision from VA.
The VA inspector general’s office last week released a report that found the EHR rollout, specifically an “unknown queue” issue, at the Mann-Grandstaff VA Medical Center in Spokane, Washington caused harm to at least 148 veterans treated there.
Adirim said the EHR rollout in Spokane was “problematic,” and said that any degree of harm to veterans during the rollout was “unacceptable.”
“I’ll be blunt: in hindsight, Mann Grandstaff wasn’t ready to adopt a new electronic health record. Planning was inadequate and lacked a thorough assessment of the site’s readiness,” Adirim said, adding that the October 2020 go-live came at a time when VA medical centers were still seriously impacted by the COVID-19 pandemic.
Committee Chairman Jon Tester (D-Mont.) said the IG’s findings should “serve as a wake-up call to everybody,” and said VA has paid Oracle-Cerner nearly $3 billion to date for a product that is “not up to snuff.”
Sen. Patty Murray (D-Wash.) expressed outrage over EHR problems documented in Spokane and Walla Walla, Washington. She said VA clinicians are, in some cases, doing double the work to provide the same level of care to patients.
“VA might have inherited this program, but you own it now, and VA owes our veterans a system that works and that puts patients first,” Murray said.
Gerald Cox, VHA’s assistant undersecretary of health for quality and patient safety, said he recognized that VA employees are going above and beyond to ensure the new EHR is doing what it’s supposed to.
“The only way that the system is being used effectively, I believe, is because our dedicated employees are putting in double time, double checking, triple checking things to make sure that the care that they intend to deliver to veterans is, in fact, intended. And that’s not the way it’s supposed to work,” Cox said.
Mike Sicilia, the executive vice president for industries at Oracle, said the company will move the Cerner EHR to a modern cloud data center within the next six-to-nine months, in order to ensure better performance and stability for clinicians and patients.
“Candidly, we anticipate this change alone will be the single most important change we make in terms of system reliability,” Sicilia told the committee.
Sicilia said the Cerner EHR system is currently running on a dated architecture with technology that is, in some cases, two decades old.
“Frankly, it is being run on a disparate set of technology and systems that have grown in place over time, making it difficult to manage, support and scale. It isn’t in the cloud and it requires massive amounts of manual support. This isn’t unusual in the EHR industry, but it does lead to more frequent outages and degradations of service,” Sicilia said.
Sicilia said that shortly after completing its acquisition of Cerner about six weeks ago, Oracle fixed a database bug that caused 13 of the EHR’s 15 latest outages.
“I can’t promise you there won’t be another outage, but since we made that fix in mid-June, there has been no unplanned downtime through yesterday,” Sicilia said.
VA Chief Information Officer Kurt DelBene said the IT architecture of the EHR “is somewhat dated at this point,” and was built using a traditional client-server architecture, as opposed to a multi-tier cloud capacity system, which he said is how it would be built today.
“We are working with Oracle-Cerner to get them to do a roadmap for us as to how they would migrate to a more modern architecture,” DelBene said.
Sicilia said Oracle will not go live at any additional VA facilities, unless the company is confident that the system is fully prepared for the additional workloads and has been thoroughly tested.
DelBene said there have been 24 outages and 48 degradation events since the first EHR go-live, and said resiliency issues are at the core of the EHR problem.
“A lot of the problems have been where the system was designed to be resilient, but didn’t perform in a resilient way. So a piece failed, and it’s supposed to fail over to another piece of capacity, and it didn’t. So we’re pushing them to get those problems solved,” DelBene said.
Oracle-Cerner, he added, is obligated to ensure 99.9% uptime for the EHR, and to be able to come back online within four hours if there’s a disaster. But he said the vendor wasn’t meeting its uptime requirement for several months.
Adirim said the VA is trying to emulate the Defense Department’s more successful rollout of the same EHR system, which is meant to be interoperable between DoD and VA. However, she said the VA’s migration is a more complicated task.
“Clearly, we’re not there yet. We’re still in initial operating capability, making all those changes and enhancements that we need to do,” Adirim said. “DOD was able to do that. They got to a point where they could take the deployment through waves, and I want us to be able to achieve that.”