VA extends EHR delay to June 2023 after review finds more system problems

The Department of Veterans Affairs is further delaying the rollout of its new Electronic Health Record to additional sites, as it troubleshoots problems that have led to patient harm and frustrated its health care workforce.

The VA announced Thursday the agency will push back upcoming deployments of its Oracle-Cerner EHR to June 2023 to address previously known and emerging problems with the system and to “make sure it is functioning optimally for veterans and for VA health care personnel.”

VA Secretary Denis McDonough, this summer, scrapped plans for EHR deployments for the rest of calendar year 2022, after the agency’s inspector general office reported instances of the EHR contributing to patient harm and decreased quality of care.

The VA is also sending letters to every veteran who may have been impacted by problems with the EHR currently running at five VA locations across the U.S.

The letter tells veterans to reach out to the VA over the phone or online if they “experienced a delay in medications, appointments, referrals, or test results” at a facility using the Oracle-Cerner EHR.

The VA said veterans can expect to hear back from the agency within five business days to resolve their issue.

Deputy VA Secretary Donald Remy said in a statement that the agency will delay all future deployments of the new EHR to fully address concerns with the system’s performance and reliability.

“Right now, the Oracle Cerner electronic health record system is not delivering for Veterans or VA health care providers — and we are holding Oracle Cerner and ourselves accountable to get this right,” Remy said.

Remy told members of the Senate Appropriations Committee in September that the EHR was “not even close” to meeting the needs of patients, and said the VA won’t proceed with future EHR go-lives if the system doesn’t pass a checklist that includes training for VA employees and patient safety criteria.

The VA said in its announcement that additional EHR problems have emerged during its review, and will need more time to address them before go-lives can resume.

“During VA’s subsequent investigation at our current sites, several additional technical and system issues were identified – including challenges with performance, such as latency and slowness, problems with patient scheduling, referrals, medication management, and other types of medical orders,” the agency said in a statement.

The VA has scheduled the EHR to go live at 25 VA medical centers in fiscal 2023, but the schedule is still subject to changes.

Oracle, the parent company of the VA EHR contractor Cerner, notified the Senate VA Committee in September that it provided a fix to an “unknown queue” problem with the VA system on Aug. 1.

The problem, as documented by the VA inspector general’s office, has led to thousands of clinical orders disappearing in an unmonitored inbox, causing patients to miss follow-up care.

VA Secretary Denis McDonough told reporters on Sept. 28 that it remains unclear whether a single fix to the unknown queue is enough to fully address the concerns of VA employees and patients, adding that the VA is still looking to determine the scope of its EHR challenges.

However, VA Undersecretary for Health Shereef Elnahal stopped short of saying the issue has been completely resolved.

“I am not confident that we’ve completely solved that set of issues,” Elnahal said.

Elnahal said that, following a site visit in Columbus, Ohio, the EHR contributed to VA employee burnout, and in some cases, led to employees quitting their jobs.

“There’s literally a systemwide focus now on clinician burnout, employee burnout, leading by example, and respecting what makes our employees whole and supporting our employees as much as we can. And so that’s going to be a huge priority for me to further those efforts, and get them to even more employees,” Elnahal told reporters last month.

Elnahal said the agency is continuing to work with Oracle-Cerner to definitively understand the basis of its EHR challenges, and troubleshooting the EHR rollout “rises to the top, in my mind, for patient safety risks.”

McDonough added that the VHA, through its REBOOT task force, is also taking steps to address burnout and working conditions among its health care workforce.

“This issue of burnout is front and center for us. And it’s an issue in the workforce generally at VA and the labor force generally in the United States. I’m really proud of the work we’re doing to get ahead of it,” McDonough said.

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