VA’s new EHR ‘not ready’ for next go-live, extending pause in rollouts

The Department of Veterans Affairs’ latest pause in the rollout of its new Electronic Health Record will last longer than expected.

The VA announced Thursday that its new Oracle-Cerner EHR won’t go-live at its medical center in Saginaw, Michigan, this summer as planned.

The agency expected to end an eight-month pause in the EHR rollout with a go-live of the system in Saginaw in June.

Laura Ruzick, director of Veterans Integrated Services Network 10 — which covers parts of Michigan, Ohio, Kentucky and Indiana — told staff in a memo that recent assessments show the Oracle-Cerner EHR “is not yet ready for the planned June deployment in Saginaw.”

“As VA leadership has promised, we will not deploy the new EHR system at any facility until we are confident it is ready to deliver for veterans and VA providers,” Ruzick wrote.

Ruzick told staff that EHR training scheduled to begin on April 11 has been postponed, and that the VISN will have additional updates in the coming weeks. She also thanked VA clinicians for their work preparing for the EHR deployment.

“I know your commitment to this project has been and will continue to be extraordinary and I am personally grateful to each one of you for your dedication,” Ruzick wrote. “I am confident that when we do roll out the new EHR system in Saginaw, we will make it a smooth, safe and positive experience for veterans and staff alike — and we will do so together.”

The VA is setting a higher bar for the criteria that needs to be met before a facility proceeds with the launch of the new EHR.

The agency recently released its EHR Modernization Sprint Report, which identifies four key issues leading to problems with the Oracle-Cerner rollout, as well as 14 issues with the system that need to be fixed.

Lawmakers, however, are frustrated by delays in the VA EHR modernization efforts, as well as patient safety issues.

Five years into its contract with Oracle-Cerner EHR, the VA is using the new system at five sites, and would eventually need to bring the system online at 171 VA medical centers.

The Defense Department, by contrast, has the same Oracle-Cerner EHR running at 75% of its clinics and hospitals, and is expected to complete its deployment next year, according to its 2024 budget request.

The VA is back at the bargaining table with Oracle-Cerner, looking to renegotiate the terms of its contract.

VA Secretary Denis McDonough told House appropriators last week that the VA had not yet finalized its go-live decision for Saginaw.

“That’s a decision we’ve not yet made.  We’ll make that [decision] based on where the technology is. But to be honest with you, increasingly, my question is, I need to see what happens in this contract before we make a decision about where we go next anyway, because the contract may not be what we need,” McDonough said.

It remains unclear when — and where — the VA will resume EHR go-lives.

The VA, as of late 2022, expected the Oracle-Cerner EHR to go live at 25 additional sites in fiscal 2023. But the VA recently postponed the EHR launch in Ann Arbor, Michigan.

The EHR is now scheduled to go live in Ann Arbor in late 2023 or early 2024. The EHR was previously scheduled to go live this July.

VA Undersecretary for Health Shereef Elnahal told reporters in February that the Ann Arbor delay is related “directly to functionality within Cerner around clinical research,” and that the facility is one of many VA medical centers that partner with academic institutions on veteran clinical trials.

Elnahal said VA delayed the Ann Arbor go-live to not put the facility’s research grants at risk. He said the VA is also close to having a revised execution plan for upcoming EHR go-lives.

“We’re basically on the cusp of having that execution plan. And many of these issues are already being addressed. We will then take that evidence-based input and determine what a real deployment schedule should look like,” he said.

House and Senate lawmakers say a renegotiated contract is only the start of what the VA needs to do to get the troubled Oracle-Cerner EHR contract back on track.

The toll of the EHR system crossed a new threshold in March, when members of the Senate VA Committee said the VA notified them of six “catastrophic events” related to a feature of the EHR modernization program over the last couple of years.

Senators said that four of the catastrophic events resulted in fatalities.

House VA Committee Chairman Mike Bost (R-Ill.) said in a recent interview that, according to the VA, those catastrophic incidents and deaths occurred because the EHR either dropped a possible appointment “that was vitally important” for a patient to receive, led to patients receiving the wrong medication or caused delays in care.

Bost said those catastrophic events don’t include many other incidents where the EHR has “caused all kinds of trouble with our veterans trying to receive care.”

“It’s one issue like this after another that we’ve noticed,” Bost said in a March 22 interview.

Bost and Technology Modernization Subcommittee Chairman Matt Rosendale (R-Mont.) said in a statement Thursday the VA’s EHR pause “should last as long as it takes for VA and Oracle-Cerner to get their houses in order.”

“That may be years, but the delivery of good care and services to veterans depends on it,” they said.

Bost and Rosendale added that it “is abundantly clear to us that the Oracle Cerner EHR system is not ready for prime time, and VA is not ready to carry out this project.”

“Local VA medical center leadership and staff have said so themselves for months,” they said.

The VA now faces four separate legislative efforts in Congress that, if passed, would set a higher bar for the EHR modernization project to continue.

Senate VA Committee Ranking Member Jerry Moran (R-Kan.) introduced one of the most recent EHR reform bills, along with 11 of his colleagues.

The VA EHR Modernization Standardization and Accountability Act would require the VA to demonstrate its new EHR meets performance metrics at the five sites already using it, before it can roll it out at new facilities.

Democrats on the Senate VA Committee introduced a similar bill: the EHR Program RESET Act.

That bill, introduced by committee Chairman Jon Tester (D-Mont.) and Sens. Patty Murray (D-Wash.) and Sherrod Brown (D-Ohio), would prevent the VA from proceeding with EHR go-lives at additional facilities, until data from the five current sites using the system “demonstrates an ability to deliver health care to veterans at standards that surpass metrics” using VA’s 40-year old legacy VistA EHR. 

The RESET Act would also require the VA to come up with “an alternative ‘Plan B’ strategy” for the Oracle-Cerner EHR, if the vendor doesn’t agree to new contract terms that “increase accountability and penalties for poor performance,” or if the agency can’t get the EHR to “serve veterans efficiently and safely.”

Top Republicans on the House VA Committee in February introduced the VA Electronic Health Record Modernization Improvement Act, which would require “significant improvements” from the EHR system before bringing it to additional VA medical centers.

A separate bill, led by Bost and Technology Modernization Subcommittee Chairman Matt Rosendale (R-Mont.) would force the VA to completely pull the plug on the Oracle-Cerner EHR.

Top Democrats on the House Veteran Affairs Committee, meanwhile, have introduced bills that more broadly target the VA’s largest IT and acquisition projects.

The Manage VA Act would require the VA to create an under secretary for management position to oversee its IT and acquisition decisions.

The VA IT Modernization Improvement Act would require the VA to hire a contractor to provide a third-party assessment of its major IT programs.

The third-party auditor would oversee the rollout of VA’s Oracle-Cerner Electronic Health Record, as well as its Veterans Benefits Management System, Financial Management Business Transformation and supply chain modernization efforts.

Committee Ranking Member Mark Takano (D-Calif.) and Technology Modernization Subcommittee Ranking Member Sheila Cherfilus-McCormick (D-Fla.) introduced the bills.

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