VA EHR sees no outages in 6 months, but employees still give system low marks

The Department of Veterans Affairs says its new Electronic Health Record (EHR) hasn't seen a total outage in more than six months.

The Department of Veterans Affairs says its new Electronic Health Record (EHR) hasn’t seen a total outage in more than six months.

But the Oracle-Cerner EHR still isn’t meeting a standard in its contract with VA for the system to run incident-free at least 95% of the time.

As of Nov. 8, the Oracle-Cerner EHR has gone 185 consecutive days without a total outage within the VA, and has seen 100% system availability in  10 of the last 12 months.

But Kurt DelBene, VA’s assistant secretary for Information and Technology and its chief information officer, told members of the House VA Committee that the EHR still doesn’t meet a standard for incident-free time outlined in its contract with the vendor.

As of Sept. 30, Oracle-Cerner reached this metric in only four of the past 10 months.

“To be sure, we’re still experiencing partial system failures that impact the users,” DelBene said in a technology modernization subcommittee hearing Wednesday.

Members of the House VA Committee remain frustrated with the department’s lack of progress with its EHR rollout.

VA has spent nearly $4 billion on the project so far, but the department has only deployed the new EHR to five small and medium-sized VA medical centers. Full deployment would bring it to more than 170 VA medical facilities.

The VA in April put a hold on all future deployments of the EHR until it addresses problems at sites already using the system.

Subcommittee Chairman Matt Rosendale (R-Mont.) said “complete, nationwide outages” have become less common over the past year, but “crashes, hangs, and errors that affect one facility, one module, or one person are still widespread.”

The VA and the Defense Department say incident-free time under their control was between 95% and 99% this year. According to Oracle-Cerner, incident-free time under its control was between 87% and 97%  this year.

But Rosendale said surveys conducted by KLAS Research show frontline VA health care employees still give low marks to the EHR.

Only 26% of VA employees surveyed agreed that, within two weeks of filling out the survey, “the EHR was available when I needed it, and downtime was not a problem.”

About 58% of the employees surveyed said the EHR was not available, and downtime was a problem. Only 10% of the VA employees said that Oracle Cerner EHR enables them to deliver high-quality care.

“There is a big disconnect here,” Rosendale said. “The criteria VA and Oracle are using are clearly not capturing all the system’s problems.”

Rosendale said that in at least a dozen incidents, some sort of EHR outage “directly contributed to a close call or patient harm.”

Subcommittee Ranking Member Sheila Cherfilus-McCormick (D-Fla.) said the data from Oracle-Cerner and VA “doesn’t seem to match what we’re hearing from frontline staff.”

“The end users that we have heard from indicate that the system is frequently either slow or nonfunctional,” Cherfilus-McCormick said.

Cherfilus-McCormick said Oracle-Cerner is also pushing updates in the middle of the workday that break other functions of the EHR.

DelBene said part of the reason why the EHR is seeing these partial system failures is because of the number of changes being made.

“It’s a well-established axiom of software development that systems stabilize when the rate of change made in the system decreases,” DelBene said. “The rate of change is still very high, resulting in more instances than we would like.”

In some cases, the VA is requesting functionality from the Oracle-Cerner EHR that has never been deployed by Oracle-Cerner commercially.

That includes the integration of the VA’s consolidated mail outpatient pharmacy. DelBene said the VA is Oracle-Cerner’s first customer to receive this functionality, which also increases incident risk.

“Ultimately, we anticipate that the system’s performance will improve when change velocity decreases, and enough time has passed to enable unanticipated defects to be found and addressed,” DelBene said.

Laura Prietula,  deputy chief information officer for VA’s EHR Modernization Integration Office, said the department has “significantly customized” the Oracle-Cerner EHR, and that most of its commercial health care customers rely on the system’s “out-of-the-box” functionality.

Prietula said the Veterans Health Administration and EHR Modernization Integration Office during the EHR “reset” have launched teams to “really assess where are we, in terms of the user experience.”

In February 2022, VA established a Performance Excellence Program to improve the overall performance and reliability of the Oracle-Cerner EHR.

DelBene said that the average user of the Oracle-Cerner EHR currently sees about two “hangs,” or pauses in the system, that last five seconds or less on any particular day.

VA leaders, DelBene said, are optimistic about the EHR’s rollout once it ends its current reset period.

“Having said that, we will not do this until the system is ready to provide a good quality experience to users,” he said. “We still think there’s a ways to go. I don’t want to present the system as all set and ready to go. There are places we have significant concerns that we’re working with Oracle on.”

The Oracle-Cerner EHR VA is rolling out is the same system in use by the Defense Department and the Coast Guard. DelBene said interoperability with DoD is a core reason for its move to the Oracle-Cerner EHR, and will lead to a better experience for veterans.

“The EHR will serve them from the day they begin their military service through the rest of their lives,” DelBene said.

Bill Tinston, director of DoD’s Federal Electronic Health Record Modernization Office,  said an interoperable federal EHR is large in scale and complexity, but said the system delivers “capabilities that enhance patient care and provider effectiveness.”

“The effort to deploy our modern EHR has been and still is a challenging endeavor. But in no way do these challenges mean that the EHR modernization is not an attainable goal,” Tinston said.

The VA’s ability to resume the EHR rollout will depend, in large part, on the success of the system’s launch in March 2024 at the Capt. James A. Lovell Federal Health Care Center in Chicago.

The facility is jointly run by the VA and the DoD, which is much further ahead in its own deployment of the same Oracle-Cerner EHR.

Tinston said the EHR rollout at the Lovell Federal Health Care Center is DoD’s final EHR deployment, and “is the culmination of all our efforts to create a joint single federal record.”

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