The Department of Veterans Affairs has abandoned plans to introduce its new electronic health records system at more facilities, announcing Friday that it has halted all future deployments as it moves to fix the system at the five places where it currently is used.
VA officials said earlier this month they had paused a planned rollout this summer of the Oracle Cerner system at the VA Saginaw, Michigan, Health Care Facility.
But Friday's announcement indefinitely stops all preparations for adoption of the new program at 166 VA medical centers and their associated clinics -- with the exception of one, the Lovell Federal Health Care Center in Chicago, which the VA operates jointly with the Defense Department. That system will remain on schedule, expected to go live in March 2024.
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VA officials said Friday that issues with the Oracle Cerner system, such as problems that range from safety issues involving patients to providers having trouble using the system, must be fixed before it can be introduced anywhere else.
"For the past few years, we've tried to fix this plane while flying it -- and that hasn't delivered the results that Veterans or our staff deserve," said Dr. Neil Evans, acting program executive director in the VA's Electronic Health Record Modernization Integration Office, in a statement released Friday. "This reset changes that."
The Oracle Cerner Millennium system was first introduced in October 2020 at the Mann-Grandstaff VA Medical Center in Spokane, Washington, and its affiliated clinics. Almost immediately, it drew criticism from medical providers for its complexity, but also led to delays in care and safety risks for patients.
Nonetheless, its use was expanded in 2022 to the VA Walla Walla Health Care System in March, and after delays, Columbus, Ohio, in April and Oregon in June.
In November, lawmakers raised concerns that two veterans may have died as a result of the system's complexities -- one who never received a needed medication because of issues with prescription tracking in the system and another who missed a medical appointment but received no follow-up because the system didn't properly record the skipped appointment.
Reviews by the Government Accountability Office and the VA have found hundreds of issues with the system -- and given the challenges, VA leaders decided the best course is a "reset," according to VA Secretary Denis McDonough.
"We've heard from veterans and VA clinicians that the new electronic health record is not meeting expectations -- and we're holding Oracle Cerner and ourselves accountable to get this right," McDonough said Friday in a statement. "This reset period will allow us to focus on fixing what's wrong, listening to those we serve and laying the foundation for a modern electronic health record that delivers for veterans and clinicians."
Oracle Global Industries Executive Vice President Mike Sicilia said Friday that the company is committed to providing VA and veterans an electronic health records system that "exceeds expectations."
Citing the Defense Department's adoption of the Oracle Cerner system, known as MHS Genesis, which had its share of delays, Sicilia said the company will coordinate with VA to adapt the system to its needs.
"We support VA's plan to improve the operation of the EHR at the current sites and take the necessary time to institute governance, change management and standardization changes to ensure the success of future VA deployments, similar to what DoD did a few years ago," Sicilia said in a statement. "DoD's modernization is now nearly complete, on time and on budget. We will continue to closely coordinate with VA to provide enhancements and updates to the EHR."
Lawmakers have introduced legislation designed to fix the problems or scuttle the program altogether. A bill introduced by Rep. Matt Rosendale, R-Mont., would end the program if improvements aren't made.
The VA Electronic Health Record Modernization Improvement Act, also introduced by House GOP members, including Rep. Mike Bost of Illinois, chairman of the House Veterans Affairs Committee, would require leadership at each medical center to certify that the system is ready and staff are comfortable with the system before launch at each facility.
Rep. Mark Takano of California, ranking Democrat on the committee, has introduced legislation that would require the VA to contract with an independent entity to verify and validate its four major information technology programs, including the health record system, supply chain modernization, financial management and veterans benefits management system.
VA officials said during a congressional hearing Wednesday that they objected to any bill that would stop all pre-deployment program activities, because this would cause significant impacts on cost and future deployment.
The VA signed a $10 billion contract with Cerner in May 2018 to develop and introduce an electronic medical record system compatible with the DoD's -- an effort to provide lifelong medical records tracking for service members.
The cost estimate for the VA system has risen to $16.1 billion over 10 years; the Institute for Defense Analyses recently estimated that the system could cost up to $38.9 billion over 13 years.
A number of large hospital systems that have used the Cerner platform have switched to another electronic health records system, mainly Epic, which, along with Cerner, hold 85% of the market share for medical records systems in large hospitals in the U.S.
Systems like AdventHealth in Florida and Atrium Health in Charlotte, North Carolina, have abandoned the Cerner system in favor of Epic, while large hospital systems such as the Mayo Clinic, the Cleveland Clinic, Johns Hopkins and Massachusetts General all use Epic.
The VA currently is in contract negotiations with Oracle Cerner for what was originally slated to be a five-year option to renew. That process is expected to be complete by May 16, but whether it will be for another five years remains to be seen.
During a roundtable with reporters on Thursday, Evans said he could not comment on the specifics of negotiations but "everything has been on the table."
"The structure of that contract is such that the actual awarding of an option does not obligate us to spend money on the contract," Evans said.
Evans added that VA will continue to fund and maintain the VA's current Veterans Health Information Systems and Technology Architecture, or VistA, system, as it provides services to millions of VA patients.
"[VistA] does perform from a system performance level and reliability level in a way that we expect, and so I'm confident that the users of [VistA] are still going to be able to deliver the excellent care to veterans that they deserve," Evans said.
-- Patricia Kime can be reached at Patricia.Kime@Military.com
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