The Pentagon and Department of Veterans Affairs launched a shared electronic health record system at a Chicago hospital on Saturday, completing the military's adoption of the system and moving the VA a step closer to restarting its rollout across its 172 medical centers and clinics.
VA officials said the Captain James A. Lovell Federal Health Care Center in North Chicago, which serves more than 75,000 patients per year, adopted the Oracle Cerner electronic health record system -- the first launch for a VA site since it paused the program in April 2023 amid concerns over patient safety, training and user-friendliness.
The VA signed a $10 billion contract with Cerner for a systemwide electronic medical record program in May 2018, selecting the same contractor as the DoD to ensure that service members and veterans would have a continuous digital health record from their initial accession until death.
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While the rollout within the Defense Health Agency caused appointment cancellations and some delays in care related to training and implementation, the rollout at the VA has been fraught with issues. In July 2022, the VA Office of Inspector General found that the system caused harm to at least 149 patients at one facility, including a suicidal veteran who had to call the VA's crisis line after his psychiatry referral was lost.
The Defense Department, which calls its version MHS Genesis, is now using the program at 138 hospitals and clinics, while the Department of Veterans Affairs now has the Oracle Cerner EHR at six sites.
"This is one of the places where the value of a consolidated single electronic health record shared within the federal sector, currently by the Department of Defense, the Department of Veterans Affairs, the United States Coast Guard and the National Oceanic and Atmospheric Administration, [where] we hope to see the realization of the promise of a single electronic health record," Dr. Neil Evans, the acting program executive director for the VA's Electronic Health Record Modernization Integration Office, said during a call with reporters Friday.
As late as last month, VA officials said they would not introduce the electronic health records system at any site that was not ready. The VA recently completed a major upgrade to the system at the five sites, as well as the North Chicago hospital, before launching it at the facility Saturday.
Evans said the rollout at the Lovell center will help determine when the department can resume adopting the new records system across its facilities.
"There still is work to be done within the overall reset, but I do feel like we are seeing the evidence of a lot of effort that's been put in for the last nine months or so," Evans said.
The facility, the largest joint VA-DoD health care center, includes a 300-bed hospital and several outpatient clinics in Chicago and its suburbs. It serves more than 30,000 Navy recruits, 25,000 veterans and 10,000 military personnel, family members and retirees.
More than 3,200 VA and DoD employees work at the center and its satellite clinics. Evans said that prior to the "go-live," the VA and the DoD conducted extensive training and worked to ensure that staff was enthusiastic about the change. They relied on computer-based and instructor-led training but also on "super users," who like the system and want to help their colleagues learn about its capabilities.
"We added several events to really help empower our super users and help coach super users on some of the softer skills they could use to actually engage with their peers," Evans said.
He added that the training also now includes "learning labs" where users can go and work through the program, a type of "sandbox environment."
The system has received a major update that includes changes to its pharmacy packages at the five sites where it is in use: Mann-Grandstaff VA Medical Center in Spokane and VA Walla Walla Health Care System, both in Washington; VA Central Ohio Health Care; and VA Roseburg Health Care and the Southern Oregon VA Health Care System, both in Oregon.
The new pharmacy program is not yet live at the Lovell facility, Evans said. He said that while the pharmacy upgrade has been working in the "vast majority of cases" at the five sites, it sometimes was behaving "oddly," and VA officials decided to fix those bugs before introducing the upgrade at Lovell.
"We made a decision -- it was really a clinical decision, based on VA's pharmacy communities -- request that we not go live with the functionality until it is fully and completely fixed 100%," Evans said.
In November 2022, lawmakers said veterans may have died as a result of the health record system's complexities, with one patient never receiving a needed medication because of issues with the system's prescription tracking and another who missed an appointment but received no follow-up because the system failed to record the skipped appointment properly.
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