Last chance for VA’s multi-billion electronic health records system?

Senator Jon Tester (D-Mont.) hopes an Oracle executive’s presence at the Senate Veterans’ Affairs Committee on July 20 signifies a “game changer” for the troubled health records system at the Department of Veterans Affairs. Ending the hearing on that note, the Montana lawmaker and VA committee chair had good reason to draw on Oracle’s decades-long experience developing complex databases. The electronic health records rollout is an injustice to veteran-patients and is becoming one of the worst government IT projects ever.

Oracle completed its nearly $30 billion acquisition of the electronic health records, or EHR, company Cerner last month, among the biggest healthcare deals in recent years. Cerner was awarded a $10 billion contract in 2018 to transition Veterans Affairs from a 1980’s era legacy system for digitizing patient records. The goal is to enable care continuity through the sharing of Defense Department medical records with the VA as military personnel transition from active duty to veteran status.

Cost over-runs, delays, service outages and malfunctioning software are detailed in over a dozen inspector general reports since the Cerner system was first deployed at the Mann-Grandstaff VA Medical Center in Spokane, Wash., in 2020. Costs have since increased to $16 billion, and there is no end in sight. At the beginning of the hearing last week, Tester cited an Institute for Defense Analysis estimate that puts the true cost of the VA’s electronic health records modernization program at over $56 billion by the time it’s completed.

There is nothing new about government contracts running over budget and behind schedule. What has members of Congress ready to pull the plug on Cerner is the faulty software causing harm to veterans.

An IG report issued this month details examples of what is described as an “unknown queue,” a bizarre process and design flaw in which referrals to specialty care providers, laboratory procedures, diagnostic imaging and other follow-up services go missing. In all, the new Cerner system failed to deliver 11,000 orders. The result is what the IG cited as nearly 150 instances of patient harm. 

Sen. Patty Murray (D-Wash.) explained at the hearing that she met with veterans and providers this month in Spokane. “There continues to be flaws with the EHR that risk patient care and safety,” she said. Murray is demanding the EHR rollout be suspended in Washington state. Regarding the so-called unknown queue, Murray mentioned a VA official who denied patients were getting harmed despite the problem having been documented months before. “I have talked to veterans who have suffered serious harm,” she said. 

It’s easy to see how patients are harmed. Even before the unknown queue issue, the Inspector General documented 38 unresolved threats to patient safety due to Cerner software. That critical report, issued in March, lists problems that include data migration from the old system, medication reconciliation and referrals to specialists. The problems range from wrong patient genders to veterans not getting their medications. The new EHR complicated medication management and care coordination, according to the IG. These are routine functions that patient data systems should perform. But too often this one doesn’t.

Veterans Affairs is not the only organization struggling with patient records data. Doctors and nurses have a love-hate relationship with electronic health records software that can affect clinical workflows throughout the country.

While the amount of paper records stuffed in filing cabinets have been reduced, doctors are often staring at a screen and trying talk to patients at the same time. Buggy, poorly-designed software prompted MedStar Health and the American Medical Association to launch an unprecedented campaign called “errors happen regularly,” — their own version of the EHR acronym. Overhauling the design and use of EHRs is a “national imperative” according to the AMA.

Oracle believes it can do better. That’s why it was not a Cerner representative but Oracle Vice President Mike Sicilia who appeared before senators last week. He claims the Veterans Administration will be the “gold standard” for EHR implementation worldwide and pledged to triage and fix patient safety issues. 

As Sen. Tester noted, this month’s hearing was “calm.” But expect the gloves to come off if Oracle falls short.

Senators and representatives can do more than vent their anger during committee hearings and require more reports on the EHR program, as they did in a measure signed into law earlier this year. Congress has the power to terminate the entire agreement based on a Congressional Research Service legal analysis of federal contracting procedures.

Veterans’ lives are at stake. Oracle is saying the right things, now it must do them. 

Dr. Shravani Durbhakula, MD, MPH, MBA is a Johns Hopkins School of Medicine anesthesiologist, pain physician, researcher and educator who focuses on innovation at the intersection of medicine, public health, and business and how it can advance patient care. Follow her on Twitter @ShravaniD_MD