The US Department of Veterans Affairs (VA) announced this week that it will postpone pending deployments of the Oracle Cerner Electronic Health Record (EHR) system to June 2023 due to ongoing issues with the system.
“Right now, Oracle Cerner’s electronic medical record system is not appropriate for veterans or VA healthcare providers — and we hold Oracle Cerner and ourselves accountable for getting this right,” Assistant Secretary of Veterans Affairs Donald Remy said in a statement.
Remy said VA is halting all deployments of electronic health records to evaluate the systems’ performance and address patient concerns.
“Veterans and clinicians deserve a seamless, modernized medical record system, and we won’t rest until they have it,” he said.
According to government reports, the EHR system has numerous problems. These include the tendency to funnel medical orders into the “unknown queue,” where they languish unnoticed by medical staff.
The purpose of this queue is to allow the system to accept orders from healthcare providers that cannot be routed to the intended location. It consists of a drop-down menu with a list of locations that, depending on the type of order, are not assigned to an actual location. These orders, which are not assigned to a specific location, would end up in an unknown queue and would not be seen or processed by the care providers. It’s as if the system allowed patients to be scheduled for surgery at Hogwarts, or to send support tickets to /dev/null.
Screenshot of the Oracle Cerner EHR system highlighting locations that don’t actually exist… Click to enlarge
North Kansas City, Missouri-based Cerner was awarded a $10 billion contract in 2018 to modernize the VA’s EHR system; Based in Redwood Shores, California, Oracle acquired the health technology company on June 8, 2022.
Cerner’s VA engagement isn’t the first to face headwinds. In 2015, the company won a $4.3 billion EHR modernization contract from the US Department of Defense. At a June 26, 2018 hearing before the House Committee on Veterans Affairs, Beto O’Rourke, then US Representative for Texas, cited an April 30, 2018 Department of Defense report [PDF] which contained 156 complaints about critical deficiencies in the GENESIS deployment of Cerner’s military health care system to the military.
“There were reports that clinicians literally stopped because they were afraid they might hurt or even kill one of their patients,” said Rep. O’Rourke (D), addressing Peter O’Rourke, then acting secretary for Veterans Affairs. “The user rating out of a possible 100 was 37.”
The Pentagon continues to defend and deploy the system, although it is still a work in progress [PDF].
The VA healthcare system overhaul faces similar issues, including latency and slow response times, as well as issues with patient scheduling, referrals, medication management, and various medical orders.
It was postponed three times under the Biden administration. In July 2022, VA Secretary Denis McDonough postponed EHR deployments to January 2023 to ensure the issues of the recording system were resolved. And in July 2021, the VA decided to delay deployments to additional locations by six months after experiencing problems with the first deployment in Spokane, Washington. The project was also twice delayed under the Trump administration.
The new EHR system, which is already operational at five locations, is expected to be deployed at 25 VA Medical Centers in fiscal 2023. Before this happens, serious problems need to be addressed.
A July report by the VA Inspector General found more than a thousand safety incidents and at least one “catastrophic patient injury” attributed to system failures.
“October 24, 2020 to May 8, 2022, VHA [Veterans Health Administration] identified a total of 1,134 patient safety events related to the new EHR,” VA Assistant Inspector General David Case said in a statement [PDF] for a Senate hearing in July. “The VHA analysis identified one catastrophic patient injury (death or major permanent loss of function) and two major cases of patient injury (permanent reduction in physical function), one of which was related to the unknown queue.”
Oracle did not respond to a request for comment Friday. ®
https://www.theregister.com/2022/10/14/dept_of_veterans_affairs_oracle_cerner/ VA Extends Oracle Electronic Health Record System Delay • The Register