VA electronic health record system ‘not yet stable enough’ for planned rollouts

The Veterans Affairs Department will be delaying future rollouts of the Cerner Millennium electronic health record system amid ongoing technical issues and a pending inspector general report detailing significant patient harm as a result.

The commercial EHR system was first deployed at Mann-Grandstaff VA Medical Center in Spokane, Washington in October 2020, after several delays. Following yet more delays while the incoming administration reviewed the program, the system was deployed at additional medical centers in the northwest in March of this year and in Ohio in May. But persistent outages—including at least 11 in the last three months—and technical issues have led to worsening care for veterans, prompting VA leadership to reevaluate the rollout schedule.

In an internal VA email distributed Wednesday and obtained by Nextgov, officials told staff an upcoming deployment at Boise VA Medical Center originally scheduled for this week—June 25—is now set for July 23.

“These additional few weeks will give Boise time to complete important staff training, give Oracle Cerner the time to finish the site’s scheduling grids, and ensure provisioning of staff,” the email states, noting, “This decision was made with input from [Veterans Health Administration] stakeholders, including site and [Veterans Integrated Services Networks] leadership.”

Similarly, the planned deployments at Puget Sound VA Health Care System set for August and VA Portland Health Care System set for November are being pushed out at least until March and April of next year, respectively, as VA and Cerner work to strengthen the system.

“In evaluating Puget Sound’s and Portland’s readiness for deployment, VA made the decision that, at this point, the system wasn’t yet stable enough to support current large-site deployments,” the note to employees states. “The date was changed to give Oracle Cerner additional time to put important system enhancements in place and make the necessary improvements to ensure system stability, consistently securing the 99.9% uptime Service Level Agreement.”

After Boise in July, the next deployment will now be Ann Arbor, Michigan in January—originally planned to go live this year—along with medical centers in Battle Creek and Saginaw.

“Therefore, there will be a period of six months between the deployment in Boise in July and the next deployment in Ann Arbor in January,” officials wrote. “During this short interim, we will not be idle; there is much work to do as we head into the busy schedule during the 2023 calendar year.”

Eleven Outages in Three Months

Various parts of the Cerner Millennium system running at VA medical centers have gone down or otherwise been out of service at least 11 times from April to June, according to documents obtained by Nextgov detailing each incident.

The severity of incidents ranged from limited access to dental records on May 10; a 1-hour downtime on May 1 that prevented clinicians from checking in or discharging patients; a nearly 7-hour outage of the PowerChart module on April 26 that prevented clinicians from updating patient charts; and multiple nationwide outages that knocked the entire system offline for extended periods.

After an outage in April prevented clinicians from accessing the systems for nearly three hours, VA officials told Nextgov there was no evidence at that time the outage led to any patient harm.

During such downtimes, clinic leadership submit “trouble tickets,” in which they note incidents that led to undue patient harm and can suggest a likely cause—such as an EHR outage.

“From what we know now, there haven’t been any reported to us,” Adirim said at the time. “The two outages … we are not aware, nor has it been reported to us that there has been any harm to patients.”

When prompted, Adirim clarified that reports might have been filed but those have yet to be fully investigated.

“There might have been reports but there were no patient safety incidents that we’re aware of,” she said.

A review by the VA Inspector General is said to include proof that previous outages and issues have harmed veterans in at least 148 cases, according to details in a draft document reported by the Spokane-based Spokesman-Review.

Further, that report states VA leadership was made aware of ongoing issues and risk to patients in October 2021 but opted to continue with additional rollouts.

The IG has yet to release the report publicly.

“Although we are still waiting for the VA’s Office of Inspector General to release its report … the draft findings raised in media coverage over the weekend are seriously troubling and contradict what we have heard from VA officials during public testimony,” Chair of the House Committee on Veterans’ Affairs Mark Takano, D-Calif., and Technology Modernization Subcommittee Chair Frank Mrvan, D-Ind., said in a statement Wednesday.

The congressmen noted they previously asked VA to delay rollouts at major facilities and asked for additional information about patient safety.

“We have already begun discussions with VA on the performance of Cerner and requested an official briefing on the forthcoming report,” they said. “Once released, we will be reviewing the findings closely in order to determine if there are any contractual or legal repercussions of these draft findings."

VA medical center staff also expressed their frustrations with the system in a November 2021 survey, with two-thirds of employees at Mann-Grandstaff saying they were considering quitting over the system.

A representative from Oracle, which recently purchased Cerner and its EHR business, told Nextgov their team is working with VA on the structural and technical changes needed to shore up the system.

“Since acquiring Cerner just two weeks ago, Oracle engineers have already been on the ground making technical and operational changes, with an emphasis on patient safety, to ensure the system exceeds the expectations of providers, patients and the VA,” Deborah Hellinger, Oracle senior vice president of global corporate communications, said in an email Thursday. “We intend to bring substantially more resources to this program and deliver a modern, state-of-the-art electronic health system that will make the VA the industry standard. We have a contractual and moral obligation to deliver the best technology possible for our nation’s veterans, and we intend to do so.”