Lawmakers interrogated representatives from the Department of Veterans Affairs and Oracle about the troubled rollout of its new electronic health record system at a House of Representatives subcommittee hearing on Thursday, focusing on problems with pharmacy and scheduling software that could impact patient safety.
“The definition of insanity is doing the same thing over and over again while expecting a different outcome, a different result,” said Rep. Matt Rosendale, R-Mont. “I have come to believe that this continuing effort to transform the Oracle Cerner pharmacy software into something completely different is insanity.”
The costly project to replace the VA’s legacy health records system, ViSTA, has been in progress for years; Cerner first scored the modernization contract in 2018, and the company was acquired by technology firm Oracle four years later.
But rollout of the new EHR has been rocky, with system reliability and safety concerns plaguing the VA. New deployments were put on hold in April last year to ensure the system is performing up to standards at existing sites.
Captain James A. Lovell Federal Health Care Center in North Chicago, Ill., a joint VA and Department of Defense facility, is scheduled to take up the new EHR in early March. Some legislators questioned whether the transition at a larger and more complex facility should go ahead.
“I understand that the DOD is motivated to finish this deployment. That cannot come at the expense of our veterans or VA providers,” said Rep. Sheila Cherfilus-McCormick, D-Fla. “I hope the VA decision makers are being incredibly deliberative in deciding whether or not the go-live should be allowed to happen as scheduled.”
Veterans have experienced inaccurate medication information when treated at different care sites that use the updated or legacy EHR, according to testimony from David Case, deputy inspector general at the VA.
When a veteran receives a prescription at a center using the new EHR, the system sends information to a data repository. If the veteran then goes to another center using the legacy system, a ViSTA program accesses the repository to perform a safety check to ensure there aren’t any allergies and the medication is compatible with other prescribed drugs.
But sometimes the information in the data repository is inaccurate, duplicative or simply missing, Case said.
The problem, which affected approximately 250,000 veterans as of September 2023, pushed one medical center to increase its pharmacy staff. Patients also weren’t adequately informed about the risks, he added.
The agency is working to communicate with veterans, said Neil Evans, acting program executive director of the EHR modernization integration office at the VA.
“I question what other dangerous pharmacy problems have not even been uncovered yet,” Rosendale said. “What we do know is that the results of the VA and Oracle strategy to improve the EHR have been one step forward and one step backwards. We're not gaining on this.”
The Office of Inspector General also briefed the subcommittee on scheduling issues with the new EHR. When a provider needs to cancel an appointment, the system moves appointments to the “displaced appointment queue” for rescheduling. But those appointments sometimes disappear from the queue, Case said.
One scheduling error resulted in staffers not contacting a patient adequately after missing a mental healthcare appointment, possibly leading to the patient’s death, according to written testimony. The missed appointment wasn’t routed to a “request queue,” and workers weren’t reminded to conduct the required scheduling attempts.
The lack of contact may have contributed to the patient’s substance use relapse, the OIG concluded.
The new EHR is still on track to deploy at Lovell next month. The Department of Defense already uses the new system, so that could help them successfully complete the transition, Evans said. Plus the medical center is unique, and they currently run into challenges using two EHRs plus custom software to enable interoperability.
The hold on deployments has allowed the agency and Oracle to focus on the rollout at Lovell too, and they’ve made a number of functional enhancements to the system, said Mike Sicilia, executive vice president of global industries at Oracle.
“The other five live sites have had to take these functional enhancements piecemeal because they were already live, and they were already functioning on a system that admittedly, when we took it over, was not stable and was not acceptable,” he said. “So I think their experience has been very different than the experience that Lovell will have as a result.”
