The Department of Veterans Affairs (VA) Electronic Health Records Modernization (EHRM) program is deployed at five medical centers but still has not won the confidence of VA pharmacists, who say they do not trust the EHR system and live in a state of “hypervigilance” as a result, according to a new survey conducted by the House Veterans’ Affairs Technology Modernization Subcommittee.
At a May 9 hearing focused on the pharmacy aspect of the EHR system, subcommittee Chairman Matt Rosendale, R-Mont., said the panel sent questionnaires to each of the five medical centers using the new Oracle Cerner EHR system, and he called the results of the survey “outrageous.”
“We received responses from Spokane, Walla Walla, Columbus, and Roseburg. The situation they described is outrageous and dangerous. The pharmacists cannot trust the system, so they have to work in a constant state of hypervigilance,” the chairman said.
Rep. Keith Self, R-Texas, took the time to read part of a survey response from a pharmacist from the Mann-Grandstaff VA Medical Center in Spokane, Wash. – the first EHRM deployment site.
The pharmacist said because of “increased risks due to delays, inefficiencies, vulnerabilities, manual workarounds, and the lack of responsiveness from Cerner to identify patient risks, pharmacy staff must remain in a constant state of hypervigilance to recognize and intervene on those risks.”
Carol Harris, director of information technology and cybersecurity at the Government Accountability Office (GAO), testified about her agency’s latest report, which also revealed that most users were dissatisfied with the EHR system.
GAO found that the pharmacy-related system module presented challenges – such as incorrect medication orders and increased prescription processing times – which contributed to patient safety risks.
“If the users are extremely dissatisfied, which is what we’re seeing now, the system is going to fail,” Harris said. “It’s just not a sustainable solution. There will be increased patient safety risks as a result.”
The VA announced last month that it is pausing all future deployments of its EHRM program – with the exception of one planned for 2024 – while it focuses on improvements at the five sites where the EHR system is currently deployed, as part of a larger program reset.
Dr. Neil Evans, acting program executive director of the EHRM Integration Office, said the VA is working closely with Oracle Cerner to address the issues identified and together, they “will be able to more comprehensively address both these issues and a broader set of changes necessary for program success.”
Mike Sicilia, executive vice president of Oracle Global Industries, noted that Oracle is working quickly to deliver on VA’s requested enhancements to the EHR system. It delivered three of the seven enhancements within four months, and it will deliver the remaining four enhancements this year for deployment in 2023 and early 2024.
“That’s a significantly faster overall timeframe timeline. We hope it shows you that Oracle is a highly capable partner for VA,” Sicilia said. “Whether it is pharmacy enhancements or other fixes, we have put tremendous engineering rigor and resources into getting the work done well and quickly.”
As for the survey results surrounding the pharmacy enhancements, Sicilia said Oracle is “not completely surprised.”
“We’re not completely surprised, given the first three enhancements delivered – as prioritized by the VA – were focused more on improving the ordering provider experience,” he explained. “The next set of enhancements are focused more on improving the pharmacist experience, and we believe that once delivered and implemented, then pharmacists will be in a position to provide very valuable feedback.”
Notably, the VA’s contract renegotiation deadline with Oracle Cerner is coming up next week, and some lawmakers are wondering if terminating the contract would be the best option.
“The worst thing the VA could do is continue down this dead-end road, perpetuating the same failed strategy, and paying out billions of dollars. That would be incredibly irresponsible,” Chairman Rosendale said.
“The contract renegotiation deadline is coming up next week, and I expect to see VA disentangle itself from this monopoly,” he continued. “If there is a continued role for Oracle, it is in using its own resources to improve its products to make the existing Oracle Cerner sites whole.”
