The rollout of the Department of Veterans Affairs' new $16 billion electronic medical records system will be delayed up to seven months at some sites because it is not considered reliable, a VA official confirmed Tuesday.
The delays come amid a string of recent system crashes that threatened patient records and reports of potential harm to veterans being treated in the VA health care system. Plans to introduce the system to the Puget Sound area of Washington state in August will be delayed until March 2023, while the expected rollout in Oregon of the VA Portland Health Care system in November will be held up until at least April 2023.
The adjustments, first reported Saturday by Military Times, were made based on an assessment that the system isn't ready for widespread deployment, as it is having problems with its research workflow component and needs changes to ensure system stability, according to VA Press Secretary Terrence Hayes.
"VA determined the system hadn't shown adequate reliability to support the current schedule," Hayes said in an email to Military.com. "The date was changed to allow Oracle Cerner to put important system enhancements in place and make the necessary improvements."
The department previously said the system was on track for broad deployment, despite problems that surfaced in March at its original testing site, Mann-Grandstaff VA Medical Center in Spokane, Washington.
A system crash March 3 at the facility forced hospital administrators to suspend appointments, intakes and pharmacy operations for nearly 24 hours. Staff was ordered to stop using the digital records system until further notice and assume that "all electronic patient data is corrupted/inaccurate."
The event was not the only pause for the system. In April, VA Secretary Denis McDonough said Mann-Grandstaff has had at least six shutdowns since the March 3 incident. McDonough told lawmakers, however, that the VA planned to hold Cerner, purchased in early June by Oracle, "accountable," working closely with the company to pursue a medical records system that eventually will be completely interoperable with the Defense Department's Cerner system, known as MHS Genesis.
"If I assess any of this could create a threat to our veterans, then I won't proceed. But to date, the experience and learnings from Mann-Grandstaff strengthen our ability to go to Walla Walla [in Washington state] and continue to strengthen our ability to go to Columbus, [Ohio]," McDonough told the House Veterans Affairs Committee on April 28.
But the Spokane Spokesman-Review reported Sunday that at least 148 veterans have been harmed as a result of errors with the system at Mann-Grandstaff that included more than 11,000 dropped referrals for specialty care, lab tests and other medical services.
The oversight resulted in delayed care for dozens of veterans, resulting in "moderate harm" and at least one case of "major harm" to a veteran, according to a draft report by the VA Office of Inspector General that was obtained by the publication.
The case of "major harm" centered around a homeless veteran at risk for suicide. The veteran saw a psychiatrist at Mann-Grandstaff in December 2020 for mental health issues, was prescribed medication and a follow-up appointment.
But the appointment request was deleted in the system, and the visit was never scheduled. Weeks after it was to have taken place, the veteran called the Veterans Crisis Line with plans to commit suicide. Veterans Crisis Line employees were able to contact first responders, who saved the veteran. The former service member was admitted to a non-VA facility for mental health treatment, according to the Spokesman-Review, citing the draft inspector general’s report.
The report also noted that an inspector general team briefed top VA officials in October 2021 on its findings, including the harmful events and 60 various safety problems with the Cerner system.
Cerner was awarded a $10 billion contract in May 2018 for a new medical records system compatible with the Defense Department's. The VA later revised the 10-year estimate for the project to $16 billion. The VA currently uses a decades-old program called the Veterans Health Information Systems and Technology Architecture, or VistA, at most of its medical centers.
VistA can communicate with the military's system but is not completely interoperable.
The VA's Millennium system launched at Mann-Grandstaff in November 2020 after two, months-long delays to address the department's information technology infrastructure and training and respond to the COVID-19 pandemic.
Just six months after its introduction, the VA launched a "strategic review" of the system after complaints from medical providers and patients that the platform was not user-friendly and did not improve data sharing, management and workflow.
The problems caught the attention of lawmakers, who requested that the VA delay rollout to additional sites until the system was fully functional. Nonetheless, the system went live at the VA's health system in Walla Walla in March, and in the Central Ohio Healthcare System in May.
The chairmen of the House and Senate Veterans Affairs Committees and other lawmakers wrote McDonough on June 7 asking for more details about the contract with Cerner and clarification on the patient-related incidents, including a systems outage that occurred during a House Veterans Affairs hearing on April 26.
"America's veterans and VA's employees deserve far better than what has been provided to-date. It is unreasonable to expect VA employees to perform their jobs when the EHR [electronic health record] is unreliable or completely unavailable," wrote Rep. Mark Takano, D-Calif., and Sen. Jon Tester, D-Mont., joined by Rep. Frank Mrvan, D-Ind., and Sen. Patty Murray, D-Wash.
The VA will begin using the system July 23 at the Boise VA Medical Center in Idaho and has no plans to delay that implementation, Hayes said Tuesday.
"VA is highly confident that this deployment schedule can be achieved and is doing everything possible to ensure safe and successful deployments. Adjustments to the go-live schedule and other important considerations simply reflect this due diligence," Hayes said.
DoD officials announced Tuesday that it has deployed MHS Genesis at more than half of its hospitals and clinics and is on track to complete the transition to the new system by the end of 2023.
Holly Joers, a program executive officer for the Defense Healthcare Management Systems, said Tuesday that the DoD has experienced disruptions with the system, although she did not say how many, but added that the department has systems in place to work around any problems evolving as a result of the disruptions.
In May, the DoD Inspector General found that roughly 58% of defense health providers responding to a survey reported incomplete or inaccurate medical records in MHS Genesis, including data on DoD patient care as well as care provided by the VA to DoD patients.
After the survey was conducted in 2020, however, the DoD's system received two upgrades and new capabilities, allowing it to continue expansion.
When asked why the DoD appeared to have fewer growing pains than the VA in adopting the system, Joers said the Defense Department is in a "very different place in the maturity curve," having signed a $5.5 billion contract for the product in 2015.
"We have been able to learn and grow, recognizing how we do workflows, that one person's job affects the next one down the line," Joers said. "We took some time to really understand and appreciate that as we have rolled out, so we're in a different place."