VA slows EHR modernization to rework operational issues

Hearings before the U.S. Senate Appropriations Committee on Sept. 21 revealed new details on  implementation challenges to the Department of Veterans Affairs (VA) EHR Modernization (EHRM) program. The VA is working with partner Oracle Cerner to address training, monitoring, outage and other operational issues.

The project calls for replacement of VA’s 40-year-old legacy system, VistA (Veterans Health Information Systems and Technology Architecture), with Oracle/ Cerner’s Millennium EHR across the agency’s 171 medical centers while also being accessible enterprise-wide to Coast Guard and Department of Defense (DoD) medical facilities.

Oracle assumed vendor management of EHR Modernization upon completing its acquisition of Cerner in June 2022. “Our intention is to lead the way with a new generation of modern, cloud-native, highly performant and secure EHR applications embracing mobility, self-service, analytics and ease of use—including virtual care, such as telemedicine—leading to better patient outcomes,” testified Mike Sicilia, Oracle’s executive vice president with responsibility for the company’s Global Health Business Unit. He noted that Millennium has been fully deployed for the Coast Guard and is running successfully at more than half of DoD sites.

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However, Sicilia acknowledged that the VA’s Millennium rollout is proceeding “far slower than anticipated,” citing substantial technical and training challenges at VA facilities. Oracle has responded by initiating more than 40 different technical operational improvement projects, four of which have been completed, with expectation that another seven projects will be wrapped up by the end of 2022.

Additionally, Oracle announced at the end of July that Millennium would be moved to a hyperscale cloud data center to enable mobility and predictive analytics capabilities while incorporating automated, “no-downtime” security patches for system infrastructure.

‘Problematic and unacceptable’

Donald Remy, deputy secretary at VA, referred to Millennium’s first deployment at Mann-Gradstaff Medical Center in Spokane, Wash., as “problematic” and “unacceptable.” Among the key concerns: An EHR queue designed to capture erroneous clinical orders was not properly monitored by facility personnel, resulting in dozens of cases of missing referral orders for patient follow-up care.

In one case, a veteran identified as a suicide risk was not scheduled for a for a follow-up appointment and later called the Veterans Crisis line threatening to kill himself. Remy said VA has since ensured that the order queue is working optimally and has assigned trained staff to monitor the queue. Further, Oracle told the committee that on Aug. 1 it delivered system updates that alert providers when an order can’t be scheduled, along with a second alert that surfaces when attempting to close a patient’s chart with an unresolved scheduling issue.

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Remy also noted actions to address system outages and degradations. Cerner failed to meet the 99.9% service uptime agreement under the EHR modernization contract 7 times between June 2021 and July 2022. He added that VA has received financial credits for contractual performance shortfalls and directed Cerner to provide a technical and operational roadmap to remedy system instability issues.

EHR Modernization project still cutting edge

Following the setback at Mann-Grandstaff, VA has revised its EHRM deployment schedule through the first quarter of fiscal 2024. The agency has also instituted a continuous feedback loop with deployed sites to identify improvement opportunities and develop future enhancements.

Accordingly, VA has postponed its planned go-live at Boise VA Medical Center, originally scheduled for July 2022; a new launch date has not been determined. VA has also shifted deployment at Puget Sound VA Health Care System from August 2022 to March 2023. Likewise, deployment at VA Portland Health Care System will move from November 2022 to April 2023.

“During the remainder of [2022], VA will be actively working on updates to the system, including testing at the department’s most complex facilities, as well as adding new capability enhancements,” Remy concluded.

Sicilia, who called VA’s EHR Modernization “the largest health IT modernization project in history,” said the ultimate goal is to improve patient outcomes across the entire data set of active-duty and retire service members. “Doing so would literally leapfrog commercial, private care systems and put DoD and VA at the leading edge of healthcare technical innovation,” he predicted.

Frank Irving is a Philadelphia-based content writer and communications consultant specializing in healthcare and technology.