VA pharmacy tech glitches put 250,000 veterans at risk, officials say

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Data transmission errors in the VA's new commercial health record could potentially lead to providers missing important prescription information on patients who visit multiple agency facilities.

Hundreds of thousands of veterans may have had inaccurate or incorrect medication information included in their charts as a result of interoperability issues between medical facilities using the Department of Veterans Affairs’ new multi-billion dollar Oracle Cerner electronic health record system and the department’s legacy system, an official with VA’s Office of Inspector General said on Thursday. 

David Case — deputy inspector general for VA’s OIG — told lawmakers that an upcoming report under review by the department found that “patients seen at both new and legacy EHR sites may be prescribed contraindicated medications, and legacy EHR providers may be making clinical decisions based on inaccurate data.”

Case spoke at a hearing of the House Veterans’ Affairs Subcommittee on Technology Modernization convened to examining issues with VA’s new pharmacy software.

“As of September 2023, there have been approximately 250,000 veterans who either received medication orders and/or had medication allergies documented in the new EHR,” Case said, adding that those veterans are “the ones that are at risk [of receiving the wrong medication or clinical determinations] if they go to a legacy EHR.”

While Oracle Cerner took steps in April 2023 to address some of the pharmacy-related software issues, Rep. Matt Rosendale, R-Mont. — the panel's chairman — warned that “VA still hasn’t notified any of the veterans who were impacted or are still being impacted” by incorrect medication information. 

VA officials and an Oracle Cerner executive at the hearing also said they are taking steps to remedy other ongoing problems with the pharmacy software, including working to address an error-prone double entry process in the system. That fix, however, was rolled back last April because it led to lost dosage instructions for patients, and it was recently delayed once again as a result of continuing problems.

VA initially signed a 10-year, $10 billion contract with Cerner — which was purchased by Oracle in December 2021 — to modernize its legacy health record system, known as the Veterans Health Information Systems and Technology Architecture, or VistA. But the modernized system, which is designed to be interoperable with the Department of Defense’s new Oracle Cerner EHR system, has been plagued by system outages, performance issues and patient safety concerns since first going live in 2020 at the Mann-Grandstaff VA Medical Center in Spokane, Washington. 

VA subsequently paused additional rollouts of the new EHR system last April as part of a “program reset” to address issues at the five VA medical facilities currently using the new Oracle Cerner software. 

Broader issues with the deployed Oracle Cerner EHR pharmacy software have also led to staffing and performance challenges. Rosendale said that VA medical facilities using the system “have had to increase their pharmacy staffing by at least 20% to navigate all the bugs and workarounds just to process roughly the same volume of prescriptions.”

“That costs millions of dollars, but these are just five small- and medium-sized hospitals,” Rosendale said. “VA projects that large, complex medical centers will have to increase their pharmacy staffing by as much as 60% to mitigate the software’s problems. If the EHR was implemented throughout the Veterans Health Administration, those personnel costs would quickly run into the hundreds of millions of dollars.”

VA officials told lawmakers they are continuing to work in partnership with Oracle Cerner to address issues with the new system, including those affecting the pharmacy software, during the ongoing reset period. 

Neil Evans, acting program executive director of VA’s Office of Electronic Health Records Modernization, said the department is “committed to getting this right” and extolled the importance of the department transitioning to a “single-instance, enterprise-wide electronic health record” that is interoperable with DOD’s new EHR system. 

He added that VA is still on track for a joint deployment of the new system with DOD at the Captain James A. Lovell Federal Health Care Center in North Chicago, Illinois in early March, which he noted “is the final deployment of the federal EHR at a DOD site, and will also be the first VA deployment at a larger and more complex VA health care facility.”

But lawmakers expressed continued frustration with VA and Oracle Cerner’s rollout and oversight of the new EHR system, with some renewing their calls to scrap the modernization project entirely.

Rosendale, who introduced legislation in January 2023 to terminate the EHR system’s deployment if significant performance improvements are not made, said “I have come to believe that continuing this effort — to transform the Oracle Cerner pharmacy software into something completely different — is insanity.”