Lawmakers Quiz VA, Cerner Staff on Major EHR Problems

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A House Veterans’ Affairs hearing examined why the agency’s EHR rollout continues to struggle, with lawmakers demanding Cerner address safety issues.

Congressmen and witnesses alike shared passionate testimony on Tuesday during a House subcommittee hearing on the Department of Veterans Affairs’s efforts to modernize and deploy their embattled electronic health records system.

The hearing, held by the Subcommittee on Technology Modernization within the House Committee on Veterans’ Affairs, focused on how to better implement the EHR technology across veterans’ hospitals after years of delayed rollouts, software bugs, low staff morale and inaccurate cost estimates.

Subcommittee Chair Rep. Frank Mrvan, D-Ill., began the hearing by expressing concern over the failure of various deliverables within the EHR software, including pharmacy and referral operations. Overall, the VA said there were 26 key issues the agency and Cerner need to address.

Among these issues are duplicated prescription requests, inaccurate patient health data and poor staff training and support.

“It's hard to do your job when the systems you rely on aren't working,” Mrvan said. “And the concerns of the facilities currently using the system needs [sic] to be addressed. Until these issues are resolved, the committee cannot support VA going live with Cerner at larger, more complex facilities.”

Cerner, the software company contracted to create and deploy the VA’s EHR, has launched its system at VA facilities in Washington and Michigan. Errors with the EHR have been reported en masse since it went live.

Officials at the helm of the rollout testified in a two-panel series, beginning with Terry Adirim, the program executive director within the Electronic Health Record Modernization Integration Office at the VA.

Adirim acknowledged that the EHR rollout remains “a tremendous challenge,” but assured legislators that the VA is committed to improving the technology, beginning with addressing dissatisfaction among hospital and medical center personnel.

“The success of this new EHR depends on how well we train and support the people who use it,” she said. “We have made great strides in both areas and we intend to further improve based on end user feedback.”

Adirim also addressed the recent outages plaguing the EHR system at several VA clinics and errors in data entries for VA pharmacies. She told Mrvan that the VA has requested code redevelopment from Cerner to better fulfill VA pharmacy needs, primarily related to streamlining prescription data. At least seven changes within the currency EHR system are being added to the contract between the agency and Cerner. 

David Case, the deputy inspector general at the VA’s Office of the Inspector General, testified on the timeline for these changes to take effect, estimating between 13 to 36 months. Adirim agreed with this timeline.

“VA has to evaluate whether that's a sufficient timeline that they can live with in terms of future deployments,” Case said. “And it has a long timeline. And if it's critical to deployments, then maybe there has to be other solutions found. But at this point, they haven't even started on the process yet really.”

He added that these upgrades warrant new cost assessments, which adds further uncertainty to when the necessary technological changes can be made.

“We do not view there to be currently a reliable budget,” Case said. “We don't know exactly what VAs plans are and how [they] intend to implement the plans over the 10 year span. And it's more than just identifying dates on a calendar. They have to account for work that has to be done, whether it's infrastructure upgrades, IT, physical infrastructure, that training that has to be done, and they have to build in a risk assessment with a best case, worst case and most likely case.”

Despite the forthcoming hurdles, Adirim told Rep. Karen McCormick, D-Co., that Cerner’s EHR implementation is expected to be fully compatible with the VA’s operations and needs. Adirim confirmed that patient safety is the VA”s priority, and is closely monitoring error reports submitted by VA personnel.

“We're in the pilot state right now so that we can learn enough to get to that, what we like to call that core EHR, what that product is that we'll be able to take to scale and implement,” she said. “We are making changes in order to improve the processes for going live, improving our training, improving the support that we do at go live, as well as determining what other changes may be needed in the system tailored to how VA wants to deliver its care.”

Following the first panel featuring VA agency officials, several Cerner Government Services representatives testified on the company’s initiatives to collaborate with the VA, address software issues and improve VA staff training. 

Lawmakers, notably Rep. Matt Rosendale, R-Mont., implored Cerner to help provide adequate training to successfully transition VA clinic staff to a new EHR system and improve end user experience with the necessary software changes, pursuant to complaints and oversight reports.

“We are five years now––five years––into this process and I am gravely concerned about the treatment of our veterans in these facilities because of records that are not being utilized or able to be utilized properly,” Rosendale said in closing statements. 

Mrvan additionally told Cerner witnesses that, should the company not address the major outstanding issues brought to light by personnel reviews and oversight reports, he will not support the expansion of Cerner’s EHR system to larger VA facilities. 

“The safety of our veterans is my number one concern regarding the future of this program,” Mrvan said. “The risks to veterans' lives is too great [sic].”