VA still needs to shore up usability of new EHR system, GAO says

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More than one-third of the government watchdog's priority open recommendations for the Department of Veterans Affairs have to do with improving oversight and management of the new electronic health record system. 

The Department of Veterans Affairs has still not fully implemented proposals for shoring up the usability and performance of its new multi-billion dollar electronic health record system, the Government Accountability Office warned on Monday.

Of the 28 priority open recommendations that GAO outlined in its annual report on the agency, 10 of the unaddressed proposals focused on addressing gaps in VA’s oversight and management of its new EHR system.

VA initially signed a five-year contract with Cerner in 2018 to modernize its legacy health record system and make it interoperable with the Defense Department’s new software, but deployment of the system has been bogged down by cost overruns, patient safety concerns and usability issues. DOD, by contrast, finished deploying its new Oracle Cerner EHR software at all military treatment facilities in March 2024. 

Oracle, which acquired Cerner in 2022, has stressed its efforts to right the modernization project, including creating a public-facing dashboard to track progress it has made on system improvements. Ongoing issues with the EHR software’s deployment, however, led to VA pausing additional rollouts of the new software last April. The system has been deployed at a total of six VA medical facilities.

GAO’s report included recommendations for VA to improve users’ ability to operate the system through the use of additional performance metrics and new strategies. 

These proposals included, in part, calling for the agency to “document a VA-specific change management strategy” to help users operate the new system; establish user satisfaction targets; evaluate the system to ensure it is “operationally suitable and effective;” take steps to “improve change readiness scores” before future system deployments; and ensure that “future system trouble tickets are resolved within established timeliness goals.”

VA said at the time that it concurred with GAO’s recommendations and that its Electronic Health Record Modernization - Integration Office would implement all of the watchdog’s proposals. The department added that the targeted completion date for addressing the recommendations was October 2023. 

The watchdog noted that VA has made some progress on its recommendations since last year, although it said the department still needs to take additional steps to fully comply with its proposals. 

GAO said that VA has worked with Oracle Cerner to update its existing change management plan, although it added that the department still needs to develop and roll out a VA-specific policy. VA has also taken steps to identify metrics and targets needed to improve its change management strategies, although the watchdog said the ongoing deployment pause has resulted in the department not collecting new data. 

Additionally, VA has conducted surveys of end-users to document their satisfaction before and after system improvements to collect feedback. GAO said, however, that the department still needs “to establish targets to assess user satisfaction” with the overall software.

GAO also cited another of VA’s unaddressed proposals as likely being impacted by the new EHR system. The watchdog said it previously recommended that VA work to improve the reliability of its collected wait time metrics for veterans’ medical appointments, but added that VA’s “direct care access measurement for the wait time standard” depends upon the implementation of a new scheduling system, which it called “integral to its new electronic health record system.”

Lawmakers have also been pushing for VA and Oracle Cerner to improve oversight of the EHR system’s performance and user satisfaction, with their proposals mirroring some of GAO’s recommendations. 

A bipartisan package of veterans’ legislation introduced last month by leaders of the House and Senate Veterans’ Affairs committees included provisions that would require VA, in part, to provide metrics to lawmakers on “user adoption and employee satisfaction” with the software. The proposal would also limit VA’s pre-deployment activities at additional facilities until it demonstrates that sites “currently using the Oracle Cerner EHR system have recovered to normal operational levels.”

VA is also continuing to negotiate a new one-year contract with Oracle Cerner to deploy the new EHR system. VA and Oracle Cerner previously renegotiated their contract in May 2023 to include additional performance metrics and change the agreement from a 5-year term to five 1-year terms. VA announced last month that it agreed to a one-month contact with Oracle Cerner to allow for talks to continue. 

Lawmakers previously said that, as the discussions continue, VA should work to include new oversight and accountability provisions in the renegotiated one-year contract with Oracle Cerner.