The VA’s new federal electronic health care records program continues to experience multiple issues. (U.S. Air Force)
WASHINGTON — The modernized electronic health records system at the Department of Veterans Affairs is designed to provide instant access to digital medical records of patients across the VA and partner health care agencies.
But the federal electronic health care records program, known as EHR, is experiencing partial system failures that are impacting the veterans and clinicians who use it. Problems span from system crashes to errors to delays and downtimes, VA technology leaders told lawmakers.
The hearing held Wednesday by the House Veterans’ Affairs Committee subpanel on technology modernization was described as a “deep dive” into ongoing challenges for users of the Oracle Health system and how the problems are being addressed.
Rep. Sheila Cherfilus-McCormick, D-Fla., said she was disappointed Oracle Health did not have a representative at the hearing, after the employee scheduled to appear had to cancel.
“The fact they did not send a representative raises major concerns for me,” she said.
Lawmakers turned to Kurt DelBene, assistant VA secretary for information and technology, and Laura Prietula, the VA’s deputy chief information officer overseeing the electronic health record modernization integration office, for answers.
DelBene said the VA is working to hold Oracle Health more accountable for system reliability.
The VA increased financial consequences under contract re-negotiations in May 2023 related to technical performance and the end-user experience. DelBene said the VA has seen improvements as a result.
“We believe that this new contract gives VA the tools we need to hold Oracle accountable to deliver an EHR that will meaningfully improve veterans’ health outcomes and benefits,” the VA said in a prepared statement when the new contract was announced.
In May 2018, the VA signed a $10 billion contract with Cerner, which later was purchased by Oracle, to overhaul its health records system and make it compatible with the Defense Department records system. The contract later was revised to $16.1 billion.
Rep. Matt Rosendale, R-Mont., the subcommittee chairman, said Wednesday that system functionality continues to be unstable in some areas.
“VA and Oracle have come up with many different words to describe this problem — outages, downtime, incidents, performance degradations, user interruptions, incomplete functionality. They all mean that the EHR is not working, and that staff can’t use it,” he said.
“Far too often the EHR amounts to a multibillion-dollar frozen screen or a brick on the employee’s desk,” Rosendale said.
Medical exams are interrupted or delayed when the system goes down. Clinicians are forced to document findings and write medical orders on paper to enter into the computer system later. Procedures sometimes are canceled altogether, Rosendale said.
“In at least a dozen incidents some sort of EHR outage directly contributed to a close call for patient harm,” he said.
Though nationwide outages with the system are down, crashes, errors and other incidents at individual facilities continue to be a challenge, Rosendale said.
Online patient registration and scheduling were another area identified as having problems.
Rosendale and other lawmakers said reports from Oracle Health and the VA about improvements and gains contradict problems reported by employees and facilities.
A recent survey of VA employees showed only 26% agreed the EHR was available as they needed it in the last two weeks, Rosendale said. More than half said downtime was a problem.
The high number of requests from users for technical help limits the responsiveness of technicians, with some employees no longer bothering to file tickets for assistance with the help desk.
“The data does not seem to match what we hear from front-line staff,” Cherfilus-McCormick said. End-users said the system is frequently slow or nonfunctional.
“We have heard repeatedly about Oracle Health pushing updates that break other functions of the EHR and in many cases pushing the updates in the middle of the day,” she added.
DelBene said that VA customizations have resulted in many changes, creating more interruptions until unanticipated defects are addressed.
“Improving system reliability remains a critical focus,” he said. “The rate of change is still very high. In some cases, the VA is requesting functionality never deployed in Oracle Health commercially.”
Prietula also emphasized the VA “significantly customized its platform,” which meant additional work had to be done for the system to run smoothly.
