A new report from the Department of Veterans Affairs (VA) Office of Inspector General (OIG) reveals that the VA does not have adequate controls in place to prevent “major system incidents” to its electronic health record (EHR) system.
According to the report, there were 826 major performance incidents – such as outages – to the EHR system from Oct. 24, 2020 (the initial EHR system go-live), through March 31, 2024. However, according to the OIG, these outages will continue if the VA does not implement sufficient controls.
“If VA does not improve controls, major performance incidents will continue, leading to further costly delays in system implementation and posing an ongoing risk to patient safety,” the report says.
The VA awarded a 10-year contract in 2018 to contractor Cerner – which has since been acquired by Oracle – to help create an interoperable EHR system for the agency.
This effort, known as the Electronic Health Records Modernization (EHRM) program, is currently in the middle of a “program reset,” while the VA and Oracle Cerner focus on improvements at the six sites where the EHR system is currently deployed.
The VA successfully renegotiated a tougher EHRM contract in May 2023 to hold Oracle Cerner accountable for technical fixes to the program whose rollout has been beset with difficulties. The renegotiation updated the contract from a five-year term to five one-year terms – that way the agency can renegotiate each year if necessary.
The agency announced an extension of its contract with Oracle Cerner again in June of this year with a focus on “improved fiscal and performance accountability.”
The contract specifies four types of major performance incidents: outages, performance degradations, incomplete functionality, and loss of redundancy.
“Ultimately, major performance incidents occurred because VA’s initial contract requirements were limited,” the new OIG report says. “Although the EHR contract was modified in May 2023, VA should consider additional controls to help prevent further incidents from occurring and strengthen the department and contractor’s response to them.”
The OIG made several recommendations to the VA, such as assess EHR major performance incident data needs and “contractually commit to real-time data sharing that will provide greater awareness of system operations.”
Other recommendations include: develop a plan to ensure all clinicians are familiar with the national downtime procedures, as well as formalize a procedure for verifying performance metrics and associated credits.
The VA agreed with all the recommendations or noted that it has already completed some of them.
This report came out the same day as a separate VA OIG report that reveals that VA facility leaders and staff still have concerns about the new EHR system.
For example, leaders at the VA Southern Oregon Healthcare System described the implementation of the new EHR as “the single largest challenge that we have here,” noting that the new EHR has impacted “every system” and resulted in “rewriting the way VA does business.”
The OIG requested that the VA evaluate whether the issues cited in the report warrant process reviews and/or contract enhancements.
