Legislators grilled leaders from the Department of Veterans Affairs and the Department of Defense about service outages and user dissatisfaction with the new Oracle electronic health record system during a House subcommittee hearing on Wednesday.
The yearslong project to modernize the VA’s EHR has been slow and more expensive than planned. Only five VA medical centers are currently live with the new system and the department put new deployments on hold earlier this year to focus on improvements.
Then, the VA renegotiated a tougher contract with Oracle this spring, promising the update would better hold the company accountable for outages. The new contract included stronger performance expectations and larger financial credits to the VA if Oracle didn’t meet expected requirements.
But end users are reporting that the system is frequently slow or not functioning, and updates can break the EHR in the middle of the day, said Rep. Sheila Cherfilus-McCormick, D-Fla.
“Transitioning to a new EHR is always hard. It doesn't need to be made harder by a system that isn't reliably there when you need it,” she said. “I find it especially problematic that we are still talking about system stability more than three years after the initial go-live at Mann-Granstaff VA Medical Center.”
System downtime is a major problem for providers and patients, forcing clinicians to document orders on paper or delay veterans’ care, Rep. Matt Rosendale, R-Mont., said during the hearing.
“In at least a dozen incidents, some sort of EHR outage directly contributed to a close call or patient harm. It's an unacceptable situation,” he said. “Finger-pointing and blame-shifting between VA, DOD and Oracle have gone on for far too long.”
System reliability is improving, though there is still work to be done, said Kurt DelBene, assistant secretary for information and technology at the VA. As of Nov. 8, the system has gone 185 consecutive days without an outage, and it’s tracked 100% system availability in 10 of the last 12 months.
But the EHR is still experiencing partial failures. Incident free time, which measures how much time the system performs without a significant problem for the end user, isn’t consistently meeting the agreed-upon 95% metric, DelBene said during testimony. Incident free time reached 95% in only four of the last 10 months.
That’s partially due to the number of changes that are currently being introduced to the system, he added.
“It's a well-established axiom of software development that systems stabilize when the rate of change made in the system decreases,” DelBene said. “The rate of change is still very high, resulting in more incidents than we would like.”
Users still aren’t happy, and that’s what counts, Rosendale said, citing a survey from Klas Research. Only 26% of employees surveyed said the EHR was available when needed and that downtime wasn’t a problem, he said.
Oracle did not send a representative to the hearing, though the technology giant did provide written comments.
“The fact that they didn't send a representative raises major concerns for me, and I expect better. I'm constantly losing faith in the process,” said Cherfilus-McCormick.
Oracle did not respond to a request for comment by press time.
Deployments are planned to resume in March next year, with the Captain James A. Lovell Federal Health Care Center in North Chicago, Ill.
Lawmakers said they’ll scrutinize that rollout.
“I understand the determination to make Oracle Cerner work, especially now that DOD has nearly finished implementing it,” Rosendale said. “I hope the two departments and Oracle can put the blame-shifting behind them once and for all and address the problems, regardless of who may have created them.”