The Department of Veterans Affairs is getting ready to resume the rollout of its new Electronic Health Record, after putting the project on pause for a year-and-a-half to address persistent performance issues at medical facilities already using the new system.
The VA put all future deployments of its new EHR on hold in April 2023. But department officials say the Oracle-Cerner EHR is running better at the five sites that switched over to the new system, and that the EHR’s launch at a sixth site it jointly operates with the Defense Department has been its most successful deployment so far.
Senior VA officials say the department is on track to resume EHR deployment efforts later this fiscal year, but none have provided more specific details.
Incoming political appointees under the Trump administration will decide on some of the next steps for the EHR rollout. But VA Secretary Denis McDonough recently told reporters that career VA employees will continue to oversee most of the day-to-day EHR modernization work, and will brief the Trump transition team on the status of the EHR project.
“The overwhelming majority of VA professionals who work on EHRM will be working on EHRM on January 21st, just as they were on January 19th,” McDonough said at a Dec. 12 press conference. “So that team stays, and we’ve benefited greatly from our opportunity to work with them.”
The VA signed the 10-year, multi-billion-dollar EHR contract with Cerner and started rolling out the system to its medical facilities under the first Trump administration. Oracle completed its acquisition of Cerner in June 2022.
‘Incremental’ EHR rollout
Kurt DelBene, VA’s assistant secretary for information and technology and the department’s chief information officer, told lawmakers last week that the VA is planning a restart of deployment efforts in 2025, “ensuring that our electronic health record system meets the needs of our veterans and VA staff.”
DelBene told the House VA Committee’s IT modernization subcommittee that the department adopted an “incremental approach” to EHR modernization during the reset period, and that the new approach is working.
“With the pause, we are resetting to getting it right, and in a sense — hindsight is 20/20 — but you probably should have done that from the beginning,” DelBene said. “The scope of the project from the beginning should have been this first pod, and then you would have broadened it beyond that.”
DelBene said the Oracle-Cerner EHR is also meeting contract standards around uptime and incident-free time.
The VA’s inspector general office reported in September that between October 2020 and March 2024, the Oracle-Cerner EHR experienced 826 “major performance incidents” — including outages, performance degradations and incomplete functionality.
The VA IG’s office has linked the new EHR’s problems to instances of patient harm — and in some cases, linked those problems to the death of patients.
“We need to get the situation right where we are, which is what we’ve been working on. And then, at that appropriate time, we’ll do the planning to do another set of [Veterans Integrated Services Networks] and locations, and again pause, get that right,” DelBene said.
Focus on employee experience
Neil Evans, the acting program executive director of VA’s EHR Modernization Integration Office, said at an industry conference on Tuesday that his office is “working better together” with other parts of the department — including the Veterans Health Administration, the Office of Information and Technology and individual VA clinicians that are using the new Oracle-Cerner EHR.
“We’ve made a tremendous amount of progress, with regard to the core stability of the federal EHR platform. Really addressing issues of user experience, based on our lessons learned, listening to the voice of our end users,” Evans said at the FedFocus VA Digital Heath Care Summit.
The five VA sites running the Oracle-Cerner EHR cover 20 community clinics and almost 100 other sites that support those facilities.
“We really rolled up our sleeves for the last year. We focused on the end-user experience. We focused on the stability of the solution. I would argue that actually we probably should have started there,” Evans said.
Evans said that VA, during the reset period, has been focused on “what it means to do continuous improvement of health IT systems to support the needs of our users.”
“The work we’ve been doing during reset isn’t going to stop when we get restarted with deployment-related activities. We can, as an organization … walk and chew gum at the same time,” he added.
Evans declined to comment on the specifics of when the VA will resume its EHR rollout.
“We’ll be keeping you informed on that very soon,” Evans told Federal News Network on the sidelines of the conference.
Fewer crashes and lags
James Bates, assistant deputy CIO of the EHRM Integration Office, said the Oracle-Cerner EHR has seen a 50% decrease in crashes and lags since the VA completed its last round of updates in August.
Over the past year and a half, the VA worked with Oracle and Cerner to make 176 enhancements to the EHR. Bates said the EHR saw a 60% reduction in incident tickets, after making these updates. Before making updates, Bates said 70% of incident tickets were routed to the wrong place, which increased the time to resolve them.
“So 70% of those are now being routed to the correct people for resolution, right off the bat,” Bates said.
The VA, he added, is taking steps to ensure the IT systems that VA employees rely on to do their jobs remain “invisible to the end user.”
“Really, we don’t want them to think about the devices they’re using. Just use the device to do their job,” Bates said.
After visiting VA sites using the new EHR, Evans said many clinicians were automatically logging onto the VPN with their laptops, which contributed to some of the lag problems.
“We went out on-site visits and realized there were an awful lot of our users who were bringing their laptops to work and logging onto the VPN automatically, without even knowing that they were logging onto the VPN while on the internal network, and it was leading to performance issues,” he said.
Evans acknowledged that “people were having a poor performance” with the Oracle-Cerner EHR prior to the reset. Around that time, the Government Accountability Office reported that 79% of the more than 2,000 VA employees who responded to a survey “disagreed or strongly disagreed that the system enabled quality care.”
The VA is the largest integrated health care system in the U.S. More than 400,000 VA health care workers rely on the EHR. In addition, 70% of all physicians in the U.S. complete some of their training at VA medical facilities. All told, Evans estimated VA’s new EHR will see about half a million users once fully deployed.
“It becomes operating at scale, while simultaneously holding to the understanding that you’re going to be judged by every one of those 500,000 people. That’s the challenge in front of us. I welcome that challenge. I’m super excited about that challenge,” Evans said.
“If we’re not delivering a rock-solid, core, fundamentally sound set of infrastructure that works reliably, quickly, in a way that makes sense to an end-user in a clinic, who does not want to be distracted by an information system, but wants the information system to be there to support them. That’s got to be step number one,” he added.
No more ‘big-bang’ IT projects
DelBene, speaking at the industry conference on Tuesday, said the VA has shifted away from “big bang” IT modernization projects, in favor of a more incremental approach.
“If you look reflectively at where we ended up with EHRM, the thing was contracted to be quite large,” he added. “And we’re getting it right with the pause. And then we will start that iteration of more and more sites over time. But that is the model we want to use everywhere,” he said.
“You don’t have a great system unless people love using it,” he added. “That’s why we’re measuring usability and whether people love our systems and what the feedback would be on the usability of those systems across the board.
Jack Galvin, the deputy CIO for IT end-user services within VA OIT, said the department is embarking on modernization projects that will support the new EHR. Around 2018, when the VA signed the Cerner EHR contract, the department had about $1.3 billion in technical debt.
“Even though we’re in that reset piece, we never stopped in this area. One of the things we did in starting the project was identify some of the requirements of underpinning technology that everything is going to need for modernization,” Galvin said.
Galvin said that, to date, the VA has installed about 8,000 new laptops and desktop computers and is about halfway through a project to modernize the bandwidth at VA medical centers.
“We didn’t just find and replace. It’s not your father’s technical refresh program. We actually modernized and future-proofed those specifications so we could scale the bandwidth,” he said.
The VA, as part of this effort, has installed next-generation Wi-Fi at more than 150 sites, and includes guest access for veterans receiving care.
McDonough told reporters earlier this month that the Oracle-Cerner EHR has been “dramatically decreasing disruptions in patient care” since January 2024.
“We’re seeing decreasing numbers of interruptions for clinicians, therefore minimizing the slowdowns for veterans,” he said last week.
McDonough said the VA’s EHR go-live at the Capt. James A. Lovell Federal Health Care Center in North Chicago, which it jointly runs with the Navy, has been a success.
“It’s obviously still too early to declare final or unequivocal success. There have been some promising results. Importantly, I think across each of the EHR systems, we’ve seen increased veteran trust since the EHR go-live,” McDonough said.
“There’s still room to improve there, dramatic room to improve. But we’re seeing increased clinician and staff satisfaction,” he added.
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