VA's Cerner EHR platform fails to deliver medications to veterans

Messy system is forcing VA pharmacies to work overtime to deal with poor IT, committee told

The US Department of Veterans Affairs' ill-fated electronic health record upgrade hasn't just proved a problem for clinicians - it's also causing serious disruptions at VA pharmacies that have led to veterans not getting needed medication.

Such was the word from witnesses at this week's hearing of the House Committee on Veterans' Affairs subcommittee on Technology Modernization Oversight, which is taking a deep dive on problems specific to the pharmacy end of the Oracle-Cerner EHR system the VA rolled out to five facilities before calling an indefinite halt to Cerner deployments over problems with the system.

While witnesses for the VA and Oracle alike copped to some level of responsibility for the snafu, the most damning evidence came from testimony provided by the US Government Accountability Office's Carol Harris, director of IT and cybersecurity, who came armed with a GAO report [PDF] that included feedback from VA staff forced to work with the new system.

According to Harris' numbers, Cerner users scored it far below the expected average of 68 out of 100 points for user satisfaction. Instead, Cerner users at four out of five sites rated it in the mid-20s, while one facility gave it a score of 32 out of 100.

Along with generally low satisfaction scores, Harris said GAO interviews with staff found serious moral and burnout concerns. "One user reported working 60 hours a week and trying not to drown in carrying out duties because completing chart reviews, which used to take 15-30 minutes using the old system, was now taking hours or even days," the GAO said in its report.

Others said clinicians were volunteering their time to speed things along, as most tasks in the new system took 10 to 15 percent more time to complete.

As for the pharmacy, the GAO said that there were multiple instances of patients receiving double prescriptions, the wrong prescription or medication that was no longer prescribed. Others reported never receiving their meds because they were mailed to the wrong address or were flagged for pickup when they should have been delivered.

(Note: This reporter is a US Army veteran and VA patient, and has experienced similar prescription issues at his local VA facility, which is not one of the five testing Cerner.)

One facility told the GAO it had to increase pharmacy staff from 15 to 60 to handle the rising workload dropped on them by Cerner. Despite all those problems, Harris' report claims that the "VA has not conducted an operational assessment and, as of January 2023, did not plan to do so."

Mike Sicilia, Oracle's EVP for global industries, said at the hearing that his company has been responding to the VA's needs in record time, stating that three out of seven Cerner pharmacy module improvement projects had been flagged by the VA as completed in four months, "not three years," which Sicilia said was the original timeline.

Sicilia said the remaining four pharmacy improvements will be completed this year, and are expected to be deployed late in 2023 and early next.

"At the five medical centers live on the new EHR today, veterans are receiving their prescriptions at the same rate they were prior to the facility converting from [the old system]," Sicilia said. 

According to Dr Neil Evans, the VA's acting program executive director for its EHR modernization office, those improvements haven't been sufficient. "Feedback from our pharmacy community on the recently deployed enhancements to the pharmacy solution is that the improvements have been small and incremental," Evans said. "The current pace of new requests for upgrades and enhancements exceeds the planned delivery schedule of changes that address those requests," Evans added. 

Cerner won its contract to replace the VA's 39-year old EHR system [PDF] in 2015, and test deployments began in 2020. The VA delayed additional deployments in 2021 after problems cropped up at the initial test site, and then in late 2022 announced a delay to its plans to roll the system out to 25 additional sites in FY 2023, which for the US government ends on September 30 of this year.

Oracle did not immediately respond to requests for comment on the hearing. ®