Morale plunges at site of VA's new electronic health record

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Morale among clinicians at the Mann-Grandstaff VA Medical Center in Washington is tanking as a result of dissatisfaction with the new Cerner electronic health record system, according to a survey conducted by the Department of Veterans Affairs.

According to the survey, which was discussed at a hearing of House Veterans Affairs subcommittee devoted to agency technology on Tuesday, 83% of employees say their morale has worsened since the switch to the Cerner software in October 2020.

One year after the initial go-live – the first of the planned 10-year, $21 billion project – just 16% of those surveyed said they were "very confident" using the Cerner EHR system, 22% said they were "neutral" and 62% indicated a lack of confidence with the new software.

Fewer than 1% of respondents said their job satisfaction has improved as a result of the new health record software implementation.

The survey of 833 employees at the facility, conducted by VA's National Center for Organization Development, found job satisfaction is getting worse, employees are feeling more burned out and more employees are questioning whether they want to remain at Mann-Grandstaff. Survey results were discussed at the hearing, and top-line results were shared by a committee staffer. A VA spokesperson said the survey was conducted for internal purposes and declined to share the full results. 

The survey was conducted as part of a strategic review ordered by VA Secretary Denis McDonough after a strategic review and pause to further implementations of the Cerner software at agency facilities. However, lawmakers on both sides of the aisle expressed frustration that the changes suggested by the strategic review haven't been put in place.

"The strategic review made sound recommendations for some of the key problems with the [electronic health record], ignored several others, and so far has implemented virtually nothing," Rep. Matt Rosendale (R-Mont.), the ranking member of the Subcommittee on IT Modernization, said in his opening statement.

VA Deputy Secretary Donald Remy, the sole witness at the hearing, testified that he thought the Mann-Grandstaff facility was safe, but acknowledged multiple issues arising from the transition to the new software, including productivity loss, data management and governance, a "fragmented" patient portal experience and other issues. The strategic review also identified multiple management weaknesses.

"Given VA's past challenge with modernization programs, it is critical that we work together to review and possibly revise the management structure surrounding IT acquisitions in general and the [Electronic Health Records Modernization] program specifically," Rep. Mark Takano (D-Cailf.) the chairman of the full committee, said at the hearing.

Some management changes are already in the works. Remy testified that the Office of Electronic Health Records Modernization (OEHRM) is dividing leadership roles and responsibilities among three separate leadership positions: an executive director to manage the contract and the program, a "functional champion" representing the clinicians of the Veterans Health Administration and an official designated by the Office of Information and Technology, who has not yet been named. Remy also said in his opening statement that he was in the process of hiring "a full-time EHRM executive-in-charge under my direct supervision who will administer and manage the day-to-day integration responsibilities for EHRM."

VA is also awaiting the Biden administration’s appointment of a permanent assistant secretary for Information and Technology – a post that requires Senate confirmation.

Lawmakers are concerned in part because of persistent patient safety issues and other complaints about use of the patient portal, which patients access to refill mail-order pharmaceuticals online, and issues with other errors in prescription orders – problems that were apparently flagged and corrected in real time in the VA's homegrown VistA system which Cerner is replacing.

Rep. Cathy McMorris Rodgers (R-Wash.), who represents the Spokane area where Mann-Grandstaff is located, said that pharmacy is "perhaps the No. 1 concern" among patients and staff communicating with her office.

More generally, McMorris Rodgers said, "there is a sense you're moving on to Columbus and you're done at Mann-Grandstaff."

VA has selected Columbus, Ohio, as its next go-live site. Remy said the agency plans to begin deployment in February 2022 and go live at some point by the end of the second quarter. However, Remy said that the problems at Mann-Grandstaff have not been forgotten and that he is planning a visit to the site in the coming weeks.