VA delays health record go-live at key Michigan site

The Department of Veterans Affairs is delaying a scheduled go-live of the Oracle Cerner electronic health record system at Ann Arbor Healthcare System facilities, FCW has learned. The installation was set to be completed in July and will now take place late this year or in early 2024.

The Ann Arbor deployment was one of several go-lives that were set for this summer following a pause in new software rollouts put in place last October. VA ordered what it called an "assess and address" process to tackle a host of user complaints about the commercial software system, ranging from usability issues, infrastructure problems and incompatibility with critical VA clinical functions that required users to adopt time-consuming workarounds.

Laura Ruzick, the network director for Veterans Integrated Service Network 10, which includes Michigan, Ohio, Indiana and parts of Kentucky, announced the decision in an email to staff that was shared with FCW.

"The reason for this decision is multi-faceted, especially focused on questions about how well EHRM would interact with VA Ann Arbor's vital medical research mission," Ruzick wrote.

Ruzick said the nearby Saginaw, Mich., network, which includes the Aleda E. Lutz Department of Veterans Affairs Medical Center and smaller clinical locations, would go-live with the Oracle Cerner software on June 17, 2023 as scheduled.

The VA electronic health record modernization program, which was originally budgeted at $16 billion over 10 years, is in the crosshairs of legislation proposed by the Republican leaders of the House Veterans Affairs Committee. Now in the majority, the Republicans on the committee have offered bills to make the software system adhere to rigid performance standards and to eliminate the program altogether and revert to VA's homegrown legacy system if the software can't be made to work effectively. 

Rep. Mike Bost (R-Ill.), the chairman of Veterans Affairs committee, told FCW in an emailed statement that he supported the move to delay implementation.

“We need to see real improvement before any more sites go live, and I remain concerned about Detroit, Battle Creek, and Saginaw. I hope Secretary McDonough will continue listening to the local leadership and employees at each facility to determine what is safe and appropriate,” Bost said. 

Ken Glueck, Oracle's executive vice president and a longtime tech industry lobbyist, said in a Feb. 10 blog post that the proposed legislation would be a big step backward for clinical care and access for veterans.

"We are working closely with VA leadership to improve the program and resume deployments in June by making sure users are well-trained, simplifying workflows, applying updates for system performance and capacity and speeding the pace of technical fixes pushed out to users," Glueck wrote. "We are ready to be held accountable and have no issue with improvements to the program so long as at the end of the day there aren’t 171 different decision-makers."

A formal budget revision from VA is still in the offing, but according to various oversight reports and independent estimates, the EHRM program will likely cost at least $21 billion and perhaps as much as $40 billion, with installation taking up to 13 years to complete. 

At a recent press conference, VA Secretary Denis McDonough said that part of the "assess and address" period including a look at how the project was being jointly managed by VA and the Department of Defense, which got a two-year head start on VA on implementing the Oracle Cerner record and is in use at 75% of DOD clinical sites.

"Too often we're a downstream consumer of this infrastructure. And too often our concern becomes secondary to, for example, DOD, which manages big parts of the network. This makes implementation of the system harder than it might otherwise be," McDonough said on Jan. 31. 

The project is also looking for a new permanent leader. Terry Adirim, who joined the program from the Defense Department, is exiting on Feb. 25. She will be replaced by Neil Evans on a temporary basis. Evans oversees telehealth programs at VA and was tapped to serve as acting chief information officer while the agency was awaiting Senate confirmation of current top tech official Kurt DelBene.

"I also look forward to working with Dr. Neil Evans in his new role as acting EHRM program director," Bost said in his statement. "As a longtime VA primary care doctor, I know he understands the potential consequences of forcing a dysfunctional system on medical centers."