VA's EHR clocks more than 800 'major performance incidents' since go-live, watchdog finds

The Department of Veterans Affairs and Oracle Cerner lack sufficient controls to mitigate major performance issues with VA’s new electronic health record system, even as medical personnel using the software continue to express concerns about its deficiencies, according to a pair of reports released on Monday by VA’s Office of Inspector General.

VA signed a 10-year contract with Cerner in 2018 to modernize its legacy EHR system, but the project has subsequently been hampered by patient safety concerns, performance and technical issues and software outages. Oracle acquired Cerner in 2022 and pledged to put the project back on track, although deployment challenges have since continued.

An OIG audit of the EHR modernization program found that both VA and Oracle Cerner failed to implement adequate protocols needed “to prevent system changes from causing major incidents, respond to those incidents when they occurred or mitigate their impact.”

The watchdog noted that VA and Oracle Cerner’s contract defined four specific types of major performance incidents, including: outages, performance degradations, incomplete functionality and loss of redundancy. 

From the system's go-live date of October 24, 2020 through March 31, 2024, OIG identified 826 incidents that fit this criteria, with these events impacting the EHR software for a total of 1,909 hours and 26 minutes.

VA previously announced in April 2023 that it was pausing additional deployments of the system to prioritize improvements at the five medical facilities where the Oracle Cerner system had been deployed, with the exception of the rollout at the Captain James A. Lovell Federal Health Care Center in North Chicago, Illinois, in March. 

VA officials said the Lovell deployment — the first and only joint rollout of the software with the Department of Defense that occurred in March 2024 — would serve as a key signifier of the department’s ability to resume the modernization effort. 

Citing that deployment’s success, VA Secretary Denis McDonough told Congress in April that the department plans to restart rollouts of the system before the end of fiscal year 2025, although lawmakers have expressed bipartisan concerns about VA’s push to resume the program.

The audit found that, despite the department’s ongoing efforts to improve the modernization program, performance issues have not been resolved. 

Although OIG noted that “the trend of incidents turned down as of quarter three of fiscal year 2023” following VA’s deployment pause that April, it noted that issues continued after the March 2024 deployment of the software at Lovell. 

The OIG also found that while “VA routinely tracks patient safety events related to the EHR system as a whole, there is no formal process to link reports of these events to specific major performance incidents.”

The audit attributed these limited controls to the language in the original May 2018 contract, noting that it “did not include specific terms that comprehensively required Oracle Health to take necessary actions to address major incidents and performance metrics were difficult to find.” 

VA and Oracle Cerner extended their contract in May 2023, with the reworked agreement including enhanced performance requirements. While OIG cited this as a positive step, it said VA still has “the opportunity to further improve its management of major incidents and thereby reduce potential risk to patient safety.”

The watchdog made nine recommendations to the department, including calling for VA officials to better identify and remediate major performance incidents that are linked to negative patient outcomes and to “identify the appropriate backup system and develop a training strategy to ensure clinicians can use the system during downtime.”

VA officials concurred with all of OIG’s recommendations. 

In addition to the audit, the watchdog also released a management advisory memorandum compiled after OIG conducted inspections of the VA Southern Oregon Healthcare System and the Jonathan M. Wainwright Memorial VA Medical Center in Walla Walla, Washington between March 4 and June 3. Both facilities use the new Oracle Cerner EHR system.

Facility leaders and medical personnel at both sites called the EHR software “a system shock” that was also leading to increased staff turnover and patient safety concerns.

“The OIG learned that hundreds of tickets have been submitted by VA Southern Oregon Healthcare System staff identifying EHR problems related to the homeless program; specifically, the new EHR lacks a view alert system, which limits staff’s ability to meet veterans’ needs timely and efficiently,” the memo noted.

The watchdog said it has tracked issues with the new EHR system since it first went live in 2020 and that feedback from the two facilities “demonstrate that new and previously-identified issues persist in 2024.”