WASHINGTON – Two weeks after the Department of Veterans Affairs launched its new electronic health record system at its hospital in Walla Walla – and a day after the system went down for more than two hours – a top VA official said Thursday the rollout has been a success.
On a call with reporters, VA Deputy Secretary Donald Remy acknowledged Wednesday’s outage and another problem with the system a week earlier but said the transition to the new computer system, which health care workers rely on to track patient information and coordinate care, was “going pretty well.”
The March 26 launch made the Walla Walla hospital, whose director joined Remy on the call, the first VA medical center to adopt the system since it was deployed in October 2020 at the Mann-Grandstaff VA Medical Center in Spokane, where a slew of problems has threatened patient safety and left employees frustrated and demoralized. The system is also used at clinics associated with the two hospitals in Washington, Idaho and Oregon.
“We’re making progress, and I’ve got to tell you I’m pleased,” Remy said. “We’ve learned quite a few lessons from our deployment at Mann-Grandstaff and we’ve incorporated those learnings into this go-live.”
While VA employees in Walla Walla had been submitting “trouble tickets” when they encountered problems with the new system, Remy said, as of Thursday all of the tickets related to patient safety had been addressed.
“We continue to monitor staff morale and clinical productivity, both at Mann-Grandstaff and at Walla Walla, to make sure that we’re providing our team with the tools that they need to be successful,” he added.
The launch went ahead over the objections of Rep. Cathy McMorris Rodgers, R-Wash., and Sen. Patty Murray, D-Wash., who called on VA to halt the rollout until it fixes problems identified by a Spokesman-Review investigation last December and a trio of reports released by the VA Office of Inspector General on March 17.
Problems with the system, developed by Cerner Corp. in a program projected to cost at least $16 billion, have continued in recent weeks. On March 3, a system update by Cerner corrupted data in some veterans’ records and forced Mann-Grandstaff to stop admitting patients for a day . While the hospital kept operating, workers had to use “downtime procedures,” a now-common process that involves hand-writing information that must be entered into the computer system once it is restored.
On March 31, an issue with Cerner’s prescription management system caused employees at Mann-Grandstaff to again resort to pen and paper for medication-related work for 31/2 hours, VA Press Secretary Terrence Hayes confirmed in an email, “because the issue caused extreme delays” with the computer system. That issue affected all Cerner customers, including the Department of Defense, whose adoption of a Cerner system in 2017 prompted VA to sign its own $10 billion contract with the company without going through a competitive bidding process.
Less than a week later, on Wednesday, Mann-Grandstaff Director Robert Fischer ordered staff once again to use “downtime procedures” for more than two hours due to “a medical center-wide outage in accessing and maintaining connectivity” with the system, according to emails obtained by The Spokesman-Review.
Terry Adirim, who heads VA’s Electronic Health Record Modernization Integration Office, told reporters Thursday that the previous day’s outage was caused by a “bug” in a server run by Oracle, the technology giant in the process of buying Cerner for $28.3 billion. Neither problem in the past week was directly caused by the launch in Walla Walla, Adirim said, and VA was “not aware of any disruptions to care” as a result.
Still, Adirim, who practiced pediatric emergency medicine for more than 25 years, said not being able to use a computer system makes it harder for clinicians to do their jobs.
“Speaking as a health care provider, you really don’t want disruption to your work,” she said. “And I would not want them to expect that this is going to happen routinely.”
In the year and a half since launching the system at Mann-Grandstaff and its associated clinics, Adirim said, “VA was not idle.”
“Numerous changes and improvements were made,” she said, “which has led to the success we are experiencing at Walla Walla. Our veterans deserve the very best health care, and to do that VA medical personnel must have modern tools to deliver that care. This is why we’re working so hard to get this right.”
Adirim and other VA officials say the Cerner system promises to streamline the transition from military service to veteran status by having the Defense Department and VA use the same system. While the health record system being replaced by Cerner’s at Defense Department facilities like Fairchild Air Force Base is famously clunky, VA hospitals use a different system that has been fine-tuned over the years and remains popular with its users.
Adirim suggested VA employees who are frustrated by the Cerner system need to understand how it can help them.
“The technology is complicated enough,” she said, “but we also need to account for the enormous change to how we are delivering health care, which relies on people to adopt the new ways – and people are more complex than the technology.”
Scott Kelter, director of the Wainwright Memorial VA Medical Center in Walla Walla, told reporters on the call his workers had benefitted from an influx of support staff from VA and Cerner, including more than twice the number of Cerner staff that had supported the launch at Mann-Grandstaff. Also unlike in Spokane, Kelter said, that support would continue for 90 days.
Adirim declined to answer directly when asked if VA and Cerner could replicate that level of in-person support at the much larger facilities scheduled to adopt the system later this year, including in Seattle and Boise, saying the rollout is “in a pilot phase” that could help identify the best ways to launch the system elsewhere.
“We want to see what works and what doesn’t work,” she said, adding that having in-person support staff “has been very helpful, but at a certain point, people want to start using the system on their own.”
Kelter said VA employees in Walla Walla were learning the new system quickly and already increasing the number of patients they can serve each day, which was dramatically reduced when the hospital made the switch.
“The staff in clinical and administrative areas have really been quite adventurous, quite accepting,” Kelter said. “I think the morale is quite good.”
Meanwhile, in Spokane, Adirim said “there were things that we should have done better” and promised not to give up on health care workers there.
“As we move forward, with our new approaches and new way of doing things, we’re going to continue to go back to Spokane and help them, support them and determine what their needs are, for them to be successful,” she said.
While Adirim promised to listen to the concerns of Mann-Grandstaff employees, she suggested that those who continue to complain about problems with the system may be “a small minority of people, because they’re using the system and they’re using it effectively.”
The Cerner system is scheduled to launch at VA facilities in Columbus, Ohio, on April 30; Roseburg and White City, Oregon, on June 11; Boise on June 25; Anchorage, Alaska, on July 16; Seattle and American Lake on Aug. 27; three sites in Michigan on Oct. 8; and Portland on Nov. 5.
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