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Lawmakers grill VA officials, Cerner execs over flawed health record system’s impact on Inland Northwest veterans

UPDATED: Tue., April 26, 2022

WASHINGTON – Lawmakers on Tuesday grilled officials from the Department of Veterans Affairs and executives with Cerner Corp. about problems with the company’s electronic health record system being piloted in Spokane, Walla Walla and other sites across the Inland Northwest.

The hearing in a House VA subcommittee charged with oversight of the $16 billion program came after the VA Office of Inspector General released a trio of reports that corroborated dozens of unresolved problems with the computer system – which health care providers rely on to track patient data and coordinate care – and just days after The Spokesman-Review reported the system contributed to a veteran’s hospitalization with heart failure in March.

“We are five years now – five years – into this process, and I am gravely concerned about the treatment of our veterans in these facilities,” Montana Rep. Matt Rosendale , the top Republican on the subcommittee, told the Cerner executives.

The panel’s Democratic chairman, Rep. Frank Mrvan of Indiana, opened the marathon hearing by asserting the system should not be deployed at VA’s biggest hospitals until the problems are fixed. Rep. Cathy McMorris Rodgers, R-Spokane, and Sen. Patty Murray, D-Wash., both called for a halt to the rollout before the system launched in Walla Walla’s VA hospital March 26, but Mrvan’s statement marked a notable shift in the key oversight panel’s stance.

The system is scheduled to launch at multiple sites in central Ohio on Saturday, the first deployment outside the Inland Northwest. The first large hospitals set to adopt the system – in Seattle and American Lake, outside Tacoma – are slated for the end of August. But Don Pirraglia, who until recently served as a top VA health official on the project, told the lawmakers he also advised against bringing the system to more complex facilities like Seattle, Portland and Boise until it’s fully functional.

Rep. Dan Newhouse, R-Sunnyside, joined the hearing despite not being a member of the subcommittee. Veterans in his central Washington district have been affected by the Cerner system since it launched at clinics in Yakima and Richland, which are connected to the hospital in Walla Walla, and he urged VA officials to address the problems quickly.

“If we in the state of Washington have the distinction or the honor of being guinea pigs in this electronic records rollout, we just have to be certain that the issues that we have seen do not happen again at any other place in the country,” Newhouse said. “We have got to be certain that we get this right in Spokane and in Walla Walla, and until we do, we should not do this – in my humble opinion – in any other location in the country.”

As a Spokesman-Review investigation found in December, the Cerner system has put veterans’ safety at risk and left health care workers exhausted and demoralized since it launched at Spokane’s Mann-Grandstaff VA Medical Center in October 2020. One recurring problem has been frequent outages where the system goes down for hours at a time, forcing VA employees to abandon their computers in favor of pen and paper.

That problem was punctuated when the system went down during VA Deputy Secretary Donald Remy’s visit to Mann-Grandstaff on Monday and again during Tuesday’s hearing. In an awkward exchange, Terry Adirim, the top VA official in charge of the Cerner system’s rollout, told Rosendale what happened Monday was not technically an outage. She then deferred to a deputy sitting next to her, who corrected Adirim and said there had in fact been an outage.

Later in the hearing, Cerner executive Patrick Sargent said Monday’s outage was caused by “a normal update that was pushed during the day and it caused the system to go down,” while saying he didn’t know what had caused the longer outage on Tuesday.

While both VA and Cerner representatives said they did not know how many outages or how much total downtime had occurred since the system launched, Rosendale said he had record of at least 50 outages since October 2020.

Members of both parties cited The Spokesman-Review’s reporting on the hospitalization in March, which leaders at Mann-Grandstaff reported as a “sentinel event,” indicating that it had the potential to cause “severe harm” to a patient.

“The safety of our veterans is my No. 1 concern regarding the future of this program,” Mrvan said in his closing remarks. “If I don’t feel that this is being taken seriously enough by VA or by your company, I will not support expanding this to larger and more complicated facilities. The risk to veterans’ lives is too great, as evidenced by the report from this weekend.”

Adirim declined to discuss details of that case, citing the law known as HIPAA that protects patients’ privacy, but she described the root of the problem – a prescription being dropped from a list of the patient’s current medications when it expired – as “a usual thing that happens.” She said the transition to the Cerner system was done “to ensure that no medications got missed” and said staff were adequately trained on how to handle the prescriptions, contradicting the accounts of multiple clinicians who spoke to The Spokesman-Review.

Newhouse and other lawmakers raised concerns about the system’s impact in Walla Walla, where Rosendale said providers were seeing only about 20% of their usual number of patients as they adapt to the new system, but Adirim said the launch had been a success after a month in the southeastern Washington city. She added that staff in Columbus are “eager and well prepared to transition to the new system.”

Another focus of the hearing was the cost of implementing the Cerner system across the VA’s 171 medical centers and more than 1,000 clinics, which VA officials have said will cost $16 billion over 10 years. The VA Office of Inspector General has estimated the true cost of the effort could be as high as $21 billion, and on Monday the internal watchdog agency released another report projecting that the already-delayed project will cost roughly $2 billion more for each additional year it takes to finish.

Newhouse and Rep. Mark Takano, D-Calif., both said they had received reports that Mann-Grandstaff was facing a budget deficit because it had hired more workers to counter lost productivity caused by the system – as many as 400 full-time employees, Rosendale said – while also losing revenue from insurance companies due to third-party billing problems. When Newhouse asked if that budget shortfall could result in cuts to services at Mann-Grandstaff, Adirim said she didn’t know.

Several of the problems identified by Mann-Grandstaff employees, Adirim said, would require modifications to the Cerner contract that could result in additional costs, although both she and Cerner executives declined to say how much the changes would cost taxpayers. One of the biggest problems, the lawmakers and VA officials agreed, is that the main program in the Cerner system doesn’t effectively communicate with the system’s pharmacy module, causing confusion and potential prescription errors.

Solving that issue, Adirim said, would take Cerner between 13 months and three years. Pressed repeatedly by lawmakers, she said the VA had not considered hiring a separate company to speed up the fix.

Since the VA signed a $10 billion contract with Cerner in 2018 – sidestepping an open bidding process on the grounds that it would help VA hospitals work better with the Department of Defense, which was already using the Cerner system – the program has seen frequent changes in leadership. Adirim has been in her role only since January, and Sargent, the top Cerner executive at the hearing, joined the company just two weeks before the hearing.

Sargent, a retired Army major general, said that his 35 years of military service made him appreciate the importance of providing veterans with good, reliable health care.

“We will not put patients at risk, our veterans at risk, with this (system),” he said. “I’m a beneficiary of the VA. I’m a beneficiary of Walter Reed Army Medical Center. And I can assure you, I will give you my commitment, that we will work to have zero preventable harm.”

McMorris Rodgers, who is not on the House VA Committee but had attended past hearings related to the Cerner system, wasn’t present on Tuesday but released a statement after visiting Mann-Grandstaff with Remy on Monday.

“The continued problems with the new system,” the Spokane Republican said, “have caused veterans and care providers an unacceptable amount of stress and frustration. On top of that, incessant delays in restoring 24-hour urgent care access at Mann-Grandstaff have further undermined veterans’ confidence that they will have access to care when and where they need it most.”

“As I told the deputy secretary yesterday, we must do better. Veterans in Eastern Washington deserve a system that works for them, and I’m going to fight to make sure they get it.”

The Cerner system is scheduled to launch at the Chalmers P. Wylie Veterans Outpatient Clinic in Columbus, Ohio, on Saturday. VA Secretary Denis McDonough is set to testify before the full House VA Committee about the department’s budget on Thursday.

Orion Donovan-Smith's reporting for The Spokesman-Review is funded in part by Report for America and by members of the Spokane community. This story can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper’s managing editor.

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