WASHINGTON – The troubled computer system that forced Spokane’s Veterans Affairs hospital to stop admitting patients Thursday has been restored and all patient data that was “jumbled” by an error should be fixed by the end of this week, the official in charge of implementing the system said in an interview Monday.
Terry Adirim, program executive director of VA’s Electronic Health Record Modernization Integration Office, oversees an effort to replace the computer system providers use to track veterans’ information and coordinate care in the nation’s 171 VA medical centers and more than 1,100 clinics. The new system, developed by Cerner Corp., is projected to cost roughly $16 billion over 10 years.
Since the Cerner system was launched in October 2020 at Spokane’s Mann-Grandstaff VA Medical Center and clinics in Coeur d’Alene, Sandpoint, Wenatchee and Libby, Montana, it has caused a series of problems, including missing prescriptions and delayed care, a Spokesman-Review investigation found. After scheduled deployments in other cities were delayed, the system is set to be rolled out next at the VA hospital in Walla Walla on March 26.
In the interview, Adirim explained what caused the critical system to be taken offline and how the department plans to avoid similar problems in the future.
On the evening of March 2, an “enhancement” made by Cerner intended to improve the system instead “introduced a code defect,” resulting in what Adirim called “a jumbling of demographic information.” When a health care worker pulled up one of the affected patients’ records, they saw information belonging to a different veteran.
Adirim said VA’s privacy office is investigating those cases but she didn’t think the federal law that protects patients’ sensitive information, known as HIPAA, had been violated.
While Mann-Grandstaff Director Robert Fischer decided to take the system offline and stop admitting new patients, Adirim said the hospital continued seeing patients who had already been admitted, including for scheduled surgeries. Until the system was restored March 4, employees wrote patient information by hand.
“Every health care institution is prepared to do that kind of thing, and it was felt that it was best, in order to investigate this more thoroughly, that they shut it down,” she said. “For all intents and purposes, the (medical center) was up and operating and running, but you can understand the challenge of doing that with an electronic system that is down so it’s hard to get records.”
When the system was restored the following morning, the VA “sequestered” the records of 205 veterans identified as possibly corrupted. As of Monday, Adirim said, a review had found 94 of those records had no incorrect demographic data and another 83 records were in Columbus, Ohio, not at Mann-Grandstaff.
The records of all patients at the Spokane hospital and its affiliated clinics were being checked one by one for errors, a process she expected to be complete by the end of the week. While the VA submitted four patient safety reports to an internal reporting system, she added, no specific patient safety problems had been identified and no prescriptions were filled incorrectly.
As for how the VA can avoid similar problems in the future, Adirim said, “In general, changes like this probably shouldn’t be happening this close to go-live at the next site.”
That next site, the Jonathan M. Wainwright Memorial VA Medical Center in Walla Walla, is “on track” to transition to the Cerner system on March 26, Adirim said.
“We’re in constant communication with Walla Walla,” she said. “They’re feeling like they’re ready, we believe that they’re ready and we – at this point, to date – do not see anything impeding us.”
She emphasized, however, that the rollout at the southeastern Washington hospital is still a pilot site, “So we’re not expecting perfection. I think we’re expecting good.”
Secondly, Adirim said, VA program managers need to be aware when Cerner is making changes to the system.
“We’re digging into this particular piece, but we just hired a very experienced program manager that started last week,” she said. “So a lot of these controls and procedures are being put in place now, but we believe that we need to be aware of all of these types of enhancements being done, and when they’re being done.”
Although adopting the new electronic health record system is intended to put the VA on the same system used by the Department of Defense, also developed by Cerner, Adirim said the data problem in Spokane did not affect the Pentagon system, “Because they’re ahead of us by a mile. They’d already done this interface enhancement.”
More than a year after the Cerner system was launched at Mann-Grandstaff, doctors and nurses have told The Spokesman-Review and federal watchdog agencies it has continued to limit how many patients they can see each day, a measure referred to as “productivity.” Adirim said that while some slowdown is inevitable when a new health records system is adopted, Mann-Grandstaff is “at least close to” the level of productivity it had before the Cerner system.
While Walla Walla could see similar effects after it adopts the system March 26, Adirim said the error that affected veterans and their health care providers in the Inland Northwest last week should not happen again.
“This incident is something that shouldn’t have happened, and we’re putting stringent controls in place so that something like this doesn’t happen again,” Adirim said. “I’m confident that this will not affect the program going forward.”