WASHINGTON – The company developing an electronic health record system used at Spokane’s VA hospital has not kept the system online consistently enough to meet a key obligation in its $10 billion contract with the Department of Veterans Affairs, according to a top VA official.
Cerner Corp., the company behind the computer system health care providers rely on to track patient information and coordinate care, is required to meet a minimum level of “uptime,” the time during which the system is fully available to users. Terry Adirim, the program executive director of the VA office in charge of the system’s rollout, said in response to questions from The Spokesman-Review that Cerner will give VA a credit in exchange for falling short of the target.
The system was down for a total of 30 hours and 33 minutes from its launch in 2020 until April 20, Adirim said, without specifying how much of a discount Cerner will provide. VA previously confirmed the system was partly or completely unusable 50 times during that same period. Neither figure includes incidents on April 25 and 26 when the system was disrupted for several more hours.
Spokane’s Mann-Grandstaff VA Medical Center – along with clinics in Spokane, Coeur d’Alene, Sandpoint, Wenatchee and Libby, Montana – have been the pilot sites for the new system since October 2020. After delays related to problems caused by the system, it launched at VA facilities in and around Walla Walla on March 26 and in central Ohio on April 30.
Rep. Cathy McMorris Rodgers, R-Wash., said in a statement Tuesday she was “deeply disturbed” by the decision of VA leadership to bring the system to additional hospitals and clinics despite the downtime issue.
“For months, they knew Cerner was failing to maintain a reliable electronic health record system at Mann-Grandstaff and only offered lip service. Despite my calls to pause the rollout until these issues were fixed, they forged ahead with a premature launch at the Walla Walla VA, further endangering the health and safety of more veterans in Eastern Washington. This is blatant negligence, and someone needs to answer for it.”
Sen. Patty Murray, D-Wash., also called for VA to pause the already-delayed project before rolling it out at Walla Walla’s VA medical center and its associated clinics in Washington, Oregon and Idaho. When Murray asked VA Secretary Denis McDonough in a May 4 hearing to commit that he wouldn’t bring the system to bigger, more complex facilities around Puget Sound until the problems are resolved, he declined, saying only that he would weigh the decision carefully.
McMorris Rodgers sent a letter on Tuesday to Mann-Grandstaff’s director, Robert Fischer, raising concerns over the outages and other problems linked to the system, including lost records and delayed care. She also urged Fischer not to cut staff in response to a budget shortfall tied to the system’s rocky rollout.
The downtime total, while an important benchmark to measure the system’s performance, doesn’t capture the full scale of reliability problems veterans and VA employees in the Inland Northwest have faced for more than a year and a half. Nor do the nine “unplanned outages” and 42 “unplanned degradations” VA has confirmed, according to definitions of both terms Adirim provided.
An outage, she explained, is an “unscheduled event where a clinician is unable to use the electronic health record because the entire system is down.” A degradation is “when all systems and applications are available, but all clinicians experience a similar issue, including the system running slower than normal.”
A third category, including “system errors, latency and application incomplete functionality” while “portions of it were still working,” is not included in the total incidents. Adirim said VA tracks those issues through the “trouble tickets” users can submit to report problems.
Adirim said the April 25 incident, which occurred while VA Deputy Secretary Donald Remy visited Mann-Grandstaff, was initially considered an outage but later reclassified as “incomplete functionality and performance degradation” lasting just over two hours. The following day, while Remy visited the Walla Walla hospital and Adirim testified before a House subcommittee, the system went down completely.
Neither of those incidents was connected to a March 3 incident when veterans’ records were “jumbled” and Mann-Grandstaff was forced to stop admitting new patients, Adirim said, adding that Cerner is conducting an analysis of the root causes of the problems on April 25 and 26. While she previously attributed the March 3 incident to a code defect introduced during a routine update, Adirim said Cerner implements changes to the system in a test before changing the live system.
In a statement, Cerner said it “understands and acknowledges” VA’s concerns with the outages and degradation, and it addresses those concerns “quickly and aggressively.” The company has “proactively initiated a technical review,” the statement said, and remains committed to providing veterans and VA employees with “an effective, reliable, and safe” system.
Calling any downtime or service disruption “unacceptable,” the company said it is taking proactive steps to address the problems, including assessing its internal processes and employee training. Cerner is also conducting a review of its federal contracts – providing similar but separate systems to VA, the Department of Defense and the Coast Guard – and analyzing the root causes of every outage over the past year.
VA signed a contract with Cerner in 2018 to replace the department’s existing electronic health record system, which is still used in the rest of the nation’s more than 1,200 VA facilities. The value of the $10 billion contract is expected to rise as Cerner makes changes to the system requested by VA, and the total cost of the project is likely to exceed $21 billion when infrastructure upgrades and other expenses are included, according to estimates by the VA Office of Inspector General.
Rep. Mike Bost, the top Republican on the House VA Committee, also called the outages and downtime caused by the Cerner system unacceptable, adding that they’re “potentially even dangerous.”
“VA and Cerner have not scratched the surface in solving this serious issue,” Bost, of Illinois , said in a statement. “Instead, they are looking the other way and moving ahead in other hospitals who will surely have the same problems. It’s past time for VA and Cerner to fix it, and stop wasting taxpayer dollars by throwing good money after bad.”
The panel’s Democratic chairman, Rep. Frank Mrvan of Indiana, had called for VA to delay the system’s launch at its biggest, most complex facilities in cities like Seattle and Portland, where problems and risks would be amplified. Unless McDonough modifies the schedule, the system will next launch in Roseburg and White City, Oregon, on June 11, followed by Boise on June 25; Anchorage, Alaska, on July 16; Seattle and other Puget Sound facilities on Aug. 27; three sites in Michigan on Oct. 8; and Portland on Nov. 5.
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