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Spokane, Washington  Est. May 19, 1883

‘Not a functioning system’: Hearing examines pharmacy problems in VA computer system tested in Spokane

Neil Evans, acting program executive director of the Department of Veterans Affairs’ Electronic Health Record Modernization Integration Office, testifies Tuesday.  (Orion Donovan-Smith/The Spokesman-Review)

WASHINGTON – House lawmakers grilled Department of Veterans Affairs officials and Oracle executives during a hearing Tuesday regarding problems with the pharmacy features of a computer system that has been tested in Spokane and across the Inland Northwest.

The department announced in April that it would indefinitely halt deployments of the troubled electronic health record system – which has caused numerous problems since it launched at Spokane’s Mann-Grandstaff VA Medical Center in October 2020 – while dedicating more resources to mitigate the system’s impact at sites where it is in use. The VA signed a $10 billion contract in 2018 with Cerner, which was acquired by Oracle last June and is now known as Oracle Cerner, to replace the department’s existing system used by clinicians to track patient data and coordinate care.

Many of the Oracle Cerner system’s problems have involved the parts of the system used to prescribe and dispense medications, which contributed to the death of a veteran in Ohio, VA officials confirmed Tuesday.

“We expect the VA pharmacists to give our veterans world-class service, and we owe them fully functional technology to do that,” said Rep. Matt Rosendale of Montana, the Republican chairman of the House VA Subcommittee on Technology Modernization.

In an effort to shed light on those specific problems, the panel sent questionnaires to pharmacists at the five hospitals where the system has been deployed: Spokane; Walla Walla; Roseburg and White City, Oregon; and Columbus, Ohio.

Rep. Keith Self, R-Texas, read part of a statement one pharmacist at Mann-Grandstaff sent in response to the questionnaire. Because of “increased risks due to delays, inefficiencies, vulnerabilities, manual workarounds and the lack of responsiveness from Cerner to identify patient risks,” the pharmacist said, “pharmacy staff must remain in a constant state of hyper-vigilance to recognize and intervene on those risks.”

James Ellzy, a former Pentagon official who joined Oracle as a vice president in January after working on the system’s rollout in Defense Department facilities, said it would take more time for VA employees to learn the new system.

“Whenever you change systems, you’re going to not be as comfortable as the system you’ve been working in for decades,” Ellzy said. “It’s going to take time to learn the new system, and two years is not enough time to get comfortable in the pharmacy sphere with the new system.”

In a September survey, only 6% of VA employees using the Oracle Cerner system said it enabled them to deliver high-quality care.

“Those scores are abysmal,” Carol Harris, director for information technology and cybersecurity and the nonpartisan Government Accountability Office, told The Spokesman-Review after the hearing. “I have never seen anything so low and I’ve been doing this a really long time. Until they address that, nothing else really matters.”

When Rosendale asked Harris during the hearing how the VA and Congress could know that the system is functioning before deploying it at other hospitals, she responded bluntly that it “is not a functioning system.”

“If the users are extremely dissatisfied, which is what we’re seeing now, the system is going to fail,” Harris said. “It’s just not a sustainable solution. There will be increased patient safety risks as a result.”

Mike Sicilia, Oracle’s executive vice president in charge of the VA project, said his company has been working quickly to address problems identified by users at Mann-Grandstaff and the other sites, but he said, “I’m not surprised to hear that right now people don’t like it, because it’s not complete.”

Oracle delivered the three most urgent pharmacy fixes in four months, Sicilia said – much earlier than the three-year timeline Cerner executives gave before Oracle acquired the company in June 2022.

“We hope it shows you that Oracle is a highly capable partner for VA,” he said. “Whether it is pharmacy enhancements or other fixes, we have put tremendous engineering rigor and resources into getting the work done well and quickly.”

Yet Harris said only six of 79 change requests made by pharmacists in Spokane have been addressed in the past two years, a pace she called “unacceptable.”

Neil Evans, the acting executive director of the VA office in charge of the system’s rollout, told Rosendale he agreed that Oracle and the VA need to fix the system’s problems much more quickly.

“I don’t think we’ve been executing with the velocity that we need to in order to get where we need to get,” Evans said, to get the system working “in a way where the pharmacists and providers are functioning as a single team, reading from the same sheet of music.”

Rep. Sheila Cherfilus-McCormick of Florida, the top Democrat on the subcommittee, raised concerns about the fact that even after using the system in Spokane for 2½ years, the VA still hasn’t defined how the “baseline” system should work, so that its users are forced to adapt to constant changes.

“I have already heard from the staff that they feel like they are being repeatedly bashed into rocks by the waves of change,” she said.

The VA has obligated at least $9.4 billion to the effort to replace its existing electronic health record system with the Oracle Cerner system, Harris said. Rosendale – along with Rep. Cathy McMorris Rodgers, R-Spokane – has called for the VA to scrap the project and revert to the existing system, which is aging and has suffered from years of underinvestment but has been customized over the course of four decades.