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More pharmacy problems endanger future of VA’s health records system

Newly discovered errors in how patient prescriptions are logged in the Department of Veterans Affairs new electronic health records system could endanger medical care for tens of thousands of veterans, according to the latest report from a government watchdog.

VA and Oracle Cerner officials said final fixes for the problem should be in place in coming days, but outside experts and lawmakers questioned whether those updates will fully address the system failures. And the setback again raises questions about when — if ever— the Millennium records system will move to other sites within the veterans health system.

The revelations came at a House Veterans’ Affairs Committee hearing on Thursday, the latest in a series of oversight events scrutinizing the embattled medical records system. Lawmakers lamented that despite repeated promises from officials involved with the project, little progress has been made in the last year.

VA won’t restart health records overhaul until next summer, if at all

“The situation we found in May of last year was dangerous and unsustainable, and it seems much the same today,” said Rep. Matt Rosendale, R-Mont., chair of the committee’s technology panel.

“Simply put, the medical centers using the Oracle Cerner electronic health records have been turned upside down. … The results of the VA and Oracle strategy to improve the EHR have been one step forward and one step backwards. We’re not gaining on this.”

In 2018, then-President Donald Trump announced a new 10-year, $16-billion plan for VA to adopt the Millennium system in an effort to put veterans health records and military medical files into the same software platform for the first time.

The new system was installed at five sites — the Spokane VA Health Care System in Washington, the VA Walla Walla Health Care System in Washington, the Roseburg VA Health Care System in Oregon, the VA Southern Oregon Health Care, and the VA Central Ohio Health Care System — before VA officials announced a full halt on the rollout in April 2023.

The move came in response to widespread employee discontent with the new software and concerns about patient safety due to system shortfalls. At Thursday’s hearing, Dr. Neil Evans, acting program director for the health records project, said no timeline has been finalized for resuming that work.

He said officials have made “incremental but steady progress” but still need to put in place other system improvements, including issues surrounding pharmacy records.

But officials from the VA Office of Inspector General found significant lingering problems with how pharmacy records are shared between medical sites, with the new health records software and sites still using the department’s legacy records system, VistA.

Investigators found evidence that mail order pharmacy data for nearly 120,000 patients is outdated or could contain mistakes. About 250,000 patients total could face complications due to incomplete information in their records.

They warned that patients “may be prescribed contraindicated medications” because of the errors and noted that some health care providers at legacy sites “are making clinical decisions based on inaccurate data.”

Officials from VA and Oracle Cerner said they have partially addressed the issue in recent months and hope to have another software patch related to the pharmacy issues in place in the next few weeks. But that update was already rescinded once because of errors that emerged in testing trials.

Despite those problems, and despite the department’s pause in the Millennium system rollout, the department is planning to launch the records software at the Lovell Federal Health Care Center in Chicago next month. The site is a joint medical center with staff from VA and the Defense Department, which has not experienced the same issues with its implementation of new health records systems.

Mike Sicilia, executive vice president at Oracle Corporation, said the improvements made to the VA records system in the last year should make the rollout at that site less complicated and error prone.

But lawmakers on the panel dismissed that optimistic outlook.

“The definition of insanity is doing the same thing over and over again while expecting a different result,” Rosendale said. “I have come to believe that continuing this effort — to transform the Oracle Cerner pharmacy software into something completely different — is insanity.”

He and several other lawmakers have called for VA to abandon the project, despite the $9 billion already spent on the effort.

VA Deputy Inspector General David Case said his office has seen improvements in project management over the last year but warned numerous other fixes will be needed to get the records system rollout back on track.

“As VA moves toward its deployment next month at a complex facility jointly operated with the Department of Defense, transparency, communication, and program management will be essential to getting it right,” he said. “Failures in these areas risk cascading problems.”

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