VA OIG Flags Medication Safety Issues with Oracle Health EHR System

The Department of Veterans Affairs (VA) Office of Inspector General (OIG) told members of the House VA Committee that issues with the Oracle Health EHR have put medication safety at risk for veterans, according to reporting from Federal News Network.

David Case, deputy inspector general, told lawmakers that veterans seeking care at one of five sites using the agency’s new Oracle Health EHR who then receive treatment at a VA facility using its legacy EHR could have inaccurate medication information.

Since September 2023, VA providers have ordered medications and documented medication allergies for approximately 250,000 veterans within the new Oracle Health EHR.

Case told lawmakers that when the legacy EHR retrieves data from the Health Data Repository, records from the new EHR may be duplicative, inaccurate, or missing.

In one case, providers at a VA residential treatment facility repeatedly denied a veteran his medication because it appeared inactive in the system.

Neil Evans, acting program executive director of VA’s EHR Modernization (EHRM) Integration Office, said the legacy Vista EHR warns providers if a patient receives care at a site using the new Oracle Health EHR.

He noted that the VA will notify impacted veterans about this issue, but the most important person to be aware of the issue is the prescriber.

“It is the prescribing provider who’s going to have to take the action to make sure that they’re verifying the medication list and that they are then making sure that there are no drug interactions for that particular patient,” Evans said.

“Notifying the patients is important, and it’s something we will do,” he continued. “It’s also very important that the providers are aware of the need for the extra vigilance in this circumstance.”

Case, however, told legislators that VA OIG has not “seen evidence that VA has sufficiently notified legacy EHR providers about this issue, and the mitigations to safely care for these new EHR site patients.”

“While VA is taking efforts to reduce this potential, we remain concerned that patients have not been informed of their individual risks, essentially being excluded as full participants in their care,” he said.

VA clinicians still using the legacy Vista EHR have been completing manual medication safety checks for patients who have their information in the new EHR platform.

However, Case said these manual safety checks are “complex and rely on the vigilance of pharmacist frontline staff.”

For instance, at the VA Medical Center in Columbus, Ohio, a prescription backlog required a permanent increase in clinical pharmacists of 62 percent.

Case explained that pharmacy leaders had to create their own workarounds and education materials, leading to burnout and low morale.

“These findings are troubling given the mitigations for pharmacy failures rely on staff vigilance,” Case said.

Matt Rosendale (R-Mont.), subcommittee chairman, said facilities leveraging the new EHR have had to increase their pharmacy staffing by at least 20 percent to address system issues.

“Simply put, the medical centers using the Oracle Cerner EHR have been turned upside down,” Rosendale said.

VA anticipates that large, complex medical centers will have to increase their pharmacy staffing by as much as 60 percent to mitigate the software’s issues, according to Rosendale.

Mike Sicilia, executive vice president of Oracle Global Industries, noted that Oracle is aware VA has increased pharmacy staffing at sites using the new EHR and that the vendor “will continue to partner with VA to find efficiency opportunities while maintaining the benefits of the new capabilities.

“It’s not unusual that, when you have a major go-live for a very complicated system, that extra staff are required,” Sicilia said. “This happens in commercial markets, this happens all the time. What is unusual is that you have sustained that staff for a long period of time.”

Sicilia said that since June 2022, Oracle has made pharmacy fixes within the EHR its top priority.

“When we took it over, it was unstable,” he said. “We listened, we received the required changes on contract from VA and delivered them in an expedited fashion.”

Unlike in private-sector healthcare, VA pharmacists and pharmacy staff are integrated into patient care teams.

“It is a unique process, and it has been the most difficult and the most challenging to get it right,” Sicilia told lawmakers.

The VA has paused future implementations of the Oracle Health EHR until the agency deals with core issues in the system.

“We’re committed to getting this right,” Evans said, pointing out that VA has made “incremental but steady progress” and that Oracle-Cerner has put all but one of seven top-priority EHR pharmacies software updates in place.

Oracle Health has installed a final feature to automate the management of prescription information between the Oracle provider and pharmacy applications. However, the vendor has not yet enabled the software.

The VA’s ability to resume the EHR rollout will depend largely on the success of the platform’s go-live in March 2024 at the Capt. James A. Lovell Federal Health Care Center in Chicago, a joint-VA and Defense Department (DoD) facility.

DoD is much further ahead in its deployment of the same Oracle Health EHR.

Sicilia said a successful go-live at Lovell would indicate that the EHR will work in larger, more complex facilities and provide a “good baseline” for new EHR enhancements.

“We should see a marked improvement in satisfaction,” Sicilia said. “We should see a marked improvement in system reliability.”

However, Sheila Cherfilus-McCormick (D-Fla.), subcommittee ranking member, said she’s “extremely concerned” the agencies are proceeding with the go-live too soon.

“I understand the DoD is motivated to finish this deployment,” Cherfilus-McCormick said. “That cannot come at the expense of our veterans or VA providers.”