Congress Voices VA EHR Implementation Patient Safety Concerns

At a House Veterans Affairs Technology Modernization Subcommittee hearing on November 2, members of Congress said they fear VA is moving on to the next site for its EHR implementation before fully addressing patient safety and training concerns at the pilot site.

The department is planning to deploy the Cerner EHR at a VA facility in Columbus, Ohio in February of 2022, but VA Deputy Secretary Donald Remy said that that doesn’t mean VA will go live with the new EHR at that time.

“We’ll have sandbox exercises to make sure that the facility is ready to receive and that we’ve provided them with the tools to be successful,” Remy said.

However, members of Congress on both sides of the aisle said that incoming data from the pilot site in Spokane, Washington is too concerning to ignore.

VA’s National Center for Organization Development conducted a survey in August and September, finding that 83 percent of employees at Mann-Grandstaff VA Medical Center said their morale has worsened since the Cerner implementation last October.

The survey found a significant lack of clinician confidence in using the system. Less than 16 percent of employees reported feeling confident with the system, while 22 percent were neutral and 62 percent of employees said they did not feel confident in their ability to use the system.

Almost 81 percent said their level of burnout has increased since the EHR implementation, and nearly 63 percent of employees said the deployment has made them consider whether they should continue working for VA.

“If any of us had polls like what that survey was we’d quit these jobs, I’ll guarantee it, because those numbers are bad,” emphasized Mike Bost (R-Ill.), ranking member of the House Veterans Affairs Committee.

Rep. Cathy McMorris Rodgers (R-Wash.) said the Mann-Grandstaff workforce has logged upwards of 61,000 overtime hours over the last year.

“Mr. Remy, there’s a sense that you’re moving on,” she said. “There’s a sense that you’re moving on to Columbus and that you’re done at Mann-Grandstaff.”

Remy noted that the survey results concerned him and acknowledged the department had to “tend to them immediately.” He said that he spoke with the Mann-Grandstaff director after the survey results came out and plans to visit the facility in a few weeks.

“I want the folks there to know we’re not forgetting about them, and we’re not trying to brush them to the side,” Remy said. “We’re hopeful that we’ll be able to make sure that we’re delivering them the tools today and tomorrow to continue the success of the program.”

In an email to EHRIntelligence, Brian Sandager, general manager and senior vice president of Cerner Government Services, noted the EHR vendor's committment to the implementation. 

"We take our responsibility to Veterans and VA providers seriously and have remained on site at Mann-Grandstaff gathering feedback and implementing change requests as directed by VA," he wrote. "Continued success of VA’s EHRM program will require transparency and an unwavering dedication to do what is right for Veterans and the VA providers who passionately serve them.”

Since VA went live with the new EHR, employees at Spokane have submitted a total 829 patient safety tickets, including 576 directly related to the EHR system, Rep. Matt Rosendale (R-Mont.), ranking member of the Technology Modernization Subcommittee, noted.

Rosendale expressed concern that these patient safety issues will continue at future deployment sites.

Remy said VA has a multi-disciplinary team that evaluates each patient safety ticket as they come in.

“With these issues that have arisen, we’ve developed solutions,” he said. “We’ve learned lessons from any issue that might arise on how to move forward so we don’t repeat that.”

The chairmen and ranking members of the House and Senate VA committees said they’re “apprehensive” VA is moving ahead with future deployments. However, Remy said that it is only a matter of time until end-users become familiar with the system.

“I understand from talking with others who have deployed electronic health records that challenges are presented in the early days,” Remy said. “As people get more familiarized with the system, that trend reverses.”

Remy said that the department is creating a new executive position that will oversee daily decisions with the project and serve as a coordinator between Remy and the VA EHR program office.

The department is also considering a new deputy chief information officer that would be solely responsible for the EHR modernization.

“I’m not in a position to say what the specific title is, but we plan on making sure that there is someone that’s focused on the electronic health records modernization program within our Office of Information and Technology,” Remy said.

Editor's Note 11/04/2021: This article has been updated with a statement from Cerner Corporation.