Since the introduction of the VA’s new EHR, there have been 826 “serious” incidents

Since implementing its new Electronic Health Record (EHR) nearly four years ago, the U.S. Department of Veterans Affairs has identified hundreds of serious problems with the performance of the record, according to a regulatory agency report.

The VA has paused the implementation of the Oracle-Cerner EHR in April 2023 to address ongoing performance issues at VA medical facilities that are already using the new system.

The VA's Office of the Inspector General has linked the new EHR's problems to cases of patient harm – and in some cases, even patient deaths.

In one of its recent reports, the VA's Office of the Inspector General found that the Oracle-Cerner EHR experienced 826 “serious performance incidents” – including outages, performance degradations and incomplete functionality – between October 2020 and March 2024.

The IG report found that more than half of these serious performance incidents — 447 in total — occurred after the VA put all future EHR deployments on hold.

According to the IG report, major disruptions to performance did not occur until March 2024.

Neil Evans, deputy program director of the VA's EHR Modernization Integration Office, told the IG's office that the new EHR “has become increasingly stable over time, resulting in improvements in the user experience.”

He added that the Oracle-Cerner EHR failed to meet the contractually agreed-upon standard for three months beginning in August 2022.

“Although the federal central EHR system has stabilized, the VA recognizes that the frequency of performance disruptions and outages remains challenging and will continue to make maximum efforts to reduce all preventable events,” Evans wrote.

Despite these efforts, Evans said, “there will likely still be some degree of system disruption, due in part to the number of changes still being made to the federal EHR environment by both the VA and the Department of Defense.”

“It is a well-established axiom of software engineering that systems stabilize when the rate of changes made to the system decreases. The rate of change is still high for the federal EHR, likely leading to more incidents,” Evans wrote.

Serious incidents with the Oracle Cerner EHR over the past four years impacted the performance of the new EHR for a total of 1,909 hours—or nearly 80 days.

In most cases, these EHR incidents resulted in incomplete functionality, but VA facilities also experienced platform outages and performance degradation.

“An EHR system that provides reliable access to patient information is critical to delivering quality health care. However, since the VA began implementing the system, there have been numerous serious performance disruptions that have hindered physicians' access to patient records and compromised patient safety,” the report said. “To address this risk, the VA needs better controls to improve incident management.”

According to the IG report, Oracle Health was responsible for 654 of the serious incidents, while the VA was responsible for 172 of the serious incidents.

In another recent report, the Office of the Inspector General found that VA medical providers and facilities are still struggling to provide care to veterans using the new EHR.

“During interviews, staff at both medical facilities described the new EHR as a systems shock,” the IG’s office wrote.

In a survey, most respondents told the IG's office that the new EHR contributed to a decline in employee morale and an increase in stress and burnout.

VA Southern Oregon Healthcare System leaders told the IG's office that implementing the new EHR continues to be “the biggest challenge we face here.”

“In addition, a psychologist at the VA Southern Oregon Healthcare System told auditors that the VA's most recent employee survey cited the new electronic health record as the number one stressor and reason for employees leaving the facility.

A pharmacy worker at a VA health center in Walla Walla, Washington, told auditors that delays in the new electronic health record made it impossible to meet expectations of treating 10 patients per day.

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