VA Reports Improved Oracle Health EHR Performance, But Snags Remain

While there has not been a total outage of the VA Oracle Health EHR for six months, frontline healthcare workers continue to experience pauses in the system.

While the Department of Veterans Affairs (VA) Oracle Health EHR has not experienced a total outage in over six months, end-users continue to report system issues, according to reporting from Federal News Network.

As of November 8, the new platform had gone 185 consecutive days without a total outage and seen 100 percent system availability during 10 of the last 12 months.

However, the EHR is not meeting the metric outlined in the VA contract for the system to run incident-free 95 percent of the time. As of September 30, Oracle Health had reached the standard for four of the past ten months.

“To be sure, we’re still experiencing partial system failures that impact the users,” Kurt DelBene, VA CIO and assistant secretary for information and technology, told members of the House VA Committee during a technology modernization subcommittee hearing this week.

VA has spent almost $4 billion on the project thus far, but the agency has only deployed the new system to five medical centers. Full deployment would bring the system to over 170 VA medical facilities.

In April, VA paused all future deployments of the EHR to address problems at sites already using the system.

Subcommittee Chairman Matt Rosendale (R-Mont.) acknowledged that “complete, nationwide outages” have become less common over the past year.

However, “crashes, hangs, and errors that affect one facility, one module, or one person are still widespread,” he said.

VA and the Defense Department said incident-free time under their control was between 95 percent and 99 percent this year. According to Oracle Health, incident-free time under its control was between 87 percent and 97 percent this year.

However, Rosendale said surveys conducted by KLAS Research show frontline employees are not satisfied with the EHR.

Just 26 percent of VA employees surveyed agreed that “the EHR was available when I needed it, and downtime was not a problem” within two weeks of filling out the survey,

Additionally, only 10 percent of the VA employees said that Oracle Cerner EHR enables them to deliver high-quality care.

“There is a big disconnect here,” Rosendale said. “The criteria VA and Oracle are using are clearly not capturing all the system’s problems.”

Rosendale noted that in at least 12 incidents, some sort of EHR outage “directly contributed to a close call or patient harm.”

Sheila Cherfilus-McCormick (D-Fla.), subcommittee ranking member, said the data from Oracle-Cerner and VA “doesn’t seem to match what we’re hearing from frontline staff.”

“The end users that we have heard from indicate that the system is frequently either slow or nonfunctional,” Cherfilus-McCormick said.

DelBene said part of the reason these partial system failures are occurring is because of the number of changes being made to the system.

“It’s a well-established axiom of software development that systems stabilize when the rate of change made in the system decreases,” DelBene said. “The rate of change is still very high, resulting in more instances than we would like.”

In some instances, VA is requesting functionality from the EHR that Oracle Health has not deployed commercially, including the integration of VA’s consolidated mail outpatient pharmacy.

DelBene said VA is Oracle Health’s first customer to receive this functionality, which also increases incident risk.

“Ultimately, we anticipate that the system’s performance will improve when change velocity decreases and enough time has passed to enable unanticipated defects to be found and addressed,” DelBene said.

DelBene said that the average user of the Oracle Health EHR currently sees about two pauses in the system that last five seconds or less on any given day.

DelBene said VA leaders are optimistic about picking up the EHR’s rollout again once it ends the current reset period.

“Having said that, we will not do this until the system is ready to provide a good quality experience to users,” he said. “We still think there’s a ways to go. I don’t want to present the system as all set and ready to go. There are places we have significant concerns that we’re working with Oracle on.”

The agency’s ability to begin EHR implementations again is largely dependent on the success of the platform’s launch in March 2024 at the Capt. James A. Lovell Federal Health Care Center in Chicago.

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