Nearly three years after Spokane's Mann-Grandstaff VA Medical Center became the test site for the Oracle Cerner electronic health record system to track patient information and coordinate care, the new system continues to limit the number of patients who receive care and contribute to harmful medical errors.
In April, VA Secretary Denis McDonough ordered a halt to the system's rollout, but it continues to be used in facilities serving about 200,000 veterans during what the department is calling a "reset" period. Leaders from four of the five hospitals using the system — in Spokane, Walla Walla, Roseburg, Oregon, and Columbus, Ohio — told members of the House VA Committee on Thursday that the pause has yet to produce results for their patients and staff.
A day earlier, the VA official in charge of the system's deployment, Neil Evans, testified before a House Appropriations subcommittee alongside Mike Sicilia, an executive from Oracle. The tech giant acquired Cerner, a health technology firm, for $28.3 billion in 2022.
The two men told the panel, which controls spending on the project, they are working together to fix problems but hadn't yet determined how to decide when the system is safe enough to launch elsewhere.
The next launch of the system is scheduled for a joint VA-Defense Department hospital in Chicago in March 2024, which will mark the end of the Pentagon's rollout of a similar system that was first tested at Fairchild Air Force Base outside Spokane in 2017. Despite warnings of similar problems at military hospitals and clinics in Washington state, the Trump administration gave Cerner a $10 billion contract in 2018 for the VA to adopt virtually the same system.
Despite the VA project's origins, its future has largely avoided the partisan bickering that derails so much work in Congress. While some members of the House VA Committee want to scrap the Oracle Cerner system if it doesn't improve dramatically, both Republicans and Democrats on the House Appropriations Committee said Wednesday they remain committed to staying the course.
"I don't think there's a plan B if it doesn't work out," Rep. John Carter, a Texas Republican who chairs the Appropriations subcommittee in charge of VA funding, said in an interview after the hearing.
Rep. Debbie Wasserman Schultz of Florida, the top Democrat on the subcommittee, said after the hearing that switching back to the VA's existing electronic health record system, which remains in use at all other VA facilities, is "preposterous."
"It wouldn't be appropriate to throw out the whole process, having wasted all the resources," she said in a brief interview, although she rejected the idea that the project is "too big to fail."
Halfway into what was supposed to be a 10-year, $16 billion project to implement the new system, Wasserman Schultz said Congress has already appropriated $10 billion for the effort, including $5 billion in payments to Oracle Cerner. An independent cost estimate by the Institute for Defense Analyses, commissioned by the VA, projects that the rollout could actually cost more than $33 billion over 13 years.
Rep. Cathy McMorris Rodgers, R-Spokane, isn't a member of the House VA Committee but made a special appearance at Thursday's hearing to repeat her call for the project to be canceled.
"The Oracle Cerner electronic health record system has been a complete failure," McMorris Rodgers said. "'Irresponsible' doesn't even begin to describe it."
The Spokane congresswoman asked Robert Fischer, Mann-Grandstaff's director, about specific problems with how the system handles chemotherapy, which involves using precise doses of potentially lethal drugs to treat cancer. Fischer said the Spokane hospital has an experienced oncologist who has been reluctant to use the Oracle Cerner system for multi-agent chemotherapy without first testing it in a way that doesn't risk the safety of a real patient.
Meredith Arensman, chief of staff at the VA hospital in Columbus, the only other site that uses the Oracle Cerner system's oncololgy module, told McMorris Rodgers she shares those concerns. Arensman, like some of the other witnesses, said she had only "a moderate level of confidence" that the broad range of problems with the system could be fixed.
According to records The Spokesman-Review received from the VA through a Freedom of Information Act request, as of July 17 the Oracle Cerner system had contributed to 4,423 cases of patient harm at the five sites that have implemented it. Nearly all of those cases occurred at the two largest facilities using the system, with more than 1,900 in Spokane and almost 2,300 in Columbus, Ohio.
More than 78% of the total cases are classified as "minor" harm, which the VA defines as not causing injury or requiring additional care. Another 885 incidents are considered "moderate" harm, meaning that they increased the length of stay or level of care needed for one or two patients.
"Major" harm — defined as a permanent loss of bodily function, disfigurement, a problem that requires surgical intervention, or that requires a longer hospital stay or higher level of care for at least three patients — occurred in 44 total case, including 18 in Spokane.
There have also been nine cases of "catastrophic" harm , which involve death or major permanent loss of function, including four in Spokane, four in Columbus and one in White City, Oregon. The VA acknowledged in March that problems with the system had contributed to the deaths of four veterans.
The current "reset" period follows multiple delays to the system's initial launch in Spokane, another pause McDonough ordered when patient harm first emerged and postponed launches at larger hospitals in Seattle, Boise and elsewhere. Evans, who has headed the system's rollout for only six months, assured lawmakers in both hearings that the current pause is different and won't end until the VA and Oracle Cerner make real progress.
Rep. Mike Bost, an Illinois Republican who chairs the VA panel, said Congress "has been letting VA grade its own test for too long."
"We were far too hands-off at the beginning of this project," he said. "It's simple: the project has to deliver results — or end."
Bost said he and Rep. Mark Takano of California, the committee's top Democrat, have been working together to revise legislation that originated in the Senate VA Committee to prevent the department from launching the system at any other sites until it can prove the system is safe. Bost has also cosponsored a bill that would end the project altogether, but that legislation has little support from other Republicans and none from Democrats.
"It cannot be understated how big this problem is, both in terms of cost and scale," Takano said, but he added that a modern electronic health record system "is necessary if we want VA to be able to provide world-class health care and for its providers and veterans to be able to access new health care technology."
Since the system launched in Spokane, it has been plagued by frequent outages and degradations, which force health care workers to document patient information on paper until the system is back online. Sicilia, an executive vice president at Oracle, told House appropriators that his company has made swift progress with the system's reliability, with zero outages caused by Oracle in 11 of the previous 12 months.
On Thursday, Arensman said those numbers don't tell the whole story. Despite fewer total outages, she said, system degradations have forced workers at her hospital to revert to paper documentation about once a month, including twice in the previous two weeks.
Switching to a new electronic health record system invariably reduces the number of patients a hospital can see until employees get used to the new system, but all four hospital leaders told lawmakers Thursday that productivity still had not recovered, forcing them to send more veterans elsewhere for care.
In an exchange with Rep. Matt Rosendale, a Montana Republican who chairs the VA subcommittee charged with oversight of the system, Fischer said that nearly three years after the system's launch in Spokane, Mann-Grandstaff still can't care for as many patients as it did before, and it is hard to predict whether that will ever change.
While much of the attention from Congress has been focused on outages, the hospital leaders agreed that even when the system is working as designed, its unintuitive setup could continue to cause problems. Fischer said the system's launch at Chicago's Lovell Federal Health Care Center in March will be a critical test, because that will be the first highly complex, "level-one" VA facility to use it.
Sen. Patty Murray, a Washington Democrat who chairs the Senate Appropriations Committee, said in an interview Wednesday that she remains committed to funding the Oracle Cerner system's development, while admitting she is not a technical expert. That points to the fundamental challenge Congress faces in providing oversight to a highly technical project with billions of dollars at stake.
"There's no wonderful, good options at this point, so what I'm really focused on right now is the reset," she said. "I want to hear from my constituents that things are going better."
If that doesn't happen, Murray said, Congress and VA leaders will need to have a discussion about changing course. "But man, that is a painful discussion, so I don't think it's one we should opt into just without thinking about it."
Asked whether she is concerned about the possibility of the government being locked into a contract that isn't sure to succeed, she said that problem began when the Trump administration gave Cerner a sole-source contract in 2018.
"Do I wish that we hadn't done that? Yeah," Murray said. " But here we are, five years into it, and it's just a real challenge, and I think we're all trying to work our way through it."
Orion Donovan Smith's work is funded in part by members of the Spokane community via the Community Journalism and Civic Engagement Fund. This story can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper's managing editor.
© 2023 The Spokesman-Review (Spokane, Wash.). Distributed by Tribune Content Agency, LLC.
