NAVAPD President Meets With Congressional Staffers
On Monday July22, 2024, NAVAPD President, Dr. Joseph Abate, was invited to speak to Congressional Senate and House staffers on the Electronic Health Record Modernization Committee. This was the first time NAVAPD was invited to speak about the Cerner-Oracle product debacle, and it was the first time the staffers were able to hear the unique perspective from a VA Dentist who has used the product.
Dr. Abate is an Army Reserve Dentist and the hospital unit to which he is attached has used Cerner-Oracle PowerChart, and it’s associated dental package, a Dentrix product, for the past 2 years. The new EHR products have been rolled out across the DOD and is in use at most DOD MTF facilities world-wide.
The staffers on the EHRM committee indicated that they were familiar with PowerChart, but none have used it or have been given the opportunity to see the PowerChart from a clinician’s perspective. They also had not see the Dentrix product but were aware that it is the new dental charting software in the new EHR. Because none of the staffers had seen a clinician’s point of view of the new record, Dr. Abate took the opportunity to demonstrate the significant differences between CPRS and Oracle PowerChart as well as VA’s Dental Record Manager and the new Dentrix software.
The staffers were shown that CPRS is logically organized into tabs and tiles, which each tab “opening” a different part of the medical record and functionality changes depending on the tab you are using. This was compared to the bulky, cumbersome, unorganized PowerChart which presents simply as a rolling scrolling paper (much akin to the scrolls of yore) and that the user must scroll up and down to go into the different sections of the chart. It was demonstrated that functionality doesn’t change in the sections and the top “toolbar” is a cluttered mess of buttons that is difficult to read. They were shown that PowerChart does not look or “feel” like a modern application; it is not user friendly, it is not intuitive, and overall cumbersome to use requiring many clicks to get the simplest thing accomplished. It was also pointed out that configurations for the user are preset by Oracle and that PowerChart is not customizable, nor is the user able to organize it in a way that makes it easier for the clinician to use.
Dr. Abate discussed that NAVAPD users, at sites that have had PowerChart deployed, have indicated that there has been a complete lack of training; that training had to occur between patient care because there was no dedicated time for training, and training that was provided was web or TMS based instead of instructor driven where front line staff would have had the opportunity to “play or test” the product before their go live dates. This left VA clinicians underprepared and undertrained prior to deployment of the new EHR creating increased stress, increased patient appointment times, lack of efficiency, all leading to poorer clinic utilization and increased wait times.
Dr. Abate stressed the importance that the VA must have front line clinicians test the product properly using patient care scenarios, before deployment, and that those clinicians should be the ones to make recommendations for changes. It was discussed that the “clinicians” who are testing the product are VA Central Office heavy and the staffers admitted that most of those clinicians have not seen patients or been in patient care for many years. Because these clinicians are not directly involved in taking care of veterans they will not see or identify the same problems as a front-line clinician.
Dr. Abate asked about updating and modernizing CPRS instead of using the Oracle product and the staffers indicated that moving forward with CPRS is not a viable long-term solution due to issues Vista has regarding cybersecurity and the aging Vista code that cannot properly support the IT mandates for EHR security.
Since none of the Congressional staffers have ever met with a dentist, Dr. Abate also discussed issues with the Dentrix application embedded in PowerChart.
Some of the same issues surfaced in Dentrix as they did in PowerChart, such as Dentrix is not customizable to the users’ preferences in the way that Dental Record Manager can be. Dentrix is not modern, it is not intuitive, it is cumbersome and like PowerChart, it is not user friendly. Dr. Abate demonstrated how in many areas of Dentrix multiple, unnecessary clicks are needed; for example, to enter a progress note you must click 4 times on the progress note date just to be able to enter the note. Dr. Abate also demonstrated that PowerChart requires dentists to reconcile medical histories, medications, and allergies to complete their progress note and it was pointed out to the staffers that this is a function which is beyond a dentist’s scope of care.
The last area that Dr. Abate discussed with the staffers is that as VA clinicians we take our patients as they come to the clinic. In VA, it not necessarily important for physicians and dentists to know what the veteran had, experienced, or was treated for while in service, especially if that service was decades before the veteran sought out VA healthcare. It was mentioned that for VA clinicians it is more important to have a longitudinal view of our patients as they move forward in time, not backwards. This is especially important if the clinician is at a VA medical center that sees a lot of “snowbirds”.
The last thing that Dr. Abate stressed was that given all the problems the Oracle product has had, and continues to have, Congress should consider alternatives. Dr. Abate proposed that Congress give Oracle a time limit to solve all the problems. The staffers indicated that there is proposed draft legislation being considered in both houses of Congress that would give Oracle a strict 2-year time frame to fix the problems and finish the roll out of the record, or Congress may consider abandoning the project and search for a different EHR solution…. although currently there are no other alternatives.