VA Continues Delay of Electronic Health Records Deployment
VA’s new electronic health record has had nothing but problems since its first deployment in Walla Walla Washington. The idea of creating a single electronic health record that follows a service member from their entry into the military to becoming a veteran through the veteran’s entire healthcare life is a monumental task that must be flawless and seamless in operation. A flawed product is unacceptable since patient’s lives are at risk.
In July 2022, VA made the decision to delay deployment to the Boise VA Medical Center and promised to determine if the Cerner product was ready for deployment, and to address concerns from the frontline staff experiencing the issues. This resulted in the VA announcing In October 2022, that VA would delay upcoming deployments until June 2023. VA then established the Sprint Electronic Health Record Team, which was a collaborative, multidisciplinary, enterprise-wide team to assess what needed to be fixed before future deployments were announced.
The Sprint team met in October 2022 to focus on identifying solutions to the most pressing patient safety issues as identified by the National Center for Patient Safety (NCPS). The Sprint Project focused their work on 4 areas as noted in the Sprint Report:
Governance: Designed and established rapid decision-making bodies and processes within VHA to determine and prioritize key functional requirements of the system
Orders Audit: Identified and implemented resolutions to address and identify as-yet unknown ordering issues
Data Collection Workbooks (DCW) Improvements: Developed recommended solutions to standardize DCWs components and processes at all sites
Orders Usability: Defined valid solutions to improve usability of order functionality to decrease the likelihood of incorrect order entry
450 issues were identified by VHA which were then prioritized into 30 safety issues for the Sprint Team to address. From these 30 issues the Sprint team came up with 138 solutions. In addition, the team recommended overarching governance that could identify and route issues to the subject matter expert teams that are best equipped to address them in a timely and efficient manner. Councils were established, staffed by clinical subject matter experts to help address specific areas of the new HER, with the end goals of providing timely treatment; reducing the need to complete same tasks over and over again; and to establish provider trust in the new record.
The Sprint team came up with a holistic approach to fixing the errors identified to make the system more intuitive and user friendly for the end user; they audited orders so that orders not going to the correct location would be re-routed to ensure timeliness of care; and they ensured that there will be governance moving forward to determine what are the functional needs of the users, and how CERNER will need to prioritize those needs; and the suggested improvements to the DCW to ensure system reliability and consistency.
“NAVAPD believes that the safe and effective deployment of an enterprise-wide electronic health record requires a commitment from VA and Cerner to continuous process improvement; being proactive in improving the EHR when issues arise, and not being reactive waiting until patients are harmed, or potentially harmed, before addressing the issues. ”
NAVAPD also believes there has been inadequate training in the new Cerner system for those users at the sites where the system has been deployed, and NAVAPD is advocating for additional training so the end user demonstrates competency on the new EHR before deployment, as well as additional training for a period during transition, and after deployment until all end users are fully competent in the new system.
NAVAPD has learned, through the Sprint Report, that most of the current sites have not returned to baseline productivity. The report states that sites have had to hire additional employees to reach their pre-CERNER productivity levels. This translates into lost revenue for the facility. Lost revenue translates into less resources to care for the veteran. The report states that “services in facilities that have returned to baseline have taken far more time than is standard in the industry (i.e., 90 days). The lag in productivity, decrease in revenue collection, and increased hires are symptoms of deficiencies in the product design, product configuration, configuration/process standardization, and training/adoption programs”.
A link to the Sprint Report can be found here.
NAVAPD is advocating on your behalf with your Congressional Leaders that all of these deficiencies be addressed before there are any additional deployments.