Clinician Burnout, Safety Issues Persist for VA EHR Implementation

After visiting a Department of Veterans Affairs (VA) clinic in Wenatchee, Washington, Rep. Kim Schrier warned VA Secretary Denis McDonough that the agency’s Cerner EHR implementation has slowed down care delivery and caused clinician burnout, according to reporting from The Spokesman-Review.

The Wenatchee clinic is connected to Mann-Grandstaff VA Medical Center in Spokane, the VA’s pilot site for its EHR Modernization project (EHRM). Since implementation in October 2020, several reports have revealed patient safety issues at the pilot site.

In a letter to McDonough, Schrier wrote that staff she met at the clinic Tuesday told her the new system has made delivering timely care more difficult.

“I truly believe the doctors and nurses in Wenatchee are doing the best they can under challenging circumstances to care for veterans, but their jobs have been made exponentially more difficult by the failed rollout of the Cerner health records system in the last year,” Schrier wrote.

“One doctor told me she is able to see just half the number of patients each day now than one year ago due to inefficiencies and technology breakdowns under Cerner,” she added.

An internal survey of 833 Mann-Grandstaff employees shared with staff October 8 and obtained by The Spokesman-Review found that 80.9 percent of employees reported the EHR implementation had worsened their level of burnout. Additionally, 62.5 percent said it had made them consider quitting.

In an email that shared the survey results, Mann-Grandstaff director Robert Fischer, MD, said employees had also reported 576 patient safety issues related to the new EHR.

In a Tuesday event at the National Press Club in Washington, DC, McDonough thanked VA employees in Spokane for their “dedication to testing out this new capability and, importantly, informing us on how to improve it.”

“We are listening very closely to our personnel in Spokane, because of the fact that they’re on the front line of testing out this technology,” McDonough said in response to a question from The Spokesman-Review. “We’re also hearing very clearly their patient safety concerns and addressing those as we find them.”

In an interview with The Spokesman-Review, Schrier said that some amount of clinician burnout is to be expected when transitioning to a new system, but the level of fatigue staff in Wenatchee described to her is out of the ordinary.

Schrier said that employees told her the EHR system frequently crashes, forcing them to do extra work to retype lost notes and ensure sure patient records are correct. Staff also told her the new system has slowed down routine aspects of care such as measuring a patient’s height, weight, and blood pressure.

Additionally, Schrier noted that staff reported issues with patient-facing aspects of the EHR, such as prescription management and appointment scheduling. These bugs have led veterans to rely on calling the clinic, but the VA phone system is often overwhelmed and routes calls away from the Wenatchee clinic. Schrier suggested VA hire veterans to answer those phones or implement a call-back system.

“They just want to be able to pick up a phone and speak to someone who can answer their questions and get them the help they need,” Schrier wrote in the letter to McDonough. “A system that leaves Veterans unable to reach their providers, especially during a public health emergency, is troubling.”

On November 9, McDonough said he won’t bring the Cerner EHR to other VA facilities until lessons learned from the pilot site are addressed.

Schrier said she hopes the department is “willing to hit pause, or even rewind” on the implementation.

“If they have to scrap this version of Cerner, it’s probably better to do that and use something that’s tried and true than to try to fix a system that is just broken from within,” she told The Spokesman-Review.