House Legislators Press VA, Oracle Cerner Officials on EHR Pharmacy Issues

House legislators pressed Department of Veterans Affairs (VA) officials and Oracle executives during a hearing Tuesday regarding problems with the pharmacy features of the agency's new Oracle Cerner EHR system, according to reporting from The Spokesman-Review.

Since deployment at Spokane's Mann-Grandstaff VA Medical Center in 2020, the EHR has caused various problems related to patient safety.

In April, VA announced it would indefinitely stop further implementations of the EHR. Officials said that the implementation pause would allow VA to dedicate more resources to improve system performance at sites where it is in use.

Many of the EHR platform's problems relate to the pharmacy module. VA officials confirmed on Tuesday that issues with EHR pharmacy features contributed to the death of a veteran in Ohio.

"We expect the VA pharmacists to give our veterans world-class service, and we owe them fully functional technology to do that," Rep. Matt Rosendale (R-Mont.), the Republican chairman of the House VA Subcommittee on Technology Modernization, said during the hearing.

The panel sent questionnaires to pharmacists at the five hospitals where the system is in use to better understand shortcomings with EHR pharmacy workflows.

Rep. Keith Self (R-Texas) read part of a statement that a Mann-Grandstaff pharmacist sent in response to the questionnaire.

Because of "increased risks due to delays, inefficiencies, vulnerabilities, manual workarounds and the lack of responsiveness from Cerner to identify patient risks," the pharmacist said, "pharmacy staff must remain in a constant state of hyper-vigilance to recognize and intervene on those risks."

James Ellzy, a former Pentagon official who joined Oracle as a vice president in January after working on the system's rollout in Department of Defense (DoD) facilities, noted it would take more time for VA staff to learn the new EHR.

"Whenever you change systems, you're going to not be as comfortable as the system you've been working in for decades," Ellzy said. "It's going to take time to learn the new system, and two years is not enough time to get comfortable in the pharmacy sphere with the new system."

In a September survey, only 6 percent of VA employees using the EHR said it allowed them to deliver high-quality care.

"If the users are extremely dissatisfied, which is what we're seeing now, the system is going to fail," said Carol Harris, director for information technology and cybersecurity at the Government Accountability Office. "It's just not a sustainable solution. There will be increased patient safety risks as a result."

However, Mike Sicilia, Oracle's executive vice president in charge of the VA project, said his company has been working quickly to address problems identified by users at Mann-Grandstaff and the other sites.

Oracle delivered the three most pressing pharmacy fixes within four months, Sicilia said, much earlier than the three-year timeline Cerner officials gave before Oracle acquired the company in June 2022.

"We hope it shows you that Oracle is a highly capable partner for VA," he said. "Whether it is pharmacy enhancements or other fixes, we have put tremendous engineering rigor and resources into getting the work done well and quickly."

However, Harris said only six of 79 change requests made by Spokane pharmacists have been addressed in the past two years, which she called an "unacceptable" pace.

Neil Evans, the acting executive director of the VA office in charge of the system's rollout, told Rosendale he agreed that Oracle and VA need to fix the EHR's problems much quicker.

He noted that Oracle and VA have not "been executing with the velocity that we need to in order to get where we need to get," Evans said.

Rep. Sheila Cherfilus-McCormick of Florida, the top Democrat on the subcommittee, raised concern that  even after the system has been in use for 2.5 years in Spokane, VA hasn't defined how the "baseline" system should function.

Rosendale and Rep. Cathy McMorris Rodgers (R-Spokane) have called VA to terminate the project and revert to the existing EHR system.