Over 41,000 VA Patients Warned of Delayed Care Due to Troubled Electronic Records System

Spokane Veterans Affairs Medical Center.
Active duty and Air National Guard leadership from Fairchild Air Force Base, Wash., visit the Spokane Veterans Affairs Medical Center to meet veterans and the medical staff in Spokane Wash., Feb. 14, 2014. (Staff Sgt. Alexandre Montes/U.S. Air Force photo)

About 41,500 patients in the Department of Veterans Affairs are receiving letters notifying them their care may have been delayed because of issues with the VA's beleaguered new electronic health records system, the agency's top health official told reporters Wednesday.

The number of potentially affected veterans comes after the department announced last week it was delaying further rollout of the system until summer 2023 over flaws that watchdog reports have found posed risks to patient safety. The number was first reported by The Spokesman-Review newspaper in Spokane, Washington.

In a roundtable with reporters, Shereef Elnahal, the VA's under secretary for health, stressed that not all of the 41,500 veterans receiving letters definitely had care delayed. But a review of the system suggested they may have been among a group where glitches resulted in clinicians failing to contact them with information about medications, lab tests or follow-up appointments.

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The VA is notifying those patients "out of an abundance of caution," Elnahal said. The agency has a call center dedicated to the issue, and he vowed that the VA would assist veteran by veteran to solve any problems.

"What we asked veterans to do in this letter ... is to check their appointments, check their medications, check to make sure they have that next step in their care scheduled and confirmed, and reach out to us if they haven't heard from us about that next step," he said.

The Oracle Cerner Millennium electronic health records system has faced numerous issues since it was first launched at the Mann-Grandstaff VA Medical Center in Spokane in November 2020, including cost overruns and incidents that have sparked patient safety concerns. The system has also been rolled out in Walla Walla, Washington; Columbus, Ohio; and Roseburg and White City, Oregon.

The Cerner system is meant to replace a decades-old program called the Veterans Health Information Systems and Technology Architecture, or VistA, and is aimed at providing veterans a more seamless health record that could follow them from their military career to their post-military life.

The VA officially estimates the Cerner system will cost $16.1 billion, but a report from the Institute for Defense Analyses earlier this year estimated the cost could actually top $50 billion. The system has also crashed repeatedly.

Meanwhile, several inspector general reports have identified issues with patient safety, including a report released in July that found at least 149 patients at Mann-Grandstaff were harmed by a glitch that put some orders and referrals into an overflow folder clinicians weren't aware of, effectively making them vanish from the system.

The issues sparked concern from Congress and calls from lawmakers, particularly those representing Washington state, to delay rolling out the system more widely.

But the VA pressed ahead until the July inspector general report that found patients were harmed by a system glitch. After that was released, the VA announced it was delaying further deployment of the system until at least January to investigate the issues.

It's that investigation that turned up the 41,500 patients potentially affected by glitches, Elnahal said. In addition to the so-called "unknown queue" issue identified in the July inspector general report, the department found "several" other examples of flaws that meant important medical information was ultimately not getting to its destination, Elnahal said.

The department started sending out the letters last week, he said.

The investigation also prompted the VA to announce last week the rollout is now being delayed until June 2023. Among the issues the VA cited in a news release last week were latency and slowness, problems with patient scheduling, referrals, medication management and other types of medical orders.

The announcement was welcomed by lawmakers in both parties who have been deeply frustrated by the issues with the system.

"Patient safety should be the guiding principle for this program. However, it is clear this program was not given a foundation for success," House Veterans Affairs Committee Chairman Mark Takano, D-Calif., said in a statement last week. "Congress needs a clear analysis of continuing with the Cerner program, the risks and costs associated with delaying modernization and continuing to rely on VistA, or the potential use of other [electronic health records] to meet VA's clinical and interoperability needs."

Asked Wednesday whether the VA has a backup plan beyond Cerner, Elnahal said the department believes the best path forward is to fix the Cerner program.

"The veterans who are getting care at the five facilities where this system exists now need a resolution to the configuration issues that have led to this disclosure," he said. "We've determined that the fastest way to address those risks is to work on the system and reconfigure it and fix those issues where that system exists. I believe that by extension, if we do that, this will be a system that will be ready to deploy elsewhere."

-- Rebecca Kheel can be reached at rebecca.kheel@military.com. Follow her on Twitter @reporterkheel.

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