250,000 VA Patients Are at Risk of Receiving Wrong Medication Due to Electronic Health Records Issue

Pharmaceuticals are seen in North Andover, Mass.
Pharmaceuticals are seen in North Andover, Mass., on June 15, 2018. (AP Photo/Elise Amendola, file)

About 250,000 veterans may be at risk of being prescribed medicine they are allergic to or that would interact poorly with their existing medications because of issues with the Department of Veterans Affairs' new electronic health records system, a government watchdog told lawmakers at a hearing Thursday.

A VA official testifying at the same hearing stressed that the department has not found any instances of patients being harmed by drug interactions specifically caused by the data issues.

But at least one veteran wasn't given critical medication they were prescribed because their records were incorrect, and the VA has not adequately notified patients their prescription records may be wrong, the watchdog said.

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"We remain concerned that patients have not been informed of their individual risk, essentially being excluded as full participants in their care," David Case, deputy inspector general for the VA, said at a House Veterans Affairs Committee technology modernization subcommittee hearing Thursday.

The faulty medication records are the latest problem to beset the rollout of the Oracle Cerner Millennium system that has been troubled enough that the VA paused adapting it at any more sites while it works to fix the network.

At issue this time is the way the Oracle system inputs data into a medical records database known as the Health Data Repository that stores information about patients' medications and allergies. When patients are prescribed new medications, a provider will check against the information in the database to ensure there are no allergies or drug interactions.

But because of an error in the way the Oracle system codes data sent to the database, incorrect information appears when the database is checked using the old electronic health records system, known as Vista.

That means, if a veteran visits one of the five medical centers that use the Oracle system, their medication history could be wrong if they later seek care at a facility that still uses the Vista system. About 250,000 veterans were affected by the issue as of September, Case testified, citing data provided by the Veterans Health Administration.

In one instance, a patient with post-traumatic stress disorder and traumatic brain injury wasn't given medication they needed to treat adrenal insufficiency because the residential rehabilitation program they were in didn't see a prescription for the medication, according to Case's written testimony. The rehab facility used the Vista system, but the veteran got the prescription at a facility that used the Oracle system.

After five days of worsening symptoms, the patient found the order for the medication on their personal cell phone and had to be transferred to a local emergency room for care, according to the testimony.

The inspector general's office has not "seen evidence that VA has sufficiently notified legacy EHR [electronic health record] providers about this issue and the mitigations to safely care for these new EHR site patients," Case said.

"While legacy site leaders were told to have providers perform manual medication safety checks to replace the automated checks for new EHR patients, these manual safety checks are complex and rely on the vigilance of pharmacists and frontline staff," he added.

Mike Sicilia, executive vice president of Oracle Corp., told lawmakers that his company made 10 separate fixes for data sent to the Health Data Repository between May and November. Still, the most recent software update, which was supposed to happen days ago, was found to have a similar data issue during final testing and was quickly pulled, Sicilia acknowledged.

"In the interest of patient safety, we decided of course not to roll out anything that did not pass all final safety checks," he said.

Sicilia also suggested the issues are not entirely Oracle's fault.

"I'm not sure that we broke anything here," he said. "This is a very complex process, and it's a byproduct of having multiple systems involved, multiple versions of Vista, multiple EHRs and lots of interfaces in between. We are of course responsible and have taken responsibility for fixing all defects in the system as designed, as scoped and on contract at our cost."

Lawmakers in both parties have grown increasingly frustrated with the Oracle system, a $10 billion program that has been deployed in just five sites in the Pacific Northwest and Ohio, as reports of patient safety issues resulting from system glitches have mounted.

Amid pressure from lawmakers to pump the brakes on the electronic health records modernization program, the VA announced in April it was holding off on implementing the new system at any more sites while officials work on fixes.

But lawmakers' anger at the new system is only growing.

"The definition of insanity is doing the same thing over and over again while expecting a different result," Rep. Matt Rosendale, R-Mont., the subcommittee chairman, said at the hearing. "I have come to believe that continuing this effort -- to transform the Oracle Cerner pharmacy software into something completely different -- is insanity."

Related: VA Electronic Health Record Rollout Unlikely to Resume for a Year After Being Derailed by Problems

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