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Internal document reveals more frequent computer problems at Spokane VA than previously known

WASHINGTON – On the morning of July 13, health care providers at the Mann-Grandstaff VA Medical Center in Spokane were greeted with a familiar message in their inboxes.

Due to a “significant malfunction” in the electronic health record system they rely on to do their jobs, the email said, clinicians who cannot use the computer system should follow a “downtime contingency plan .”

After more than 18 months of serving as a de facto beta tester for the troubled system, in which the Department of Veterans Affairs pays Cerner Corp. at least $10 billion, VA employees in Spokane know exactly what the email means. Instead of using a computer system to track patient information and order prescriptions and follow-up care, they must document everything on paper.

“It basically just stopped everything at a crawl,” said Gary Bilendy, an urgent care nurse at Mann-Grandstaff who has experienced many of the same Cerner malfunctions. “You can’t act that way. Something will slip through the cracks.”

In response to questions from The Spokesman-Review, VA Press Secretary Terrence Hayes said there have been a total of 24 outages and 48 “performance degradation events” on the Cerner system since it was launched by Mann-Grandstaff and her affiliated clinics throughout the Inland. Northwest in October 2020.

But a document obtained by The Spokesman-Review suggests the numbers underestimate the true frequency of system disruptions. The document includes more than 180 incidents classified as degradations, “downtime” and full or partial outages affecting system users since September 2021.

Cerner’s system problems are putting veterans’ safety at risk and leaving health care workers exhausted and exhausted. A report published Friday by the VA’s Office of the Inspector General revealed that a part of the system caused long delays in care when referral orders were effectively lost, resulting in 149 cases of damage

After The Spokesman-Review obtained a draft of that report, the VA announced on June 18 that it would delay the launch of the system at Western Washington facilities from August to March 2023. But despite the VA’s conclusion that the system will not ” reliable enough” has been deployed around the Puget Sound, it continues to be used by facilities serving thousands of veterans in Washington, Idaho, Oregon and Ohio and is scheduled to launch in Boise on Saturday.

While poor training and errors in the system have caused problems even when it’s up and running, VA officials admit the system has been partially or completely out of order several times since it was launched.

In May, the top VA official overseeing the system’s rollout, Terry Adirim, told The Spokesman-Review that there were nine “unplanned outages” and 42 “unplanned malfunctions” as of April 20.

Adirim defines an outage as an “unscheduled event where a clinician cannot use the electronic health record because the entire system is down.” A malfunction is “when all systems and applications work, but all clinicians experience the same issue, including the system running slower than normal.”

Other incidents that did not meet the definitions – including “system errors, latency and incomplete application functionality” while “parts of it are still working” – were not included in the figures, it said. said Adirim in a statement at the time.

Hayes, the VA press secretary, did not offer a variety of definitions to explain why the numbers he gave on July 6 — 24 destructions and 48 injuries — were higher than the numbers Adirim revealed in May. . Most of the problems have occurred since September 2021, Hayes said in a statement: 20 breakdowns and 29 malfunctions.

Of the 24 outages, Hayes said 22 were caused by a component or system owned by Cerner and two were caused by the Department of Defense, which implements a similar Cerner system at its medical facilities that share the database. in VA. Of the 48 demotions, he said, 29 were caused by Cerner, 15 by the Department of Defense and four by the VA. Cerner was acquired by Oracle for $28.3 billion in a deal that closed in June, making it a division of the tech giant.

In response to The Spokesman-Review’s reporting, top Democrats on the House and Senate VA committees sent questions to VA Secretary Denis McDonough on June 7 asking for detailed information about each of the incidents described. by Adirim on June 21. A spokesman for the House VA Committee’s Democratic staff, Miguel Salazar, said the committee agreed to give VA officials until July 1 to provide answers. Despite that extension, Salazar confirmed, the VA has not responded since July 19.

Bilendy, the urgent care nurse, said the system has stopped working so often that Mann-Grandstaff employees know what they need to do.

“We panicked a little the first two or three times,” he said. “But now, ‘Cerner is down,’ and we’re starting to fill in the pieces of paper.”

But he stressed that not accessing the system limits what health care providers can do, leaving them without access to a patient’s medical history and other important information. It also means they have to enter handwritten records into the system when they can access them again.

“We are so confident in this system that, if it decides to fail, it will fail,” Bilendy said. “We have solutions, but they are not effective. Basically you have to give people the care they need and the documentation falls by the wayside.

Five other Mann-Grandstaff clinicians, who asked not to be named for fear of retaliation, corroborated Bilendy’s description of the computer problems and their impact.

Cerner, now known as Oracle Cerner, is required to meet contractual obligations for “uptime,” the percentage of time when the system is working. Hayes provided numbers showing 100% uptime in October 2021, January 2022 and February 2022. That number fell to more than 97% in March, well below the industry standard, but still didn’t catch the most of the problems faced by employees at Mann-Grandstaff and the other VA facilities that use the system.

In October 2021, when the uptime was officially 100%, an incident occurred where users who had logged out of the system could no longer log in, according to an internal document. When asked about that incident and others that the VA apparently doesn’t count as downtime, Hayes declined to say how the department classifies those incidents. He said VA officials could not verify the incidents listed in the internal document, because they “didn’t recognize the terminology used in the spreadsheet.”

While all “major degradation events” are tracked by the VA, Hayes said, the department does not track every incident that causes health care workers to use “downtime procedures,” a decision left to each director of medical center

Deborah Hellinger, Oracle’s senior vice president for corporate communications, said in a statement that the company is “confident that the VA system will be the standard bearer for the industry.”

“We have not discovered anything since the completion of the Cerner acquisition that causes us to waver from that conviction,” he said. “We have fixed the issues that caused previous losses, and we expect to overcome any subsequent obstacles with the same urgency and skill.”

The Senate VA Committee will hold a hearing Wednesday on the Cerner system rollout with Adirim and other VA officials scheduled to testify, along with an Oracle executive and a representative from the Office of the Inspector General. General of the VA.

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