Computer errors after the go-live of a new Oracle Cerner electronic health records system harmed nearly 150 patients at a Washington hospital, as revealed during a US hearing.
Four days after the Mann-Grandstaff VA Medical Center in Spokane switched to new Cerner software, staff learned of an “unknown queue” problem that had the potential to harm patients, a The US Senate Committee on Veterans’ Affairs heard last week. .
Oracle acquired Cerner — a specialist developer of electronic health record systems used around the world — for $28.3 billion in June.
With the acquisition, Oracle inherited a 10-year, $10 billion contract with the Department for Veterans’ Affairs signed in 2018. The deal was to design a health records system for VA hospitals and communicate of an EHR system installed by Cerner for the US Department of Defense, replacing legacy systems, some of which are 40 years old.
The committee heard the total budget for the project could bulge to $49 billion, $40 billion in early cost estimates, according to Senator Jerry Moran, (R-Kan), citing an Institute for Defense Analysis report.
Witnesses described how the early launch of the five hospitals was fraught with problems.
Speaking at the hearing, David Case, deputy inspector general, Office of Inspector General, Department of Veterans Affairs, said (1:31:00) that the so-called “unknown queue” problem is in the top three.
He explained that the Oracle Cerner EHR system requires a healthcare provider who writes a medical order for tests or other services to match the order to a delivery location. If a provider’s chosen option does not match the order with the correct shipping location, then the order goes to the unknown queue. Healthcare providers do not know that their orders are not being processed.
“Cerner leaders told us they didn’t know the VA was told about the unknown queue before going live. We were given exit documents that indicated a VA leader agreed to use of this, but that official told us that they did not know about it, ” Case said, adding, “This is reinforced by the fact that there is no training in the unknown queue, there is no planning for it and its existence is unknown- i in Mann-Grandstaff (hospital). in an unknown queue’.”
In 2021, patient safety experts at the Veterans Health Administration found 60 safety concerns with new software: unknowns were among the top three highest risks.
The same experts identified “almost 150 Mann-Grandstaff veterans who suffered damage due to an unknown number from go-live until June 2021”, confirmed Case.
Although Cerner and VA have taken steps to mitigate the problem in 2021 and 2022, each facility using the software will need to monitor and manage their anonymous queues, Case said.
“We have concerns about the adequacy of the current mitigation plan,” he said.
Other VA hospitals already using the Cerner system are Walla Walla (Washington), Columbus (Ohio), Roseburg (Oregon), and White City (Oregon). The VA plans for another 25 hospitals and medical facilities to go live with the system between now and the end of next year.
While the queue’s unknown problem was in design and user training, Cerner’s system also hit stability problems. The EHR system in Walla Walla, Washington, was down for about 127 minutes in April.
Dr. Gerard Cox, assistant under secretary for health for quality and patient safety, Veterans Health Administration, agreed that an unknown part of the Oracle Cerner EHR queue was not working properly and created instances of patient harm. .
He said that since the first hospital went live with the system, the technology and clinical teams tried to mitigate the effects of the problem.
“There are strategies put in place to monitor that queue and ensure that orders that have been missing for months are identified and dealt with daily,” he said.
Speaking to the senators, Terry Adirim, program executive director, Electronic Health Record Modernization Integration Office, Department of Veterans Affairs, said: “The unknown queue is not something that needs to be fixed. It is part of Cerner’s software. . This is the way it was designed and people can discuss whether it is a good or bad design. What happened during the deployment was poor communication, no one was trained to use this feature and a process was not put in place.”
He also said that the clinicians who coped during the height of the pandemic affected the implementation, increasing the safety of the patient is the main priority.
“Because of the concerns of the first deployment, patient safety and risk reduction activities are incorporated into every aspect of the [further] deployment,” he said.
Speaking before the senators, Mike Sicilia, executive vice president of Oracle said that Cerner and the VA have already implemented system changes to reduce the number of orders going into the unknown queue and to better address the orders sent to it.
Oracle plans to add automation and alerts, as well as improve workflow designed largely to “prevent orders from entering the unknown in the first place,” he added.
During the next six to nine months, with the approval of the VA and the DoD, Oracle will transfer the Cerner solution to an Oracle second-generation cloud infrastructure datacenter at no additional cost, he said.
“If something doesn’t work for caregivers or patients, we plan to fix it first and do the economics later. Patients and providers always come first. ®