The Department of Veterans Affairs (VA) faces significant medication safety challenges with the Oracle Health Electronic Health Record (EHR) system, including duplicative, inaccurate, or missing medication data. Despite ongoing efforts to address these issues, concerns persist regarding communication gaps and workload strain on pharmacy staff. The success of future EHR implementations hinges on resolving core issues and ensuring patient safety. Collaboration between VA and Oracle is crucial to enhancing system efficiency and reliability.
The Department of Veterans Affairs (VA) Office of Inspector General (OIG) recently raised red flags regarding medication safety issues linked to the Oracle Health Electronic Health Record (EHR) system. According to reports from the Federal News Network, the Oracle Health EHR poses significant challenges for veterans, including duplicative, inaccurate, or missing medication data, potentially jeopardizing their health and safety.
During a session with the House VA Committee, David Case, the deputy inspector general, highlighted concerns about the Oracle Health EHR system. He emphasized that veterans receiving care at one of the five sites employing the new EHR and subsequently seeking treatment at a VA facility utilizing its legacy EHR may encounter discrepancies in their medication information.
Since September 2023, VA providers have entered medication orders and documented allergies for approximately 250,000 veterans within the Oracle Health EHR. However, issues arise when the legacy EHR retrieves data from the Health Data Repository, leading to duplicate, inaccurate, or missing records.
The case provided an example where a veteran at a VA residential treatment facility was repeatedly denied medication due to it appearing inactive in the system. This incident underscores the urgency of addressing the medication safety concerns within the Oracle Health EHR.
Neil Evans, the acting program executive director of VA’s EHR Modernization Integration Office, acknowledged the challenges and emphasized the importance of prescribers in ensuring medication safety. He stressed the need for prescribing providers to verify medication lists and check for potential drug interactions diligently.
However, Case expressed concerns regarding the adequacy of communication and mitigation efforts. He noted that VA OIG has not observed sufficient notification to legacy EHR providers about these issues, potentially leaving patients uninformed and excluded from participating fully in their care.
While VA clinicians using the legacy Vista EHR have been conducting manual medication safety checks for patients in the new EHR platform, Case highlighted the complexity of these checks and their reliance on vigilant pharmacy staff. This reliance has led to challenges, such as prescription backlogs and increased workload for clinical pharmacists.
Matt Rosendale, the subcommittee chairman, emphasized the strain on facilities leveraging the Oracle Health EHR, necessitating significant increases in pharmacy staffing to address system issues. He highlighted the disruption caused by the transition to the new EHR system, particularly in larger medical centers.
Mike Sicilia, executive vice president of Oracle Global Industries, acknowledged the staffing challenges but assured ongoing collaboration with VA to enhance efficiency while maintaining the system’s benefits. He highlighted Oracle’s commitment to addressing pharmacy-related issues and delivering necessary updates promptly.
Despite these challenges, the VA remains committed to resolving the issues with the Oracle Health EHR. The agency has paused future implementations until core issues are addressed. Evans emphasized the progress made and the installation of crucial software updates by Oracle-Cerner, indicating incremental but steady improvement.
However, the success of the EHR rollout hinges on the upcoming implementation at the Capt. James A. Lovell Federal Health Care Center in Chicago. This joint VA and Defense Department (DoD) facility will serve as a crucial test for the system’s viability in larger and more complex settings.
While DoD has made significant progress in deploying the same Oracle Health EHR, concerns linger about the timing of the go-live at Lovell. Sheila Cherfilus-McCormick, the subcommittee ranking member, voiced apprehensions about proceeding too hastily, emphasizing the paramount importance of safeguarding veterans’ well-being and ensuring the readiness of VA providers.
The medication safety issues identified in VA’s Oracle Health EHR system necessitate urgent attention and concerted efforts to implement effective solutions. While progress has been made, communication gaps and workload strains on pharmacy staff underscore the need for ongoing collaboration and mitigation strategies. Resolving core issues and prioritizing patient safety is imperative as the VA navigates the complexities of EHR modernization. By working closely with stakeholders and leveraging lessons learned, VA can enhance the reliability and efficiency of its EHR system to better serve the healthcare needs of veterans.
