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VA delays computer system's launch in Boise as Senate hearing spotlights harm, massive cost increase

Spokesman-Review - 7/21/2022

Jul. 21—WASHINGTON — In a last-minute decision Wednesday, the Department of Veterans Affairs delayed the planned Saturday launch of a troubled computer system in Boise after a watchdog report linked the system to 149 cases of harm at Spokane'sVA hospital.

VA Secretary Denis McDonough confirmed the decision to reporters minutes before a Senate hearing focused on a report published Friday by the VA Office of Inspector General. The hearing found the system health care providers rely on to track patient data and coordinate care had effectively lost thousands of referral orders, resulting in delayed care and harm to veterans.

Sen. Patty Murray, a Washington Democrat who visited Mann-Grandstaff VA Medical Center on July 7, told four VA officials who appeared before the Senate Veterans Affairs Committee that their testimony contradicted what she heard from veterans and clinicians in Spokane.

"Frankly, I was pretty outraged by what I heard," Murray said, pointing to flaws in the system that threaten care. "And VA's written testimony does not match what I heard from the providers. I don't want to hear a rosy picture minimizing the concerns — I don't want to hear any of that. VA might have inherited this program, but you own it now, and VA owes our veterans a system that works and puts patients first."

Murray, along with Rep. Cathy McMorris Rodgers, R-Spokane, has repeatedly demanded the VA fix problems in the system before bringing it to other sites in Washington.

After launching at Mann-Grandstaff and its affiliated clinics across the Inland Northwest in October 2020, it has since launched at facilities in Walla Walla as well as Oregon and Ohio.

The system was scheduled to launch in Seattle and other Puget Sound sites in August until The Spokesman-Review obtained a draft of the Inspector General's report, prompting VA leaders to delay those deployments until March 2023. But until Wednesday, the launch in Boise had been pushed back by just a month to July 23.

In his monthly briefing with reporters, McDonough declined to give a clear answer when asked why the system the VA has determined to be too unreliable for Seattle or Boise is safe enough to be used in Spokane, Coeur d'Alene, Richland and other cities in the Inland Northwest where it has already been rolled out.

The VA had projected the effort to replace its existing electronic health record system with one developed by Oracle Health, formerly known as Cerner, would cost $16.1 billion over 10 years. In Wednesday's hearing, Senate VA Committee Chairman Jon Tester, D-Mont., revealed the nonprofit Institute for Defense Analyses had estimated the project would cost $33.6 billion to implement over 13 years and a total of $50.8 billion to sustain over 28 years.

Oracle, which acquired Cerner in a $28.3 billion deal that closed in June, is set to receive at least $10 billion for the system under a contract signed during the Trump administration in 2018.

"This should serve as a wake-up call to everybody," Tester said, "including the folks at VA, Oracle Cerner and of course us — Congress — because we have a lot of work ahead of us."

Terry Adirim, who took the helm of the VA office in charge of rolling out the Oracle Cerner system in January, told the senators she would not have made the same decisions as her predecessors but insisted the system is getting better.

"I'll be blunt," Adirim said. "In hindsight, Mann-Grandstaff wasn't ready to adopt the new electronic health record."

"But that was nearly two years ago," she said, adding that her office has learned valuable lessons from the mistakes in Spokane. "While we're planning to move forward with other deployments, we're still very much engaged with our past sites, closely monitoring and assessing for user experience and adoption."

Returning a hospital to its normal operations after implementing a new electronic health record system can take up to six months, Adirim told the senators. Yet more than 18 months after the system launched in Spokane, it is still frequently unusable due to outages and service degradations.

VA's top patient safety expert, Gerard Cox, also told the senators the problem that caused at least 149 cases of harm has not been fully resolved. When Murray asked Cox if it was responsible to continue to use the system in Spokane, he gave a revealing response.

"The only way that this system is being used effectively, I believe, is because ... our dedicated employees are putting in double time, double-checking, triple-checking things," he said. "That is not the way it's supposed to work."

When Murray asked again if the safety expert believed the system should still be used, Cox said, "I believe that we have taken sufficient steps to build additional safeguards, knowing where the vulnerabilities are, based on the experience in Spokane, to reduce the risk of additional harm."

Murray also asked Adirim about the number of disruptions in the system, which a document obtained by The Spokesman-Review suggests have been far more frequent than the VA has admitted. Adirim responded that she was unfamiliar with the document, though The Spokesman-Review shared it with the VA prior to publishing the story.

Orion Donovan-Smith's reporting for The Spokesman-Review is funded in part by Report for America and by members of the Spokane community. This story can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper's managing editor.


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