VA has ‘unresolved’ patient safety issues with pharmacy software, OIG says

The Department of Veterans Affairs has corrected a series of issues connected to its troubled electronic health record modernization initiative with Oracle Cerner, but problems with legacy pharmacy software from the contractor remain, an agency watchdog said Thursday.

Testifying at a House Veterans’ Affairs Subcommittee on Technology Modernization hearing, VA Deputy Inspector General David Case said an upcoming OIG report will highlight “unresolved, insufficiently communicated pharmacy-related patient safety issues.” 

While the VA fixed issues tied to inaccurate medication information that was input to its Health Data Repository, OIG found that Oracle and the VA’s Electronic Health Record Modernization Integration Office “did not test for medication and allergy data accuracy after that information was transmitted” to the repository from new EHR sites. 

“As of September 2023, there have been approximately 250,000 veterans who either received medication orders and/or had medication allergies documented in the new EHR,” Case said. “They may be unaware of the potential risk for a medication or allergy-related event if they visit a legacy EHR site.”

In response to questions from Subcommittee Chair Matt Rosendale, R-Mont., Case noted that if a medication check is based on wrong information listed in electronic health records, then a patient could be prescribed something that results in side effects or is ineffective. 

Rosendale pressed Mike Sicilia, executive vice president at Oracle, on why the contractor hasn’t corrected every coding error associated with the Health Data Repository. Sicilia said that during the testing of enhancements to the system, “another issue” surfaced and Oracle made the decision to “not roll out anything that did not pass all final safety checks.” The Oracle team fixed the issue Wednesday and was set to resume testing Thursday. 

“So in other words, we’re still working on the same problem that you’re trying to tell me that was resolved last year,” Rosendale said.

The OIG findings on lingering issues with the VA’s EHRM program come less than a month before a critical test of the system is set to begin with the March 9 opening of the Captain James A. Lovell Federal Health Care Center in North Chicago, Illinois. 

The Lovell center — the first fully integrated VA and Department of Defense joint health care system — will include the deployment of the EHRM program that was paused in April 2023 following myriad problems associated with the system’s rollout earlier that year.

Neil Evans, acting program executive director for the VA’s EHRM Integration Office, said the Lovell health system was exempted from the deployment pause given the “deep interdependencies” between the Department of Defense and VA health care systems. The DOD, Evans said, “has been able to successfully deploy the record across the rest of their enterprise health care system.”

“One of the three primary goals of the reset was to put our focus on” Lovell, Evans said. “We’ve been working to improve the system and do the enterprise work that we need to be able to successfully move forward with this program. But we’ve also been able to put a significant amount of attention on [the Federal Health Care Center] and we will benefit from the DOD’s experience in support of all of our users.”

Evans confirmed that the “core system” of the Defense Department’s EHR is the same as the VA’s, though some of the workflows are different. Pharmacy benefits are different in the VA compared with the DOD, Evans noted, but “having a single record will be important.”

Sicilia said the providers and pharmacists at the new facility will be ready to use the EHR system “with the current enhancements” once the doors open in North Chicago next month. A visit last week from the VA and Oracle team to provide training to those clinicians yielded positive feedback and “readiness for using the new pharmacy system,” he added.

“We are anxious to evaluate the deployment and get feedback from the pharmacists at Lovell,” Sicilia said. “It will provide valuable insight, along with the continued review with the feedback from other live sites for other enhancements that may be required as we seek to continually improve the system. Oracle looks forward to continuing to provide VA with a pharmacy module in the new EHR that enables veterans to receive their medication when they need it, and safely.”