Updates with more information from inspector general reports.
Oracle’s acquisition of electronic health records company Cerner was billed as “the future of healthcare” in a presentation featuring top executives at both companies. More is at stake than shareholder expectations and lofty visions for transforming healthcare.
The U.S. Department of Veterans Affairs Office of Inspector General issued a dozen reports detailing problems with its EHR modernization initiative, for which Cerner was awarded $16 billion in contracts. The most urgent issues affecting veterans care surround the Mann-Grandstaff VA Medical Center in Spokane, Washington, which began using Cerner in 2020 and was the first “go live” site in a nationwide rollout.
The IG reviews the status of resolving technical issues periodically and did so most recently in March. A published report shows 38 unresolved issues including data accuracy, medications, referrals to specialists and laboratory orders.
Warning lights are flashing with potentially deadly consequences.
For example, inaccurate, missing or discontinued medication orders are mentioned in several allegations. Medication reconciliation, a process doctors use to confirm what medications a patient is on and to ensure no adverse interactions between drugs, does not always work, according to the report.
“Medications disappeared from the reconciled medication list,” according to the IG report. A reliable medication reconciliation process is one of the most basic functions clinicians should expect of their EHR systems.
Reported lapses in care coordination are equally alarming.
“Referrals were being lost or not addressed,” the report states. In other instances, laboratory orders “disappeared.”
Preliminary findings in another IG report, based on a draft not yet publicly released, appeared in the Spokesman-Review on June 19th. According to the newspaper, the report quantifies the numbers of patients impacted by Cerner software glitches. Nearly 150 patients were said to be harmed at Mann-Grandstaff, the first time the IG reached such a conclusion about the number of lives impacted, the newspaper reported.
Oracle now owns the problems and needs to show progress in solving them soon. If not, Congress should consider terminating the contract.
Reacting to the Spokesman-Review’s findings, an Oracle vice president said additional software engineers were already working on technical and operational changes. The company stated it has “a moral obligation to deliver the best technology possible for our nation’s veterans, and we intend to do so.” This statement is a good step on the public relations front, but the company must go further.
Oracle should commit to triaging the most significant technical problems affecting patient safety and provide a timeline for doing so. Such a move would inspire confidence the company is fully in charge of Cerner and managing the project. The status quo alternative of harming untold numbers of patients is unacceptable.
Sen. Patty Murray, a Democrat from Washington who sits on the Veterans Affairs subcommittee, has said she is eager to review the latest report once it is released.
“The reporting we’ve seen from local news reinforces many of the concerns I have repeatedly raised with VA and Cerner about patient safety,” she said.
Legislation signed into law last month requires quarterly reporting of performance metrics on the Cerner EHR roll out. Congress established a dedicated account for the VA’s electronic health records initiative which Senate and House appropriators control. Appropriators could make additional funding contingent on resolving technical issues threatening patient safety.
It’s in Oracle’s self-interest to get ahead of this. As company founder Larry Ellison has said, “better information will fundamentally transform healthcare.” His goal of acquiring Cerner is to develop a nationwide patient database that can be leveraged into emerging technologies like artificial intelligence. There is no better place to make this work than the Veteran’s Health Administration, the nation’s largest integrated health system with nine million patients.
We have a responsibility to protect those who protected our freedoms. Mann-Grandstaff is named after Washington state’s Joe Mann, who died in combat during World War II, and Bruce Grandstaff, who died in combat in Vietnam. This is a stark reminder that veterans’ healthcare must be of the highest quality— it is our way of paying back those willing to die for our country.
Dr. Shravani Durbhakula is a board certified interventional pain physician and anesthesiologist with nationally recognized media projects. She joined the faculty of the Johns Hopkins School of Medicine in 2017.
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