Murray, Tester Again Urge VA Secretary to Address Repeated Electronic Health Record System Failures

ICYMI: Senator Murray to VA: Stop the Rollout of EHR in Washington State Until It’s Fixed – MORE HERE

(Washington, D.C.) – U.S. Senator Patty Murray (D-WA), a senior member of the Senate Veterans’ Affairs Committee (SVAC), and committee Chairman Jon Tester (D-MT) joined their Democratic colleagues in the House of Representatives urging Department of Veterans Affairs (VA) Secretary Denis McDonough to address and fix repeated failures of Cerner’s Electronic Health Record Modernization (EHRM) program at VA medical centers in Washington state and across the country. The Senators were also joined by Representatives Mark Takano, Chair of the House Committee on Veterans’ Affairs, and Frank Mrvan, Chair of the Subcommittee on Technology Modernization.

“We are concerned about the numerous unplanned degradations and system downtime experienced by the Cerner electronic health record (EHR) system,” the members of Congress wrote. “Multiple media reports as well as VA’s testimony at the Subcommittee on Technology Modernization’s most recent hearing on the Electronic Health Record Modernization (EHRM) program have confirmed over 50 discrete incidents. One such outage even occurred during that hearing. These system difficulties have frequently necessitated the use of downtime procedures (e.g., reverting to paper records), causing disruptions at the impacted facilities and inhibiting providers from delivering the promised level of care to veterans.”

Last month, the Senate passed H.R.4591, the VA Electronic Health Record Transparency Act, which Senator Murray cosponsored in the Senate. The legislation would hold the VA accountable and increase transparency by requiring the VA Secretary to submit periodic reports to Congress regarding the costs, performance metrics and outcomes for EHRM. Senator Murray helped introduce the bill in December following three reports released by the VA Office of Inspector General (OIG) that raised concerns surrounding the deployment of the EHRM program. Two of the reports raised issues with cost estimates and reporting. Just last week, the OIG released another report indicating that the VA has not been collecting and reporting metrics in a way that would provide an accurate picture of the EHRM program at the Mann-Grandstaff VA Medical Center (VAMC) in Spokane, Washington.

In the letter, Senator Murray and her colleagues noted ongoing problems with the EHR system, citing gaps between Cerner’s performance goals and actual implementation. The members of Congress slammed unreasonable expectations put on VA employees who have had to work with a defunct EHR system, and demanded answers on how the VA will address the multiple disruptions keeping providers from delivering veterans with the high-quality care they deserve.

“VA’s inability to ensure Cerner’s system maintains consistent uptime for the new EHR system is unacceptable. Cerner’s public website advertises a ‘goal’ of 99.99% uptime for its systems. VA’s contract with Cerner includes escalating tiers of financial penalties, in the form of invoice credits, for uptime below 99.9%. Unfortunately, Cerner’s implementation of the EHR at VA falls short of that goal. America’s veterans and VA’s employees deserve far better than what has been provided to-date. It is unreasonable to expect VA employees to perform their jobs when the EHR is unreliable or completely unavailable.”

Senator Murray has been conducting oversight on the EHR rollout at Mann-Grandstaff VAMC for years. She pressed then-VA Secretary Wilkie about the EHR rollout in September of 2018 and wrote a letter in January 2020 to VA leadership expressing her concern on reports of staffing and facility issues at Mann-Grandstaff VAMC, and how those issues could affect the EHR rollout. Following Senator Murray’s actions, VA initially delayed rollout of the EHR program at Mann-Grandstaff until March 2020.

In July of 2021, Senator Murray pressed Secretary McDonough on patient safety in light of reports of veterans receiving incorrect medications, the need for more staff support from VA, and how VA will avoid the issues that have arisen at Mann-Grandstaff VAMC moving forward and at other VA medical centers. Senator Murray has since raised the need to resolve issues with care at Mann-Grandstaff with Secretary McDonough and other VA officials multiple times in private meetings and public hearings.

In December of 2021, Senator Murray pressed Secretary McDonough for solutions and transparency during a Senate Veterans’ Affairs Committee hearing. During the hearing, Senator Murray underscored VA’s responsibility to address the problems that veterans are seeing at Mann-Grandstaff VAMC, and pressed Secretary McDonough for assurances that these issues would be resolved quickly and would not arise at other VA medical centers in Washington state, such as Jonathan M. Wainwright Memorial VAMC in Walla Walla. Importantly, Senator Murray pressed Secretary McDonough for concrete steps being taken to address the challenges in Spokane and secured a commitment from him that VA would share clear indicators of readiness before deploying the new EHR program at any other sites in Washington state, specifically Walla Walla.

In March of this year, Senator Murray issued a statement demanding a pause of the Cerner Electronic Health Record system rollout in Washington state, citing patient safety risks, and demanding the concerns laid out in reports from the VA OIG – and previous reports over the last two years – be resolved first before the EHR program be deployed at any other sites in Washington state. Last month, during a Senate Appropriations Committee hearing, Senator Murray pressed VA Secretary McDonough to halt the rollout of the Cerner Electronic Health Record System rollout in Washington state until the program’s ongoing issues are fixed.

The full letter can be found here and below:

Dear Mr. Secretary:

We are concerned about the numerous unplanned degradations and system downtime experienced by the Cerner electronic health record (EHR) system.

Multiple media reports as well as VA’s testimony at the Subcommittee on Technology Modernization’s most recent hearing on the Electronic Health Record Modernization (EHRM) program have confirmed over 50 discrete incidents. One such outage even occurred during that hearing. These system difficulties have frequently necessitated the use of downtime procedures (e.g., reverting to paper records), causing disruptions at the impacted facilities and inhibiting providers from delivering the promised level of care to veterans.

VA’s inability to ensure Cerner’s system maintains consistent uptime for the new EHR system is unacceptable. Cerner’s public website advertises a “goal” of 99.99% uptime for its systems. VA’s contract with Cerner includes escalating tiers of financial penalties, in the form of invoice credits, for uptime below 99.9%. Unfortunately, Cerner’s implementation of the EHR at VA falls short of that goal. America’s veterans and VA’s employees deserve far better than what has been provided to-date. It is unreasonable to expect VA employees to perform their jobs when the EHR is unreliable or completely unavailable.

As part of Congress’s continued oversight of the EHRM program, please answer the following no later than June 21, 2022:

Contract Management:

• Has VA signed off and/or paid an invoice for any task-order that has not been fully completed?
  • If so, please provide the Committee with a copy of the invoice or task order.
• Has Cerner submitted an invoice for any task-order that has not been fully completed?
  • If so, please provide the Committee with a copy of the invoice or task order.

System Outages and Degradations:

• Please provide a complete list of all unplanned and planned degradations and indicate the following for each:
• How long was each episode?

• When did the degradation occur?

• What was the nature of the degradation? Specifically, which systems or functions were impacted?

• Were the degradations limited to a single facility, or did it affect multiple facilities?

• Has a root-cause analysis been completed?

• If so, what was the root-cause and what is the expected resolution and timeframe for resolution?

• If not, when will the root-cause analysis be completed?

• What corrective actions have been taken for each instance?

• Please provide a complete list of all unplanned and planned outages and indicate the following for each:
• How long was each episode?

• When did the outage occur?

• What was the specific nature of the outage? Which systems were impacted?

• Were the outages limited to a single facility, or did it affect multiple facilities?

• Has a root-cause analysis been completed?

• If so, what was the root-cause and what is the expected resolution and timeframe for resolution?

• If not, when will the root-cause analysis be completed?

• What corrective actions have been taken for each outage?

• What is Cerner’s current uptime?

Contractual Details:

According to an email received from VA’s Office of Congressional and Legislative Affairs (OCLA) “SLAs are discussed in Attachment 16 to the IDIQ contract which is titled ‘Cerner Hosting Document.’” The section of the document referenced is titled “Proposed Application Availability and Remedy (SLA) for Infrastructure” (page 46) and appears to only refer to the supportive infrastructure rather than the Millennium product itself.

• Please confirm this is the relevant section addressing uptime for the entire Cerner contract. If there are others, please provide them to the Committee.

• Is there a Service Level Agreement (SLA) or uptime requirement for the Millennium product separate from hosting infrastructure?

• If yes, please provide all such SLAs or uptime requirements.

• If not, what guarantees does VA have that Millennium will meet VA’s performance and stability requirements? How is the Cerner Hosting Document sufficiently comprehensive to meet VA’s performance and stability requirements?

• Cerner’s website advertises a “goal” of 99.99% uptime for its systems (https://www.cerner.com/solutions/hosting-monitoring; see screenshot below). Why has VA accepted a lower standard for its systems than Cerner’s goal for its commercial clients?

• What are the financial penalties to Cerner for poor performance and/or if the EHRM system fails to meet expectations?

• What financial penalties, including invoice credits, deductions, or rejections, has VA imposed in accordance with the Cerner Hosting Document, SLA, or any other relevant contract requirements?

• In the event of continued or further under- or non-performance, what are VA’s options under the existing contract or contracting law/regulations? What actions has VA already taken to hold Cerner accountable?

• Has VA issued a cure notice to Cerner for failure to meet the SLA or other uptime requirements? If so, please provide a copy of the cure notice.

• Has Cerner provided VA the outcome of their publicly announced technical review of system degradation? If so, please provide the Committees’ a copy of that review. If not, when is it expected?

• Has Cerner indicated to VA whether their system is capable of meeting required performance levels at the scale VA requires or whether Cerner requires significant changes to bolster their networks?

SLA Calculation:

• How is uptime calculated?

• What does Cerner consider “downtime”? What does VA consider “downtime”?

• How are outages or degradations affecting single as opposed to multiple or all sites considered under the SLA? (e.g. If on a given day, Mann-Grandstaff is down for 2-hours, but Columbus is fully functional, does the 2-hour count against Cerner’s contractual SLA
• requirements?)

• What is Cerner’s current uptime?

Thank you for your attention to this important matter.

Sincerely,

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