The Department of Veterans Affairs (VA) faces significant medication management challenges in its transition to the Oracle Health electronic health record (EHR) system. Deputy Inspector General David Case highlighted concerns about inaccurate medication information and patient safety issues during a congressional hearing. Despite efforts to address these issues, discrepancies persist between Oracle Health and legacy Vista EHR systems, posing risks to veterans’ health. The ongoing deployment of Oracle Health without fully resolving medication-related challenges warrants urgent attention and comprehensive strategies to ensure accurate and reliable medication management across VA healthcare facilities.
The Department of Veterans Affairs (VA) faces significant medication management challenges in its transition to the Oracle Health electronic health record (EHR) system. Deputy Inspector General David Case highlighted concerns about inaccurate medication information and patient safety issues during a congressional hearing. Despite efforts to address these issues, discrepancies persist between Oracle Health and legacy Vista EHR systems, posing risks to veterans’ health. The ongoing deployment of Oracle Health without fully resolving medication-related challenges warrants urgent attention and comprehensive strategies to ensure accurate and reliable medication management across VA healthcare facilities.
The primary concern revolves around discrepancies in medication information when veterans transition between medical sites utilizing different EHR systems. Specifically, if a veteran receives treatment at a facility employing Oracle Health EHR and subsequently seeks follow-up care at a site operating on the legacy Vista EHR, there is a risk of encountering incorrect medication data. While efforts have been made to rectify some of these issues, the OIG remains apprehensive about the ongoing deployment of the Oracle Health EHR without fully addressing the lingering challenges related to medication ordering, reconciliation, and dispensing, all of which directly impact patient safety.
Deputy Inspector General Case emphasized the importance of these findings during a hearing focused on the safety and effectiveness of the EHR system. He underscored that despite Oracle Health’s attempts to resolve identified issues, concerns persist regarding patient safety. The OIG has issued over 70 recommendations for corrective actions to the VA since April 2020, indicating the magnitude of the problem. Alongside medication-related safety concerns, persistent challenges in appointment scheduling continue to affect veteran patient engagement and contribute to prolonged wait times.
The investigation into pharmacy-related patient safety concerns stemmed from reported prescription backlogs at the VA Central Ohio Healthcare System following the implementation of the Oracle Health EHR. While efforts were made to address the backlog promptly, the OIG uncovered additional unresolved issues posing significant risks to patient safety. These included inaccuracies in patient medication records, usability challenges, flawed medication data, excessive reliance on workarounds by staff, overwhelming educational materials, and inadequate staffing levels.
One critical finding revealed flaws in Oracle Health’s software coding, resulting in the transmission of incorrect unique medication identifiers between EHR systems. Despite subsequent patches by Oracle, erroneous data dating back to October 2020 remained uncorrected, potentially affecting approximately 120,000 patients. This situation poses a continued risk of adverse medication-related events for individuals receiving care across different EHR platforms.
Moreover, the OIG identified shortcomings in the transmission of medication and allergy information from the Oracle Health EHR to the VA’s health data repository (HDR). This led to discrepancies such as discontinued medications appearing as active prescriptions and incomplete or inaccurate allergy warnings. The consequences of such errors further compound the challenges of ensuring patient safety and accurate medication management within the VA healthcare system.
Efforts to address these issues have been complicated by the renegotiation of contracts between the VA and Oracle, which acquired Cerner, the previous EHR vendor. This renegotiation followed years of rollout challenges and performance issues with the Cerner EHR, culminating in critical incidents affecting veteran care. The OIG has expressed concerns about the oversight and control of interface programming within the Electronic Health Record Modernization Integration Office, casting doubt on the efficacy of current leadership in managing EHR system transitions.
As of September 2023, an estimated 250,000 veterans with medication orders or documented allergies in the Oracle Health EHR since October 2020 remain unaware of potential risks when receiving care at legacy EHR sites. Despite this significant concern, there appears to be a lack of comprehensive strategies for conducting retrospective evaluations of patient care, including medication prescriptions, at these legacy sites.
The medication management challenges within the Department of Veterans Affairs (VA) electronic health record (EHR) system demand immediate attention and systematic solutions. Deputy Inspector General David Case’s testimony has shed light on the persistent discrepancies and patient safety risks associated with the transition to the Oracle Health EHR. As the VA continues its efforts to modernize healthcare delivery, ensuring accurate and reliable medication management across all facilities is paramount. Comprehensive strategies and enhanced oversight are essential to address these challenges effectively and safeguard the health and well-being of our nation’s veterans.
