In a statement to the U.S. House of Representatives Committee on Veterans Affairs, the VA’s Office of Inspector General reported that if veterans have had treatment at one of five sites using the department’s Oracle Health electronic health record and then follow up at a site on the legacy Vista EHR, their medication information may be incorrect.
WHY IT MATTERS
“Although Oracle Health has since resolved some of the NCPS-identified issues, the OIG is concerned that the new EHR will continue to be deployed at medical facilities before resolving the remaining issues related to inaccurate medication ordering, reconciliation and dispensing that can affect patient safety,” said David Case, deputy inspector general at OIG in a statement to the House Veterans Committee’s subcommittee on technology modernization at a February 15 hearing on the safety and efficacy of the beleaguered EHR.
OIG has provided the VA more 70 recommendations for corrective action since April 2020, Chase noted in the statement. In addition to the national pharmacy-related patient safety issues, ongoing scheduling affects veteran patient engagement and appointment wait times remain, he said.
Case reported that the recent OIG work on pharmacy-related patient safety issues began with a reported prescription backlog at the VA Central Ohio Healthcare System in Columbus, Ohio after the Oracle go live in April 2022.
“The OIG found that facility leaders took timely and sustainable steps to manage the backlog issue,” he said in the statement.
“During its review, however, the OIG identified other unresolved high-risk patient safety issues, including patient medication inaccuracies, user challenges, inaccurate medication data, staff’s creation of numerous workarounds to provide patient care, a volume of staff educational materials for pharmacy-related functions that was overwhelming and insufficient staffing.”
Case provided the representatives an overview of the error in Oracle Health’s software coding, which resulted in the widespread transmission of incorrect of unique medication identifiers from new EHR sites to legacy EHR sites through the agency’s health data repository.
“The OIG learned these unique identifiers became inaccurate during their transmission to the HDR when fills for certain prescriptions were processed through the Consolidated Mail Outpatient Pharmacy (referred to as the mail order pharmacy),” said Case.
While Oracle patched the software to ensure the accuracy of the medication identifiers, the incorrect data – entered as far back as October 2020 – was not corrected.
“The mail-order pharmacy-related data generated from approximately 120,000 patients served by new EHR sites are still incorrect,” he said.
“These patients face an ongoing risk of an adverse medication-related event if they receive care and medications from a VA medical center using the legacy EHR system.”
He noted that with the discovery, OIG found further problems with the transmission of medication and allergy information from the new EHR to the HDR.
The consequences include discontinued medications by new EHR-site providers appearing in the legacy EHR as active and current prescriptions and similar errors with allergy warnings and other incomplete or inaccurate information.
We have reached out to Oracle Health for comment and will update this story as more information becomes available.
THE LARGER TREND
This past year, the VA renegotiated its with Oracle (which acquired Cerner in 2021) following five years of rollout challenges and performance issues with the Cerner EHR that impacted veterans’ care. In at least one report, a veteran was hospitalized after medication was dropped from the list in the EHR.
Medication management under the EHR modernization program has been a concern for OIG and lawmakers since the incident at Mann-Grandstaff VA Medical Center in Spokane, Washington, in 2022.
“The OIG is not confident in [Electronic Health Record Modernization Integration Office] leaders’ oversight and control of the new systems’ HDR interface programming,” Case said in the statement last week.
ON THE RECORD
“As of September 2023, about 250,000 veterans – who either received medication orders or had medication allergies documented in the new EHR from October 2020 – may be unaware of the potential risk for a medication- or allergy-related patient safety event if they receive care at a legacy EHR site,” Case said.
“A VHA leader told the OIG that, as of December 2023, they had no knowledge of the development of a comprehensive strategy to conduct a look-back of the care of the growing number of patients who have received and continue to receive services, including medication prescriptions, at legacy sites,” he said.
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.