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 received treatment at one of five locations using the department’s Oracle Health electronic health record and then follow up at a location with the Legacy Vista EHR, their medication information may be incorrect.
WHY IT MATTERS
“Although Oracle Health has since resolved some of the issues identified by the NCPS, the OIG is concerned that the new EHR will be deployed in medical facilities before resolving remaining issues associated with inaccurate ordering, reconciliation, and dispensing medications that could impact patient safety,” David Case, OIG deputy inspector general, said in a statement before the House Veterans Committee Technology Modernization Subcommittee during a Feb. 15 hearing on the safety and efficacy of the beleaguered EHR.
OIG has provided more than 70 corrective action recommendations to the VA since April 2020, Chase noted in the rack. In addition to national pharmacy-related patient safety issues, ongoing scheduling is impacting veteran patient engagement and appointment wait times remain, he said.
Case reported that recent OIG work on pharmacy-related patient safety issues began with a reported backlog of prescriptions at the VA Central Ohio Healthcare System in Columbus, Ohio after Oracle went live in April 2022.
“The OIG has determined that facility leaders have taken timely and sustained steps to address the backlog problem,” he said in the statement.
“However, during its review, the OIG identified other unresolved issues with a high risk to patient safety, including inaccuracies in patient medications, user challenges, inaccurate medication records, staff devising numerous solutions to provide patient care, an amount of educational material for pharmacy staff. related positions that were overwhelming and understaffed.”
Case provided the representatives with an overview of the Oracle Health software coding flaw that resulted in the widespread transfer of incorrect or unique medication IDs from new EHR sites to legacy EHR sites through the agency’s health data repository.
“The OIG discovered that these unique identifiers became inaccurate during their transmission to the HDR when refills for certain prescriptions were processed through the Consolidated Mail Outpatient Pharmacy (also known as the mail order pharmacy),” Case said.
Although Oracle patched the software to ensure the accuracy of the medication identifications, the incorrect data – which was entered as early as October 2020 – has not been corrected.
“The mail-order pharmacy-related data generated from approximately 120,000 patients served by new EHR sites is still inaccurate,” he said.
“These patients are at ongoing risk for an adverse medication-related event if they receive care and medications from a VA medical center that uses the existing EHR system.”
He noted that with the discovery, OIG identified further issues with the transfer of medication and allergy information from the new EHR to the HDR.
Consequences include discontinued medications by new EHR site providers appearing in the old EHR as active and current prescriptions and similar errors with allergy warnings and other incomplete or inaccurate information.
We have contacted Oracle Health for comment and will update this story as more information becomes available.
THE BIG TREND
This past year, the VA renegotiated with Oracle (which acquired Cerner in 2021) after five years of rollout challenges and performance issues with the Cerner EHR that impacted veteran care. In at least one report, a veteran was hospitalized after medications were removed 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 the Mann-Grandstaff VA Medical Center in Spokane, Washington, in 2022.
“The OIG has no confidence in the (Electronic Health Record Modernization Integration Office) leadership oversight and control of the new systems’ HDR interface programming,” Case said in the statement last week.
ON THE RECORD
“As of September 2023, approximately 250,000 veterans – who received medication orders or had medication allergies documented in the new October 2020 EHR – may be unaware of the potential risk of a medication- or allergy-related patient safety event if they receive care on a legacy EHR site,” Case said.
“A VHA leader told the OIG that as of December 2023, they had no knowledge of developing a comprehensive strategy to look back on care for the growing number of patients who have received and continue to receive services, including medication prescriptions, at legacy sites “, he said.
Andrea Fox is editor-in-chief of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.