Hidden costs and faulty training plague the huge AV software upgrade

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The Department of Veterans Affairs is revamping the country’s oldest electronic health records system into the country’s largest hospital network. Even if it goes well, planners have repeatedly warned it will be an extremely complicated task that will take 10 years and cost more than $ 16 billion.

And so far it has been going anything but smooth.

The new health record software is believed to increase efficiency and speed care in the besieged veterans health system, which serves more than nine million veterans. But when the department first used it in October at a VA medical center in Washington state, it did the opposite.

The department’s inspector general released two scathing reports on the deployment this week. One of them found that the company that got a non-competitive contract from the Trump administration to do the overhaul underestimated the costs by billions. The other report stated that the hospital staff training program created by the company was so flawed and confusing that many employees saw it as “a total waste of time.”

All employees who took the training at the first hospital to use the new health records system, Mann-Grandstaff VA Medical Center in Spokane, Wash., Then took a test to see if they had learned how to use it. effectively. Almost two-thirds have failed, according to the report.

Shortly after Mann-Grandstaff started using the software in October, employees began to complain that the training was rushed and inadequate. Tasks that were simple before have become complex. The new system was so cumbersome that productivity fell by about a third, according to the inspector general’s report.

“Staff were exhausted, struggling, felt they were failing and morale was low,” the report said.

The software upgrade also came with unexpected additional costs, the Inspector General reported, as the ministry will need to spend at least an additional $ 2.5 billion on new laptops and other equipment that can run the new software.

The Department of Veterans Affairs pioneered electronic health records in the 1980s with an in-house created system known as Vista. The open source software used in Vista has enabled hospital workers across the country to develop and adapt the system to meet local needs. But because anyone could change it, Vista became a tangled software slum of over 130 systems and thousands of applications. Although in general they worked transparently within the veterans hospital network, Vista was not able to easily share patient information with the military or private hospitals.

The department has tried several times over the past 20 years to modernize Vista in its 1,500 hospitals and clinics, and has spent nearly $ 1 billion in the process. But the hydra of the local code defied all his efforts.

In 2018, the Trump administration signed a 10-year, $ 10 billion deal with a private medical records contractor, the Cerner Corporation, to replace Vista and train the department’s 367,200 health workers to use the new. system.

Spokane was chosen for the trial, and there were issues early on, including two postponements. The office overseeing the facility did not consult with frontline healthcare workers who would use it, according to the inspector general.

Employees were denied access to software they could exercise, according to the report. Trainers provided by Cerner were regularly unable to answer employee questions about practical use cases, and often hesitated, saying, “Let’s put this in the parking lot.

After being inundated with complaints, Rep. Cathy McMorris Rodgers, a Republican who represents Spokane in Congress, sent a letter to the Department of Veterans Affairs in March, describing a system so confusing it caused veterans to receive the wrong drugs and nurses to break. burst in tears.

“I hear a growing number of complaints and requests for help,” Ms. McMorris Rodgers wrote in the letter. She added, “I have a report from a VA doctor who ordered a veteran two drugs, but he received 15 wrong drugs. I have several reports of prescription delays, which in one case resulted in the withdrawal of a veteran. These impacts are dangerous and unacceptable.

In surveys of hospital workers, two-thirds of those who completed the training said they still could not use the new system without difficulty, according to the inspector general’s report.

The ministry’s official test scores told a different story, indicating that 89 percent of employees passed proficiency tests after training. But investigators found that in fact, only about 44 percent were successful. Officials from the ministry in charge of the deployment had “removed outliers” to improve the appearance of official results and removed additional data that could have shown other training problems, according to the inspector general’s report.

The ministry said on Friday it was taking the inspector general’s findings “very seriously,” but declined to comment further on the reports.

In a statement, Cerner said, “Cerner fully supports VA and shares its commitment to getting it right. Together, Cerner and VA have made progress toward achieving a lifetime of continuing care for our country’s veterans and we look forward to continuing this important mission.

In the spring, as the problems became apparent, Veterans Affairs Secretary Denis R. McDonough, who took over as head of the department this year, suspended deployment of the new system for three months to examine the problems. This review is now complete and the ministry is expected to announce next week how it will proceed. A veterans hospital in Columbus, Ohio, was the next to get the new system, but McDonough hinted at a press conference in June that the Columbus facility could be postponed.

The secretary is due to testify before the House of Veterans Affairs committee next week and is expected to face pointed questioning.

“It is clear from these reports,” said Representative Mark Takano, the Californian Democrat who chairs the committee, in a statement, that the cost “was vastly underestimated by the previous administration and that there are major failures with the current staff training program. “


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