Because of the well-publicized difficulties identified with the rollout of the EHR Modernization effort at the Department of Veterans Affairs (VA), some members of Congress have introduced a bill, H.R. 608, that would direct the VA to abandon the program and revert to the legacy VistA system. That bill is unlikely to pass. However, in a Feb. 3 blog post, Oracle Cerner executive Ken Glueck offers several reasons why that is a really bad idea and also gives some glimpses of innovations in store for the VA project.
Glueck, executive vice president at Oracle, starts out by admitting that the rollout of the Cerner EHR across the VA has not been without its problems. “In hindsight, rolling out the first deployment in October 2020—at the height of the pandemic—was a mistake. It is understandable that overworked healthcare providers focused intently on patient care, being directed to invest time, effort and training to learn a new EHR system was justifiably frustrating while facing an onslaught of COVID patients,” he says. He adds, however, that the same Cerner technology is being successfully rolled out across the DoD, and indeed across many other types of hospital systems.
The Oracle Cerner executive says that what the proponents of H.R. 608 are suggesting would be harmful to veterans. “The fact is the VA is already four years and $4 billion into modernizing the VA EHR. Thirty-five years of VA legacy health data including nearly 24 billion health records for 23.5 million patients, has been migrated from VA to the central database running the new EHR. Nine hundred standardized new workflows in the EHR have been established between DoD, VA and the Coast Guard, and more than 11,000 veterans and service members have now utilized both a DoD and VA facility running the new EHR,” he says.
In addition to stabilizing and improving performance, Oracle has promised to “leapfrog” private care institutions and deploy the first modern, “stateless” web EHR to the VA, he said, within the same budget envelope. “We are in the process of a progressive rewrite of the Millennium EHR into a modern, stateless web application. In plain language, that means we intend to move Millennium to a cloud-based application that will have a modern web-based user interface, be mobile friendly, allow for voice recognition and include machine learning-based clinical decision support and analytics. Oracle has committed to delivering a beta version of the new EHR in 2023, and again—we will provide this next-generation EHR at no extra cost to the VA or DoD, simply as an upgrade to the currently contracted system.”
Glueck said the vision is that you will be able to carry your EHR in your pocket and interact with your care provider as easily as you interact with a Starbucks barista. Bringing your own health record (BYOHR) will be as simple as pulling out your mobile device. “Care professionals deserve modern voice interfaces which reduce fatigue and human errors. Sick patients deserve the benefits of modern analytics to make sure they are getting the best possible treatment alternatives for their care situation. Predictive technology should be employed to flag risk of suicide and catch opioid addiction. It is unclear what vision perpetuating VistA advances.”
Glueck also stresses the ways in which the VA will likely benefit from Cerner’s acquisition by Oracle. “Unlike Cerner, Oracle is a hyperscale cloud provider and major enterprise applications vendor. Oracle runs many of the world’s most mission critical enterprise systems. Oracle is an engineering company with 100 percent of our effort focused on system performance and security,” he says. “Oracle is orders of magnitude larger and more resourced than Cerner alone. So, VA now has essentially two vendors for the price of one—one with extensive clinical expertise and one with extensive engineering expertise. And Oracle has committed to deliver the full program scope within budget and on time.”
