Patient safety at risk with electronic health records at DOD

Jonathan Kaupanger
May 15, 2018 - 1:54 pm



The new Electronic Health Record (EHR) system failed initial testing.  System outages, connectivity issues and lack of compatibility between hospital departments contributed to the failure, according to a DOD report

Users felt the most critical deficiencies dealt with patient safety.

VA’s plan is to use the same system as DOD so that both agencies' medical systems could communicate with each other.  For the testing phase, the new system was installed in four DOD hospitals, but only three sites were evaluated for the report.  Testing at the fourth site was canceled because of significant problems found at the first three sites. 

At one test site, Naval Station Bremerton, clinicians quit because they were afraid they might hurt or even kill patients if they continued to use the electronic system according to the report. On average, users at the sites gave the system a score of 37 out of 100.  It takes a score of 70 to hit the minimum acceptable usability. 

During the 11 month testing period, 14,383 help desk tickets were submitted, quickly overwhelming the help desk personnel.  System outages were common.  At one point, users in one Urgent Care Clinic lost connectivity for about seven hours, in five-minute intervals.  The system would slow down significantly each time a new site came online.  Login times were inconsistent, ranging from three to 20 minutes.  Time was such an issue that some providers had to work overtime, but still reported seeing fewer patients.

The system was so slow that emails took eight hours to travel from one office to another, even if they were located across the hall from each other. 

The EHR didn’t pull patient information correctly.  Radiologists couldn’t add results to patient records, immunization data couldn't be accessed and patient personal information was put at risk.  Patient information could be opened by staff without the proper security level.  Investigators found at least three ways this access could be changed.

Pharmacists had the most problems with time.  Prescriptions that would normally take 15 to 20 minutes to fill took 45 minutes or more.  The EHR system doesn’t support the database pharmacists use to find the medication – the National Drug Codes -- so they had to manually search for patient meds.

VA’s Assistant Secretary for Management John Rychalski explained at least part of the delay to the Senate’s VA subcommittee on Military Construction last week.  Acting VA Secretary Robert Wilkie needed time to get caught up on what was going on with VA.  “He knew what was going on with DOD, not enough about the VA,” said Rychalski.  “He felt he needed to do due diligence to make sure that he was comfortable in making a decision of this magnitude."

Last year, former VA Secretary David Shulkin made the decision to use the same EHR as DOD.  The contract was put on hold while an outside company evaluated the system.   Rychalski now says Wilkie will make a decision about the EHR contract by Memorial Day. 

So far, DOD has spent $4.3 billion on the EHR system and the contract for VA is expected to reach $16 billion.