(Bloomberg) — Oracle Corp.’s best-known health-records customer, the U.S. Department of Veterans Affairs, says the company’s software isn’t fulfilling its key role of helping improve patient care, according to previously unreleased internal investigation data.
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The VA is renegotiating its $16 billion contract with Oracle due to poor system performance and poor employee feedback. The department is Oracle’s largest public customer in the health sector, which also includes electronic health records provider Cerner, which it acquired in 2022 for $28 billion.
Fewer than one in five doctors, nurses and other VA health care workers said Oracle’s products enable them to provide “high-quality care,” according to the survey, which was part of the department’s internal report.
“Despite signs of improvement, most users still reported having negative experiences,” VA researchers wrote in the report, seen by Bloomberg.
Oracle’s acquisition of Cerner came in conjunction with a major contract to replace the EHRs at 172 VA facilities. For hospitals, EHRs are a technology backbone and a huge expense: They help doctors and nurses with clinical tasks like taking notes and writing prescriptions during patient visits.
But the rollout of the system has been controversial, with the government pausing the rollout after highly publicized outages and patient deaths occurred in the handful of hospitals where the new software was installed.
The VA’s internal review, conducted in March and April, was part of a routine review of Oracle’s performance that the department has been conducting for more than a year with consultants. The review was crafted for department officials and members of Congress who have been harsh critics of the contract.
Industry analyst KLAS Research conducted the survey of nearly 2,000 users at five VA facilities and several off-site centers. The VA report said the responses from VA users were more negative than any other organization KLAS surveyed as part of a consulting service. However, the report said most of the other healthcare organizations compared to VA hospitals had more time to improve their digital records systems.
Yet only 30 percent of system users at a U.S. Department of Defense medical center, which has implemented Cerner software for years and is often touted by Oracle as a success story, said the software enables “high-quality care.” About half of health care workers surveyed at the average U.S. medical facility using Oracle EHR software praised the product, according to the report.
KLAS recommended providing specialized training to clinicians on the new Oracle software and developing a communications plan. Only 22% of VA respondents said they found training on the new system helpful. About 45% said they received communication about why the VA was moving to a new EHR.
“When we talk to VA clinicians, we know that the electronic health record still isn’t meeting users’ expectations, and we hold Oracle Health and ourselves accountable for fixing this problem,” VA spokesman Terrence Hayes said in a statement. “That’s why we’re conducting this study – to better understand the experience of frontline health care workers and make the EHR better for both staff and veterans.”
Spokespeople for Oracle and KLAS Research declined to comment. In a May blog post, Oracle executive vice president Ken Glueck wrote that since taking over the VA contract, Oracle has “made thousands of improvements to improve the system’s performance, reliability, and usability.” He added that “the technology being deployed at VA is the same technology that helps doctors and nurses deliver trusted, high-quality care at all 3,890 DoD locations — the largest EHR deployment in the world.”
Cerner was selected in 2018 to replace the VA’s outdated software in an effort to create a more modern system that would standardize patients’ digital records and make them easier to transfer between different health care providers.
VA officials “knew the introduction of a new commercial EHR would be unpopular with VA providers” but said it was necessary to ensure quality care, according to a late 2023 earnings report seen by Bloomberg.
The VA is “committed to efforts” to bring satisfaction up to the average level of other Oracle Cerner customers in the U.S., it wrote in the 2023 report. The department said it hopes to one day achieve the same level of satisfaction it saw with its previous custom-built software, but that “the new commercial system may never become as popular.”
Oracle has made improvements to its software in recent months to reduce crashes and glitches, according to a presentation reviewing performance and sentiment for March and April. Still, “users have not reported any notable improvements,” and “overall satisfaction remains low,” VA researchers wrote.
Doctors, nurses and other employees were asked to respond through a confidential email system. The roughly 2,000 responses represented about 25 percent of the employees who were asked to participate, according to the report.
Big technology companies have tried to seize control of different aspects of the health care industry with little success, and Oracle has struggled to meet lofty expectations for Cerner, with revenue from the division expected to decline this year.
The VA also considered working with more software vendors to improve its electronic health record system, according to a November 2023 request for information. The department asked companies that create user interface overlays like WellSheet, workflow support like Premier’s TheraDoc, and care planning software like Wolters Kluwer’s UptoDate to explain how their products would help improve the performance of electronic health records. The VA said in February that it did not intend to move forward with procurement of those tools at the time.
The VA’s contract with Oracle is currently on pause “to prevent this type of feedback from becoming the norm at other VA medical centers,” the department wrote in a report for 2023. The VA won’t schedule additional EHR rollouts “until we are confident that the EHRs are functioning well in current facilities and ready to serve Veterans and VA clinicians in future facilities,” said Hayes, the department spokesman.
Leaders of the House and Senate Veterans Affairs committees introduced legislation in May that would increase oversight of the project, including terminating it entirely within two years if improvements aren’t made. Oracle has “launched an extensive lobbying effort to repeal this liability provision,” Rep. Matt Rosendale, R-Vt., who chairs the House subcommittee on VA technology modernization, said in a statement.
“For the VA to deliver on its promises to veterans, Oracle Cerner needs to focus more on providing reliable technology to those who care for veterans, rather than on ripping off American taxpayers and making billions of dollars by continually refusing to fix bugs in its software,” the Montana Republican said.
For now, in a recent VA survey, only 13% of healthcare providers said their EHR systems “keep patients safe.”
Oracle, known as one of the most active technology companies in Washington, has been lobbying to have its contract with the VA reinstated this year, meaning its software could be deployed in more facilities and bring in bigger revenues. The system is used in just six VA medical centers.
The VA has already spent $6 billion on the project, according to data compiled by Bloomberg Government.The department said in the report that it will share the results with lawmakers and also survey users at Illinois hospitals that recently began using Oracle’s software, a survey seen as a key test of whether the company can meet the contract’s performance targets.
–With assistance from Caleb Harshberger.
(Updates lawmaker’s statement; an earlier version of this story corrected the spelling of Premier Inc.’s TheraDoc product.)
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