(Bloomberg) — Oracle Corp.’s most high-profile medical records customer, the US Department of Veterans Affairs, says the company’s software is failing at its main job of helping improve patient care, according to previously unpublished internal survey data.
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The VA has been renegotiating its $16 billion contract with Oracle due to poor performance of the system and employee feedback. The department is Oracle’s top public client in its health unit, which includes Cerner, the electronic medical records provider purchased for $28 billion in 2022.
Fewer than 1 in 5 doctors, nurses and other VA health employees say Oracle’s product enables them to deliver “high-quality care,” according to the survey, which is part of an internal report from the department.
“There is a trend toward improvement, however most users still indicate a negative experience,” VA researchers wrote in the report seen by Bloomberg.
Oracle’s acquisition of Cerner came with the flagship contract to replace the EHR, or electronic health records system, at the VA’s 172 facilities. For hospitals, the EHR is a backbone of technology and a massive expense. It aids doctors and nurses in clinical tasks like note-taking during patient visits or writing prescriptions.
But the work to implement the system has been marked by controversy — after highly publicized outages and patient deaths at just a handful of hospitals where the new software was installed, the rollout was paused by the government.
The VA’s internal survey, conducted in March and April, is part of a recurring review of Oracle’s performance that the department has conducted for more than a year with a consultant. It was prepared for the department’s leadership as well as members of Congress who have been highly critical of the contract.
The survey of nearly 2,000 users at five VA facilities and several off-site centers was completed with industry analyst KLAS Research. Responses from VA users were the most negative of any organization KLAS has surveyed as part of its consulting service, the VA said in the report. However, most other medical organizations used as a comparison with the VA hospitals have had more time to improve their digital records systems, according to the report.
Still, only 30% of the system’s users at US Department of Defense medical centers, which have deployed Cerner software for years and are often touted as a success story by Oracle, say it enables “high-quality care.” Just under half of the health care employees surveyed at average US health facilities using Oracle’s EHR software praised the product, according to the report.
KLAS recommended offering specific trainings to clinicians on the new Oracle software and building a communication plan. Only about 22% of VA respondents said their training on the new system was helpful. About 45% said they had received communication about why the VA was moving to the new EHR.
“We know from listening to VA clinicians that the electronic health record is not yet meeting expectations for our users — and we’re holding Oracle Health and ourselves accountable to get this right,” Terrence Hayes, press secretary for the VA, said in a statement. “That’s why we conduct surveys like this: to better understand the experience of our providers in the field, so we can make the EHR better for staff and veterans alike.”
Spokespeople for Oracle and KLAS Research didn’t 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 enhance the performance, reliability, and usability of the system.” He added that “technology being deployed at the VA is the same technology helping doctors and nurses provide reliable, quality care at all 3,890 DoD locations — the largest EHR implementation in the world.”
Cerner was chosen in 2018 to replace outdated software at the VA in hopes of a more modern system that would standardize patients’ digital records and let them be transferred easily among different medical providers.
The agency “knew the effort to implement a new commercial EHR was going to be an unpopular effort with VA providers,” but was necessary to ensure high-quality care, VA officials wrote in a performance report from late 2023 viewed by Bloomberg.
The VA “is focused on putting in the work” to get satisfaction up to the average level of other Oracle Cerner customers in the US, it wrote in the 2023 report. The department said it hoped to someday achieve the satisfaction levels seen with its previous custom-built software, though the “new commercial system may never be as popular.”
In recent months, Oracle has made software improvements to reduce crashes and glitches, according to the presentation that reviewed performance and sentiment in March and April. Still, “users are not reporting noticeable improvements,” and reflect a “persistent low level of overall satisfaction,” the VA researchers wrote.
Doctors, nurses and other employees were asked to respond through a confidential email system. The roughly 2,000 responses made up about 25% of those workers who were asked to participate, according to the report.
Big Tech companies have had little success in trying to take over various aspects of the health care industry. Oracle, too, has struggled to fulfill its high hopes for Cerner, and division revenue is expected to decline in the current fiscal year.
The VA also explored working with more software vendors to improve its electronic health records system, according to a November 2023 request for information. The department asked companies that make user interface overlays like WellSheet, workflow support like Premier Inc.’s TheraDoc and care planning like Wolters Kluwer NV’s UpToDate to explain how those products could help improve the performance of the EHR. The VA said in February that it didn’t intend at that time to pursue procurement of those tools.
The Oracle-VA contract is currently on pause to “ensure this kind of feedback does not become the standard sentiment at other VA Medical Centers,” the department wrote in its 2023 report. The VA won’t schedule additional deployments of the EHR until the department is “confident that it is highly functioning at current sites and ready to deliver for Veterans and VA clinicians at future sites,” said Hayes, the department’s spokesman.
Leaders of the House and Senate Veterans’ Affairs committees introduced a bill in May that would increase oversight on the project, including ending it entirely in two years unless improvement is shown. Oracle “has started a massive lobbying campaign to kill this provision that would hold them accountable,” said Republican Congressman Matt Rosendale, who leads the House subcommittee on VA technology modernization, in a statement.
“For the VA to fulfill its promise to veterans, Oracle Cerner needs to focus more on delivering reliable technology to those caring for veterans and less on the billions of dollars in profits they are making from defrauding American taxpayers by continually refusing to fix the bugs in their software,” the Montana Republican said.
For now, the recent VA survey found that only 13% of the health care workers said the EHR system “keeps my patients safe.”
Oracle, known as one of the most active tech companies in Washington, has lobbied for the VA contract to restart this year, meaning the software would be expanded to more facilities and contribute significant revenue. The system is in use at 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 planned to share the results with members of Congress as well as to survey users at a hospital in Illinois that recently began using the Oracle software and is seen as a critical test of the company’s ability to meet the performance goals of the contract.
–With assistance from Caleb Harshberger.
(Updates with lawmaker statement. A previous version of this story corrected the spelling of Premier Inc.’s TheraDoc product.)
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