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VA’s Struggle to Modernize: The Unresolved Issues with its EHR & Oracle

Author

Jared Dashevsky, MD
September 22, 2024 • Estimated Reading Time: 11 minutes

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VA’s Struggle to Modernize: The Unresolved Issues with its EHR & Oracle

After a month-long rotation at a VA hospital, one question kept nagging: why does the EHR feel like a relic from the 90s?

The system, called CPRS, looks and functions like something a computer science student might design for their first project. It’s clunky, unintuitive, and despite some functionality, leaves much to be desired in 2024 (aka ‘modern times’).

It’s not just me—many healthcare providers share similar frustrations.

In response, the VA has been trying to transition to a more modern EHR system, Cerner (now Oracle Health), for the past couple of years, pouring billions into the effort. Yet, here we are, years later, with little to show for it in terms of a meaningful, widespread rollout.

In this article, I’ll share my personal experiences with CPRS, unravel the VA’s journey to modernize its EHR, and explain why I think CPRS is here to stay.

An Experience with CPRS

Below is a screenshot from a CPRS training video I found on YouTube.

This is what VA providers are working with every day.

The entire system feels like it was designed to make things harder. It takes an absurd number of clicks to order medications or labs. Need labs every 4 hours for a patient with a GI bleed? Good luck. CPRS won’t let you set a recurring frequency. You’re stuck manually entering each individual order, which gets tedious fast (though I’ll admit, this could cut down on unnecessary labs).

Want to see lab trends at a glance? Forget about it—there’s no intuitive way to do that either. Need to coordinate with other teams? Unlike Epic, CPRS doesn’t have a chat feature to streamline communication (though Epic’s chat has its own issues). And don’t even get me started on the lack of guardrails to prevent order or note errors—it feels like there’s no safety net in place.

To be fair, CPRS gets the job done. But in terms of efficiency and user-friendliness? It leaves a lot to be desired.

The VA’s EHR Fumble

To understand the VA’s EHR modernization saga, you really need a timeline.

CPRS launched when I was two years old, way back in 1997. At the time, it was revolutionary. This was well before the HITECH Act, long before any legislation strong-arming (I mean “encouraging”) physicians to use EHRs. Fast forward to today, and while I’ve grown up, gone to med school, got married, had a kid, and started residency—CPRS? Well, it’s still basically stuck in 1997.

Then, in 2018, when I graduated college, the VA decided to finally get with the times and switch to Cerner (now Oracle Health), one of the largest EHR systems in the country. The VA agreed to spend $10 billion over 10 years to replace CPRS with Oracle.

By 2021, the first VA hospital—in Spokane, Washington—implemented Oracle. In 2022, four more followed. But keep in mind, the VA has almost 1,400 healthcare facilities serving about 9 million veterans a year. So, we’re talking about a very slow rollout.

What’s the holdup? Three big reasons:

In response to these issues, the VA hit the pause button on the rollout in 2023 to work on fixing the sites that had already adopted Oracle. And yes, Congress got involved because, well, nothing says government accountability like a good hearing.

After a year-long hiatus, the VA and Oracle came to terms on an 11-month, $375 million contract extension with plans to finish the rollout by the end of 2025.

Will they meet this deadline? I’ll let you be the judge.

But let’s zoom out for a moment—by the time CPRS launched in 1997 to my final year of residency in 2025, the VA still won’t have fully modernized its EHR.

Dashevsky’s Dissection

Despite everything I’ve said, I have to admit—I actually don’t mind CPRS.

Sure, it’s outdated and clunky, but once you get the hang of it, the simplicity can be a relief. It’s not as bloated or complicated as some of the more modern EHRs. In fact, when I switch from Epic to CPRS between rotations, it feels oddly refreshing. It’s like swapping your smartphone for a flip phone—no frills, but it gets the job done. And I’m not alone. Many of my colleagues feel the same way. I’ll dive deeper into this in my upcoming Inefficiency Insights newsletter.

This is all to say, sometimes, in healthcare, the best tech is the simplest one. It doesn’t have to be fancy—it just has to work. And you know I’m all about simplicity (I mean, it’s in my email signature).

Throughout this article, I’ve emphasized CPRS’s longevity, which ties into a recent piece I wrote on the Lindy Effect. The Lindy Effect suggests that the longer something has been around, the longer it’s likely to stick around. Applied to CPRS, it’s a compelling reason why this system has endured for so long—and why VA providers might not be thrilled about switching to Oracle’s EHR after years of familiarity with CPRS.

So, is CPRS here to stay? I think so—at least for a while longer.

In summary, while CPRS may be outdated and lack modern features, its simplicity and familiarity offer a certain comfort to VA providers. Despite the VA’s efforts to modernize with Oracle, the challenges and setbacks with the rollout suggest that CPRS, for all its faults, may not be going anywhere soon. As healthcare continues to evolve, the endurance of older systems like CPRS raises important questions about the balance between innovation and reliability.

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OUTSIDE THE HUDDLE

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