New report on Cerner in the VA

[Nancy Anthracite]

https://www.fiercehealthcare.com/health-tech/va-watchdog-finds-software-flaw-oracle-cerner-ehr-led-patient-harm

 

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Nancy Anthracite

 

[Sam Habiel]

I just don't really think this is being fair to Cerner. VistA has had its own share of scandals over the years because of its "features". The last major one was the "Wait List" system. Consults in VistA (the closest equivalent to what's described in the story), have had decades to mature, and it's still very creaky.

--Sam

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[Nancy Anthracite]

I am not going to say VistA is perfect, but Cerner has many more drawbacks for the VA than just these issues the IG has recognized and the VA had said they would not push ahead and yet they did. So, I am sorry, but in this case, Sam, I disagree with you, which I think you know very well.

 

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Nancy Anthracite

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[Margaret Heinikel]

On the contrary, I'm a contractor (and 30 year VA employee- retired) doing cancer registry work in V20 and V10.  Cerner has no utility for ascertaining cancer cases from pathology, radiology or PTF.  I have tried to use the CERNER record at some of these places.  It's absolutely terrible compared to CPRS.  In CPRS, you can browse though notes rather quickly to find information, you can search for key words.  This thing has none of that.  You choose one note and sit and wait for it to open.  Choose another note, wait some more.  Not built for the Kinds of things that we do in the VA, built mainly for reimbursement purposes.  They should cut their losses and stop trying to push it on us.  Patients will be hurt and/or die, they already have.

[Roy Gaber]

VistA is far better than the commercial products available.  We can develop it into whatever they want, but they decided to farm things out to those who have shiny new things and lofty goals, we see the reality of that, but they don’t want to pull.  I surely hope it does not take more patient safety issues to realize the mistake made.

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[Phillip Johnson]

Cerner is capable of searching note text using DA2 (Discern Analytics). It’s capable of creating a cancer registry using HealtheIntent, and you can drop it into a mPage as a widget. 

Cerner’s problem is they lack tech talent for being a tech company. They’re all about sales. Their “consultants” are generally kids fresh out of college with no work experience. As a client, it’s frustrating because you pay to train their consultants leaving you feeling like you’ve been sold a bill of goods. 

However, the order misroutes should have been identified in the TEST and CERT domains before the defect made its way to PROD domain. Are VA employees engaged in the Cerner “Genesis” (Millennium) SLDC/change control process or is Cerner/contractors owning all of it? 

Sent from my iPhone

On Jul 22, 2022, at 9:28 AM, Roy Gaber <roy....@att.net> wrote:



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[ivaldes]

You can have both.  Tooting my own horn here but we've made modifications to CPRS especially Encounter dialog box to guide the user into diagnosing and coding as correctly as possible such that simple visits can be billed without having a department of people comb through the chart or fix it on the back end to bill.  We also have a new tab in Encounter dialog to assemble complex visit coding structures so that they sail through insurance and get paid without someone having to do remedial billing work.  There was also dormant, non-functional, archaeological artifacts in Encounter that we removed or hid so that the user doesn't get confused. 

[Margaret Heinikel]

What do you mean Cerner can "create" a cancer registry? 

[Phillip Johnson]

A cancer registry is just a table of data in HealtheEDW using clinical concepts. Cerner uses a FHIR API to pull data from HealtheEDW into Cerner Millennium. 

Sent from my iPhone

On Aug 1, 2022, at 2:24 PM, Margaret Heinikel <hein...@gmail.com> wrote:

What do you mean Cerner can "create" a cancer registry? 

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[Margaret Heinikel]

No, actually a cancer registry uses separate software, with data collected and abstracted from the medical record.  The VA has it's own in house software:  Oncotrax.  We accession cases by using VISTA to go into the Pathology, Radiology and PTF systems to give us a list of possible cancer cases, we then review the chart and decide if the patient actually has cancer.  Once accessioned we abstract the case by entering all of the information about the patient and his disease.  Hundreds of data elements that are entered manually by the registrar.   CERNER does not have the capability to do case finding, therefore at the facilities where CERNER has been installed in V20, we are unable to accession any cancer cases. I've been working as a cancer registrar for the VA starting in 1990 to 2010 and then as a contract registrar for multiple VA's since then.  CERNER cannot "create" a cancer registry and a cancer registry is not a table of data!     https://www.cdc.gov/cancer/npcr/value/registries.htm

[Phillip Johnson]

Margaret,

Cerner has many cancer registries that work in tandem with Care Recommendations, Cerner’s front-end tool used by clinicians. You may be resistant to using Cerner’s tools, but that doesn’t mean they don’t exist or don’t work. I summarized the registry as a table of data created from clinical concepts because I’m not going to write a 5000 word explanation of HealteIntent in an email. 

Sent from my iPhone

On Aug 2, 2022, at 1:46 PM, Margaret Heinikel <hein...@gmail.com> wrote:

No, actually a cancer registry uses separate software, with data collected and abstracted from the medical record.  The VA has it's own in house software:  Oncotrax.  We accession cases by using VISTA to go into the Pathology, Radiology and PTF systems to give us a list of possible cancer cases, we then review the chart and decide if the patient actually has cancer.  Once accessioned we abstract the case by entering all of the information about the patient and his disease.  Hundreds of data elements that are entered manually by the registrar.   CERNER does not have the capability to do case finding, therefore at the facilities where CERNER has been installed in V20, we are unable to accession any cancer cases. I've been working as a cancer registrar for the VA starting in 1990 to 2010 and then as a contract registrar for multiple VA's since then.  CERNER cannot "create" a cancer registry and a cancer registry is not a table of data!     https://www.cdc.gov/cancer/npcr/value/registries.htm

To view this discussion on the web visit https://groups.google.com/d/msgid/hardhats/e42f6162-bccf-4293-8e16-3130df76a413n%40googlegroups.com.

[Margaret Heinikel]

The folks working in Central Office have not been able to find a way to do case finding using CERNER in V20, so if you can figure it out, please have at it. They've been working at it at Spokane for months now to no avail. We've been trying to do some work there and test out accessioning a case or 2.  VISTA and ONCOTRAX work in tandem and all of the demographics from VISTA are automatically entered into ONCOTRAX.  So far we have had to enter every single demographic MANUALLY as nothing comes over from CERNER, No address, date of birth, race, ethnicity, age, sex, agent orange exposure,  period of service, NOTHING. Those data items come over into ONCOTRAX from VISTA,  but they are the least of our work, but having to enter them manually is a step back 50 years in the work that we do.  And as I said, no utility for finding cancer cases.  And quite frankly, as a Cancer Registry Professional, I find it insulting for you to describe the work we do as a table of data, that somehow magically gets sucked into a "registry" from CERNER.  So if you can tell us about the "many cancer registries" that work in tandem with CERNER, maybe we can talk to them and find out how it works for them, let us know.  

[Skip]

Ms. Heinikel,

I've long ago have retired from the VA, so I do not know the latest and greatest, but when I first started out at a VAMC in IRM, 30+ years ago, there was always a way to report and document DHCP/VistA issues and problems. Also, VA OIG was always another route. Have you reported your particular issue via either of these routes?

[Margaret Heinikel]

Yes, not only reported but we've also written to our congresspeople, senators, VP,  and POTUS.