VA deputy secretary visits Mann-Grandstaff

Donald Remy, deputy secretary of the Department of Veterans Affairs, visited Mann-Grandstaff VA Medical Center on Monday amid the continued troubled rollout of the electronic health records system and proposed modernization plans that could alter how care is delivered to veterans in the Inland Northwest.

His visit comes a year after VA Secretary Denis McDonough visited Spokane after pausing the rollout of the electronic health records system, which continues to occasionally crash and disrupt patient care.

During Remy’s visit Monday, the system, created by Cerner Corp. and sold to the VA for $16 billion to replace the old records system, was down for about 45 minutes.

He met with hospital leadership as well as a select group of providers from pharmacy to cardiology without the leadership team. Representatives from Cerner were there as well. Remy got a tour of the facility and met with nurses and clinicians as well during his half-day tour.

On Tuesday, the deputy secretary will visit Walla Walla, where the new health records system recently launched.

Remy acknowledged the challenges staff in Spokane have faced with not only the pandemic but also the launch of the electronic health records system, which has led to myriad challenges for veterans including delayed care and lost referrals. On at least two occasions, veterans missed medications due in part to a problem with the health records, after their medications were mistakenly stopped.

One veteran who did not receive their heart medication was hospitalized as a result of their medication being dropped off their active medication list. Mann-Grandstaff leaders warned of potentially “severe harm” after the electronic health records played a role in the mistake. Mann-Grandstaff leaders have confirmed two instances when a legacy medication dropped off a veteran’s active medicine list.

Remy said he believes the team at Mann-Grandstaff VA Medical Center and the information they provided surrounding the two instances where this happened.

Staff at the Spokane medical center had questions for the deputy secretary on Monday, he said.

“How do we get more information? How do we get more training?” Remy said clinicians asked him. He said there has been constant training for improvement to make the new electronic health records system work better as well as understand how it works.

“I talked to some folks who weren’t getting those training improvements here in Spokane, so we talked about how to make sure that happens here as well,” Remy said.

The Cerner electronic health records system is set to launch Saturday in Columbus, Ohio.

When asked if he was confident in the new electronic health records system, Remy said, “I’m confident in our people; they are a resilient lot, and they are focused on success.”

“We look at this electronic health record as a vehicle to improve access and outcomes for our veteran community, and what I saw today was a group of people that are committed to that result,” he added. “And I recognize that there have been challenges and impediments along the way, but they’ve overcome them.”

More changes could be coming to Mann-Grandstaff in the coming years beyond the new health records system.

Last month, the VA published their recommendations for changes to its system of care nationwide. The Asset and Infrastructure Review Commission, whose members are appointed by the president, will hold public hearings and review the VA’s recommendations this year. By 2023, the commission will submit its recommendations.

For the Inland Northwest, VA recommended reducing services in Walla Walla as well as eliminating inpatient and surgical services at Mann-Grandstaff VA Medical Center. Instead, the VA recommends that veterans in the Inland Northwest receive those services in community, at existing clinics and hospitals.

These recommendations were finished up during the pandemic, with patient census counts and capacity figures reflecting data from before the pandemic began.

Remy acknowledged that the pandemic provided lessons that could be learned going forward to help the department further integrate its services in the future.

Dr. Teresa Boyd, the network director of all eight Pacific Northwest VA medical centers, said the department must be constantly examining what veterans need, based on what they are saying.

“A clinical service line is an operational decision and one that every medical center director and the staff clearly want to be pivoting when needed, so a lot of information will be taken into account – updated information – and really boots on the ground-level setting as we move forward on that, so more to come,” Boyd said.

Boyd added that community partners will be included in the planning process going forward, including the private health care sector, the Department of Defense, tribes and federally qualified health centers.

“We have a lot of great, complex work ahead of us,” Boyd said.