The Cerner EHR system set to be installed at all healthcare sites under the Department of Veterans Affairs has been down more than 50 times since launching at its pilot location in 2020.

Known as Millennium, the system experienced 42 “unplanned degradations” and eight “unplanned outages” between 2020 and April 2022, according to The Spokesman-Review. Two additional outages occurred on April 25 and 26.

Developed by Cerner starting in 2018 to provide veterans with faster and seamless access to care at the VA’s more than 1,200 sites, the solution was first installed in October 2020 at Mann-Grandstaff VA Medical Center in Spokane, Washington. Initially estimated to be under $10 billion, the cost was later upgraded to $16 billion. Still behind schedule, the project today is estimated to cost as much as $21 billion, with another $2 billion added on for each additional year needed to finish it.

The solution has run into several setbacks that have pushed back its full implementation. One occurred in early April 2022 when a nationwide outage took down the EHR systems used by the VA, as well as the U.S. Department of Defense and the Coast Guard. For three hours, over 95,000 clinicians were unable to access or update their patient medical data.

The month before, administrators at Mann-Grandstaff took the system offline temporarily after an update led to potential data corruption. Rep. Cathy McMorris Rodgers (R.-Spokane) called the shutdown “another event in a series of challenges that the new electronic health record has created for staff and veterans at the facility,” and called for the system’s end-of-March launch at the VA hospital in Walla Walla to be delayed until the issues were resolved.

“No matter the type or size of incident, VA and Cerner employ an extensive incident management protocol to ensure users can continue to provide quick, safe and effective care,” VA spokesman Randal Noller told The Spokesman-Review in an email.

He added, however, that unlike the incident in early April, most incidents were not “large-scale outages” and that many of the “degradations of service” affected only some users at Mann-Grandstaff and its affiliated clinics in Spokane, Coeur d’Alene, Sandpoint, Wenatchee and Libby, Montana.

In November, issues were found within the EHR’s scheduling platform that “reduced the system’s effectiveness and risked delays in patient care." New reports said that the VA was aware of these limitations prior to installing the solution in Spokane. Despite the delays and concerns about patient safety and healthcare worker burnout, the VA launched the Cerner system at facilities in Walla Walla and in Columbus, Ohio earlier this year.

In a Senate Appropriations subcommittee hearing in May 2022, VA chief Denis McDonough said he would “make every decision based on the experience of the learning to date.” He also said in a House VA Committee hearing in late April that he would not allow the VA to continue rolling out the Cerner system “if I ever have any reason to think that this is creating risk for our patients,” reported The Spokesman-Review.

In addition to the outages and degradations, a veteran was hospitalized earlier this year with heart failure for five days due to the Cerner system mistakenly instructing that his medication distribution stop, reported the Spokesman-Review.

The system has also been plagued by financial issues. A report in May 2021 estimated that the agency may be short by as much as $2.6 billion due to infrastructure upgrades, including electrical work, cabling and heating, ventilation and cooling. This was followed by another in July that found an additional deficit of $2.5 billion for IT infrastructure needs, including system interfaces and end-user devices, making the VA short by as much as an estimated $5.1 billion.

An independent cost estimate was initiated in October to determine how much it can expect to spend on the project, including for IT and physical infrastructure upgrades. The VA said it would work with the Office of the Inspector General over the next year to improve planning and coordination.

The pandemic also delayed the project in early 2020, with work resuming in August of that year. Another six-month delay was initiated in July 2021 due to training failures, data migration problems and concerns over patients safety at Mann-Grandstaff. An investigation carried out by the Spokesman-Review in December still found that Mann-Grandstaff employees believed the system poses harm to veterans.

The system is scheduled to launch in Roseburg and White City, Oregon on June 11; Boise on June 25; Anchorage, Alaska on July 16; Seattle and other Puget Sound facilities on August 27; three sites in Michigan on October 8; and in Portland on November 5.