The ABCs of Washington state’s government
A multi-million dollar project to bring electronic health records to Western State Hospital and other buildings overseen by the state Department of Social and Health Services is several years behind schedule, and the state says it doesn’t know when it will be completed.
The state selected a Missouri-based company, Cerner Corp., as the project’s contractor.
The company announced its hiring in a 2015 press release and included a statement from Victoria Roberts, a deputy assistant secretary at DSHS: “Implementing the (electronic health records) system will enable providers to give the best possible care to our patients through easily accessible, up-to-date patient information based on best clinical practices across our state hospitals.”
Four years later, DSHS acknowledges that none of the work has been completed despite $21.8 million being spent. The department has said installing the system in older buildings has been a challenge, and DSHS has referred to a contract dispute with Cerner.
“With any contract that you have with a vendor, there comes times when there may be differences in how we see the contract and how they see the contract,” said Sean Murphy, an assistant DSHS secretary. “We continue to work with them to work through those elements to get where we need to at the end of the day.”
Of the $21.8 million that the state has spent on the project, Cerner has received $8 million, Murphy said.
Asked what the tax dollars have been spent on, Murphy said: “With the integration of any electronic health record, there are specifications that have to be met. There’s a variety of equipment that would have to be utilized and put into place. There are specifics to the contract that cover the vendor services and we continue to work with the vendor to get to compliance with their contractual obligations.”
The remainder of the $21.8 million has been spent in several ways, including salaries and benefits for DSHS employees working on the project and professional service contracts, according to a department document.
Asked if delays in the project stem from a contract violation, Murphy replied in an email: “DSHS is working with its attorneys regarding legal questions like this and cannot comment further at this time.”
Cerner, based in North Kansas City, didn’t respond to requests for comment. The corporation specializes in health information technology and has had contracts with the Department of Veterans Affairs to modernize its electronic health records and was part of a team that implemented a new system for the Department of Defense.
State Rep. Laurie Jinkins, a Tacoma Democrat, said she and other legislators have been told that DSHS and Cerner have clashed over contract language and what it requires, but details have been scarce.
“This has not been a transparent process, even for legislators,” Jinkins said.
Eastern State Hospital near Spokane, Western State in Lakewood, the adjacent Child Study Treatment Center and several other facilities that DSHS oversees use a combination of paper records and electronic record-keeping systems for patients, according to the department.
The department has said electronic health records also would be implemented at residential centers, including Rainier School, that serve people with intellectual and developmental disabilities, and in the Office of Financial Recovery, the centralized collection agency for the department’s programs.
Murphy, the DSHS assistant secretary, said the state chose Cerner based on a “request for proposal” process that attracted interest from 13 vendors.
The state’s contract with Cerner was amended in 2014, which extended the implementation deadline for electronic health records by four months, from June 30, 2015 to Oct. 1, 2015, he said.
An additional amendment in May 2015 broke the project up into different phases. Under the phased approach, the implementation of priority items was to be completed by Oct. 1, 2015, and the implementation of all other items was to be completed by Sept. 30, 2017.
Those deadlines were not met, DSHS said.
“The project needed more time,” said Murphy, who added that the age of several of the buildings and the “complexity of the installation” were factors.
Murphy said in an email that DSHS now has two contracts with Cerner — one for implementation and hosting of the electronic health records system and one for support after the project is installed. The total of the two contracts is $32 million, he said.
A 2016 consultant’s report commissioned by the state about Western State Hospital stated that adding electronic health records was “crucial.”
“There are too few staff to provide adequate care based on standards in the field and the demands of trying to provide care to challenging patients in a physical environment that is far from ideal. The lack of an electronic health record compounds these difficulties,” according to the report by Clinical Services Management, a New Jersey-based firm.
The federal government in 2018 pulled annual funding of $53 million from Western State after the facility failed an inspection. Infractions included the restraint of a patient for hours without cause and an insufficient number of sprinklers in parts of the hospital.
A detailed federal inspection by the Centers for Medicare and Medicaid Services showed persistent managerial problems, staffing shortages, incomplete data and record keeping, and dangerous missteps in medical and psychiatric care. The violations of the federal regulations for data and record keeping did not cite a lack of electronic health records as the cause.
Asked if the state has considered severing its contracts with Cerner, Murphy said: “We are committed to putting in an electronic medical record within ... the Department of Social and Health Services. To that end, we want to continue to work toward that goal.”
Jessie Payne, a spokeswoman for Gov. Jay Inslee, said DSHS “has kept our staff and the governor apprised of this ongoing work. We understand the benefits and need of an electronic health record system; and DSHS will continue to keep us informed of this complex endeavor.”
The state Office of the Chief Information Officer said Wednesday that the electronic health records project is “on pause” as DSHS holds negotiations with Cerner. A document from earlier this year referred to the project as “on hold.”
The chief information officer oversees the project and is part of Washington Technology Solutions, a state agency known as WaTech which consolidated several state information technology efforts.
“We’re not privy to that information,” said WaTech spokeswoman Vickie Sheehan, when asked about negotiations between Cerner and DSHS. “We’re oversight to make sure the project is going along according to policy. What happened between them and the vendor is between them and the vendor.”