How VA’s electronic record system shuts out visually impaired patients

Sarah Sheffield, Nurse Practitioner Veterans Clinic in Eugene, Oregon, there was a problem. Her patients, mostly in her 70s and older, were unable to read computer screens. This is not an uncommon problem for older people. Oracle ThurnerThe developer of a new digital health record system for government agencies would have expected it.

But they didn’t.

Federal law requires that patients with disabilities have access to government resources. However, the patient cannot easily enlarge the text. “They all learned to get strong reading glasses and magnifiers,” said Sheffield, who retired in early October.

These difficulties serve as daily reminders of the distressing reality for patients with VA systems. Over 1 million people are blind or have low vision. We rely on software to access prescriptions and send messages to doctors. But technology often fails them. Either the screen does not allow the user to zoom in on the text, or the screen reader software that converts the text to speech is not compatible.

Said these patients “cannot access any system” Donald Overton,executive director blind veterans association.

Patients often have trouble logging into websites or entering the basic information required to check-in for hospital visits.

The VA medical records system currently under development is already bloated at enormous expense. delay Until June 2023. So far, this project threatens to exacerbate these problems.

Users are commonly affected by a number of incidents such as downtime, delays in treatment, and missing information, making access difficult for visually impaired users, whether they are patients or workers within the healthcare system. Barriers are particularly acute. At least she was provided with one Oregon-based employee to help navigate the system—a helper responsible for reading and clicking buttons.

Over 1,000 Section 508 complaints are on the backlog and are either evaluated or assigned to Oracle Cerner for remediation.VA spokesperson Terrence Hayes confirmed. or section It is part of federal law that ensures that people with disabilities have access to government technology.

Hayes said the problems described in these complaints do not prevent employees or patients with disabilities from using the system. assigned to — means that a user’s disability makes the problem more difficult and requires mitigation, he said.

The project is under new management with great promise. Cerner, a North Kansas City, Missouri-based developer, originally signed his VA deal but was recently acquired by database technology giant Oracle, which is planning a software overhaul, according to company executives. Mike Sicilia said at his September Senate hearings. “I’m going to rewrite” the system, he said. “I didn’t find anything that couldn’t be addressed in a relatively short period of time.”

But it comes under constant scrutiny. Rep. Mark Takano (D-California), chairman of the House Veterans Affairs Committee, said his committee will continue to oversee the department’s adherence to accessibility standards. “Whether they work for veterans or receive medical care or benefits, the needs of veterans must be addressed by companies that want to work with veterans,” he said. rice field.

Takano, along with Sen. Bob Casey of Pennsylvania and Rep. John Tester of Montana, sent a letter to VA Secretary Dennis McDonagh on Oct. 7, citing major gaps in the agency’s system. and urged the Department of Veterans Affairs to engage all disabled veterans. blind person.

Interviews and review of records show that VA was warned early and often that Cerner’s software was causing problems for visually impaired and low vision users.As early as 2015, when the Pentagon and VA were considering purchasing the new system, the National Federation of the Blind filed letter We have raised concerns with both departments and Cerner that the product is unusable for clinicians and patients.

An alert was also sent from within VA. “We pointed out to Cerner that their system is really vision dependent and that’s the big problem. The icons are really, really small.” Dr. Art Wallace saida VA anesthesiologist who participated in one of the agency’s user groups to provide input for the final design of the system.

The Cerner system is not user-friendly, the agency told KHN. Clinicians need multiple high-definition monitors to view the entire patient record, and VA facilities don’t always have that abundance of equipment available. “It would be very difficult for the blind and ordinary people wearing progressive lenses to use,” he concluded.

Before the software was deployed, the system also failed tests by employees working with the University of Oregon team. White City VA Medical Center It is dedicated to helping visually impaired patients develop skills and become independent, said Carolyn Schwab, president of US Government Employee Local 1042.

In tests, she said, the system didn’t work with adaptive devices such as text-to-speech software. Despite receiving these complaints about the system, VA and Cerner “implemented it anyway.” When her AFGE president in the region recently asked the VA why it used the software, she didn’t get an answer despite federal orders, he said.

There were also voices saying that it would be a hard time within the company. Two former Cerner employees said the standard medical record system was getting long when VA signed a deal to buy and customize the product.

Because it was built on old code, it was difficult to patch the software when problems were discovered, employees said. Additionally, according to employees, Cerner took a patient and incremental approach to correcting errors. Employees said that if someone complained about a malfunctioning button on a page with holes, the company would fix just that button, not the entire page.

VA spokesman Hayes denied the allegations, saying developers and the department were trying to address the issue collectively. Cerner did not respond to multiple requests for comment.

Accessibility errors exist in private sector medical records systems just as they do in the public sector. Cerner patched a patient portal rendering bug in the Safari Web browser when a Massachusetts Institute of Technology student clinic threatened to sue, a former employee said. (“MIT Medical, as a general practice, does not discuss individual vendor contracts or services,” spokesman David Tytell said.)

legal threats — and hospital system When medical record system Face lawsuits on a daily basis — this is the most obvious sign of a lack of accessibility in the U.S. healthcare system.

The burgeoning telemedicine sector suffers from severe inaccessibility.a Recent research A study by the Federation of the Blind of America found that 57% of respondents struggled to use their provider’s proprietary telemedicine platform. Some resorted to FaceTime. Many people said they were unable to log in or read the information sent from the chat sidebar.

In theory, existing federal regulations could be used to enforce accessibility standards for medical technology. The Department of Health and Human Services’ Office for Civil Rights has issued guidance on making it easier for patients with disabilities to use telemedicine technology during the pandemic. Other institutions may also start relying on hospitals. Because hospitals are recipients of government funding and federal vendors, they want to ensure that their offerings benefit such patients.

it may not happen. Proponents warn that these regulations could prove ineffective.There are several laws on the books, but proponents claim no enforcement or tighter regulation is planned. is it?” said Joe NaraDirector of Government Relations, Powers Law, a law firm in Washington, DC.

Building in accessibility has historically benefited all users. Voice-assistive technology was originally developed to assist visually impaired users before becoming widespread in gadgets like Siri and Alexa.

Disability advocates believe that vendors often promote technology without adequate consideration of its impact on those who rely on it. “In their rush to be the first, they put accessibility on the back burner,” he said. Eve HillBrown, Goldstein & Levi, a disability rights attorney at the civil rights law firm.