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Exam Code: 1Z0-100 Practice exam 2022 by Killexams.com team
1Z0-100 Oracle Linux 5 and 6 System Administration

Exam Title: Oracle Linux 5 and 6 System Administration
Exam Number: 1Z0-100
Format: Multiple Choice
Duration: 150 minutes
Number of Questions: 80
Passing Score: 61%

Linux Essentials
Customize the shell environment using startup files*
Use shell and environment variables, I/O redirection and pipes*
Create and maintain shell scripts*
Create and manipulate files, directories and their permissions*
Manage processes*
Switch users using the su and sudo commands
Administer /etc/sudoers
Set and manage system time using the date, hwclock and ntp commands
Perform file archiving and compression*
Installing Oracle Linux
Obtain Oracle Linux operating system software
Describe the Anaconda installer
Install Oracle Linux
Describe the FirstBoot utility
Understanding System Configuration options
Describe the /etc/sysconfig directory
Describe the /proc and /sys filesystems
Configure and maintain kernel parameters using the /proc filesystem and the sysctl utility
Managing Ksplice
Describe the purpose of Ksplice
Describe how Ksplice works
Configure and maintain Ksplice updates
Managing System Logging
Describe the structure of the rsyslog configuration file
Describe and configure facility/priority-based filters, actions and templates
Describe and configure rsyslog actions
Describe and configure rsyslog templates
Describe and configure log rotation
Describe and configure logwatch
Managing Users and Groups
Describe user and group concepts
Describe user and group configuration files
Create, modify and delete user accounts and groups using command-line utilities
Implement the user private group schema
Describe and configure password aging and hashing algorithms
Use the User Manager GUI tool
Describe user and group implementation in the enterprise
Managing Storage Devices
Describe Logical Volume Manager (LVM) concepts
Configure and maintain LVM components
Describe Multiple Device Driver (MD) concepts
Create and maintain MD devices
Managing File Sharing
Describe NFS concepts
Configure and maintain a NFS server
Configure and maintain NFS clients
Describe and use the exportfs utility
Describe, configure and maintain the automounter
Describe and configure vsftpd
Managing Pluggable Authentication Modules (PAM)
Describe PAM concepts
Describe and configure PAM configuration files
Describe and configure PAM authentication modules and module types
Describe PAM control flags
Monitoring and Troubleshooting Oracle Linux
Describe the purpose of the sosreport utility
Use the iostat, mpstat, vmstat, sar, top, iotop, and strace utilities
Use the netstat and tcpdump utilities
Use the OSWatcher Black Box (OSWbb) tool
Describe Enterprise Manager Ops Center
Covered in UNIX and Linux Essentials
Describing Oracle Linux Concepts
Describe the history of the Linux operating system
Explain the Linux kernel development model
Describe Linux distributions
Describe Oracles comprehensive Linux solution
Describe Oracles contributions to the Linux community
Describe Oracle Linux (OL) compatibility with Red Hat Enterprise Linux (RHEL)
Describe the Unbreakable Enterprise Kernel
Understanding and Configuring the Linux Boot Process and Service Administration
Describe the Linux boot process
Describe and configure the GRUB bootloader
Describe and configure kernel boot parameters
Describe the Upstart architecture
Describe Linux runlevels and runlevel scripts and associated directories
Describe the /etc/rcN.d directories
Configure and maintain services
Installing and Maintaining Packages
Describe Oracle Linux package management concepts
Use the rpm utility
Describe the Oracle public yum server
Describe and configure yum repositories
Use the yum utility
Describe the Unbreakable Linux Network (ULN)
Describe the steps to switch from RHN to ULN
Automating Tasks
Describe available automated tasks utilities
Configure cron and anacron jobs
Describe cron directories and files
Use the user and system crontab functionality
Configure anacron jobs
Use the at and batch utilities
Managing Kernel Modules
Describe loadable kernel modules
Dynamically load and unload kernel modules
Configure kernel module parameters
Managing Filesystems and Swap on Oracle Linux
Describe disk partitioning
Create, modify and remove disk partitions using command line tools
Describe supported file systems
Create and manage Linux Filesystems
Describe and configure swap space
Managing the Network Configuration
Describe and maintain network interface configuration files
Configure and manage network interfaces using command line utilities
Describe and configure network interface bonding
List and manipulate the routing table using the route utility
Use the NetworkManager tool to configure network connections
Use the system-config-network utility
Using OpenSSH
Describe OpenSSH concepts
Describe OpenSSH configuration files
Configure OpenSSH servers and clients
Use Open-ssh commands (ssh, scp and sftp)
Use Open-SH utilities (ssh-keygen, ssh-agent and ssh-add)
Managing Linux Security
Describe chroot concepts
Create and maintain a chroot jail
Describe iptables concepts
Use the firewall configuration tool
Describe iptables tables, chains, rules, and targets
Create and maintain firewall rules using the iptables command
Describe TCP wrappers concepts
Configure TCP wrappers
Managing Oracle on Oracle
Prepare an Oracle Linux server for Oracle Database installation
Create Oracle software user and group accounts
Set kernel parameters for Oracle Database
Set Oracle database shell limits
Configure HugePages
Configure Oracle Database Smart Flash Cache (DBSFC)
Describe the benefits of the Oracle pre-install RPM
Install, configure and maintain ASMLib
Consult MAN pages or relevant documentation.

Oracle Linux 5 and 6 System Administration
Oracle Administration health
Killexams : Oracle Administration health - BingNews https://killexams.com/pass4sure/exam-detail/1Z0-100 Search results Killexams : Oracle Administration health - BingNews https://killexams.com/pass4sure/exam-detail/1Z0-100 https://killexams.com/exam_list/Oracle Killexams : US Veterans Affairs hits brakes on $10b Oracle Cerner health record system

The US Department of Veterans Affairs (VA) this week announced it is delaying pending deployments of the Oracle Cerner electronic health record (EHR) system until June 2023 because of ongoing problems with the system.

"Right now, the Oracle Cerner electronic health record system is not delivering for Veterans or VA health care providers – and we are holding Oracle Cerner and ourselves accountable to get this right,” said Deputy Secretary of Veterans Affairs Donald Remy, in a statement.

Remy said VA is halting all electronic health record deployments to assess how the systems perform and to address patient concerns.

"Veterans and clinicians deserve a seamless, modernized health record system, and we will not rest until they get it," he said.

The EHR system has numerous problems, according to government reports. Among them is its tendency to route medical orders into "the unknown queue" where they languish unnoticed by medical staff.

The purpose for this queue is to allow the system to accept orders from healthcare providers that cannot be routed to the intended location. It consists of a drop-down menu containing a list of locations that, depending on the nature of the order, do not get mapped to an genuine location. These orders, associated with no place in particular, would end up in an unknown queue and would not get seen or processed by care providers. It's as if the system allowed patients to be scheduled for surgery at Hogwarts or to submit support tickets to /dev/null.

Screenshot of Oracle Cerner EHR system

Screenshot of Oracle Cerner EHR system highlighting locations that don't actually exist ... Click to enlarge

Cerner, based in North Kansas City, Missouri, was awarded a $10 billion contract to modernize the VA's EHR system in 2018; Oracle, based in Redwood Shores, California, acquired the health technology company on June 8, 2022.

Cerner's VA engagement is not the first to run into headwinds. In 2015, the company won a $4.3 billion EHR modernization contract from the US Department of Defense. At a June 26, 2018 hearing before the House Committee on Veterans' Affairs, Beto O'Rourke, then a US Representative for Texas, cited an April 30, 2018 Defense Department report [PDF] that contained 156 complaints of critical deficiencies with the Cerner's Military Health System GENESIS deployment for the military.

"There were reports that clinicians literally quit because they were terrified that they might hurt or even kill one of their patients," Rep. O'Rourke (D) said, addressing then Acting Secretary of Veterans Affairs Peter O'Rourke. "The user score out of a possible 100 was 37."

The Pentagon continues to defend and deploy the system, though it remains a work-in-progress [PDF].

The VA healthcare system makeover faces similar issues, including latency and slow response times, and problems with patient scheduling, referrals, medication management, and assorted medical orders.

It's been delayed three times under the Biden administration. In July 2022, VA Secretary Denis McDonough postponed EHR deployments until January 2023 to ensure that the record system's issues had been resolved. And in July 2021, the VA decided to delay deployments at additional sites for six month after problems surfaced at its initial deployment in Spokane, Washington. The project was also delayed twice under the Trump administration.

The new EHR system, already operational at five locations, is slated to be deployed at 25 VA Medical Centers in FY 2023. Before that happens, serious problems need to be ironed out.

A July report from the VA Inspector General found more than a thousand safety events and at least one "catastrophic patient harm" attributed to system shortcomings.

"From October 24, 2020, through May 8, 2022, VHA [Veterans Health Administration] identified 1,134 total patient safety events related to the new EHR," said VA Deputy Inspector General David Case in a statement [PDF] for a July Senate hearing. "VHA’s analysis identified one catastrophic patient harm (death or major permanent loss of function) and two major patient harm cases (permanent lessening of bodily functioning), one of which was related to the unknown queue."

Oracle did not respond to a request for comment on Friday. ®

Fri, 14 Oct 2022 14:39:00 -0500 en text/html https://www.theregister.com/2022/10/14/dept_of_veterans_affairs_oracle_cerner/
Killexams : What 3 health systems are paying for EHR installs, upgrades

Naomi Diaz -

Here is how much three health systems are expected to pay for the cost of purchasing, installing and upgrading a new or current electronic health record system:

  • Winnsboro, La.-based Franklin Medical Center will receive $41,640 to upgrade its Oracle Cerner EHR system. Hospital Administrator Blake Kramer told Franklin Medical Center's Board of Commissioners the hospital needed to upgrade its Oracle Cerner system to meet government regulatory requirements related to data collection on medical diagnoses. The health system's board agreed to the upgrades, which will cost about $31,500 to implement, and an additional $1,000 per month after that.
  • Aspen (Colo.) Valley Hospital went live with an Epic EHR system Oct. 1. The cost to license Epic for the hospital was $6.1 million, with training, staff, new interfaces, and installing Epic-compatible systems bringing the total cost to $16 million. 
  • Gillette, Wyo.-based Campbell County Health is switching EHRs from Meditech to Epic in a move that will cost $8 million. The health system said its Epic implementation was made possible — and about half as expensive — because of its partnership with a larger organization, Aurora, Colo.-based UCHealth.

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Thu, 13 Oct 2022 02:51:00 -0500 en-gb text/html https://www.beckershospitalreview.com/ehrs/what-3-health-systems-are-paying-for-ehr-installs-upgrades.html
Killexams : VA extends delay of electronic health record launch to June 2023
The Department of Veterans Affairs has suspended the rollout of its new multibillion-dollar electronic health records system until June 2023 to allow more time to overcome recurring problems with the computer program at several hospitals across the country, agency officials announced Thursday, Oct. 13, 2022.

The Department of Veterans Affairs has suspended the rollout of its new multibillion-dollar electronic health records system until June 2023 to allow more time to overcome recurring problems with the computer program at several hospitals across the country, agency officials announced Thursday, Oct. 13, 2022. (U.S. Air Force)

WASHINGTON – The Department of Veterans Affairs has suspended the rollout of its new multibillion-dollar electronic health records system until June 2023 to allow more time to overcome recurring problems with the computer program at several hospitals across the country, agency officials announced Thursday.

“Right now, the Oracle Cerner electronic health record system is not delivering for veterans or VA health care providers – and we are holding Oracle Cerner and ourselves accountable to get this right,” Deputy Secretary of Veterans Affairs Donald Remy said in a prepared statement. “We are delaying all future deployments of the new EHR while we fully assess performance and address every concern. Veterans and clinicians deserve a seamless, modernized health record system, and we will not rest until they get it.”

The announcement followed the death of a veteran in September at the Chalmers P. Wylie Veterans Outpatient Clinic in Columbus, Ohio, which was reported by The Spokesman-Review, a newspaper in Spokane, Wash.

“Patient safety is VA’s top priority, and we are investigating the patient’s death, which occurred at a community hospital,” according to a VA statement issued Friday. “Currently, this investigation is ongoing and there has not been any determination made on the root cause of this incident.”

There was also another records system outage that affected pharmacy services on Oct. 7 for almost 10 hours, according to Fed Scoop, a federal technology website.

The VA said the outage impacted all Defense Department, Coast Guard and VA sites that now use the new records system from the company Oracle Cerner. The agency said Oracle Cerner engineers are working on fixing the problem, but this outage was not the reason for extending the delay on the records system rollout.

The VA had originally scheduled to launch the new records system in July at the Boise VA Medical Center but moved it to 2023 after the VA inspector general released a report that revealed the system caused harm to 149 VA patients.

So far, the new records system has been launched at five of the VA’s 166 health care facilities. In some cases, additional launches at some facilities have been postponed because of ongoing problems with records system, along with delays caused by the impact of the coronavirus pandemic.

At the Mann-Grandstaff VA Medical Center in Spokane, Wash., where the system was launched first in October 2020, issues included unauthorized and inaccurate medication orders, patients' name and gender errors, issues in scheduling primary care appointments, misdirected links to video medical appointments and lost referrals.

In the meantime, the VA said it will continue to focus on the five facilities where the new records system has been launched. The agency said it also will send letters to veterans who had been impacted by the system’s issues, inquiring whether they had experienced delays in medications, appointments, referrals, or test results. If they have experienced any issues, the VA said the veteran should reach out to the agency and expect someone to follow up with them within five business days to resolve the issue.

“When it comes to delivering the quality health care our nation’s veterans have earned, we have to hit the mark the first time around,” Sen. Jon Tester, D-Mont., chairman of the Senate Committee on Veterans’ Affairs, said in a prepared statement. “That’s why I’ll continue holding VA and Oracle Cerner’s feet to the fire in fixing system-wide issues so existing facilities and any future rollouts certain VA health care staff have the tools to provide veterans safe, timely care.”

The VA originally signed a $10 billion contract with Cerner in May 2018 to overhaul the agency's health records system and make it compatible with the Defense Department’s system. However, the cost of the project later increased to about $16 billion.

Last October, Paul Brubaker, acting principal deputy assistant secretary and deputy chief information officer at VA's Office of Information Technology, told House lawmakers that the agency contracted with the nonprofit Institute for Defense Analysis to calculate an estimate of costs of the Cerner electronic health record system. A review issued in July by the institute estimated the implementation of the electronic health record system would cost nearly $39 billion in 13 years. The estimate also included more than $17 billion to sustain the system.

Rep. Mike Bost of Illinois, the top Republican on the House Committee on Veterans’ Affairs, said the new electronic health record should not be rolled out anywhere else until Oracle Cerner fixes its problems.

“When I visited [VA facilities in] Walla Walla [Wash.] in July and Columbus [Ohio] in September, the staff made it clear that this flawed system is making their jobs more difficult and crippling the delivery of care to veterans, and I have heard the same thing from the other sites,” Bost said in a prepared statement. “Unfortunately, these delays are nothing new. VA and Oracle must prove that this time is different, and I won’t allow them to continue throwing good money after bad.”

Mike Sicilia, executive vice president for industries at Oracle, which purchased Cerner in June, told the Senate Committee on Veterans' Affairs in July that he reviewed the system's problems. Oracle took over Cerner's electronic health record contract with the VA, Defense Department and the Coast Guard and established a command center led by Oracle's senior engineers.

Sicilia said at last month’s Senate Appropriations Committee that Oracle hosted a summit with the VA, Defense Department, Federal Electronic Health Record Modernization Office, and Leidos Holdings Inc. to discuss the federal electronic health record system's performance and its problems. Sicilia said the meeting led to plans for the system and that Oracle sent a letter to the VA detailing the plans and a roadmap.

Sicilia also said Oracle is working with the VA to revamp training for employees to learn to use the electronic health records system. He also said he still thinks the company can still launch a safe rollout at the rest of the VA’s facilities in 10 years as it was originally contemplated.

Thu, 13 Oct 2022 09:51:00 -0500 en text/html https://www.stripes.com/veterans/2022-10-13/veterans-affairs-health-records-7682551.html
Killexams : Upcoming EHR Deployments Pushed Back to June 2023 to Make Way for VA’s Assess and Address Plan

The Department of Veterans Affairs has further delayed from January to June 2023 the upcoming deployments of the Oracle Cerner electronic health record system to review and address technical and system performance issues facing VA health care personnel and veterans.

Some of the additional concerns identified are problems with patient scheduling, medication management and referrals and latency and slowness, VA said Thursday.

We are delaying all future deployments of the new EHR while we fully assess performance and address every concern. Veterans and clinicians deserve a seamless, modernized health record system, and we will not rest until they get it,” said Donald Remy, deputy secretary of VA.

VA said it will continue to work with Oracle Cerner to address issues with the EHR system before resuming deployments at other medical centers, including those that may have implications for patient safety.

As it implements the “assess and address plan,” the department will continue to monitor the five VA facilities where the new EHR system has already been fielded to ensure that the platform is running smoothly in support of veterans.

In 2018, Cerner, which is now part of Oracle following its acquisition in June, received a potential $10 billion contract to help VA replace its Veterans Health Information Systems and Technology Architecture with a modernized EHR system that integrates with that of the Department of Defense.

Fri, 14 Oct 2022 08:52:00 -0500 Jane Edwards en-US text/html https://executivegov.com/2022/10/upcoming-va-ehr-deployments-pushed-back-to-june-2023/
Killexams : VA warns 41,500 veterans that EHR deployment issues may have affected care — report Written by

The Department of Veterans Affairs has warned 41,500 veterans that their care may have been affected by delays in the rollout of the Oracle Cerner electronic health records system.

In an interview with The Spokesman-Review newspaper, VA Under Secretary for Health Shereef Elnahal on Oct. 12 said the department’s findings from a latest review led it to send letters to veterans whose medications, appointments, referrals or test results may have been delayed due to problems with the system.

“Unfortunately, we discovered that safety concerns were voluminous enough and prevalent enough throughout the system that we had to disclose to 41,500 veterans that their care may have been impacted as a result of the system’s deployment as it is currently configured,” Elnahal told the newspaper.

Veterans who may have been affected were identified through a review by VA patient safety experts and through data provided by Oracle Cerner on all patients enrolled at hospitals and clinics where the system has been deployed.

According to the report, the VA began mailing letters on Oct. 12 and all affected veterans are expected to receive them within about two weeks.

The group of about 41,500 patients represents a minority of the veterans enrolled for care at facilities using the new system.

News of the letters comes as the VA Thursday announced that it would delay all future deployments of the electronic health record system until June next year.

In a statement, the department said it was pushing back the rollout to “address challenges with the system and make sure it is functioning optimally for veterans and for VA health care personnel.”

Earlier this year, a leaked draft report by the VA Office of Inspector General revealed nearly 150 cases of harm linked to the Oracle Cerner system, and shortly after VA Secretary Denis McDonough hit pause on deployments planned for the summer of 2022 in Seattle, Tacoma and Boise.

Thu, 13 Oct 2022 08:47:00 -0500 John Hewitt Jones en text/html https://www.fedscoop.com/va-warns-41500-veterans-that-ehr-deployment-issues-may-have-affected-care-report/
Killexams : VA adds 6 months to health record deployment pause

The rollout of new commercial electronic health record software to new locations at the Department of Veterans Affairs is on pause until June 2023, the agency announced on Thursday.

The VA had hoped to resume deployments in January, after years of recurring problems including system slowness, unexpected downtime, problems with scheduling and referrals and other issues.

"Right now, the Oracle Cerner electronic health record system is not delivering for veterans or VA health care providers—and we are holding Oracle Cerner and ourselves accountable to get this right," said Donald Remy, the agency deputy secretary and the official charged with oversight over the multibillion Electronic Health Record Modernization program. "We are delaying all future deployments of the new EHR while we fully assess performance and address every concern. Veterans and clinicians deserve a seamless, modernized health record system, and we will not rest until they get it."

The VA said it will "correct outstanding issues—especially those that may have patient safety implications—before restarting deployments at other VA medical centers" in a release announcing the news. 

A VA spokesperson said there was nothing specific to add to today's release in response to a question from FCW about whether holding "Oracle Cerner and ourselves accountable" included financial consequences for the vendor.

For patients at the five clinical facilities that already use the Oracle Cerner software, VA said it will focus on improvements to the system and ask veterans whose care has been impacted by the new system about the timeliness of prescription deliveries, referrals, scheduling and other aspects of their relationship with VA. Veterans who get in touch with complaints about their care can expect to hear back within five business days, the VA said.

The program to replace the homegrown VistA system with Cerner's electronic health record has been troubled since before it went live in October 2020 at the Mann-Grandstaff Medical Center in Spokane, Washington. Training deficiencies, technical problems including very long login times for users and frequent outages with consequences for morale among clinicians and reports of risks to patient safety are among the major issues cataloged by VA's Office of Inspector General and congressional overseers.

In May 2018, VA signed a $10 billion sole-source deal with Cerner (since acquired by Oracle for $28 billion) to supply its commercial electronic health record software to VA. The agency selected Cerner because it was already contracted to supply a system to the Department of Defense. The use of the same software for active duty and retired military personnel was designed to promote interoperability—a problem that has historically dogged VA, which relied on a stopgap read-only system to communicate between military and veterans' records. 

VA planned on spending $6 billion on infrastructure improvements and program management over the 10-year install period’ however, that total $16 billion outlay is likely dwarfed by the true costs of the change to Cerner. Various watchdogs have put the final costs of installing and running the Cerner system at between $21 billion and over $50 billion. 

"This program shows all the signs of a classic large scale government program failure," Roger Baker, former chief information officer at VA, told FCW. "It keeps missing schedule dates, the budget keeps expanding, no one seems to be in control, and users hate it. All there is left to do now is waste a billions of dollars more trying to save face before admitting the obvious." 

Rep. Mark Takano (D-Calif.) the chairman of the House Veterans Affairs Committee, said in a statement that he supported the delay for the sake of patient safety and added, "the sole-source nature of this contract, the lack of market research, misunderstandings about interoperability, and incomplete requirements development under the Trump Administration led to the situation VA is currently in."  

Rep. Matt Rosendale (R-Mont.), the ranking. member on a House subcommittee focused on oversight of the EHRM program and other VA tech, said the pause was "welcome news, adding: "There has been a lot of demonstrated problems with this program and I’m glad that Secretary McDonough is honoring his word in delaying this program until it can be fixed."

VA Secretary Denis McDonough has said at various times that the deployment schedule initially drafted was a "mistake" and that his "confidence has been shaken" after multiple outages, service degradations and other problems with the system.

However, VA so far has only withheld $156,750 in payments to Oracle Cerner for failing to hit system uptime targets under the $10 billion contract, according to congressional testimony from Dr. Terry Adirim, the program executive director for the EHRM project.

At a subsequent hearing of the House Veterans Affairs Committee's Subcommittee on Investigations, Michael Parrish, VA's principal executive director for the Office of Acquisition, Logistics and Construction said he did not think the $156,750 penalty was high enough given the extent of the system outages—which totaled 44 days.

"Coming from the corporate world, that would be different, and that's something we're looking at renegotiating," Parrish said.

Thu, 13 Oct 2022 06:22:00 -0500 en text/html https://fcw.com/it-modernization/2022/10/va-adds-6-months-health-record-deployment-pause/378386/
Killexams : VA extends EHR delay to June 2023 after review finds more system problems

The Department of Veterans Affairs is further delaying the rollout of its new Electronic Health Record to additional sites, as it troubleshoots problems that have led to patient harm and frustrated its health care workforce.

The VA announced Thursday the agency will push back upcoming deployments of its Oracle-Cerner EHR to June 2023 to address previously known and emerging problems with the system and to “make sure it is functioning optimally for veterans and for...

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The Department of Veterans Affairs is further delaying the rollout of its new Electronic Health Record to additional sites, as it troubleshoots problems that have led to patient harm and frustrated its health care workforce.

The VA announced Thursday the agency will push back upcoming deployments of its Oracle-Cerner EHR to June 2023 to address previously known and emerging problems with the system and to “make sure it is functioning optimally for veterans and for VA health care personnel.”

VA Secretary Denis McDonough, this summer, scrapped plans for EHR deployments for the rest of calendar year 2022, after the agency’s inspector general office reported instances of the EHR contributing to patient harm and decreased quality of care.

The VA is also sending letters to every veteran who may have been impacted by problems with the EHR currently running at five VA locations across the U.S.

The letter tells veterans to reach out to the VA over the phone or online if they “experienced a delay in medications, appointments, referrals, or test results” at a facility using the Oracle-Cerner EHR.

The VA said veterans can expect to hear back from the agency within five business days to resolve their issue.

Deputy VA Secretary Donald Remy said in a statement that the agency will delay all future deployments of the new EHR to fully address concerns with the system’s performance and reliability.

“Right now, the Oracle Cerner electronic health record system is not delivering for Veterans or VA health care providers — and we are holding Oracle Cerner and ourselves accountable to get this right,” Remy said.

Remy told members of the Senate Appropriations Committee in September that the EHR was “not even close” to meeting the needs of patients, and said the VA won’t proceed with future EHR go-lives if the system doesn’t pass a checklist that includes training for VA employees and patient safety criteria.

The VA said in its announcement that additional EHR problems have emerged during its review, and will need more time to address them before go-lives can resume.

“During VA’s subsequent investigation at our current sites, several additional technical and system issues were identified – including challenges with performance, such as latency and slowness, problems with patient scheduling, referrals, medication management, and other types of medical orders,” the agency said in a statement.

The VA has scheduled the EHR to go live at 25 VA medical centers in fiscal 2023, but the schedule is still subject to changes.

Oracle, the parent company of the VA EHR contractor Cerner, notified the Senate VA Committee in September that it provided a fix to an “unknown queue” problem with the VA system on Aug. 1.

The problem, as documented by the VA inspector general’s office, has led to thousands of clinical orders disappearing in an unmonitored inbox, causing patients to miss follow-up care.

VA Secretary Denis McDonough told reporters on Sept. 28 that it remains unclear whether a single fix to the unknown queue is enough to fully address the concerns of VA employees and patients, adding that the VA is still looking to determine the scope of its EHR challenges.

However, VA Undersecretary for Health Shereef Elnahal stopped short of saying the issue has been completely resolved.

“I am not confident that we’ve completely solved that set of issues,” Elnahal said.

Elnahal said that, following a site visit in Columbus, Ohio, the EHR contributed to VA employee burnout, and in some cases, led to employees quitting their jobs.

“There’s literally a systemwide focus now on clinician burnout, employee burnout, leading by example, and respecting what makes our employees whole and supporting our employees as much as we can. And so that’s going to be a huge priority for me to further those efforts, and get them to even more employees,” Elnahal told reporters last month.

Elnahal said the agency is continuing to work with Oracle-Cerner to definitively understand the basis of its EHR challenges, and troubleshooting the EHR rollout “rises to the top, in my mind, for patient safety risks.”

McDonough added that the VHA, through its REBOOT task force, is also taking steps to address burnout and working conditions among its health care workforce.

“This issue of burnout is front and center for us. And it’s an issue in the workforce generally at VA and the labor force generally in the United States. I’m really proud of the work we’re doing to get ahead of it,” McDonough said.

Thu, 13 Oct 2022 08:13:00 -0500 en-US text/html https://federalnewsnetwork.com/veterans-affairs/2022/10/va-extends-ehr-delay-to-june-2023-after-review-finds-more-system-problems/
Killexams : VA delays health record rollout again — this time until summer 2023

Veterans Affairs officials are again delaying further deployment of their new electronic health records system amid ongoing issues with the new software, this time pushing back any new site rollouts until June 2023.

In a message to the VA workforce Thursday, Under Secretary for Health Dr. Shereef Elnahal said the delay is needed “to address challenges with the system and make sure it is functioning optimally for veterans and for VA health care personnel.”

In June, department officials announced a halt to all new deployments of the Oracle-Cerner Millennium electronic health record system until early 2023 because of patient safety issues that occurred in the first five sites using the software.

“Over the coming months, we will implement an ‘assess and address’ period to correct outstanding issues with the new system — especially those that may have patient safety implications — before restarting deployments at other VA medical centers,” Elnahal wrote in his message to staff.

“In the meantime, VA will continue to focus on the five facilities where the new system has already been deployed to ensure every patient is getting the world-class health care they deserve.”

VA officials will also send letters in coming weeks to patients who “may have been impacted by these system challenges” to make sure they are able to schedule appointments, receive medications and fulfill other medical needs.

The 10-year, $16 billion health records modernization project started in 2017 and was touted as a way to provide better care to troops and veterans throughout their lives.

But the effort has been besieged by problems since its initial implementation. Deployments have been postponed multiple times because of staff training and patient safety issues.

In September, Elnahal told lawmakers on the House Veterans’ Affairs Committee that problems with the new system have encouraged some staffers to quit. VA Secretary Denis Mcdonough has said he is frustrated with the progress so far, and frequent past outages with the software.

But VA leaders said they are still confident that the Oracle-Cerner plan is the best option for updating the department’s aging health records system.

“VA remains committed to building an [health record] solution that will link with the Department of Defense’s health record system to create a lifetime of seamless care for service members and veterans,” Elnahal wrote. “That end goal is achievable if we take these necessary steps forward.”

In September, Mike Sicilia, executive vice president for Oracle, said officials are making improvements to the system and are working closely on a new deployment schedule to get the project back on track.

He said he still believed a 2028 end date for the project is realistic, but that was assuming a restart in early 2023.

VA officials have been more reserved in their timelines, saying they are focused on getting the training and implementation processes right.

Meanwhile, lawmakers have expressed concerns with the high price tag and low return on investment of the project thus far. Several House committee members told VA officials last month that they need to show results soon or risk having the entire program canceled.

Leo covers Congress, Veterans Affairs and the White House for Military Times. He has covered Washington, D.C. since 2004, focusing on military personnel and veterans policies. His work has earned numerous honors, including a 2009 Polk award, a 2010 National Headliner Award, the IAVA Leadership in Journalism award and the VFW News Media award.

Thu, 13 Oct 2022 04:45:00 -0500 en text/html https://www.airforcetimes.com/veterans/2022/10/13/va-delays-health-record-rollout-again-this-time-until-summer-2023/
Killexams : VA postpones rollout of computer system until mid-2023, warns 41,500 veterans it may have delayed care

WASHINGTON — The Department of Veterans Affairs announced Thursday it will postpone the rollout of a troubled computer system it has been testing in Spokane for the past two years and will notify more than 40,000 veterans in the Inland Northwest, Oregon and Ohio that their treatment may have been delayed by problems with the system.

The new electronic health record system, developed by Oracle Cerner under a $10 billion contract to replace the VA's existing system, had been scheduled to launch in the first quarter of 2023 at hospitals in Western Washington, Michigan and Ohio, but those and all other deployments have been pushed back to at least June , the department said in a news release.

"Right now, the Oracle Cerner electronic health record system is not delivering for Veterans or VA health care providers — and we are holding Oracle Cerner and ourselves accountable to get this right," VA Deputy Secretary Donald Remy said in the release, adding that the system's rollout would be delayed "while we fully assess performance and address every concern."

The system, which VA employees rely on to track patient information and coordinate care, was first launched at Mann-Grandstaff VA Medical Center and its associated clinics across the Inland Northwest in October 2020. After multiple delays prompted by patient safety risks caused by the system, the department deployed it in March in Walla Walla; in April in Columbus, Ohio; and in June in Roseburg and White City, Oregon.

On Tuesday, in response to questions from The Spokesman-Review, the VA confirmed it was aware of the death in late September of a patient at the VA clinic in Columbus, Ohio. That incident is being treated as a potential "sentinel event," a designation that prompts an investigation to prevent a similar occurrence in the future.

"Patient safety is VA's top priority, and we are currently investigating to determine the root cause of this incident and get to the bottom of it," VA spokesman John Santos said in a statement. "Our sincerest condolences go to the family and friends of this Veteran."

In an email sent to all clinicians at Mann-Grandstaff on Oct. 7 and obtained by The Spokesman-Review, the hospital's assistant chief of pharmacy, Sharon Oakland, attributed the sentinel event in Columbus to a patient not receiving a medication due to incorrect information in the Oracle Cerner system. "This is one more example," she wrote in the email, of how the VA facilities using the new system are relying on "hypervigilance on everyone's part to work within Cerner."

After a leaked report by the VA Office of Inspector General in June revealed nearly 150 cases of harm linked to the Oracle Cerner system, VA Secretary Denis McDonough hit the brakes on deployments planned for last summer in Seattle, Tacoma and Boise while the department investigated safety risks reported by health care providers.

Shereef Elnahal, the VA's under secretary for health, said in an interview with The Spokesman-Review on Wednesday that the department's findings prompted it to send letters to veterans whose medications, appointments, referrals or test results may have been delayed due to problems with the new system.

"Unfortunately, we discovered that safety concerns were voluminous enough and prevalent enough throughout the system that we had to disclose to 41,500 veterans that their care may have been impacted as a result of the system's deployment as it is currently configured," Elnahal said.

The affected veterans were identified through a review by VA patient safety experts and data provided by Oracle Cerner on all patients enrolled at the hospitals and clinics where the system has been deployed in Washington, Idaho, Oregon, Montana and Ohio, Elnahal said. That group of roughly 41,500 patients represents a minority of the veterans enrolled for care at the facilities using the new system.

The VA began mailing the letters Wednesday and all of the affected veterans should receive them within about two weeks.

Soon after Elnahal started his job in July, becoming the first Senate-confirmed head of the Veterans Health Administration since 2017, he met with employees on Sept. 9 at the VA clinic in Columbus, Ohio, where the Oracle Cerner system was launched in April. The most concerning pattern he saw there, Elnahal said, was the highly complex system making it hard for clinicians to perform routine tasks, such as ordering a test or a follow-up appointment. The veterans who will receive letters were identified as potentially being affected by those problems.

"This is actually a list of veterans who at some point, we have evidence, got caught up in this phenomenon of commands not getting where they need to go," Elnahal said. "That definitely went above the threshold for us to proactively contact those veterans, because that is far and away our first priority, the safety and quality of the care we provide to veterans."

Delayed follow-ups due to orders in the system not reaching their intended recipient was the main cause of 149 cases of harm identified in a VA Office of Inspector General report released in July. Similar errors led to a roughly yearlong delay in treatment for a veteran in Chewelah, Washington, who was eventually diagnosed with terminal cancer.

The text of the letter, which the VA provided to The Spokesman-Review, explains that the department is transitioning to the new system "to ensure that you have the modernized, integrated, and world-class care that you deserve" and encourages the affected veterans to make sure their prescriptions are correct, appointments are scheduled and test results are delivered to them. Veterans who believe their care may have been impacted are directed to call a dedicated call center at (800) 319-9446.

"We purposefully made a separate call center so that our clinicians in the field, seeing veterans, don't take a huge volume of calls that forces them to disrupt veteran care that's happening over the next couple of weeks," Elnahal said.

Staff at the call center, he said, will take information from veterans who believe their care has been affected by the Oracle Cerner system and a VA health care team will follow up within five days.

The letters, which will be signed by Elnahal and local VA leaders in each region, conclude by saying, "We apologize for any inconvenience or concern this may cause you and your family. Our staff care deeply about your health, and we want to continue to partner with you for your health and wellbeing. Thank you for your understanding as we work quickly to ensure that you receive the best possible medical care."

The system's launch in Spokane was delayed twice by the Trump administration before going ahead just days before the 2020 election, during a local surge in COVID-19 cases and despite warnings that it was not ready to safely use. Thursday's announcement marks the third time the rollout has been delayed under the Biden administration, but Elnahal's focus on the system's poor design represents a notable departure from VA leaders' past remarks, which have often downplayed problems and pointed blame at health care workers themselves.

Elnahal said that while the VA is sending more technical assistance and additional clinicians to support the sites already using the Oracle Cerner system — which has decreased the number of patients each provider can see in a day — the biggest need is simply to make the system work better.

"The most definitive thing that will help us address clinicians' stress as they interface with Cerner is reconfiguring the systems to solve what they worry about the most, which is any safety issue that could befall veterans," he said. "We're trying to be proactive and get ahead of that issue with the letter, but at the same time we are starting now in solving that piece of the system's configuration, which is what I worry about the most, because our clinicians on the front line worry about that the most."

Elnahal is the first permanent leader of the Veterans Health Administration — the nation's largest health care system, serving more than 9 million veterans — since former President Donald Trump named Elnahal's predecessor, David Shulkin, as VA secretary in early 2017. As under secretary for health, Elnahal said his role in the Oracle Cerner rollout is "to be the voice of our clinicians" and to make tough decisions about how the system should be configured.

While the VA estimates that delaying the system's rollout until mid-2023 will provide enough time to work with Oracle Cerner to fix the problems, Elnahal emphasized that the department won't bring the system to new facilities until the "top-level safety issues are resolved," even if that means further delays.

"Those specific patient safety risks have a lot to do with the way the system is configured right now," he said. "It's not as intuitive as it should be and there's a lot of room for improvement."

Problems related to transitioning between electronic health record systems have been widely documented and are not unique to the VA, but the rest of the U.S. health care system doesn't have the same level of transparency as the VA, which is subject to oversight by Congress and the Office of Inspector General, an internal watchdog agency. The VA also has a confidential reporting system that encourages clinicians to report patient safety risks and incidents of harm, which improves safety but can provide the impression that the VA has a poor safety record in comparison to private hospitals, which often don't have similar reporting mechanisms.

"Not many other health systems would have been able to surface, so swiftly and effectively, these safety concerns," Elnahal said, crediting VA clinicians and patient safety experts. Because the VA had "robust systems in place" to detect safety threats, he said, the department raised the problems quicker than any other health care system would have.

The system being replaced by Oracle Cerner, known as VistA, is still used in nearly all VA facilities and has been credited with pioneering the electronic health record field. Elnahal, who used VistA during his medical training, said the existing system "represents a really amazing part of VA history, but it is just too old and simply cannot meet the future needs of veteran health care."

While Elnahal said all commercial electronic health record systems are "not optimal," he called the Oracle Cerner system "a workable product" that can be configured to meet the VA's needs.

Asked whether the sites currently using the Oracle Cerner system could revert to VistA until problems with the new system are fixed, he said doing that "would actually introduce more risk than benefit at this point in the process."

"Sometimes, you're not presented with options to immediately resolve the safety concerns that are in front of you," he said. "It is simply the case that the best option in front of us to resolve these patient safety concerns is to work with Oracle Cerner over the next several months to resolve the Cerner system issues at the sites where it exists. We know that this is possible, because other health systems have gone through this journey before, and I think we can do it."

Orion Donovan-Smith's reporting for The Spokesman-Review is funded in part by Report for America and by members of the Spokane community. This story can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper's managing editor.

Fri, 14 Oct 2022 03:00:00 -0500 en text/html https://www.union-bulletin.com/news/northwest/va-postpones-rollout-of-computer-system-until-mid-2023-warns-41-500-veterans-it-may/article_0cab39e7-bfce-59d5-8c16-17733da776e3.html
Killexams : Nebraska Health System Renews 10-Year Contract with Oracle Cerner No result found, try new keyword!October 13, 2022 - Nebraska-based Methodist Health System has announced its commitment to a ten-year contract extension with Oracle Cerner, which will continue access to the full suite of Oracle ... Thu, 13 Oct 2022 14:01:00 -0500 en-US text/html https://ehrintelligence.com/news/nebraska-health-system-renews-10-year-contract-with-oracle-cerner
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