John Plahovinsak
A blind, ten (10) year Department of Veterans Affairs (VA) employee, Ms. Laurette Santos, has recently filed a lawsuit against the VA. The lawsuit claims that the VA’s Electronic Health Records (EHR) system discriminates against veterans and employees with disabilities.
The allegation contends that the implementation of the EHR system at the VA Medical Center in White City, Oregon, is not accessible to veterans and employees, who are visually impaired. The EHR system was installed in June of 2022 and is one of six (6) sites currently using the new system.
The lawsuit was filed in June of 2024 in the U.S. District Court and focuses on the EHR system’s failure to integrate with screen readers and other assistive technologies.
Ms. Santos, a Visual Impairment Services Team coordinator, provides therapeutic counseling to veterans who are experiencing vision loss or blindness. She emphasized with veterans the difficulty and isolation that comes with blindness.
She relies on a screen reading software called Job Access With Speech (JAWS) to access computer screens. This technology was compatible with the VA’s previous system, allowing her to perform essential job functions with minimal assistance.
In 2019, she was asked by the Oracle-Cerner Corporation, who developed the software platform, to review the planned EHR for its accessibility issues. Immediately she cited that the EHR’s codes did not recognize the presence of additional software, such as JAWS.
Even after her feedback comments were received by the EHR system developer, the crucial accessibility software problems were ignored and the system was launched.
According to Ms. Santos’ attorneys, the VA’s contract with Cerner required the EHR system to be compatible with accessibility-related software and assistive technology devices, including screen readers, screen magnifiers and speech recognition software.
This was a stipulation stemming from requirements that were outlined in Section 508 of the agreed-upon contract. Section 508 was part of the Rehabilitation Act of 1973 and applies to all federal agencies.
These federal agencies, like the VA, must give disabled employees and members of the public access to information that is comparable to access available to others.
Section 508 mandates that all technologies purchased and used by federal agencies, such as the VA, must be accessible. The attorneys for Ms. Santos criticized the VA for not ensuring compliance with these legal requirements.
The lawsuit claims the Cerner EHR requires users to operate a computer mouse, which Ms. Santos and other blind employees are unable to use. The VA was also made aware that all training simulating the Cerner EHR was not Section 508 compliant.
The lawsuit stipulates that the failure to integrate accessibility features has had “disastrous consequences” for Ms. Santos’ capability to effectively do her job. This has forced her to delegate tasks to sighted employees, which could jeopardize her clinical license.
Ms. Santos has pointed out that the lack of accessibility also profoundly affects veterans who are visually impaired, limiting the disabled veterans’ ability to interact with the new EHR system.
Between November 2020 and November 2021, the VA’s Section 508 Office conducted several audits and found the Cerner EHR was inaccessible. These audits have led the VA to a “reset” period, pausing further implementation of the Cerner EHR until these significant issues are corrected.
According to Ms. Santos, who has not been able to read text since 1988 due to her retinitis pigmentosa, this situation has had “disastrous consequences” for her ability to do her job. Also, Ms. Santos’ clinical license may be in jeopardy.
Her lawsuit indicated that delegating tasks, such as placing orders for devices software, must be accomplished with assistance from sighted VA employees.
Ms. Santos, by filing her lawsuit, hopes for improvements in the Cerner’s EHR systems compliance with Section 508 to better support both employees and veterans relying on its’ functionality.
My Opinion: This lawsuit by Ms. Laurette Santos could have been avoided if the VA’s Office of the Inspector General (OIG) would have investigated if Section 508 provisions applied to the existing EHR Contract.
The VA signed a $10 billion EHR contract in May of 2018 with Cerner, now owned by Oracle. It was a move from the VA’s customized VistA platform, which Ms. Santos used for a decade, to a new health records system.
Unfortunately, I do not have access to the contract to determine if the Section 508 provisions and stipulations were contained in the initial EHR contract. However, the VA’s OIG should be able to obtain access to the contract and make that determination.
It would be pure speculation to determine who was at fault in the contract preparation and signing – either the VA or Cerner, and now Oracle. The only thing clear right now is at Ms. Santos and other vision-impaired veterans and VA employees can not utilize the existing EHR system.
It is sad that we must rely on a lawsuit to resolve a situation that could be settled by the VA OIG. Either the VA is at fault for not inserting a Section 508 adherence clause in the initial 2018 EHR contact or Oracle is at fault for failing to comply with the Section 508 clause.
Whoever’s fault it is, the situation still must be resolved for Ms. Santos and the other disabled veterans and VA employees.
BioSketch: John Plahovinsak is a retired Army veteran who served from 1967 to 1999. He is the Disabled American Veterans (DAV) Department of Ohio’s Hospital Chairman and Adjutant of Chapter #63 (Clermont County). He can be contacted at: plahovinsak@msn.com.