No News Might Not Mean Good News for VA’s New Electronic Records System

No News Might Not Mean Good News for VA’s New Electronic Records System
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Things have been quiet on the public front since the VA halted the rollout of its electronic health record modernization system (EHRM) in July, hours before it was scheduled to go live at the VA Medical Center in Boise, Idaho. Boise was the third in a series of pauses instituted to address system problems impacting VA’s delivery of health care to veterans; no more VA facilities will transfer to the system until early 2023.  


That silence prompted a recent hearing by appropriators on the Senate Subcommittee on Military Construction and Veterans Affairs to hear from VA officials on the status of the EHRM project, what the future holds for further deployments, and the true costs of the system over time. 


System Setbacks 

The project has been plagued with ongoing problems and setbacks dating back to its initial launch at Mann-Grandstaff VA Medical Center in Spokane, Wash. Lingering issues related to patient safety, training, employee morale, and a myriad of other deployment problems still exist, though some progress has been made.  


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Some of that progress has taken place behind the scenes after Oracle bought out the existing contractor Cerner and acquired the new EHRM contract in early June — now called Oracle Cerner Millennium EHR. At a July hearing soon after the Boise pause, Oracle’s vice president of global business units, Mike Sicilia, told skeptical lawmakers his company intends to exceed expectations. He insisted EHRM system problems can be fixed in short order. 


Where Things Stand 

While progress continues, some Senate appropriators noted the hearing offered little new information or clarity on what has been done to date.  


One significant change since the July hearing is a new VA Under Secretary for Health Affairs: Dr. Shereef Elnahal assumed a position vacant since February 2017.  


Elnahal joined VA Deputy Secretary Donald M. Remy at the subcommittee hearing, testifying on the EHRM topic for the first time.  


“I am committed to getting the VA a modern electronic health record system that meets the clinical needs of veterans,” Elnahal told Sen. John Boozman (R-Ark.) ranking member of the appropriations subcommittee.  


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There are still major improvements needed before the VA can achieve its goal of ensuring zero veteran harm, Remy said, adding that “the VA is holding Oracle Cerner accountable, which is why all new go-live sites have been paused until 2023.” 


The VA is using this pause to make system enhancements and to perform tests to ensure the system is stable, resilient, and provides the capability VA employees and veterans need to improve access and quality of care. 


Sen. Jon Tester (D-Mont.), a member of the subcommittee and chair of the Senate Veterans’ Affairs Committee, expressed frustration with the project’s progress. “This has been going on for so long and so little has apparently been achieved,” he said.  


“I don’t want anything implemented before it’s ready for prime time, but on the same token, we’ve got an investment in a program that needs to start delivering,” Tester added. “Same with Cerner … you have to hold yourselves accountable, and we need to get this damn thing done.”   


IG Testimony 

Testimony from the VA deputy inspector general did not necessarily calm the concerns of lawmakers as to what progress VA has made in addressing the EHRM system problems and its plans for moving forward. 


The Office of Inspector General (OIG) has released 14 reports on the system over the last two years focused on VA’s planning, user training, and deployment actions. 


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“The OIG found in April 2022, the VA had not executed a reliable and comprehensive integrated master plan,” said Deputy Inspector General David Case. “The OIG remains concerned over the 15 outstanding recommendations from its reports that have been opened for longer than one year.” 


The OIG had closed out six recommendations in the last few days related to training, Case said. While the VA has made a good effort at progress, there remain serious problems dealing with medication management, care coordination, and budget concerns. 


Future Deployments 

While the VA has paused all EHRM system deployments this year, the department is still planning to resume deployments in 2023. Three years into the project, the VA and Oracle Cerner still expect to deliver the system by 2028 


Sicilia also told lawmakers even with delays and the extended timeline for deployments he expects to deliver the system within the $10.7 billion currently provided under the contract.  


The VA initially estimated project costs to be $10 billion, then adjusted the projection to $16 billion over 10 years. Some in Congress, the OIG, and the authors of a recent report by the Institute for Defense Analyses are expecting costs to rise to nearly $50 billion — costs that assume a longer deployment timeline and lifecycle funding needed to sustain the system over the coming years. 


As the VA continues to incorporate lessons learned and address current system glitches, Congress and MOAA are committed to supporting the VA and ensuring the new system improves the delivery of health care to veterans. Like Congress, MOAA and veterans want the VA to get this project right but also want to see more visible progress and transparency from the VA going forward. 


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About the Author

Cmdr. René Campos, USN (Ret)
Cmdr. René Campos, USN (Ret)

Campos currently serves as MOAA's Senior Director of Government Relations, managing matters related to military and veterans’ health care, wounded, ill and injured, and caregiver policy.