Lawmakers Need to Enhance VA’s Oversight of Oracle EHR Rollout or ‘Move On,’ Top Republican Says

Congress needs to advance legislation cracking down on Oracle Cerner’s management of the Department of Veterans Affairs’ multi-billion dollar electronic health record system, according to the top Republican on the House Veterans’ Affairs Committee, or lawmakers will have no choice but to terminate the project and reevaluate the future of the department’s EHR software modernization efforts. 

In an interview with Nextgov, Rep. Mike Bost, R-Ill.—who chairs the House panel—placed much of the blame for the EHR system’s troubled deployment on the companies behind the new software, saying that “it’s Cerner and Oracle that need to get their act together.”

“VA simply has to make sure that, at the place where they're going to roll it out, the standards are met,” he said. “And the most important standard is that the operator and manager and overseer of the particular VA [medical facility] where it is going to roll out is comfortable moving forward with changing a system.” 

VA’s legacy system, known as the Veterans Health Information Systems and Technology Architecture—or VistA—has been in use for more than 40 years, and the department has tried and failed several times to modernize it. U.S. Comptroller General Gene Dodaro previously told members of the committee during a Feb. 28 oversight hearing that VA has spent “over $1.7 billion dollars for failed predecessor electronic healthcare record systems” prior to the new Oracle Cerner EHR system.

Cerner—which was acquired by Oracle last June—received a $10 billion contract in 2018 to upgrade VA’s EHR software. Since then, however, the deployment of the new system has been hampered by software outages, patient safety concerns, training difficulties, delays and cost overruns. A highly critical report released by the VA's Office of Inspector General in July 2022 also found that, following the new system’s rollout at the Mann-Grandstaff VA Medical Center in Spokane, Washington in October 2020, over 11,000 orders for clinical services were inadvertently directed to an “unknown queue” without alerting clinicians, which resulted in “multiple events of patient harm" to roughly 150 veterans.

VA announced last October that it was extending a previously announced delay on additional rollouts of the Oracle Cerner system until June 2023 “to address challenges with the system and make sure it is functioning optimally for veterans and for VA health care personnel.” As a result of delays and other issues associated with the software, the Oracle Cerner system has only been deployed at five facilities across the VA’s national network of 171 medical centers.

“I don't think they're ready to go live with new ones until we get that straightened out,” Bost said about VA’s plan to continue deploying the Oracle Cerner system at additional medical facilities in roughly three months. He added that, while modernizing the department’s EHR system “wasn’t a wrong decision,” the implementation of the new software “has been wrong.”

“We do have an existing system that actually does work,” he said about VistA. “There might be some growth that needs to occur in that system, if we go back to that. But the idea is to make any incidents where we endanger the lives of our veterans as minimal as possible, not with what we're getting at these five facilities.”

Bost, along with 10 Republican co-sponsors, introduced legislation in January that would prevent the department from moving forward with future rollouts of the new EHR system at additional VA medical facilities until the sites certify in writing to VA Secretary Denis McDonough that the software has met certain performance and facility readiness standards. 

This includes certifying “a monthly uptime for the electronic health record system of 99.9% for four sequential months,” and the completion of all necessary system improvements and modifications prior to deployment. Medical facility leaders and the director of the Veterans Integrated Services Network would also be required to provide written certification that the proposed “build and configuration” of the EHR system is “accurate and complete,” that facility staff and infrastructure are “adequately prepared” for the software’s deployment, and that the Oracle Cerner system “will not have significant, sustained adverse effects on patient safety, patient wait-times for medical care or health care quality.”

Bost is also a co-sponsor of legislation introduced by Rep. Matt Rosendale, R-Mont.—who chairs the panel’s subcommittee on Technology Modernization—that “would end the Oracle Cerner electronic health record program at VA if it cannot demonstrate significant improvement but is nonetheless introduced to additional medical centers.” 

Bost said he believes the department “is waking up to the fact that they've got to have what we're proposing,” but added that “if VA can't get together themselves, that will force their hand to get it together.” 

“That's what these two bills are doing: we set standards, we ask the VA to make sure that Oracle Cerner does what we're requesting in the law and, if not, then we'll move on,” Bost said. “And we'll either go back to the VistA system, or we will look at a different direction to go.”

Bost said he viewed continuing patient safety concerns, as well as recent revelations about veteran deaths tied to the Oracle Cerner system, as significant barriers to the department’s plans to restart deployments in just a few months. 

During a Senate Veterans’ Affairs Committee hearing on March 15, lawmakers said that VA officials informed them the previous day that flaws with the Oracle Cerner system were responsible for six “catastrophic events,” including the deaths of four veterans. 

Bost said that any veteran death associated with the EHR system “is too many,” but added that the endangerment of patients as a result of software issues raised larger questions about potential disparities in care resulting from the Oracle Cerner system. 

He cited VA data which showed that medical facilities using VistA had an average of 55 patient safety reports from 2020 through 2022, compared to the more than 1,000 reports generated at Mann-Grandstaff alone in the two years since the software was deployed at that medical center. Bost said these issues have affected the quality of veterans’ healthcare, “whether it is getting a prescription, whether it is getting an appointment, whether it is transferring vital information from one doctor to another.”

VA’s contract with Oracle Cerner is set to expire May 16, and lawmakers have pushed for the department to negotiate a new contract that imposes harsher penalties for poor performance. Bost said VA should be pushing for better terms in any new agreement, adding that “VA should have been doing that before I carried a bill.” 

“Republicans and Democrats and the House and Senate, with all of us being aligned on what we know we want to fix and the problems that we’re seeing, we will all be working with the [VA] secretary to make sure that we don't continue down this path for very long, because it’s not good for our employees, but most of all, it’s not good for our veterans,” he added.