House Republicans Seek to Mandate VA's EHR Program Improve or Face Termination

A group of Republican House lawmakers introduced legislation on Friday that would block the Department of Veterans Affairs from rolling out its multi-billion dollar Oracle Cerner Millennium electronic health record at future medical facilities until certain performance and facility readiness metrics are met, as well as a companion bill that would terminate the program unless significant improvements are made to the software’s deployment. 

Rep. Mike Bost, R-Ill.—chairman of the House Veterans’ Affairs Committee—and nine Republican co-sponsors introduced the VA Electronic Health Record Modernization Improvement Act to fix the EHR system’s deployment by ensuring that the software meets certain verification standards before it is deployed. 

The bill would prevent the VA from commencing any further EHR-related go-live program activities at the department’s medical facilities until VA Secretary Denis McDonough submits written certification to the House and Senate Veterans’ Affairs Committees that the system has met certain improvement objectives. These include “a monthly uptime for the electronic health record system of 99.9% for four sequential months,” as well as the completion “of all improvements or modifications of the electronic health record system required to be completed pursuant to a contract, task order, modification or other similar instrument,” according to a copy of the legislation shared with Nextgov. 

The bill would also limit implementation of the EHR system at new medical facilities until Secretary McDonough submits written certification to the House and Senate committees that the proposed “build and configuration” of the software is “accurate and complete;” that facility staff are “adequately prepared to receive such system;” and that the system “will not have significant, sustained adverse effects on patient safety, patient wait-times for medical care or health care quality.”

The rollout of the VA’s new Oracle Cerner EHR software has been hobbled by system disruptions, performance concerns, patient safety issues and cost overruns since first going live at the Mann-Grandstaff VA Medical Center in Spokane, Washington in 2020. An estimate provided to congressional leaders last year by the Institute for Defense Analyses found that it would cost more than $50 billion over 28 years to implement the software across all of VA’s medical facilities. The original estimated cost to deploy the software was $10 billion over 10 years. 

Lawmakers’ concerns about the new system’s rollout were further exacerbated by a July 2022 report from the VA's Office of Inspector General which found that the EHR software deployed at Mann-Grandstaff routed more than 11,000 clinical orders for veterans to an “unknown queue” without alerting clinicians, which caused “multiple events of patient harm" to roughly 150 veterans.

VA announced in October that it was extending a previously announced pause on future rollouts of the new software until June 2023 “to address challenges with the system and make sure it is functioning optimally for veterans and for VA health care personnel.” Thus far, the new system has only been deployed at a total of five sites across the VA’s national network of 171 medical centers.

Bost previously told VA officials during a subcommittee hearing in July 2022 that lawmakers “will have to seriously consider pulling the plug” on the software rollout if significant progress was not made to address problems with it by the beginning of 2023. He warned at the time that he was “writing legislation to do just that.”

In a statement announcing the new legislation, Bost said that the EHR software “has crippled the delivery of care, put veteran patient safety at risk and stressed an already overwhelmed healthcare system.”

“While I commend the secretary for pausing deployment of the new EHR at future sites, I am not confident that will be enough,” he added. “It’s simple: the Oracle Cerner system should not be implemented at any more VA sites until the VAMC leadership certifies that the medical center is ready.”

Beyond moving to extend additional oversight over the VA’s handling of the EHR rollout moving forward, GOP leaders on the committee are also readying plans to terminate the program if technical and performance problems continue to persist. 

Rep. Matt Rosendale, R-Mont., who was recently appointed chairman of the Subcommittee on Technology Modernization, also introduced legislation on Friday—co-sponsored by Bost—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.” Both bills have been referred to the House Veterans’ Affairs Committee for consideration. 

According to Rosendale’s office, the legislation would, in part, abolish the VA’s Electronic Health Record Modernization Integration Office, revert all medical facilities currently using the new EHR system back to VA’s legacy health information system—known as the Veterans Health Information Systems and Technology Architecture, or VistA—and prevent VA “from exercising any options on Oracle Cerner’s contract” within 180 days of the bill’s enactment.

“The Oracle Cerner electronic health record program is deeply flawed—causing issues for medical staff and posing significant patient safety risks,” Rosendale said in a statement. “We cannot continue to further implement this inadequate system at the expense of billions of dollars in government funding. We must hold the VA to the high standard of care promised to our veterans and be good stewards of taxpayer dollars.”

Even with GOP lawmakers threatening to terminate the program if system improvements are not made, Democrats in the House and Senate have largely refrained from publicly calling for the EHR rollout to end, and have instead focused on ensuring that VA and Oracle are taking the necessary steps to right the software’s deployment moving forward. 

Oracle, which acquired Cerner last year, has taken steps in recent months to be more transparent about its ongoing efforts to rectify issues with the EHR system’s rollout. Last year, Oracle launched a public-facing dashboard to track the company’s progress on updates to the system. As of Feb. 1, the dashboard—the link to which Oracle previously shared with Nextgov—shows that the company has closed out eight “assigned issues as originally identified by VA as priorities in February and May 2022 briefings to Congress and as cited in a letter from Congress to VA on June 27, 2022.” 

The dashboard also lists three issues to address that are marked as “in progress,” one issue that is listed as “scheduled” and eight others that are identified as “in development.”