Despite Issues, VA’s EHR Deployment Remains Scheduled to Pick Up in Mid-2023

The deployment of the Department of Veterans Affairs’ new multibillion-dollar Oracle-Cerner Millennium electronic health record system faced significant setbacks in 2022, but agency officials and lawmakers—despite growing concerns about the project’s cost and technical issues—are continuing to fund and support the software’s rollout across the VA’s network of medical facilities for, at least, a little while longer.

The new EHR software—which is meant to be interoperable with the Defense Department’s EHR system—first went live in 2020 at the Mann-Grandstaff VA Medical Center in Spokane, Washington, but deployment issues at the pilot site and other medical facilities in the ensuing years have slowed the system’s rollout across the VA’s national network of 171 medical centers.

Beyond system outages, cost overruns and patient safety concerns across the five sites where the new EHR system has been deployed, a report released by the VA Inspector General’s office in July found that software’s uneven rollout at Mann-Grandstaff led to more than 11,000 clinical orders for veterans being improperly routed to an “unknown queue” without the knowledge of clinicians.

VA officials said in July that they were delaying all of the remaining EHR system rollouts scheduled for this year until early 2023 to address technical and patient safety issues associated with the software. In October, VA officials announced that they were once again extending the delay in the software’s deployment, this time until June 2023. 

These delays and deployment issues have led to increased scrutiny from Congress, which passed the VA Electronic Health Record Transparency Act to give lawmakers more oversight over problems associated with the software’s rollout. President Joe Biden signed the bipartisan legislation into law in June. 

Oracle, which acquired Cerner in June, has also been working to address issues with the EHR system in the face of deep concerns from VA officials and lawmakers. As of Dec. 29, Oracle’s public-facing dashboard tracking the progress it has made on the project showed that the company has closed out eight issues “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.” 

Oracle’s dashboard lists four other issues to address that are in progress, another four issues that are scheduled and an additional four more that are marked as “in development.”

While the EHR system’s rollout has received bipartisan and bicameral criticism, Republicans on the House Veterans’ Affairs Committee have been particularly critical of the problems with the software’s deployment, citing cost overruns, technical glitches and negative patient outcomes as grounds for defunding the project, or extending additional congressional oversight over the VA’s management of its major acquisitions. 

Rep. Mike Bost, R-Ill.—who, as the current ranking member of the House Veterans’ Affairs Committee, is likely to become the panel’s chairman in the 118th Congress—previously said during a hearing in July that Congress should “seriously consider pulling the plug” on the EHR system’s rollout if the technical and logistical issues affecting the project were not adequately addressed. 

A cost analysis provided to lawmakers by the Institute for Defense Analyses earlier this year estimated that the full cost of deploying the EHR system across all of the VA’s medical centers would be more than $50 billion over 28 years.

Influential Democratic lawmakers—such as Sen. Jon Tester, D-Mont., the chairman of the Senate Veterans’ Affairs Committee—have similarly excoriated the system’s botched rollout, but have also largely stopped short of calling for the cancellation of the EHR system’s deployment and instead focused on “holding VA and Oracle-Cerner’s feet to the fire in fixing system-wide issues.”

Despite the EHR system’s cost, other major IT projects at VA that have received significant pushback from lawmakers have not been immune from drastic operational changes. The VA announced earlier this month that it will “transition” from using the Defense Department’s multibillion-dollar supply chain management system—the Defense Medical Logistics Standard Support, or DMLSS—after its rollout at a pilot site in Illinois was hampered by functionality problems and led to calls from Congress and an agency watchdog to cancel the project. 

For now, at least, Congress is continuing to support the rollout of the EHR system, with lawmakers already securing funding to resume the software’s deployment next year. The omnibus spending bill—which was approved by Congress on Dec. 23—included more than $300 billion in funding for VA during the 2023 fiscal year, including $1.8 billion “to continue the department’s work to roll out the electronic health record system to facilities across the country.”

VA is also continuing to move forward with the EHR system’s deployment, including working to build on-the-ground facilities to streamline the software’s rollout at future medical centers. VA published a presolicitation notice on Sam.gov on Dec. 6 regarding a “single, firm-fixed-price contract for the construction only [Electronic Health Record Modernization] training and admin space support at the John J. Pershing VA Medical Center" in Poplar Bluff, Missouri.

A VA spokesperson told Nextgov that the presolicitation notice was specific to planned “facility infrastructure improvements“ at Pershing that were “in support of electronic health record modernization at the facility” and would be used “to prepare [Veterans Health Administration] staff for the deployment of the Oracle-Cerner electronic health record.” They added that the timing of the construction project “is not an indication of the Oracle-Cerner deployment schedule” and that the training space “must be ready months before the go-live date.”

The VA’s fiscal year 2023 EHR deployment schedule currently lists 25 planned rollout sites next year, but does not include Pershing on the upcoming schedule. The spokesperson confirmed that future EHR system deployments remain postponed until June 2023, and added that “VA is currently in the process of developing an updated deployment schedule” that “will be shared once approved.”