VA needs stricter oversight for EHR deployment, top Republican says

Republican lawmakers criticized the Department of Veterans Affairs’ handling of its electronic health record modernization program during a hearing on Tuesday, although one member who has expressed support for terminating the project said enhanced oversight measures are needed to get it back on track. 

VA initially signed a 10-year contract with Cerner in 2018 to modernize its legacy EHR system, but the project has been bogged down since then by cost overruns, patient safety concerns and technical issues. Oracle acquired Cerner in 2022 and pledged to right the effort, although issues with the new software’s rollout have continued. The EHR system has been deployed at just six VA medical facilities.

During Tuesday’s House Veterans’ Affairs Committee oversight hearing, Rep. Greg Murphy, R-N.C., who is a practicing physician, said Oracle Cerner “is not a system that is meant for the VA medical system” and that it “should be abandoned today.”

“Why is the VA not willing to say ‘we screwed up, we made a mistake, we picked the wrong system’ and we move on to a better system?” he asked.

VA paused additional deployments of the Oracle Cerner EHR system in April 2023 to address technical challenges plaguing the facilities where the new software had been deployed, save for the rollout of the software at the Captain James A. Lovell Federal Health Care Center in North Chicago, Illinois, in March. 

Although the so-called “program reset” remains in effect, VA Secretary Denis McDonough told lawmakers that the department plans to resume deployments of the system before the end of fiscal year 2025.

VA Undersecretary for Health Shereef Elnahal told Murphy the EHR modernization project “has not gone as it should have been.” He added, however, that VA has worked across two different presidential administrations “to try to get it right” and that the department is “now poised to be able to start deployments again.”

VA and Oracle Cerner agreed to renew their five-year base-period contract in May 2023, although the restructured agreement included additional accountability measures and changed the terms of the overall contract extension from a 5-year term to five 1-year terms.

Oracle Cerner and VA agreed to a contract extension earlier this year, which the department said emphasized “improved fiscal and performance accountability.”

Although lawmakers have expressed bipartisan concern about VA’s push to restart deployments in fiscal year 2025, they have also largely embraced the notion of stricter oversight measures as a key component of righting the modernization program. 

Rep. Matt Rosendale, R-Mont., the chair of the House Veterans' Affairs Subcommittee on Technology Modernization, acknowledged Murphy’s criticisms and said that “a change has to be made” when it comes to streamlining the modernization project.

Rosendale introduced legislation in January 2023 that would terminate the EHR modernization program two years after the bill’s enactment if VA medical facilities using the system did not show any improvement. His measure was included in a bipartisan package of veterans’ proposals that was introduced in May and also included enhanced accountability measures for the EHR project. 

During Tuesday’s hearing, however, Rosendale said he appreciated VA’s engagement with Congress “about establishing some metrics that Oracle has to abide by in order to keep this [project] moving forward.”

“And I think that we all can agree that that is the best path,” he said, adding that “we have some standards set, and then you continue your compensation.”