House passes veterans’ package without EHR accountability measures

House lawmakers overwhelmingly passed a legislative package on Monday to enhance a range of services for veterans, but the measure noticeably did not include provisions that would have pushed the Department of Veterans Affairs to enhance oversight of its electronic health record modernization initiative.

The bill, known as the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, was rolled out with the backing of the bipartisan leaders of the House and Senate Veterans’ Affairs committees. The proposal cleared the House in a 389-9 vote. 

When first introduced in May by Rep. Juan Ciscomani, R-Ariz., the package included an entire section focused on proposals designed to improve VA’s beleaguered rollout of its new Oracle Cerner EHR system. 

VA has struggled to deploy the modernized software at its medical facilities since it signed a contract with Cerner in 2018 to replace its legacy health record system, with the new EHR beset by technical glitches, cost overruns and patient safety concerns. Oracle subsequently acquired Cerner in 2022, although challenges with the software’s rollout have continued. The new EHR system has been deployed at just six VA medical centers out of 172 facilities.

The department announced in April 2023 that it was pausing additional deployments of the Oracle Cerner EHR — with the exception of a joint VA-Department of Defense facility rollout in March — to remediate issues at the centers using the new software. VA officials have said that they are planning to restart rollouts of the software at VA facilities during fiscal year 2025.

The section removed from the legislation included many of the provisions from the EHR Program RESET Act. The measure was introduced in March 2023 by Sen. Jon Tester, D-Mont., chairman of the Senate Veterans’ Affairs Committee, and subsequently introduced by the leaders of the House Veterans’ Affairs Committee the following month. 

The excluded proposals would have, in part, required the VA secretary to submit data to Congress showing that facilities currently using the Oracle Cerner system have “met or exceeded” their pre-deployment operational levels before additional rollouts of the new software can occur.

VA would also have been required to provide lawmakers with additional metrics in required quarterly reports detailing data “on user adoption and employee satisfaction” with the Oracle Cerner system, as well as “data on employee retention and turnover at medical facilities where such electronic health record system is in use.”

A spokesperson for the House Veterans’ Affairs Committee said the EHR section was removed from the package during bipartisan negotiations “due to a lack of political viability in both the House and Senate,” although they added that it remains a high-priority issue for the panel. 

During floor remarks ahead of the bill’s passage, Rep. Mark Takano, D-Calif. — ranking member of the House committee — said the stripped measures “would have installed much-needed guardrails” on the department’s EHR rollout.

“It is no secret that the Oracle-driven modernization effort has struggled at VA,” he said, adding that “the EHR Program RESET Act would have required minimum operational criteria to be met before Oracle could be deployed to any further facilities, which would have prevented many of the current problems.”

Rep. Matt Rosendale, R-Mont., who chairs the House Veterans' Affairs Subcommittee on Technology Modernization, was one of the nine lawmakers who voted against the bill’s passage. 

Rosendale — a vocal critic of VA’s management of the EHR deployment — previously introduced a measure that would terminate the modernization effort if quantifiable improvements to the system’s rollout were not made within two years. Although his bill was included in an earlier version of the package, his proposal was also stripped from the legislation that passed the House.

In a statement, Rosendale said his opposition to the overall legislative package was due, in part, to the fact that the measure “ignored years of bipartisan work focused on requiring Oracle Cerner to fix its EHR system, that has resulted in veteran deaths, before it could be expanded to new VA medical centers and the company can continue to collect on its multibillion-dollar contract.”

Both lawmakers placed the blame for the removal of the EHR-related provisions on Oracle.

Takano said it was not surprising the EHR Program RESET Act provisions were removed from the package “given the army of lobbyists that Oracle unleashed to kill it.” Rosendale similarly torched the company, alleging that “Oracle Cerner bought and bullied their way into getting this bill passed without their company being scrutinized.”

A representative for Oracle did not respond to a request for comment before publication. 

Although the legislative package that passed the House did not include the proposed EHR modernization measures, lawmakers approved a host of provisions that would expand healthcare services and benefits for veterans. 

Among these was an extension of a popular tech training program — the Veteran Employment Through Technology Education Courses program, or VET-TEC — which expired in April. The program provided veterans with financial support to attend high-tech education training courses from approved providers without having to use their GI Bill benefits.