House lawmakers want VA's $20 billion-plus electronic health record program to improve or else

This story was updated with new information on Jan. 31

Leaders of the House Veterans Affairs Committee introduced legislation to force improvements to the VA's troubled $20 billion-plus electronic health records modernization project, or else cancel the program outright.

The bills landed days after the pilot site of the VA's Oracle Cerner system in Spokane, Wash. suffered a service interruption because of updates being made to the overall system by the Department of Defense. 

The Department of Veterans Affairs Electronic Health Record Modernization Improvement Act introduced by new committee chairman Rep. Mike Bost (R-Ill.) would mandate the Oracle Cerner electronic health records system currently in use at a handful of VA facilities hit 99.9% uptime targets for four consecutive months before new deployments may begin.

Additionally, certifications from senior hospital officials would be required before new deployments could go live. Facility directors, network directors and chiefs of staff would sign off on the completion of pre-deployment activities such as network upgrades and physical infrastructure improvements as well as on clinician training. 

Currently the Cerner system is in place in VA facilities in Spokane, Wash. and Columbus, Ohio and a few other locations, but new deployments are on pause and not scheduled to resume until June.

"I have traveled across the country and seen and heard firsthand the impact the Oracle Cerner product has had on VA providers and veterans," Bost said. "It has crippled the delivery of care, put veteran patient safety at risk, and stressed an already overwhelmed healthcare system." 

A second bill from Rep. Matt Rosendale (R-Mont.), who will chair the technology subcommittee of HVAC in the current session of Congress, provides for a path to completely scrapping the Electronic Health Records Management program if Oracle Cerner fails to improve its performance. The legislation transfers the management of the EHR modernization to the Veterans Health Administration or the Office of Information and Technology – the VA's CIO shop – and would revert back to the agency's homegrown Veterans Health Information Systems and Technology Architecture. 

Rosendale's bill, if enacted, would prohibit the VA secretary from exercising options on the $10 billion Oracle Cerner contract – it does not call for the contract to be canceled before the end of the period of performance.

"We cannot continue to further implement this inadequate system at the expense of billions of dollars in government funding," Rosendale said.

The bill is also sponsored by Rep. Cathy McMorris Rodgers (R-Wash.), who chairs the House Energy and Commerce Committee and whose district is home to the VA medical centers where the new health record software was initially deployed.

The VA contracted with Cerner on a sole-source basis in 2018 to supply the same commercial electronic health record that was being deployed by the Department of Defense to support record sharing and collaboration between DOD's medical services and VA. The program was initially budgeted at $16 billion over 10 years, with $10 billion for Cerner and the remainder for infrastructure updates and program management. 

The implementation and migration of health records were soon hobbled by software outages and technical issues, complicated further by the onset of the pandemic. Various oversight bodies have estimated that VA has more than $20 billion on the books for the program.

A July 2022 report by the VA's Office of Inspector General found that the health record software sent 11,000 clinical orders to a queue assigned for requests with incomplete routing information and failed to alert clinicians that the orders didn't reach their intended destination.

As a result, the report noted that the error "placed patients at risk for incomplete care, and caused multiple events of patient harm" to nearly 150 veterans.

VA officials postponed further rollouts until January, but Rosendale said last July that the department might be better off sticking with the legacy system. 

Cerner was acquired by Oracle for $28.3 billion in a deal that closed in June 2022.