There’s been an uptick in conversations with senators on Capitol Hill centered on the stalled, problematic and costly Veterans Affairs electronic health records modernization project this past week.
According to Seema Verma, Oracle Health and Oracle Life Sciences executive vice president, a national standard for change management along with advanced testing automation, web-based and virtual tools and the company’s partners could push the project at scale to the finish line in a “timely manner.”
Meanwhile, the Government Accountability Office added three new recommendations for cost estimating, schedule and system metrics, bringing its total recommendations to improve the beleaguered electronic health records modernization project to 18. To date, the VA has implemented one of the recommendations since the office began investigating the system in 2020, the GAO said in a new draft report released Feb. 21.
Also, the Trump administration’s nominee for VA deputy secretary, Paul Lawrence, a former under-secretary of the Veterans Budget Administration, told the Senate Committee on Veterans Affairs at his Feb. 19 nomination hearing that he would “foot stomp urgency” on the drawn-out project.
GAO details critical changes needed
In its new report, the GAO said the VA have made progress on EHR modernization, but more is needed. The office maintains that the VA still needs to address more than 1,800 requested configuration changes, update the cost estimate, and schedule “to reflect the pause and work that remains” and address continued user dissatisfaction with the new system.
“We have multiple recommendations that VA still needs to implement to improve its [EHR] system,” the report said.
“GAO’s preliminary results show that VA is making incremental improvements,” such as more than 1,500 system configuration changes and “initiating projects to address user challenges.”
The office added that as of this February, “VA had not addressed approximately 1,800 complex configuration change requests,” and reiterated concerns about the overall cost and lack of clarity on the total amount at present.
“Existing EHRM life cycle cost estimates range from VA’s $16.1 billion to an independent estimate of $49.8 billion,” GAO said.
“Updating the independent life cycle cost estimate is imperative to understanding the full magnitude of VA’s investment,” the office said in a statement Monday.
However, trouble ticket resolution timeliness thresholds were met since the implementation of financial consequences in September 2023, GAO said.
Many “but not all” patient safety and pharmacy enhancement issues were closed and should be before future deployments, according to the office.
Prior to this new report, GAO issued four reports on the VA’s EHR modernization program from June 2020 to May 2023, which offered 15 total recommendations.
Tackling the VA’s ‘Big Rocks’
On Monday, Dr. Neil Evans, acting program executive director for the VA’s EHRM Integration Office, assured lawmakers that throughout the project’s reset period, improvements to the system were made.
The agency “took steps to understand the issues, updated our contracts to better hold Oracle Health accountable, made hundreds of improvements to the system and instituted a simpler and more effective process to address concerns when they arise,” Evans said in his testimony.
A series of complex projects to improve the VA’s EHR – “referred to as ‘Big Rocks’ – are in motion,” said Evans.
They include standardizing user roles, improving new EHR user training for new users, and addressing coordination between clinicians and pharmacists, he said.
In her testimony, Verma provided the senators with plans to rapidly scale system deployment to the remaining 164 VA healthcare facilities.
During the reset, Oracle completed more than 3,000 functional changes to the formerly Cerner EHR that improved its stability, added enhancements and simplified functions, Verma said in her testimony to the Subcommittee on Technology Modernization.
However, “Maintaining the current pace will take decades, which is not acceptable to anyone, and which is why we recommend the path of acceleration,” Verma told lawmakers ahead of laying out seven key initiatives for completing the VA’s EHR modernization program.
In addition to developing a standard for a robust change management process across all users of the VA EHR, Oracle Health is investing in a series of automated implementations, which Verma said would shorten the testing phase by reducing manual testing efforts, user onboarding and training.
“Automation ensures that each deployment is thoroughly tested in less time, enabling us to support a higher volume of simultaneous deployments without compromising quality,” she said.
The EHR vendor also recommends using a “web-based tool to collect site-specific data more efficiently,” Verma said.
For the “Big Rocks” projects, Oracle’s efforts focused on pharmacy, referrals, Quick Orders, and other aspects of the EHR.
“We have greatly enhanced the process and procedures used for patient safety,” Verma said.
“Notably, an important part of the planned pharmacy improvements, known as ‘pharmacy 3b,’ is scheduled for release this month as part of a bi-annual software code update,” Evans also told the subcommittee.
According to GAO’s new report, the agency delivered six of seven pharmacy enhancements identified by pharmacists and providers. In June 2024, VA said the remaining pharmacy enhancement for synchronization between the pharmacists’ module and the healthcare team’s pharmacy module would be delivered with the planned February 2025 system update.
Also of significance, Evans noted, is the development of a tool called the Federal EHR system baseline, which provides data on more than 2,300 functional and technology components that are used to better standardize the VA’s healthcare delivery and is expected to increase efficiencies and prevent future user delays.
“Using the baseline to better conform to national VA standards in advance of go-live will help avoid staff frustration, deployment delays and increased cost,” he told the subcommittee.
Interviewing the EHR’s next ‘COO’
In a prepared statement to the Senate Committee on Veterans Affairs at a Feb. 19 hearing on his pending nomination for VA deputy secretary, Lawrence pledged to work with lawmakers to “get VA’s [EHR] modernization effort back on track.”
If confirmed, Lawrence would effectively be the chief operating officer of the VA’s EHR implementation.
Sen. Thom Tillis, R-North Carolina, asked what he would do about the agency’s past mistakes.
Lawrence answered that he would “foot stomp urgency” and noted that driving accountability with measurement helped him in his past role as the under-secretary for benefits leading the Veterans Benefits Administration.
Sen. Patty Murray, D-Washington, said that because the VA announced in December that it would resume planned EHR deployments in mid-2026, she wanted to know what Lawrence would do differently to hold Oracle accountable.
“I need your commitment that it’s not just ‘convene people’ and take a look at it, that they are going to make changes to it and demand changes and get those fixed,” because the system continues to jeopardize veterans’ care and frustrate VA clinicians, she said.
Lawrence responded that the difference he brings is he implemented effective technology improvements in his previous role at the VBA. He then pledged to get the VA’s EHR “done.”
Sen. Jim Banks, R-Indiana, asked Lawrence why he thought the EHR project had gone “so off the rails.”
“There are too many unanswered questions,” Lawrence said, which he said that he intends to ask, if confirmed.
Tillis asked Lawrence if he could report on the EHR implementation within 90 days and outline “what practices got us into the ditch” that has to be stopped, what actions need to be taken and what is going well.
Lawrence said he would commit to such a review, as it was something the new VA Secretary Doug Collins has prioritized, but added he could not commit to the timeframe.
“Anybody worth their salt can figure out what’s wrong with a project within 90 days,” Tillis said.
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.