⚡NIMITZ NEWS FLASH⚡

“Ready, Set, Go-Live: Assessing VA’s EHR Modernization Deployment Readiness”

House Veterans Affairs Technology Modernization Subcommittee Hearing

December 15, 2025 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked):

• Dr. Neil Evans: Acting Program Executive Director, Electronic Health Record Modernization Integration Office, U.S. Department of Veterans Affairs

• The Honorable Seema Verma: Executive Vice President, Oracle Health and Oracle Life Sciences, Oracle Corporation

• Ms. Carol Harris: Director, Information Technology and Cybersecurity, U.S. Government Accountability Office

Keywords mentioned:

• EHR, VA, IT Issues, Veteran Healthcare, readiness, system testing, system stability, VISN, accountability, deployment

IN THEIR WORDS

OPENING STATEMENTS

• Chairman Tom Barrett framed the hearing as oversight of the VA’s Electronic Health Record Modernization (EHRM) program, noting the upcoming April go-live in Michigan in roughly 117 days. He emphasized that veterans should not need to care which system the VA uses, but should be able to schedule appointments and receive safe, timely care without technology becoming a barrier. He cited progress since the prior pause, such as workflow standardization and August updates without disrupting care, while warning that major untested tools and new workflows, plus a four-site simultaneous test strategy, created risk with little margin for error. He also stressed that costs had ballooned from an initial $10 billion estimate to about $37 billion and said Congress needed proof, transparency, and a “flawless” go-live to avoid repeating past failures.

• Ranking Member Nikki Budzinski said she expected a progress update on the VA’s readiness to resume go-lives, but opened by criticizing reports that VA leadership planned to eliminate 35,000 physician positions without direct communication to Congress. She argued that staffing reductions would worsen appointment delays, undermine the VA’s specialized care capacity, and potentially jeopardize the EHRM's success as the program accelerated toward Michigan and subsequent sites in her region. She said unresolved GAO and OIG recommendations and persistent problems at the first six live sites—such as prescription errors and faulty alerts—left her unconvinced the VA was ready for a broad 2026 rollout. She also questioned the Accenture contract’s role and authority as a “systems integrator,” raised concerns about shifting lifecycle cost estimates, and urged accountability from both the VA and Oracle rather than finger-pointing between administrations.

SUMMARY OF KEY POINTS

• Dr. Neil Evans testified that the VA remained committed to implementing a modern, interoperable “federal EHR” across the enterprise and described substantial progress since the February hearing. He said the VA planned 13 deployments in 2026, spanning over 100 locations and transitioning more than 27,000 employees from VistA, with additional facilities preparing for 2027 and an enterprise completion schedule as early as 2031 using a market-based deployment approach. He stated that leadership attention from Secretary Collins and Deputy Secretary Lawrence had intensified and that site-level engagement was driving momentum as the Michigan go-live approached. He reported that incident-free time exceeded the 95% threshold for 21 consecutive months, highlighted planned pharmacy improvements and a “seamless exchange” feature that reduced manual external data review by more than 95%, and said user-experience surveys had shown consistent improvement.

• Ms. Seema Verma said Oracle was confident it was prepared and aligned with the VA to meet an accelerated deployment schedule targeting full implementation by 2031, with 13 sites going live in 2026 and additional facilities planned for 2027. She asserted system stability had improved, pointing to meeting the 95% incident-free requirement for 21 straight months and avoiding systemwide outages for eight consecutive months through tighter joint incident review and targeted upgrades. She claimed optimizations had improved productivity and that cash collections exceeded FY25 goals, reaching 180% of target, and she highlighted “seamless exchange” as reducing manual review through de-duplication of patient data. She also described expanded training and change-management efforts, planned migration to Oracle Cloud, and future capabilities such as a clinical AI agent, a voice-first ambulatory EHR, and enhanced interoperability, including Oracle’s designation as a Qualified Health Information Network (QHIN).

• Ms. Carol Harris reported that the VA began the EHRM program in 2017 to replace VistA and had deployed the new system to six medical centers at a cost of about $12.7 billion, but user dissatisfaction and operational challenges led the VA to pause deployments in April 2023. She said the VA planned to resume with four Michigan sites in April and then accelerate additional deployments through 2031, and she summarized GAO’s five reports identifying oversight gaps and deployment challenges. She stated GAO had issued 18 recommendations, 12 designated as priority, but the VA had not fully implemented 16, including key items such as updated cost estimates and an integrated master schedule, and she said GAO had not yet received the VA’s newer $37 billion estimate for review. She also warned that the VA had not sufficiently demonstrated that change-management and user-satisfaction improvements resolved underlying barriers and noted the absence of plans for an independent operational assessment or IV&V testing, which she said increased the risk of premature deployment and potential patient safety harms.

• Chairman Barrett asked whether the VA could provide the GAO the department’s lifecycle cost analysis, and Dr. Evans said they had provided it to the committee on September 30 and could furnish it to the GAO.

• Chairman Barrett then relayed mixed, skeptical feedback he had heard from staff at the Battle Creek VA and Lansing clinic about readiness and asked whether end users would be prepared at go-live. Dr. Evans said VA was confident, citing completion of Michigan “super user” training (over 400 participants), a 96% completion rate, roughly 4/5 course ratings, and added “learning labs” that let users practice in a sandbox, with general user training starting February 1 and labs in March.

• Chairman Barrett then pressed on whether simultaneous four-site testing was tied to independent verification and validation. Ms. Harris said the four-site, market-based strategy made end-to-end IV&V harder and increased risk because managing inevitable go-live issues across four sites would require tremendous resources with little margin for error.

• Ranking Member Budzinski pressed on whether the VA had enough manpower to execute accelerated deployments, asking how many program office positions were open and whether VA would fill them. Dr. Evans said there were just over 100 vacancies, largely due to an expanded org chart, and said the VA was actively hiring.

• Ranking Member Budzinski asked how the VA could support four simultaneous go-lives. Dr. Evans said hiring was also underway at go-live sites (510 positions in recruitment, with 163 already onboard) and that VA would be supported by contractors (Oracle, Booz Allen, and Accenture Federal Services), while maintaining the VA’s current staffing was sufficient for the April Michigan go-live.

• Ranking Member Budzinski then asked how Oracle would ensure surge contractors understood the VA’s unique mission and culture. Ms. Verma said Oracle handled large-scale implementations globally, was adding staff, and required internal training plus federal certifications and security training before deployment.

• Ranking Member Budzinski raised concerns about reported plans to eliminate 35,000 VHA positions and asked how that would affect EHRM. Dr. Evans said it would not, reiterating hiring plans at go-live sites.

• Finally, Ranking Member Budzinski asked the VA to define its “life cycle” estimate and whether it included detail. Dr. Evans said VA had provided a “program cost estimate” through 2031 (deployment plus sustainment/operations), broken into four categories: implementation, site/system operations, infrastructure, and office operations.

• Rep. Luttrell asked what sustainment would cost once EHR was deployed across all sites and pressed for an annual post-2031 figure. Dr. Evans initially referenced an operations estimate of about $2.1 billion in the final year but then clarified he did not have a definitive annual sustainment number and said future funding discussions would also consider savings from retiring legacy systems.

• Rep. Luttrell then asked what the contingency plan was if the four Michigan sites failed and whether deployments would stop. Ms. Verma said Oracle was focused on success, described “elbow-to-elbow” support and war rooms to triage issues, and said a decision on whether to proceed after a failure would be made with VA, noting they had not planned around a “total failure” scenario.

• Rep. Luttrell then asked how sites were selected and whether regional connectivity drove sequencing. Dr. Evans said the VA prioritized sites with the highest readiness and prior investment (including infrastructure upgrades) and adopted a market-based approach so interdependent facilities in a region shared the same EHR.

• Chairman Barrett pressed to justify the GAO’s concern about doing four go-lives simultaneously and asked what Oracle could do to convince him and GAO that the approach was risk-managed rather than deadline-driven. Ms. Verma said Oracle supported robust testing, argued the system had already been live at six sites and repeatedly tested through ongoing optimization projects with the VA, and claimed bringing in an independent IV&V vendor would add cost without adding meaningful new value.

• Chairman Barrett then challenged that simultaneous go-lives inherently raised risk because sites were not “cookie-cutter” and issues discovered late could cascade across all four. Ms. Verma responded that it was primarily a scale problem that Oracle could address with adequate staffing, elbow-to-elbow support, and war rooms both before and during go-live, and she said Oracle had been on the ground assessing each site and planning for its differences.

• Chairman Barrett asked whether Oracle’s commitments satisfied the GAO’s concerns, and Ms. Harris said the initial deployments showed ticket-resolution struggles and that four simultaneous sites would demand tremendous, potentially unsustainable resources to meet contractual obligations.

• Chairman Barrett asked who requested the simultaneous strategy, and Dr. Evans said the VA did, adding that standardizing workflows into a single federal EHR baseline reduced variation and should make testing easier at scale.

• Ranking Member Budzinski asked to move beyond North Chicago and describe how the other live sites were performing and what the VA was seeing on readiness and operations. Dr. Evans said the VA tracked multiple metrics across Spokane, Walla Walla, Roseburg, White City, and Columbus, and he cited improved revenue capture and productivity, including Roseburg exceeding its 2019 pre-pandemic productivity baseline.

• Dr. Evans said the VA held daily problem-management forums with site representatives, reduced the ticket backlog for significant change requests by more than 40%, and enabled daily escalation at a 10 a.m. meeting, which he said reflected improved operations.

• Ranking Member Budzinski asked how the VA measured productivity, and Dr. Evans said they used RVUs, an industry-standard metric, tracking RVUs per provider based on documented encounters.

• Ranking Member Budzinski then asked which open GAO recommendations were most concerning, and Ms. Harris said change management and training remained major gaps, noting vendor-led training at early sites had not prepared users for specific roles and workflows and urging the VA to take leadership on training.

• Ranking Member Budzinski asked for the plan and timeline to close open OIG recommendations and challenged him on whether the GAO items were nearing closure. Dr. Evans said the VA took the recommendations seriously and claimed substantial progress on about eight of the remaining GAO recommendations, with GAO keeping some open to validate effectiveness after Michigan.

• Ms. Harris agreed the VA had taken actions but emphasized that most priority recommendations remained open and that GAO needed to see evidence, likely in Michigan, that corrective steps were effective.

• Rep. Luttrell cited reported user complaints at the six live sites, including slow performance, excessive clicks, cumbersome documentation, workarounds, burnout, and staffing strain, noted user-experience survey improvement from roughly 7% (2022) to 33% (2025) while the VA planned to add four Michigan sites and then 26 more in 2027.

• Rep. Luttrell asked what scaling this “heavy weight” rollout would realistically look like if the system still worked well for only a minority of users. Dr. Evans said the reset period produced over 1,500 functional changes driven by end-user feedback—averaging more than 50 per week—plus additional platform “block” upgrades from Oracle, and he argued these changes had materially improved the user experience and that survey scores were rising as the VA addressed requests in a standardized national way with better communication, training, and support.

• Rep. Luttrell then asked whether Michigan would inherit all lessons learned so it would not repeat earlier problems, and Dr. Evans said the improvements and lessons from the six sites, DoD experience, Oracle, and commercial best practices were being delivered to Michigan.

• Chairman Barrett asked who ultimately owned change management, and Dr. Evans said the VA was responsible because it was the VA’s healthcare system and the VA’s project.

• Dr. Evans described a revamped VA-led change management strategy, including a market-by-market “Change Leadership Team” executive onboarding event where VA leaders spoke peer-to-peer to staff about what the change would feel like and why a single record would improve care continuity for veterans across locations; he said clinicians were more willing to adopt when they understood the “why” and were supported, while contractors helped execute the work.

• Chairman Barrett then asked whether the user-experience survey was methodologically sound or skewed toward negativity, and Dr. Evans said participation averaged about 20%, the questions were standardized across many health systems and comparable with DoD, and the survey was anonymous to encourage honesty.

• Chairman Barrett then asked how Oracle was addressing VA’s unique pharmacy needs and drug-interaction safety, and Ms. Verma said Oracle was adapting an off-the-shelf solution to VA-specific requirements, cited safety-related improvements (including around opioid prescribing) and better pharmacy–provider communication when drugs were unavailable, acknowledged pharmacy remained a continued focus requiring training and leadership attention, and said Oracle leadership had visited sites to examine pharmacy workflows firsthand.

• Ranking Member Budzinski challenged on Oracle’s public push to build a new EHR and her past characterization of Cerner as “crumbling infrastructure,” asking whether that same product was being deployed at the VA. Ms. Verma said the VA was using the Cerner-based system but argued Oracle was improving it through optimization projects and layering AI agents “on top” to improve the provider experience. She said frequent, structured engagement with VA leadership, including regular meetings and site visits, fed lessons learned into ongoing optimization and capability block updates that were improving sentiment.

• Ranking Member Budzinski asked whether all this would drive additional cost, and Ms. Verma said she had not reviewed the newest estimates but said standardization would make costs more predictable, the pause increased costs by forcing the VA to maintain two systems, and Oracle was migrating the federal EHR to Oracle Cloud at Oracle’s expense to improve security and performance.

• Ranking Member Budzinski then asked whether AI capabilities were included in the VA’s contract or would cost extra. Ms. Verma said it depended on the specific AI agent, with some included and some additional options the VA would decide on, while Oracle was not charging the VA for the new ambulatory system itself.

• Ranking Member Budzinski asked about concerns with the $37 billion figure, and Ms. Harris said the GAO had not received the $37 billion estimate to scrub and would compare it against an earlier independent lifecycle estimate of roughly $49.8B, while noting that the older figure was also outdated due to delays and the pause.

• Ranking Member Budzinski also asked whether the VA veteran data was being used to train Oracle’s commercial AI, and Ms. Verma said it was not and that Oracle had no data rights for that purpose.

• Ranking Member Budzinski then asked what an independent operational assessment should entail, and Ms. Harris urged an independent third-party IV&V after the four Michigan go-lives to catalog defects systematically, citing DoD’s MHS GENESIS experience as evidence IV&V supported successful deployment.

• Rep. Luttrell argued the VA appeared to be buying only a “baseline” EHR and then facing add-on purchases for AI and other features, likening it to in-app upgrades, and he criticized VA’s current situation of paying for a patchwork of software across sites while most facilities remained on VistA.

• Rep. Luttrell asked whether, once Oracle’s EHR was live everywhere, the VA could tell other software vendors they were not needed anymore, and Ms. Verma said she expected the standardized Oracle EHR to meet needs across hospitals and clinics, though she did not claim to know every site’s specific software inventory.

• Rep. Luttrell then pressed the math problem of avoiding double-paying for VistA-era tools on top of Oracle, and asked how the VA would manage that. Dr. Evans said the federal EHR would be the common operating system, but not all hospitals offered the same clinical services, so some specialized tools would still be needed (he cited radiation oncology as an example). He said the VA was publishing a supported-software list tied to the federal EHR baseline, which would also define what the VA would not support, and he emphasized cost control through standardizing interfaces and peripherals.

• Ranking Member Budzinski closed by saying she supported giving veterans and VA employees modern tools, but argued the EHR must actually work for the VA’s mission and workflows, and she did not believe the program was there yet. She said she left the hearing unconvinced that the next round of go-lives would improve meaningfully, despite claims of increased leadership attention and momentum. She warned that the administration appeared to be pushing the program faster rather than better, while the GAO, IG, and Congressional recommendations remained unaddressed. She urged VA leadership to put veterans first to avoid risking patient safety.

• Chairman Barrett finished by saying he had shifted from optimism to realism and argued the committee needed an honest assessment of readiness given past performance. He said skepticism was appropriate and warned he would not accept post–go-live finger-pointing among the VA and vendors if problems emerged. He emphasized a “no-fail” mindset for the Michigan go-live in 117 days, noting VA facilities were already adjusting scheduling around that week. He acknowledged progress but reiterated concerns about simultaneous testing and unresolved questions, stressing the committee sought accountability as a partner, not an antagonist.

SPECIAL TOPICS

JOIN THE NIMITZ NETWORK!

Enjoying our updates? Don’t keep it to yourself — forward this email to friends or colleagues who’d love to stay informed. They can subscribe here to become part of our growing community.