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“From Reset to Rollout: Can the VA EHRM Program Finally Deliver?”

House Veterans Affairs Committee, Technology Modernization Subcommittee Hearing

February 24, 2025 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked):

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

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

• Mr. David Case: Acting Inspector General, U.S. Department of Veterans Affairs, Office of Inspector General

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

Keywords mentioned:

• Modernization, VA IT systems, patient safety, system outages, Oracle, VA OIG, training issues, deployment schedule, cost estimates, user satisfaction, artificial intelligence (AI)

IN THEIR WORDS

OPENING STATEMENTS FROM THE SUBCOMMITTEE

• Chairman Tom Barrett described the importance of the VA’s Electronic Health Record Modernization (EHRM) program. He voiced concerns about the program’s ongoing issues, including system outages, patient harm, budget overruns, and inefficiencies. He acknowledged that while improvements have been made, he was not convinced that all issues had been resolved. The Chairman committed to thorough oversight, ensuring that progress is made before further implementation of the system.

• Ranking Member Nikki Budzinski illustrated her concerns regarding the VA’s lack of progress in addressing recommendations from oversight bodies, stating that unresolved issues must be fixed before further rollouts. She also raised concerns about the training deficiencies in the program and the impact of recent reductions in VA staff on implementation. While she supported moving toward successful deployment, the Ranking Member called for detailed plans and improvements before proceeding.

SUMMARY OF KEY POINTS

• Dr. Neil Evans acknowledged the Subcommittee’s oversight role and affirmed the VA’s commitment to improving the EHRM program. He stated that the reset period allowed the VA to address user concerns, enhance system stability, and improve health system outcomes. While he admitted that challenges remain, he claimed that the VA is now resuming deployments while continuing to work on necessary improvements. He shared his optimism about the program’s future and committed to continue collaborating with Congress.

• Ms. Seema Verma stated that the EHRM program had reached a turning point, with recent improvements positioning it for a more successful rollout. She outlined Oracle’s investments in system optimizations, improved training, and a migration to Oracle’s cloud for better performance and cybersecurity. Ms. Verma acknowledged past challenges but argued that the system had significantly improved since Oracle’s acquisition of Cerner. She articulated Oracle’s commitment to delivering modern technology for veterans' healthcare needs.

• Mr. David Case provided an overview of the Office of Inspector General’s (OIG) extensive oversight of the EHRM program, noting significant unresolved issues. He mentioned concerns about patient safety, including deficiencies in scheduling and pharmacy operations that create risks for veterans. He also stressed the need for the VA to improve system stability and develop a reliable master schedule to track costs and deployment. Mr. Case said that transparency, careful planning, and addressing safety concerns are essential for the program’s success.

• Ms. Carol Harris listed four key challenges with the EHRM program. She criticized the VA for lacking a strategic roadmap and relying on outdated cost and schedule estimates. She underscored the need for an independent operational assessment to determine whether the system meets its intended mission. Finally, she noted that user satisfaction remained low, with a majority of respondents reporting that the system hindered their efficiency and quality of care. She claimed that addressing these concerns is essential to ensuring a successful implementation.

• Chairman Barrett questioned Ms. Harris about the reliability of the 2022 cost estimate of $32.7 billion for the VA’s EHRM program. Ms. Harris responded that Congress could not rely on that estimate, as significant program changes and resets had not been factored in, making the actual cost likely to be much higher. She pointed out that the program had already spent $12.7 billion while deploying the system to only six sites, suggesting that the total cost could be in the hundreds of billions if this trend continued.

• The Chairman then asked about the number of recommendations the Government Accountability Office (GAO) had made to the VA regarding the program. Ms. Harris stated that GAO had made a total of 18 recommendations, of which only one—related to data migration—had been implemented. When asked about incremental improvements, Ms. Harris confirmed that while the VA had made 1,500 complex system configuration changes, a significant number of critical changes remained outstanding.

• Chairman Barrett also asked if the VA had a full understanding of the system’s problems and a plan to resolve them. Ms. Harris stated that the VA did not have a comprehensive understanding and urged the department to conduct an independent verification and validation (IV&V) assessment.

• Ranking Member Budzinski focused on the impact of workforce reductions at the VA on the EHRM implementation. She asked Dr. Evans how many employees had been lost due to recent workforce cuts. Dr. Evans responded that eight employees in their probationary period had been let go and that 16 others had taken deferred resignations. He also noted that the office was operating with approximately 250 staff members out of an approved 330 positions.

• Ranking Member Budzinski then asked how confident the VA was in its ability to move forward with these staffing changes. Dr. Evans emphasized that the success of the program did not rely solely on the EHRM Integration Office but also on contributions from the Veterans Health Administration, the Office of Information Technology, and vendor partners. He maintained that the implementation remained a top priority.

• The Ranking Member asked whether the system was ready for deployment in Michigan in 2026, given past failures. Dr. Evans stated that the system had undergone significant improvements and was much different from what was initially deployed at previous sites. However, he acknowledged that continued vigilance and improvements were necessary to ensure success.

• Rep. Morgan Luttrell pressed Ms. Harris on why the VA had not conducted an IV&V test, despite it being a best practice used successfully by the Department of Defense (DoD) for its own EHR implementation. Ms. Harris reiterated that IV&V testing was critical for identifying issues in a systematic way before deployment. Rep. Luttrell turned to Dr. Evans, asking why the VA had not conducted this test. Dr. Evans responded that the VA had relied heavily on feedback from end users and internal assessments to identify and address problems but conceded that an independent review might still be beneficial.

• Rep. Luttrell questioned whether better planning at the start could have prevented the backlog of system changes and delays. Dr. Evans acknowledged that early assessments might have helped but defended the VA’s current approach as effective in identifying necessary fixes.

• Rep. Luttrell then asked whether Oracle had been aware of the problematic issues within the system when it took over the project. Ms. Verma responded that Oracle had since become more fully acquainted with the challenges. Rep. Luttrell pressed further, asking for an updated cost projection for fully implementing the EHR system across all 172 VA facilities and satellite campuses. Ms. Verma did not provide a specific figure but stated that Oracle did not agree with the independent estimate of $50 billion. She argued that there were opportunities to run the program more efficiently and that accelerating deployments could help control costs.

• Chairman Barrett asked Dr. Evans about the VA’s decision not to conduct an IV&V test. He echoed Rep. Luttrell, questioning whether a thorough IV&V assessment, conducted at the outset as GAO recommended, would have prevented many of the backlogged system changes and deployment delays. Dr. Evans responded by noting that the DoD had conducted a similar operational test after experiencing problems at its early deployment sites, rather than before going live. He again defended the VA’s approach, stating that extensive internal assessments, collaboration with Oracle, and research from the VA’s national experts had already contributed to identifying and addressing key system issues.

• The Chairman questioned Ms. Verma about her claim that accelerating deployment could help control costs. He expressed skepticism, pointing out that previous implementations had failed and required a freeze. Ms. Verma argued that the program was in a different place now than it had been in the past and pointed to the successful go-live in Chicago as evidence of progress. She acknowledged that this deployment had received significant help from the DoD, but she maintained that the VA had led the implementation and learned valuable lessons from the process.

• Chairman Barrett questioned whether it was responsible to accelerate deployment when the VA still lacked a clear schedule and a full understanding of system deficiencies. Ms. Verma insisted that Oracle had made significant improvements and that moving forward with deployments was the best course of action.

• Ranking Member Budzinski asked the witnesses what it would take to accelerate deployment successfully. Ms. Verma advocated for standardization across VA sites, arguing that excessive customization was increasing costs and complicating training.

• Ranking Member Budzinski pointed out that the VA system was inherently more complex than the DoD’s and asked whether this posed unique challenges to standardization. Ms. Verma acknowledged the challenge but reiterated that standardization was necessary to streamline the process. She also stated the importance of better training and on-the-ground support for end users. Dr. Evans added that the VA agreed with the need for a revised master schedule and life-cycle cost estimate. He reassured the Subcommittee that the VA was working on these elements in parallel with preparations for Michigan.

• Rep. Luttrell shifted the focus to the recent rollout of the 3B solution. Dr. Evans admitted that while the deployment had gone well overall, a few minor issues had been identified and fixed. Rep. Luttrell noted that Ms. Verma had previously described the rollout as a complete success and questioned the discrepancy between their statements. Dr. Evans clarified that while the implementation was largely successful, unforeseen minor issues often emerged with any major IT deployment.

• Rep. Luttrell then turned to Ms. Verma, inquiring about Oracle’s confidence in the success of the Michigan deployment and the overall program. Ms. Verma stated that she was confident but declined to provide a specific probability of success. When asked again, she maintained that Oracle had learned from past challenges and was applying those lessons to ensure future success.

• Chairman Barrett questioned Dr. Evans about the complexity of the Michigan rollout scheduled for 2026, specifically noting that Ann Arbor and Detroit are level 1 facilities. Dr. Evans responded that the James A. Lovell Federal Health Care Center in North Chicago had already implemented the system at a similar level of complexity. He expressed confidence in the leadership teams at the four Michigan sites and said that successful implementation depended on the willingness of staff to adopt and adapt to the system.

• The Chairman then asked about the incomplete "big rock" projects necessary for rollout. Dr. Evans underlined the need for standardizing user roles, explaining that the VA had initially created more than 300 different roles in the system, making training and maintenance cumbersome. Efforts were underway to consolidate those roles, with reductions already completed for certain provider categories and ongoing work for nursing roles.

• Chairman Barrett turned back to Ms. Verma, asking whether the system was ready to go live in Michigan immediately. Ms. Verma responded that while the system could be deployed anywhere, optimizations were still being made to ensure smoother adoption. The Chairman viewed her response as unsatisfactory.

• Ranking Member Budzinski pivoted to the feasibility of an accelerated deployment plan by 2028 or 2029. She asked whether such a timeline was realistic. Mr. Case claimed that the VA needed to produce a detailed master schedule outlining how it intended to meet deployment targets, identify risks, and determine the necessary steps to completion. He also pointed to the need for a productivity impact analysis, noting that no rigorous assessment had been conducted on how the system affected operational efficiency at deployed sites.

• The Ranking Member asked if improved training could mitigate productivity losses, and Mr. Case agreed but noted that the VA’s early training efforts had been inadequate. While the VA had made improvements, he stressed that the effectiveness of training for the new system had yet to be fully assessed. Ms. Harris added that training should be fully controlled by the VA rather than outsourced to Oracle. She also warned that even if Michigan deployed in 2026, there were only two years left on the Oracle contract, making it impossible to implement the system at 160 remaining sites by May 2028. When asked directly if this goal was achievable, Ms. Harris, Dr. Evans, and Mr. Case all responded that it was not. Ms. Verma initially hesitated but ultimately acknowledged that while the technology could support the timeline, operational and logistical challenges made it unrealistic.

• Rep. Luttrell focused on defining the metrics for success in Michigan. He asked Dr. Evans to clarify the standards that must be met before moving to additional facilities. Dr. Evans responded that the VA had identified nine core metrics to measure success, most of which had established performance thresholds. He insisted that Michigan’s deployment would be rigorously evaluated, with continuous monthly oversight from the Subcommittee, but Rep. Luttrell cautioned against repeating past mistakes by advancing before ensuring full system readiness.

• Chairman Barrett asked Ms. Harris to clarify the number of sites expected to be operational under the new system by 2026. She confirmed that only 10 sites would have implemented the system, leaving 160 remaining. The Chairman then asked Ms. Verma whether Oracle believed it could complete all 160 sites by May 2028. Ms. Verma avoided a direct yes-or-no answer, stating that multiple variables—technology, training, and internal VA processes—needed to align. Dr. Evans and Mr. Case definitively said that completing the deployment by 2028 was not possible.

• The Chairman then posed the question of what would happen if the Michigan rollout failed. He asked Dr. Evans whether the VA would go into another system pause or continue accelerating deployment. Dr. Evans did not give a direct answer, stating only that success in Michigan was a necessity and that failure would lead to "very hard discussions" with the Subcommittee. Chairman Barrett pointed out that the VA had also "needed" to succeed in previous rollouts, yet failures had still occurred. Dr. Evans responded by claiming that Michigan’s VA staff were enthusiastic about the system and believed in the benefits of a unified EHR.

• Ranking Member Budzinski shifted the discussion to AI’s role in the EHR system. She asked Ms. Verma to explain how AI would be used in the VA’s EHR rollout. Ms. Verma described AI as a supportive tool for clinicians, capable of generating patient summaries, identifying care gaps, and assisting in administrative tasks like scheduling and reimbursement processing. She assured the Subcommittee that AI would not replace human decision-making and that physicians would retain full control.

• The Ranking Member asked whether AI-driven features were included in the current contract or if additional costs would be required. Ms. Verma responded that some AI capabilities were included, while Oracle had also committed to providing an upgraded AI-powered EHR to the VA at no additional cost. When asked about AI’s impact on patient safety, Ms. Verma said that all AI recommendations would include clear sourcing of data and that any AI-generated documentation would require patient consent.

• Rep. Luttrell then raised concerns about the security of veterans’ health data. He asked Dr. Evans whether all VA data was being moved to the Oracle Cloud and whether it remained under VA control. Dr. Evans confirmed that data was being migrated and that it remained VA property. Rep. Luttrell asked Ms. Verma whether any other Oracle clients could access the VA’s data. Ms. Verma assured him that the VA's data was completely standalone and inaccessible to other organizations.

• Chairman Barrett revisited the cost issue, asking Dr. Evans whether all previously deployed sites had fully recovered and were functioning at pre-deployment productivity levels. Dr. Evans admitted that productivity recovery varied by specialty, with emergency and urgent care recovering quickly, while primary care remained more challenging. He stated that productivity across all facilities was above 85% of pre-go-live levels.

• Ranking Member Budzinski stressed that while she appreciated the VA’s commitment to an integrated master schedule, she was concerned about pressure to accelerate deployment for the sake of meeting contractual deadlines rather than ensuring a successful implementation. She reiterated that veteran healthcare must be the priority.

• Chairman Barrett concluded the hearing by claiming that the Michigan rollout would be a critical test of whether the system had fundamentally improved. He warned that the Subcommittee expected clear evidence of progress before more veterans and VA staff were forced to adapt to a system that had yet to prove its viability.

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