Top Republican to 'seriously consider pulling the plug' on VA's new EHR system

The top Republican on the House Veterans’ Affairs Committee on Wednesday expressed an openness to scrapping the Veterans Affairs Department’s multi-billion dollar Oracle-Cerner Millennium electronic health record system, if serious deficiencies in the rollout of the new software are not addressed by the end of the year. 

Rep. Mike Bost, R-Ill., ranking member of the full committee, said that Congress “has to set a deadline” for the EHR system rollout, and if there isn’t major progress by early next year, “we will have to seriously consider pulling the plug.” Bost added that he "will be writing legislation to do just that."

Bost’s comments came during a House Veterans’ Affairs subcommittee hearing examining patient safety concerns that have been raised during the initial rollouts of the new EHR system at VA medical centers across the country. Members of the Senate Veterans’ Affairs Committee also grilled VA officials last week about delays and technical issues with the rollout of the new software.  

Samantha Gonzalez, a spokeswoman for Bost, said after the hearing that the ranking member intends to introduce a bill before the end of the year.

“The bill is in the drafting stage and the final product will depend on the initial progress, if any, that VA and Cerner make over the next few months addressing the serious problems at the initial rollout sites,” Gonzalez told Nextgov. “At this point, the Ranking Member is considering all legislative options, including reorienting or completely halting the project.”

The VA signed a $10 billion contract with Cerner in 2018 to implement the new EHR system over a 10-year period, to replace its prior customized health information system, the Veterans Health Information Systems and Technology Architecture, or VistA. The new EHR software is currently in use at five VA medical sites, but software outages, logistical delays and technical issues have hampered the rollout. 

Earlier this month, the VA Inspector General’s office also issued a highly critical watchdog report, which found that the software implemented at the first site of EHR system rollout—the Mann-Grandstaff VA Medical Center in Spokane, Washington—improperly routed more than 11,000 clinical orders for veterans to an “unknown queue” without the knowledge of clinicians. That glitch, according to the OIG report, resulted in direct harm to at least 149 veterans.

In addition to concerns about patient care, cost overruns have also raised additional questions about the deployment of the Oracle-Cerner EHR system. The cost of the software’s implementation has already grown to $16 billion over the course of the 10-year contract, and a new cost estimate provided to Congress by the Institute for Defense Analyses found that the EHR software’s implementation and maintenance expenses would be $50.8 billion over 28 years. 

VA announced last week that it would be postponing future rollouts of the Oracle-Cerner software at new medical sites until January 2023 as it works to address concerns about the EHR system’s deployment.

Bost said the EHR system “as it exists now is already a bad investment at $16 billion,” noting that the Oracle-Cerner effort “is already 10 times more expensive” than the VA’s previously abandoned effort to modernize VistA. 

Rep. Matt Rosendale, R-Mont., ranking member of the House Veterans’ Affairs Subcommittee on Technology Modernization, echoed Bost’s sentiment and said that the legacy VistA system “still works and is much less expensive than any of the alternatives.”

“I’m not hearing a credible argument for continuing this effort other than bureaucratic inertia and profit,” Rosendale said, adding that “the responsible thing to do is to stop throwing money at Oracle-Cerner and make targeted investments to shore up VistA.”

Mike Sicilia, executive vice president for industries at Oracle, told the committee that addressing issues with the EHR system was the company’s top priority. He said that Oracle, which acquired Cerner seven weeks ago, has set up a dedicated ‘war room’ of its senior engineers to make needed improvements to the software. 

“After reviewing all of the engineering issues, I have concluded that there is nothing here that can’t be materially improved in reasonably short order,” Sicilia said.

Democratic leaders on the committee, meanwhile, seemed to agree that VA’s health system is in need of modernization, but they also expressed serious concerns about the ways in which both VA and Oracle-Cerner have addressed—and been transparent about—deficiencies within the EHR software rollout. 

Committee Chairman Mark Takano, D-Calif., said that “VA needs a modernized EHR system” and that continuing with VistA is “not sustainable in the long-term,” but added that he “will not sit idly by and allow this program to endanger veterans.”