Top senator says modernizing VA’s EHR 'is not optional'

The Democratic chair of the Senate Veterans’ Affairs Committee signaled his support for VA to continue moving forward with its multi-billion dollar electronic health record modernization program, even as leading House Republicans have introduced legislation that would terminate the new system’s rollout unless significant changes are made to improve its deployment. 

Sen. Jon Tester, D-Mont., indicated that technical and performance issues with the Oracle Cerner EHR system’s rollout do not undercut the fact that VA’s legacy health information system—known as the Veterans Health Information Systems and Technology Architecture, or VistA—needs to be updated. 

“Make no mistake, modernization of the electronic health record is not optional—one way or another, it has to be done,” Tester said in an emailed statement to Nextgov. “And I will keep demanding results on behalf of every veteran and dedicated VA medical professional until we get this right.”

Tester’s comments came after Rep. Matt Rosendale, R-Mont.—chairman of the House Veterans’ Affairs Subcommittee on Technology Modernization—introduced legislation on Jan. 27 that “would end the Oracle Cerner electronic health record program at VA if it cannot demonstrate significant improvement but is nonetheless introduced to additional medical centers.” The bill would also revert all of the medical facilities currently using the EHR system back to VistA. Rosendale’s bill was co-sponsored by Rep. Mike Bost, R-Ill., the chairman of the House Veterans’ Affairs Committee.

Bost, along with nine Republican co-sponsors—including Rosendale—also introduced legislation on Jan. 27 that would block VA from deploying the EHR system at any additional medical facilities until the software meets certain performance and facility readiness standards. 

Rep. Mark Takano, D-Calif., the ranking member of the House Veterans’ Affairs Committee, previously voiced his opposition to Rosendale’s bill that would terminate the program, saying he did not agree “with completely canceling the EHR program without a viable solution to replace it.” 

The rollout of VA’s Oracle Cerner EHR system—which is designed to be interoperable with the Defense Department’s Cerner-developed EHR system—has received bipartisan criticism since the system was first deployed in 2020 at the Mann-Grandstaff VA Medical Center in Spokane, Washington. Cost concerns, system outages, patient safety issues and performance and training challenges have limited the system’s deployment to just five sites across the VA’s national network of 171 medical centers. These concerns were magnified by a July 2022 report from VA's Office of Inspector General, which found that the EHR system deployed at Mann-Grandstaff directed over 11,000 veterans’ clinical orders to an “unknown queue” without alerting clinicians, which resulted in “multiple events of patient harm.”

Republican lawmakers, in particular, have also voiced strong opposition to the EHR program’s ballooning cost. The system’s deployment was initially estimated to cost $10 billion over 10 years, but a cost estimate conducted by the Institute for Defense Analyses last year found that it would cost over $50 billion, and take 28 years, to deploy the software at all of VA’s medical facilities. 

VA announced last October that it was extending its delay on future deployments of the Oracle Cerner EHR system until June 2023 to “fully assess performance and address every concern” with the software’s deployment. 

Oracle, which acquired Cerner last year, has already voiced opposition to both bills introduced by House Republicans. Ken Glueck, executive vice president of Oracle, said in a Feb. 3 blog post that the legislation terminating the EHR system’s deployment and reverting back to VistA would be “the wrong approach and will take VA and healthcare for our nation’s veterans backward.”

“VistA cannot be made better; it will just be made older, less secure and more expensive to operate,” he added.

In a follow-up blog post published on Feb. 10, Glueck said the improvements-focused bill “ensures an end-state that would be worse than terminating the program and staying with VistA” by “placing the go/no go decision to migrate to the new EHR to…171 different medical centers.”

To highlight its efforts to address issues with the system’s deployment, Oracle rolled out a public dashboard last year to track the company’s response to congressionally-identified priorities. As of Feb. 13, Oracle said it had closed out eight “assigned issues as originally identified by VA as priorities in February and May 2022 briefings to Congress and as cited in a letter from Congress to VA on June 27, 2022.” Three other issues are listed as “in progress,” while one issue is “scheduled” and eight others are identified as being “in development.”

Congress, however, has already moved to extend additional oversight and transparency around VA’s EHR deployment efforts, and more legislative proposals to streamline the system’s rollout are likely on the horizon. 

A staffer for Senate Veterans’ Affairs Committee Ranking Member Jerry Moran, R-Kan., told Nextgov the senator is currently working on legislation regarding the EHR system, although the bill is still in the early stages of being drafted, and the details of what it will entail are still being worked out. Democrats on the House Veterans’ Affairs Committee are also reportedly working to draft their own “comprehensive” bill to reform the EHR system’s rollout as an alternative to the Republicans’ legislative proposals.

Last June, President Joe Biden signed into law the VA Electronic Health Record Transparency Act—bipartisan legislation co-authored by Moran and Tester—that enhanced congressional oversight of the EHR program by requiring VA Secretary Denis McDonough to “submit periodic reports to Congress regarding the costs, performance metrics and outcomes” of the system’s deployment. 

Tester also worked to include a provision in the 2023 omnibus spending bill that withholds 25% of VA’s budget for the EHR modernization program “until the VA Secretary reports to Congress on improvements made to the system’s stability, usability, patient safety and related issues to better protect veterans and taxpayers.”

“The men and women who risk their lives to defend our country deserve to get the care they have earned when they return home,” Tester said. “That is why I am holding VA and Oracle Cerner accountable to deliver a safe and viable health IT system for veterans and taxpayers.”

A staffer on the Senate Veterans’ Affairs Committee told Nextgov that Tester met with VA Deputy Secretary Donald Remy—who oversees VA’s EHR program—on Feb. 1 to discuss ongoing issues with the system’s deployment. They added that the committee is also planning to hold a hearing regarding the system’s rollout sometime in March.