“Overall we still think there’s a ways to go. I don’t want to present the system as all set and ready to go,” Kurt DelBene, the VA’s chief information officer, said during a House Committee on Veterans’ Affairs hearing on the implementation of the VA’s EHRM initiative with Oracle Cerner. 

Oracle Cerner did not send a representative to the hearing despite being invited to.

“There are places we have significant concerns that we’re working with Oracle on: the incident-free time, not hitting standards is important, the end user responsiveness we think still has a ways to go, we think there are still functional workflow issues that still have to be resolved,” DelBene added.

The VA partnered with Oracle Cerner in 2018 to lead the development and implementation of its EHR modernization under a 10-year, $16 billion contract. But since then, the program has faced a number of significant challenges, some of which have reportedly brought harm to veterans. 

This led to bipartisan congressional criticism of the program and, ultimately, the decision in April by the VA to stop the rollout of the system at veteran hospitals until major patient safety issues are remediated.

Multiple members of Congress expressed frustration during the hearing that the VA and Oracle Cerner were not moving fast enough with improvements to the EHR system while spending billions in taxpayer dollars. 

“[Oracle] training and change management are still woefully inadequate and user satisfaction is still critically low,” said Rep. Sheila Cherfilus-McCormick, D-Fla., the ranking member of the House Veterans’ Affairs Subcommittee on Technology Modernization. 

“I’m disappointed that Oracle Health isn’t here to participate in this conversation. I would like to stress that they are not present with us today. The fact that they didn’t send a representative raises major concerns for me and I expect better. I’m constantly losing faith in the process,” said Cherfilus-McCormick.

VA Secretary Denis McDonough will next year make the final decision regarding the exact timing of the continuation of the EHR rollout.

Meanwhile, the VA continues to use the Veterans Health Information Systems and Technology Architecture (VistA) EHR system in almost all of its VA hospitals. The modernized EHR system meant to replace VistA was delivered to five VA facilities before the department halted its nationwide rollout. The legacy VistA system has faced its own issues, including a lack of interoperability and nationwide access for veterans who change hospitals or move between states. 

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Montana Republican Rep. Matt Rosendale, who is chairman of the House Veterans’ Affairs Subcommittee on Technology Modernization, is bullish on removing Oracle Cerner’s EHR system and instead wants the VA to continue using its precursor, the Veterans Health Information Systems and Technology Architecture (VistA).

“If it was up to me, not only would Oracle Cerner be gone, but we would be clawing back some of the money that we’ve already spent on them,” Rosendale told FedScoop earlier this week during a brief interview after a hearing on the VistA and Oracle Cerner EHRs.

The Oracle Cerner EHR has faced grave performance issues since it was rolled out to five VA hospital locations in October 2020, with repeated outages that, according to the agency’s watchdog, have resulted in serious harm to veterans.

The implementation of the VA’s new EHR system is expected to be delayed from its original estimates by at least one to two years while the cost has ballooned by billions.

“If it’s up to Matt Rosendale, we would claw back every dollar from them,” the Republican said.
“We have a bill out there to terminate the Cerner contract but I think we should take it a step further. I do listen to the recommendations of my staff and so I haven’t done that but I think that they [Cerner] have done an absolute disservice.”

Instead, Rosendale said that the incumbent VistA EHR system still used in most VA hospitals today is much better than the Oracle Cerner system and could be improved and strengthened in certain ways if needed.

“Every time that I have the VA in front of me and the more information that I get, I get more convinced that VISTA is absolutely a system that can accommodate the needs of our veterans in the best fashion possible,” Rosendale told FedScoop.

“There’s not even a comparison between Oracle Cerner and VistA. When we’re talking about delivering safe, quality health care to their veterans, nobody can refute it. The numbers just don’t lie,” he said, referring to the high rates of dissatisfaction with the Oracle Cerner EHR system. 

Rosendale cited a recent survey of VA medical staff who use the Oracle Cerner EHR that showed 78% are dissatisfied. Meanwhile, Rosendale said over 70% of VA medical staff surveyed approve of the VistA EHR system.

Some Democrats, who are currently working on their own comprehensive legislation to fix the VA EHR, have argued that VistA is also plagued with its own issues including a lack of interoperability and nationwide access for veterans who change hospitals or move between states. 

Nevertheless, Rosendale, who has a history of slamming Oracle Cerner, said House Democrats have been very supportive in conversations with Republicans and during congressional hearings “in recognizing that Oracle Cerner is not delivering on the contractual promises that they made to us.”

During an interview with FedScoop in February, Oracle senior executives said the company would take a little less than a year to correct issues with the Cerner EHR system, after it acquired Cerner in June 2022, and said the IT giant would need another 9-12 months to right the ship. 

Oracle also highlighted that EHR system transitions, like the one from VistA to Oracle Cerner, are notoriously challenging and require significant training, culture adjustment, and major technical problem-solving. 

“The clock is running, now. Oracle has said they’ll come up the curve quickly within a year and time will tell,” Rep. Rosendale’s staff told FedScoop.

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The VA last week announced a further delay of the EHR rollout within the Ann Arbor Healthcare System until late 2023 or early 2024 due to concerns about how well the health record system would interact with the Ann Arbor hospital’s vital medical research mission.

During a media roundtable, VA Under Secretary for Health Dr. Shereef Elnahal told FedScoop that if the medical research issues with the EHR are not fixed, similar concerns could arise at other other VA hospitals.

“So there are many VA medical centers that are heavy with clinical research because of their academic affiliations,” Dr. Elnahal said. “And so those centers will need this research functionality. It’s not just an issue with the Ann Arbor Hospital.” Dr. Shereef Elnahal, VA Under Secretary for Health

He added the full EHR deployment schedule was still being deliberated within the VA.

When asked about the current state of cybersecurity and veteran health data security within the VA, Dr. Elnahal told FedScoop that the VA’s Office of Information Technology has a special team focused on such issues led by Chief Information Officer Kurt Delbene. 

“He has a team focused on this and our agency is regularly engaged with interagency discussions after major cybersecurity incidents. And we are always trying to be proactive in limiting that risk,” said Dr. Elnahal.

He highlighted that the VA’s use of two different EHR systems has created additional difficulties and complexities to security within the agency. Most VA hospitals currently still run on the Veterans Health Information Systems and Technology Architecture (VistA) while the VA has rolled out the new Oracle Cerner EHR to five VA hospitals in the past two years with more rollouts expected later this year.

“Right now, as you know, we’re dealing with two different EHRs currently in place in our system. And so we have to contend with those risks, instance by instance, and make sure that the entire network is secure,” Dr. Elnahal said.

The Oracle Cerner EHR has faced grave performance issues since it was rolled out to five locations in October 2020, with repeated outages that, according to agency’s watchdog, have resulted in serious harm to veterans.

The implementation of VA’s new EHR system is expected to be delayed from its original estimates by at least one to two years while the cost has ballooned to be tens of billions more than originally estimated.

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Dr. Terry Adirim will leave the agency on Feb. 25, according to an internal note announcing her departure sent to VA staff by Deputy Secretary Donald Remy.

Following her departure, the role of program executive director will be carried out on an acting basis by Senior Advisor to the Assistant Secretary for the Office of Information and Technology at the VA, Dr. Neil Evans. He starts work on Feb. 27.

Adirim has served as electronic health records modernization (EHRM) program director within the department’s electronic health record modernization integration office since late 2021.

She led the EHRM program during a period of intense challenges, including the publication of a report by the VA’s Office of Inspector General that identified nearly 150 cases of harm caused by the system at a Spokane medical center.

Following that report, the Department of Veterans Affairs took the decision to pause implementation of the Oracle Cerner electronic health records platform at other medical centers until June this year.

While program leader, Adirim and other VA leaders have given evidence at multiple congressional hearings, during which their responses to program failures received sustained scrutiny from lawmakers.

Adirim is a medical doctor who has worked in leadership roles within the Defense Department on multiple health system initiatives and previously was senior associate dean and a professor at Florida Atlantic University’s (FAU) medical school. 

She earned her doctor of medicine degree from the University of Miami, a Master of Public Health at Harvard University and a Master of Business Administration at the University of Massachusetts, Amherst.

In his memo to staff, Deputy Secretary Remy thanked Adirim for her service in the role.

He said: “I appreciate Dr. Adirim’s medical and technical expertise, diligence, and commitment in improving and implementing the EHR and for all of her work in the EHRM IO.”

He added: “VA is confident that Dr. Evans with his robust expertise can lead the EHRM effort in partnership with VHA, OIT, and our Federal partners, continuing to implement and deploy the EHR as anticipated in June 2023. I will continue to oversee our EHR modernization efforts.”

Editor’s note, 2/10/23: This story was updated to include details of the internal memo sent by Deputy Secretary Remy.

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VA spokesperson Randall Noller confirmed details of the degraded service, which occurred on Monday and Tuesday and affected all locations using the electronic health record (EHR) system.

“Changes made by the Department of Defense (DOD) had the unintended consequence of interrupting services that provide connectivity to the network,” Noller told FedScoop. 

“This caused long intervals to display items or respond to “button” clicks. While the Oracle Cerner systems were not “down,” users experienced issues in response times and connectivity to the EHR,” he added.

The VA worked with DOD and Oracle Cerner on configuration changes to resolve the issue earlier this week, according to Noller. Details of the network connectivity issue were first reported by The Spokesman-Review newspaper.

The Oracle Cerner EHR system is a key platform used by doctors to access the medical records of current and former military personnel. It is being rolled out at the VA as a replacement to the open-source Veterans Health Information Systems and Technology Architecture (VISTA) health information system.

It has attracted controversy since it was deployed at certain VA hospitals in 2020 — including at the Mann-Grandstaff VA medical center in Spokane, Washington.

A report published last year by the VA’s watchdog found that at least 148 veterans were harmed at a health center in Spokane, Washington, during the agency’s rollout of the health records system

Data published by FedScoop in August revealed nearly 500 incidents when the system was partly or completely unusable between Sept. 8, 2020, and June 10, 2022.

Lawmakers from both parties in the past year have repeatedly called out major issues with the cost, transparency and reliability of the VA’s electronic health record (EHR) system rollout that have seriously put veterans’ lives at risk.

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In a statement to FedScoop, spokesperson Cori B. Hughes said: “The Federal Electronic Health Records Modernization [office] coordinated efforts after a solid functional analysis to bring NOAA providers/clinicians onto the single common federal EHR currently used by VA, DOD, and the U.S. Coast Guard.”

She added: “There are 24 projected provider/clinicians that are USPHS officers located at 7 NOAA sites serving 300 officers and 400 divers. For NOAA, our Leidos Partnership for Defense Health will implement MHS GENESIS as a standard package. NOAA’s deployment is targeted for summer 2023.”

The Federal Electronic Health Records Modernization Office is charged with overseeing the rollout of the electronic health records system at the Department of Defense, Department of Veterans Affairs, Coast Guard and other federal agencies. Its director and deputy director report to the deputy secretary of Defense and the deputy secretary of Veterans Affairs.

NOAA is expected to implement the Oracle Cerner Millennium platform as part of the federal electronic health records modernization program (FEDHRM), which is intended to create a single, common health record for employees working at the DOD, VA, Coast Guard and other federal agencies.

In a separate statement to FedScoop, a NOAA spokesperson said: “The system meets the security requirements for NOAA uniformed service members’ health records, and integrates with the medical care system used by all uniformed service officers. No timeline for implementation is available at this stage.”

According to the NOAA spokesperson, the DOD’s instance of the electronic health records platform, MHS Genesis, will be deployed within its Office of Marine and Aviation Operations to manage health records for the NOAA Commissioned Officer Corps.

Details of the NOAA system rollout come after the VA earlier this month announced that it would delay all future scheduled deployments of the Oracle Cerner electronic health record system at VA hospitals until June 2023.

NOAA has approximately 12,000 employees but only a few hundred of them are commissioned officers who would be affected by the adoption of MHS Genesis.

The DOD, VA and Coast Guard all deploy the same Oracle Cerner Millennium platform, however, each agency has a different name for the system. The DOD calls its health records system MHS GENESIS, while the VA simply calls it the Electronic Health Records Modernization Program.

The VA’s EHRM system has been plagued by outages, and has caused major harm to some veterans who did not receive treatment because records disappeared in the computer system. 

Concerns over the impact of the system on patient care have been expressed by frontline medical staff, lawmakers and oversight bodies. Earlier this year, the VA’s Office of Inspector General published a trio of reports that identified major concerns about care coordination, ticketing and medication management associated with the EHR program launch.

Meanwhile, MHS GENESIS has faced outages and issues of its own, but not with the same frequency and scale as the VA’s EHRM rollout problems.

The VA signed on for Oracle Cerner’s Millennium EHR platform in May 2018, while the DOD started using the platform in 2015 and is further ahead with its system implementation.

The Defense Department had completed over half of its scheduled rollout for MHS Genesis in June of this year, and expects to deploy the system on time by the end of 2023.

The VA referred FedScoop to the FEHRM when asked for comment.

Editor’s note: This story was updated to reflect comment from the Federal Electronic Health Records Modernization Office.

Dave Nyczepir contributed to this report.

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At a House hearing Tuesday, Rep. Rosendale, R-Mont., cited a figure of $156,750 that according to the lawmaker the VA has withheld from the technology giant, and contrasted this with number of outages that have occurred since the rollout of the EHR system.

“Why has the VA only withheld $156,750 for Cerner’s failure to meet the service level agreement for the system up time? Do you think it’s a fair penalty for over 44 days of outages, degradations and losses of functionality?” said Rosendale.

The lawmaker was referring to the almost 500 major incidents with the VA’s Oracle-Cerner electronic health records system and at least 45 days of downtime that have occurred within the system since it was rolled out in the fall of 2020. Details of the downtime were included in an internal VA dataset exclusively obtained by FedScoop through a Freedom of Information Act.

Giving evidence at the hearing, Michael Parrish, the VA’s chief acquisition officer, replied to Rosendale saying that Oracle-Cerner’s failures would not be tolerated in the private sector. Parrish also said that the agency requires further financial support from Congress to modernize all of its aging technology systems.

“69% of VA medical centers are more than 50 years old and require full modernization. VA’s infrastructure footprint is not flexible enough, and changes in Veteran’s needs, demographics and locations are outpacing our ability to transform and manage it,” said Parrish.

He added: “With additional funding, VA would be better poised to modernize the full portfolio of assets to best serve our Veterans.”

The rollout of the electronic health records modernization continues to attract scrutiny from lawmakers following recent new research from the Institute for Defense Analyses, a nonprofit, that puts the life cycle cost of the EHR system at $50.8 billion over 28 years. The VA’s original rollout implementation tag was about $10 billion over 10 years.

The EHR system rollout issues has been plagued by outages — including at the VA’s medical center in Spokane, Washington — that have caused major harm to veterans. The implementation of VA’s new EHR system is expected to be delayed from its original estimates by at least one to two years.

Rosendale, who is the House VA Subcommittee on Technology Modernization Ranking Member, asked the VA for the total amount that the agency has withheld from Oracle-Cerner for failures on their end and is expected to get an answer in writing from the agency.

Speaking also at the hearing, House VA Committee Chairman Rep. Mark Takano, D-CA., highlighted that the recently passed veterans healthcare expansion bill – the PACT Act – would benefit veterans and the VA by allowing it to hire more employees and invest in modernising its technology given a record new 3.5 million veterans who’ve become eligible for the VA recently.

“Everything at the VA has an IT component and when there’s an IT component that almost always requires an acquisition of technology and support. We’ve seen what happens when the VA does not plan and execute these major acquisitions,” Takano said.

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Rep. Matt Rosendale, R-MT., said that VA Secretary Denis McDonough should take responsibility for major flaws and ongoing risks to veterans associated with the platform.

“It’s a s*** show. They’ve made a total mess out of it,” the lawmaker told FedScoop. “Meanwhile Cerner is profiting off this debacle. They’re profiting from it. This is unacceptable. It’s a little game of disaster.” 

Rosendale, who is the House VA Subcommittee on Technology Modernization Ranking Member, added that it was incumbent on McDonough to hold everyone involved in the EHR program accountable.

“At the end of the day Secretary McDonough has to take responsibility for it because he’s in charge of the VA. So it’s up to him to hold everyone else accountable,” he told this publication outside a House hearing Wednesday on the issue.

The senior Republican’s trenchant criticism came after lawmakers from both parties aggressively called out rampant issues with the cost, transparency and reliability of the VA’s electronic health record (EHR) system rollout during the House hearing. They were speaking at a House committee on Veterans’ Affairs hearing Wednesday on patient safety and the electronic health record modernization program.

Multiple Congressmen speaking at the hearing were angry that despite internal VA reports from October 2021 showing that the EHR system had major flaws and ongoing risks that could harm veterans, Secretary Denis McDonough and the VA continued to launch the system in medical facilities in multiple states.

Rosendale also accused the VA’s Executive Director of the EHR Modernization Integration Office at the VA Terry Adirim, and her staff, of contradicting themselves during their interactions with him and during hearings in Congress.

The implementation of the VA’s new EHR system on an Oracle Cerner developed platform to medical centers around the country will be delayed from its original estimates by at least one to two years and the system rollout is far behind where it was expected to be at the moment, a top VA executive said during a Senate hearing last week.

The EHR system rollout issues have in some instances, including at the center in Spokane, Washington, caused major harm in which a veteran at risk for suicide did not receive treatment because records disappeared in the computer system. This system error occurred due to technical issues with what’s known as an “unknown queue,” that has caused nearly 150 instances of patient harm, according to the  VA’s Office of Inspector General (OIG). 

The Institute for Defense Analyses, a nonprofit research entity, puts the life cycle cost of the EHR system at $50.8 billion over 28 years, while the VA’s original rollout implementation tag was about $10 billion over 10 years, but some Congressmen are even skeptical of these estimates.

“The new [IDA] estimate says the cost could be as high as $63 billion if everything goes wrong, and I see a lot of things going wrong,” said Rep. Mike Bost, R-IL, a member of the House VA Subcommittee on Technology Modernization.

“Cerner says the rollout would be 13 years instead of 10, but even 13 years seems like a best case scenario given all the issues,” said Bost.

Oracle-Cerner said during the House hearing Wednesday that problems with the VA’s current cost estimates are due to the federal government assuming the EHR technology stands still. However, the company took responsibility for the VA EHR software being too complicated and cumbersome, requiring extensive staff training which typically shouldn’t be the case.

Adirim from the VA during the House hearing Wednesday attributed some of the increased EHR rollout costs to Oracle-Cerner contract modifications regarding pharmacy enhancements that went above and beyond the baseline of the original contract because they were “technically considered enhancements,” not fixes to the system, Adirim said.

Rep. Rosendale, however, said that Oracle Cerner was getting paid more money for their contract while veterans continued to get poor service at medical facilities where the EHR system has been rolled out without permanently solving latent issues with reliability and stability. 

Former VA leaders who have experience with EHR systems have also observed deep entrenched issues with the agencies ongoing rollout and its ballooning costs.

“If you don’t have discipline, if you don’t control costs tightly and if you don’t even know what your costs are, you’ll get sucked for every dollar the government has. Like with Cerner. That’s how this game works,” said Roger Baker, chief information officer (CIO) and assistant secretary for information and technology for the Veterans Affairs Department from 2009 to 2013.

“The VA doesn’t know how much things cost and it has no clue how to do so, it would be like me trying to estimate what it could cost to build the Empire State Building,” he said.

Baker added that the VA had repeatedly shown management and execution issues with the EHR rollout due to their lack of prioritization on the day-to-day experience of doctors and staff within VA hospitals while instead focusing on trying to expand the rollout to as many medical facilities as quickly as possible.

Adirim declined to comment further after the hearing.

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The implementation of the VA’s new EHR system on an Oracle-Cerner developed platform to medical centers around the country will be delayed from its original estimates by at least one to two years and the system rollout is far behind where it was expected to be at the moment, a top VA executive said during a Senate hearing.

“Today we held what we call a ‘go no go’ decision with the Boise VA medical center using what we know in our checklist for what needs to be in place for it to be successful and safe,” said Terry Adirim, Executive Director of the Electronic Health Record Modernization Integration Office at the VA.

 “It is a struggle, we are looking for ways we can achieve efficiencies and get the system to a place where core EHR and management activities can be taken across enterprise systems in waves much more quickly. Clearly we’re not there yet, we’re still just in an initial operating capability trying to make all the changes and enhancements to do that,” Adirim said during a Senate Veterans Affairs committee hearing on Examining the Status of VA’s Electronic Health Record Modernization Program.

The EHR system rollout issues have in some instances, including at the center in Spokane, Washington, caused major harm in which a veteran at risk for suicide did not receive treatment because records disappeared in the computer system.

Adirim said the EHR system rollout to bigger VA medical centers around the country would face longer delays because of ongoing system stability issues that could cause major issues within larger more complex VA medical centers. 

Kurt DelBene, the chief information officer at the VA, said during the same Senate hearing that the Oracle-Cerner EHR system had major stability issues primarily related to change control and testing; challenges with increased capacity; basic functionality; its resilience design, and its response in last resort disaster situations. 

Delbene added that he was working with Oracle to improve the software of the EHR system. 

Sen. Marsha Blackburn, R-TN., accused Adirim during the hearing of painting a “very rosy picture” of the VA EHR rollout being successful and productive while the VA’s Office of the Inspector General (OIG) has torched the agency with over a dozen reports and over 68 significant recommendations in the past two years for ways to improve the rollout. 

Adirim pushed back saying that the VA takes the OIG reports seriously and admits it faces challenges in implementing the EHR rollout in a timely and safe manner but that it had some successes nevertheless.

“We’ve had what a lot of people would say are four successful [EHR] deployments, but we still have things to work on absolutely,” Adirim said in response to Blackburn.

Adirim added that the Defense Department also faced similar stability and performance issues with their EHR rollout and that the VA had tried to learn from its shortcomings but pointed out that the VA healthcare system is much more complex and care oriented than the DOD’s system.  

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The Oracle Health Management System uses digital identifiers to track the outcomes of people who have received COVID-19 treatment or therapies as part of clinical trials to determine their efficacy. Previously, before a cloud management system, this was difficult to track after patients were discharged from the hospital, Arrieta said.

HHS implemented the technology in July but didn’t announce it before Arrieta left the job Aug. 28.

Collecting data from people once they’ve left the health care system is critical to getting a vaccine in the hands of as many people as possible.

“There are 340 million people that need to get vaccinated in this country, and we know not all of them will get vaccinated,” Arrieta said at ACT-IAC’s Reimagine Nation ELC 2020 on Wednesday. “And we still need to have people volunteer for clinical trials, but there was no mechanism to actually reach those people directly.”

The Oracle Health Management System creates digital identifiers for state and federal governments, machine endpoints and people.

Volunteers — of which there were nearly 700,000 when Arrieta departed HHS — can walk into a CVS, buy an over-the-counter COVID-19 test, scan the QR code, and establish an electronic health record on their mobile device to register for clinical trials or a forthcoming vaccine.

Previously clinical trials treating other diseases largely went through states or hospital systems, but the federal government can use the system to manage them now.

“One of the biggest obstacles is really a lack of transparency and integration in our health care technology systems, and that’s across the country and globally,” said Rebecca Laborde, master principal scientist for clinical innovation at Oracle. “And we lack the ability to gather real-time data from patients and providers, especially when any kind of care occurs outside of the traditional health care system.”

Oracle is also working with the National Institutes of Health to support the COVID-19 Prevention Network by creating the covpn.org Volunteer Screening Registry.

People can visit the site to learn more about clinical trials and take a five-minute, pre-screening survey to volunteer for Operation Warp Speed, the government’s program to produce 300 million coronavirus vaccine doses by January 2021.

“We really need to have a large number of Americans volunteer for these trials representing different demographics all across the country,” Laborde said. “So it’s a really easy way for people to volunteer and get involved.”

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