“In the summer of 2024, we should be having, and even before that we should be having real discussions about whether we’re ready to move forward with [the EHRM] restart,” Dr. Neil Evans, acting program executive director of the VA’s EHRM Office, said during a House Appropriations Oversight hearing on implementation of the VA’s EHRM initiative with Oracle Cerner.

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.

The VA also renegotiated its contract with Oracler Cerner in a way that it believes “dramatically increases” its ability to hold the technology company to account for the system’s performance.

Speaking at Wednesday’s hearing, Mike Sicilia, executive vice president at Oracle, said: “I would concur with Dr. Evans’s time frame. It seems to me next summer we should be in a position, particularly if the go-live is trending well in March, that we should be in a position to resume [the rollout]. That is our expectation.” 

VA Secretary Denis McDonough will next year make the final decision regarding the EHR rollout timeframe, according to Evans and Sicilia.

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

Evans also said there are major issues in having two different EHR systems operating within the VA rather than one central, functioning EHR system.

“I wake up every day wondering are we moving in this direction? We don’t want to stay in reset forever. In fact, I would argue that we’re at higher risk the longer we maintain a healthcare system that’s running two different electronic healthcare systems. So we need to feel an urgency to move forward with a single electronic health record system,” he said.

Multiple members of Congress expressed strong 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. 

“$10 billion dollars of taxpayer dollars. What the hell has that gotten us? What if we cut funding? What if next year it was zero? Would that light a fire in terms of fixing this program?” said Rep. Tony Gonzales, R-Texas.

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In a missive sent on June 5 to Department of Veterans Affairs Secretary Denis McDonough, Mike Bost, R-Ill., said that the agency has so far failed to provide requested documents setting out how the agency collects information about recusals.

According to Bost, House Veterans’ Affairs Committee staff in late April held a meeting with VA CIO Kurt DelBene and VA Special Counsel Michael Waldman, during which it was established that the VA did not have a formal process in place for recording ethics waivers.

Bost wrote: “[VA Special Counsel] Michael Waldman confirmed that VA currently does not have a formal process in place to document Mr. DelBene’s recusals – or for that matter recusals of any of its executives – including recusals relating to former employment. Mr. Waldman acknowledged that it may be a good idea to start a formal recusal documentation process and volunteered to start discuss the idea internally and inform the Committee of their conclusions.”

“I am concerned that, more than a month after meeting with Mr. DelBene, I have not received a response from you or your staff,” he added.

In a previous note sent to Denis McDonough on May 10, Rep. Bost said that during the previous late-April meeting, DelBene noted that he had only twice interacted with Microsoft or its employees: once to discuss a problem VA was experiencing with Microsoft Teams software, and once when he had dinner with his former chief of staff to provide career advice.

In the May 10 note, Bost requested that the agency provide a written summary of its plan to document the recusals of DelBene and other senior executives, or its reasoning for not adopting such a measure.

All federal employees are required to abide by the ethics stipulations set out in the Code of Federal Regulation, and failure to do so carries criminal penalties.

These include a requirement that federal officials take appropriate steps to avoid any actual or appearance of loss or impartiality in the performance of their official duties, including through personal or another “covered relationship.”

Prior to his confirmation as VA chief information officer in December 2021, DelBene was an executive at technology giant Microsoft.

Earlier in his career, DelBene worked in the Obama administration for a brief time, during which he led improvement work on Healthcare.gov as a senior adviser to the secretary of the Department of Health and Human Services. While working on Healthcare.gov, he helped to troubleshoot issues encountered during the first open enrollment period.

DelBene is also married to Rep. Suzan DelBene, D-Wash.

In a statement to FedScoop, a VA spokesperson said: “The Biden Administration and VA are committed to the highest ethical standards for public officials. Consistent with those high standards, before joining the VA, CIO Kurt Delbene agreed to an Ethics Agreement whereby he was recused from involvement in Microsoft specific matters, including a number of specifically enumerated procurements and programs.”

He added: “VA and CIO Delbene have scrupulously adhered to that Agreement. In recent meetings with HVAC staff, it was requested that VA develop a formal process to document procurements or programs from which Mr. Delbene may be recused. VA has been working on finalizing such a formal documentation process and expects to respond to the Chairman Bost and the Committee shortly.”

Editor’s note, 6/6/21, 4:12 p.m. ET: This story was updated to include comment from the Department of Veterans Affairs.

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VA employees in the National Capital Region who telework regularly will now be required to work a minimum of five days in office per pay period beginning in the fall, Secretary Denis McDonough wrote in an email sent to all department personnel.

Previous Office of Personnel Management federalwide guidance set the baseline requirement for teleworking employees reporting to an agency office at two days per pay period.

McDonough wasn’t specific about when the change would take place but said: “This will be implemented by early fall, with the specific effective date to be announced within the next several weeks, based on our coordination with other federal agencies.”

“This change will allow us to spend more time in the office together, learning from one another and strengthening our culture while preserving flexibility, something on which VA has always led – and will continue to lead,” he added.

President Biden in April signed a bipartisan resolution ending the national emergency related to the COVID-19 pandemic. The Office of Management and Budget in short order issued a memo calling on agencies to update workplace plans and “substantially increase meaningful in-person work at Federal offices.”

“With the national Public Health Emergency now ended, we can return to the office more regularly to work together in person rather than virtually,” McDonough wrote in his email Wednesday.

He said he spent recent weeks speaking to personnel across the VA about the change. “I heard many concerns, and I acknowledge those concerns,” he said. “However, I believe that the benefits of having more time in the company of our colleagues outweigh the costs.”

For VA employees outside of the Washington, D.C., metro area, this new requirement doesn’t apply, “though we will continue reviewing our workplace posture in all locations,” McDonough said. And for employees who are members of a union, the secretary said supervisors shouldn’t begin conversations with those members “until VA fulfills its collective bargaining obligations.”

“I understand this change will be difficult, as the change to telework was very difficult in 2020. Working together we will again lead the federal workforce as we address this new challenge,” McDonough wrote in closing.

The move comes also as Republican lawmakers in both chambers have taken action recently to question agencies’ teleworking plans and force federal employees back into offices.

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The system will not be brought online at any further locations until it is “highly functioning” and issues at current locations are resolved, according to the VA. No timeline has been set for the continuation of the rollout.

The agency’s decision to halt implementation of the system comes during contract negotiations between the agency and Oracle Cerner over a potential extension of the initial $10 billion IT modernization contract that was signed in 2018 as it nears the end of its base period.

In a briefing call with reporters, VA official Dr. Neil Evans declined to give specific details about ongoing contract negotiations but noted that “everything has been on the table.”

“The original contract was a five-year base period with a five-year option, but everything has been on the table as part of the contract negotiations. I anticipate we’ll be able to share more as we near the end of those negotiations,” Evans said.

He added: “We are working towards an amended contract that will hold Oracle Cerner accountable to delivering the high-functioning, high-reliability EHR system that veterans deserve and will lay the groundwork for our expectations around improvements to the system that we think are necessary.”

In its statement announcing the program stoppage, VA said the agency would work with Congress on resource requirements for the modernization program and estimated that costs for fiscal year 2023 will be reduced by $400 million. 

One exception to the implementation freeze will be at the Captain James A. Lovell Federal Health Care Center in Chicago, which houses the only fully integrated VA and Department of Defense healthcare system. This go-live remains scheduled for March 2024. 

According to the department, system readiness at the five existing locations will be measured by clear improvements in clinician and veteran experience, sustained high performance and high reliability of the system, and improved levels of productivity.

The Oracle Cerner platform is currently in use at Spokane VA Health Care System, VA Walla Walla Health Care, Roseburg VA Health Care System, VA Southern Oregon Health Care, and VA Central Ohio Health Care System.

Commenting on the decision, VA Secretary Denis McDonough said: “We’ve heard from Veterans and VA clinicians that the new electronic health record is not meeting expectations – and we’re holding Oracle Cerner and ourselves accountable to get this right.”

“This reset period will allow us to focus on fixing what’s wrong, listening to those we serve, and laying the foundation for a modern electronic health record that delivers for veterans and clinicians,” McDonough said.

Details of the decision to halt further implementation of the system follow a five-hour incident earlier this week, during which clinicians using the platform experienced latency issues and freezing, according to an internal briefing note. 

“For the past few years, we’ve tried to fix this plane while flying it – and that hasn’t delivered the results that veterans or our staff deserve,” Evans said.

“This reset changes that. We are going to take the time necessary to get this right for veterans and VA clinicians alike, and that means focusing our resources solely on improving the EHR at the sites where it is currently in use, and improving its fit for VA more broadly. In doing so, we will enhance the EHR for both current and future users, paving the way for successful future deployments,” he added.

In a statement, Oracle Global Industries Executive Vice President Mike Sicilia said: “Oracle is proud to continue working together with VA to modernize its Electronic Health Record system.  We support VA’s plan to improve the operation of the EHR at the current sites and take the necessary time to institute governance, change management and standardization changes to ensure the success of future VA deployments, similar to what DoD did a few years ago.”

“DoD’s modernization is now nearly complete, on time and on budget. We will continue to closely coordinate with VA to provide enhancements and updates to the EHR. We appreciate Secretary McDonough’s leadership on this project and reiterate our commitment to providing VA and our nation’s veterans with an EHR that exceeds expectations,” he added.

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McDonough set out concerns about a $345 million shortfall within the VA Office of Information Technology (OIT) and a $465 million shortfall in infrastructure and technology funding regarding major construction elements if Republican proposals to cap the budget succeed. 

“The EHRM is our 3rd biggest outlay in our office in our Office of Infrastructure and Technology, so the cut would be indiscriminate across that account,” McDonough said during a House Appropriations Committee VA budget hearing Wednesday. “Remember that the other and biggest request in that account is for cybersecurity which when we’re increasingly reliant on for telehealth so I’d be really worried about the effect on cybersecurity too.” ‘

The secretary’s comments follow a commitment by House Republicans, reiterated earlier this month, to cap the federal government budget at 2022 levels. In particular, McDonough stressed the potential negative effects of Republican proposals on telehealth reliability. 

“I’m told the office of [information] and technology would have a $345 million shortfall… which would have a significant impact on network reliability which is increasingly what we use for a 3000% increase in use of telehealth so it would have an impact there,” McDonough said.

The VA’s 2024 budget request includes $6.4 billion for the OIT for discretionary funding for continued modernization of aging infrastructure and IT services for VA employees and veterans. McDonough’s 2024 budget also requests $1.9 billion to support the EHR modernization effort.

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Reps. Mark Takano of California and Sheila Cherfilus-McCormick of Florida have proposed the Manage VA Act and the Department of Veterans Affairs IT Modernization Improvement Act, which are intended to spur a wider overhaul of how technology services are procured at the agency.

The draft pieces of legislation are intended to fundamentally overhaul how the VA
approaches the use of information technology, including its electronic health record modernization program.

If enacted, the Manage VA Act would create a VA undersecretary for management post, which the lawmakers say would have the effect of consolidating and standardizing acquisition and IT functions across the department.

The IT Modernization Improvement Act, meanwhile, would require VA to contract for an independent verification and validation assessment of four major IT modernization programs: its EHR modernization, supply chain modernization, financial management and business transformation and veterans benefits management system.

Details of the legislative proposals come after FedScoop in February revealed that Democratic lawmakers were working on “comprehensive” plans to reform the VA’s electronic health record modernization program as an alternative to Republican bills.

Sources speaking to FedScoop at the time said the legislation would seek to provide a more holistic approach to solving issues that have dogged the EHR system without resorting to its precursor system, the Veterans Health Information Systems and Technology Architecture.

In late January, House GOP lawmakers introduced two complementary bills that would compel the VA either to substantially modify the rollout or scrap entirely implementation of Oracle Cerner’s electric health record platform.

Commenting on the proposals, House Committee on Veterans’ Affairs Ranking Member Takano said: “While I am encouraged by President Biden’s and Secretary McDonough’s efforts to make investments in our veterans a top priority in recent years, it is time we also invest in making sure that veterans and taxpayers are getting what they pay for – a modernized and efficiently managed VA.”

“My two bills will bolster accountability at VA by requiring outside verification and validation assessments of major IT modernization programs, and by establishing an Under Secretary for Management to help consolidate and standardize business functions – from acquisition to IT – across VA,” he added. “I hope this is the beginning of a bigger discussion about making VA work better for veterans and moving VA healthcare into the future.” 

Cherfilus-McCormick, the House VA Subcommittee on Technology Modernization ranking member, said: “As the new Ranking Member of the Technology Modernization Subcommittee, I have already seen the issues that have led to a lack of progress in modernizing IT at VA. These bills will support effective implementation at VA and focus on building up our capacity to provide the healthcare and benefits our veterans deserve while ensuring that taxpayers are getting what they are paying for.” 

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Remy, who has overseen the VA’s troubled Oracle Cerner electronic health records modernization (EHRM) program, steps down just weeks after VA EHR executive director Dr. Terry Adirim left the agency. 

Remy was nominated by President Biden and started the role in July 2021, will temporarily hand over the job to Kiyokawa who currently advises the VA on strategic planning, risk management, policy analysis, data analytics and governance; and interagency coordination and collaboration.

“Deputy Secretary Remy is a great leader, a true friend, and a steadfast public servant who has fought like hell every day for our nation’s Veterans,” said VA Secretary Denis McDonough in a statement. 

“He’s helped lead VA through the pandemic and to the point where we are delivering more care and more benefits to more Veterans than ever before,” McDonough said.

The VA said it is working with the White House to nominate a candidate for a Senate-confirmed deputy secretary as soon as possible.

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A new bill is expected to take a fresh approach to the IT crisis that has dogged the agency’s Oracle Cerner electronic health record (EHR) system in recent years, according to two senior congressional sources.

The legislation from Democrats on the House Veterans’ Affairs Committee aims to provide a comprehensive solution for long-running problems with the IT system and an alternative to two Republican bills introduced last week. 

The sources told FedScoop that the legislation is supposed to provide a more holistic approach to solving issues with the EHR system while not resorting to its precursor system, the Veterans Health Information Systems and Technology Architecture (VistA).

VistA was also plagued with issues including a lack of interoperability and nationwide access for veterans who change hospitals or move between states. 

Precise details and the timing of the legislative proposal were not immediately available, however it is expected to land in the coming weeks.

According to one person familiar with the matter, the proposal may have a wider scope than prior attempts at legislative oversight and could involve a complete rethink of how other IT projects are conducted within the agency.

“This proposal is focused at a higher level than just one program,” the person added.

News of the alternate proposals comes after GOP lawmakers late last week put forward a pair of bills that would either substantially alter the Oracle Cerner electronic health records system or scrap the project entirely.

Those bills were introduced after Rep. Mike Bost, R-Ill., was named chairman of the House Committee on Veterans’ Affairs, and after Rep. Matt Rosendale, R-Mont., was elected as chairman of the VA tech modernization subcommittee. 

Both sources speaking with FedScoop said it may be possible for an alternate proposal to win support from both sides of the aisle, with one describing the EHR as a “unifying issue.” 

The 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.

Last week the system was hit with network issues that affected the system’s performance at hospitals where it is deployed by the Department of Veterans Affairs, the Department of Defense and the Coast Guard.

Representatives for Democratic lawmakers on the VA committee were contacted for comment.

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In an interview with The Spokesman-Review newspaper, VA Under Secretary for Health Shereef Elnahal on Oct. 12 said the department’s findings from a recent review led it to send letters to veterans whose medications, appointments, referrals or test results may have been delayed due to problems with the system.

“Unfortunately, we discovered that safety concerns were voluminous enough and prevalent enough throughout the system that we had to disclose to 41,500 veterans that their care may have been impacted as a result of the system’s deployment as it is currently configured,” Elnahal told the newspaper.

Veterans who may have been affected were identified through a review by VA patient safety experts and through data provided by Oracle Cerner on all patients enrolled at hospitals and clinics where the system has been deployed.

According to the report, the VA began mailing letters on Oct. 12 and all affected veterans are expected to receive them within about two weeks.

The group of about 41,500 patients represents a minority of the veterans enrolled for care at facilities using the new system.

News of the letters comes as the VA Thursday announced that it would delay all future deployments of the electronic health record system until June next year.

In a statement, the department said it was pushing back the rollout to “address challenges with the system and make sure it is functioning optimally for veterans and for VA health care personnel.”

Earlier this year, a leaked draft report by the VA Office of Inspector General revealed nearly 150 cases of harm linked to the Oracle Cerner system, and shortly after VA Secretary Denis McDonough hit pause on deployments planned for the summer of 2022 in Seattle, Tacoma and Boise.

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In a statement announcing the delay Thursday, the department said it was pushing back the rollout to “address challenges with the system and make sure it is functioning optimally for veterans and for VA health care personnel.”

The decision comes after VA Secretary Denis McDonough in July announced that the department would delay certain EHR deployments until at least January 2023 to ensure that all issues with the system are resolved before a wider rollout.

Details of the delay were first reported by The Spokesman-Review newspaper.

According to the VA, a subsequent investigation at the five hospital locations where the system is deployed identified a range of additional technical and system issues including “challenges with performance, such as latency and slowness, problems with patient scheduling, referrals, medication management and other types of medical orders.”

The Oracle Cerner EHR is currently deployed at VA facilities at Spokane and Walla Walla in Washington State, Roseburg and White City in Portland and Columbus in Ohio.

News of the delay follows a litany of reported problems with the system, including latency issues and outages.

Last week, FedScoop revealed the latest of such problems, which government sources said left EHR pharmacy services unavailable for outpatients during much of the day on Oct. 8.

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.

Commenting on the decision to push back all future EHR deployments, Deputy Secretary of Veterans Affairs Donald Remy said: “Right now, the Oracle Cerner electronic health record system is not delivering for Veterans or VA health care providers — and we are holding Oracle Cerner and ourselves accountable to get this right.” 

He added: “We are delaying all future deployments of the new EHR while we fully assess performance and address every concern. Veterans and clinicians deserve a seamless, modernized health record system, and we will not rest until they get it.”

In an internal note announcing the rollout delay obtained by FedScoop, VA Under Secretary for Health Shereef Elnahal said: “Over the coming months, we will implement an “assess and address” period to correct outstanding issues with the new system – especially those that may have patient safety implications – before restarting deployments at other VA medical centers. This decision is a continuation of Secretary Denis McDonough announcement in July, when he said that we would delay EHR deployments to ensure that the system’s issues have been resolved.”

“For those of you working at our EHR sites, thank you for your unwavering support in ensuring the best systems are in place for Veterans. I had a chance to meet many of you at the Columbus VA Medical Center only weeks ago, to learn about some of these issues firsthand. The team there is extraordinary and wants to get this right. And that’s exactly what we’re going to do: get this right for the facilities already using the new EHR, and for all future deployments.

He added: “VA remains committed to building an EHR solution that will link with the Department of Defense’s health record system to create a lifetime of seamless care for service members and Veterans. That end goal is achievable if we take these necessary steps forward.”

Editor’s note: This article was updated to include details of the VA Under Secretary’s internal note.

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