“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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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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DelBene joins the VA after retiring from Microsoft in September, where he was executive vice president of corporate strategy, core services and operations. In that role, he led the technology giant’s cross-engineering and cross-business strategy, and also spearheaded its response to COVID-19.

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.

Other previous roles include a spell at McKinsey and Company, where he focused on business strategy for technology companies. Before that, he also worked as a software developer and systems engineer for AT&T Bell Laboratories.

When DelBene left Microsoft to work on Healthcare.gov, Bill Gates in a blog post described him as “a talented and capable executive.”

“I’m certain he’ll make an important positive contribution in his new role with HHS,” Gates added at the time.

If confirmed by the Senate, DelBene would be the first permanent CIO of the VA during the Biden administration. Jim Gfrerer vacated the position at the end of the Trump administration after serving in it for two years. Since then, the role has been filled in an acting capacity by Dominic Cussatt and, more recently, Neil Evans.

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

Editor’s note: This story was updated to correct an error in DelBene’s job title.

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