Capitol Hill Intensifies Scrutiny
Senators on Capitol Hill have ramped up discussions about the Veterans Affairs electronic health records modernization (EHRM) project. This long-delayed initiative has faced mounting concerns over its costs and implementation challenges. Oracle Health’s Executive Vice President Seema Verma emphasized that establishing national standards for change management, along with advanced testing automation and virtual tools, could accelerate the project’s completion “in a timely manner.”
GAO Issues New Recommendations
The Government Accountability Office (GAO) recently added three new recommendations focused on cost estimating, scheduling, and system metrics. This brings the total to 18 recommendations since GAO began investigating the system in 2020. Notably, the VA has implemented only one recommendation thus far, according to the February 21 draft report.
Leadership Changes Signal New Urgency
At his February 19 nomination hearing, Paul Lawrence, the Trump administration’s nominee for VA deputy secretary and former under-secretary of the Veterans Budget Administration, promised to “foot stomp urgency” on the drawn-out project if confirmed. Lawrence would effectively serve as the chief operating officer for the EHR implementation.
Critical System Improvements Needed
The GAO report acknowledges incremental progress but highlights that the VA still needs to address over 1,800 configuration change requests. Additionally, the agency must update cost estimates and scheduling “to reflect the pause and work that remains” while addressing persistent user dissatisfaction.
Cost Uncertainty Remains Significant
Current EHRM lifecycle cost estimates vary dramatically—from the VA’s projection of $16.1 billion to an independent estimate of $49.8 billion. The GAO emphasized that “updating the independent lifecycle cost estimate is imperative to understanding the full magnitude of VA’s investment.”
Progress on Critical Issues
Despite ongoing challenges, some improvements have materialized. Trouble ticket resolution has met timeliness thresholds since implementing financial consequences in September 2023. Many patient safety and pharmacy enhancement issues have been resolved, though some remain open ahead of future deployments.
VA’s “Big Rocks” Improvement Strategy
Dr. Neil Evans, acting program executive director for the VA’s EHRM Integration Office, testified that the agency has implemented numerous improvements during the project’s reset period. The VA has launched several complex improvement projects—dubbed “Big Rocks”—focused on standardizing user roles, enhancing training for new users, and improving coordination between clinicians and pharmacists.
Oracle Proposes Accelerated Implementation
Oracle Health has proposed an accelerated implementation strategy to deploy the system across the remaining 164 VA healthcare facilities. During the reset period, Oracle completed more than 3,000 functional changes to the formerly Cerner EHR system, enhancing stability and simplifying functions.
Seven Key Initiatives for Completion
Verma outlined seven key initiatives to complete the VA’s EHR modernization program. These include developing robust change management standards and investing in automated implementations to shorten testing phases and reduce manual efforts.
“Automation ensures that each deployment is thoroughly tested in less time, enabling us to support a higher volume of simultaneous deployments without compromising quality,” Verma explained.
Focus on Pharmacy Improvements
Significant pharmacy enhancements are scheduled for release this month as part of a bi-annual software update. According to the GAO, the agency has delivered six of seven pharmacy enhancements identified by pharmacists and providers, with the final enhancement expected in February 2025.
New Federal EHR System Baseline
A notable development is the creation of the Federal EHR system baseline tool, which provides data on more than 2,300 functional and technology components. This tool aims to standardize healthcare delivery, increase efficiencies, and prevent future delays.
“Using the baseline to better conform to national VA standards in advance of go-live will help avoid staff frustration, deployment delays and increased cost,” Evans told lawmakers.
Congressional Expectations for Accountability
During Lawrence’s nomination hearing, Senator Thom Tillis (R-North Carolina) requested a 90-day report outlining what practices led to current problems, necessary actions, and any positive developments. While Lawrence committed to such a review, he wouldn’t commit to the specific timeframe.
Senator Tillis responded pointedly: “Anybody worth their salt can figure out what’s wrong with a project within 90 days.”
As the VA announced plans to resume EHR deployments in mid-2026, the agency faces continued pressure to demonstrate meaningful improvements in this critical healthcare modernization initiative.
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