House VA Chair Calls for Crack Down on Management of EHRM

The top Republican on the House VA Committee is calling on Congress to advance legislation cracking down on Oracle Cerner's management of the Department of Veterans Affairs (VA) EHR modernization (EHRM), according to reporting from Nextgov.

In an interview with the news outlet, Rep. Mike Bost (R-Ill) blamed much of the EHR's troubled implementation on the vendors behind the health IT, noting that "it's Cerner and Oracle that need to get their act together."

"VA simply has to make sure that, at the place where they're going to roll it out, the standards are met," Bost said. "The most important standard is that the operator and manager and overseer of the particular VA [medical facility] where it is going to roll out is comfortable moving forward with changing a system."

VA has used its legacy EHR, the Veterans Health Information Systems and Technology Architecture (VistA), for over four decades. The department has tried and failed several times to modernize the system.

Gene Dodaro, comptroller general, previously told committee members during a February 28, 2023 oversight hearing that VA has spent more than $1.7 billion on failed predecessor EHR systems before the new Oracle Cerner platform.

Cerner, acquired by Oracle last June, received a $10 billion contract in 2018 to update VA's EHR. Since then, the deployment of the new system has been hindered by software outages, cost overruns, and issues with patient safety.

In a briefing on March 15, 2023, the Department of Veterans Affairs (VA) officials informed the Senate committee staff of six "catastrophic harm" incidents, including four veteran deaths, linked to patient safety issues with the EHRM) project.

Last October, VA announced that it was extending a previous delay on additional rollouts of the Oracle Cerner system until June 2023 "to address challenges with the system and make sure it is functioning optimally for veterans and for VA health care personnel."

"I don't think they're ready to go live with new ones until we get that straightened out," Bost said about VA's plan to continue deploying the Oracle Cerner system at additional medical facilities in roughly three months.

"We do have an existing system that actually does work," Bost said about VistA. "There might be some growth that needs to occur in that system, if we go back to that. But the idea is to make any incidents where we endanger the lives of our veterans as minimal as possible, not with what we're getting at these five facilities."

Bost and 10 Republican co-sponsors recently introduced legislation that would bar the VA from future rollouts of the EHR at VA medical facilities until sites certify that the health IT has met performance and facility readiness metrics.

Bost is also a co-sponsor of legislation 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."

Bost noted that he thinks the department "is waking up to the fact that they've got to have what we're proposing," but said, "if VA can't get together themselves, that will force their hand to get it together."

"That's what these two bills are doing: we set standards, we ask the VA to make sure that Oracle Cerner does what we're requesting in the law and, if not, then we'll move on," Bost said. "And we'll either go back to the VistA system, or we will look at a different direction."

VA's contract with Oracle Cerner will expire on May 16, and legislators have called on the agency to negotiate a new contract that imposes stricter penalties for poor system performance.

Bost said VA should push for better terms in any new agreement, adding that "VA should have been doing that before I carried a bill."

"Republicans and Democrats and the House and Senate, with all of us being aligned on what we know we want to fix and the problems that we're seeing, we will all be working with the [VA] secretary to make sure that we don't continue down this path for very long because it's not good for our employees, but most of all, it's not good for our veterans," he added.