VA to Use Legacy VistA EHR for Up to 10 Years Amid Paused Oracle Cerner EHRM

The Oracle Cerner Electronic Health Records Modernization (EHRM) program has been underway for years. However, the majority of Department of Veterans Affairs (VA) facilities are still relying on the outdated VistA legacy EHR system and will continue to do so for the next five to ten years as the agency faces delays in the implementation of the Oracle Cerner EHRM program, according to a Federal News Network reporting.

“In essence, we are supporting two EHR systems simultaneously, until the Cerner implementation is complete,” Daniel McCune, executive director of software product management of VA, told the technology modernization subcommittee in a hearing on March 7, 2023. “In the interim, VistA remains our authoritative source of veteran data.”

According to VA officials, although the Oracle Cerner EHR has issues, VistA is insufficient for meeting long-term veteran healthcare needs. Additionally, under the current legislation, performance issues with the Oracle Cerner EHRM must be addressed without relying on the legacy platform. Still, the agency is planning to modernize VistA to improve veteran service and ensure uninterrupted care, said McCune.

A survey of VA employees currently using the Oracle Cerner EHR system revealed that 78 percent felt that the new system did not enable them to provide high-quality care. In contrast, 64 percent of respondents agreed that the legacy VistA system helped them to deliver quality care to veterans.

“It’s like a stable old family car,” Sheila Cherfilus-McCormick (D-Fla.), subcommittee ranking member, said about the VistA EHR. “Everyone knows you need to jiggle the clutch when it gets stuck in third gear.”

“I’m not here to say that the Oracle Cerner approach in EHRM is going well, but I’m not sure returning to VistA is correct either,” Cherfilus-McCormick added.

Other VA officials believe that keeping the EHR legacy system is inevitable.

“The reality is regardless of whether the Oracle Cerner implementation can be accomplished, and regardless of how we feel about that, the VA will probably continue to rely on VistA for at least another decade,” Matt Rosendale, technology modernization subcommittee chairman, said at the hearing. “And some of the elements of VistA will probably never go away because no replacement even exists.”

The agency has already moved 20 instances of VistA to the cloud this year, with plans to migrate an additional 54 instances later. However, each migration comes at the cost of approximately $70,000 for the VA. Despite the expense, the VA is prioritizing these cloud migrations as part of its efforts to modernize VistA and improve veteran healthcare services.

“The version of cloud migration that’s taking place today is what we call a lift-and-shift, meaning we’re not changing VistA, we’re simply taking it out of our data center and moving it into a virtual cloud environment,” McCune said.

The Oracle Cerner EHR is currently in use at five VA sites, but delays due to safety issues flagged by the VA inspector general and frequent system outages have plagued rollout.

Recently, the VA delayed the EHR rollout at an Ann Arbor facility due to concerns over compatibility with the hospital’s medical research system. In October 2022, the VA postponed further EHR go-lives until June 2023 after watchdog reports raised patient safety concerns related to the system. The purpose of the pause was to “assess and address” EHR issues and shortcomings of the EHRM program.

The troubled EHR has several issues that have caused some lawmakers to question whether the program should continue.

In early May, Matt Rosendale (R-Mont.) introduced a bill that would require significant improvement or discontinuation of the VA Oracle Cerner EHR program. Additionally, all facilities would return to using the legacy VistA system.

Rep. Mike Bost (R-Ill.), the chairman of the House Veterans Affairs Committee, co-sponsored the bill.

On January 27, Rep. Bost introduced another bill that would prohibit the VA from implementing the Oracle Cerner EHR platform at additional facilities without the approval of senior clinicians. Both bills have faced opposition from Oracle, which acquired EHR vendor Cerner last year.

Ken Glueck, executive vice president of Oracle, argued that reverting to the legacy VA EHR would take healthcare for veterans backward.

“VistA cannot be made better; it will just be made older, less secure, and more expensive to operate,” Glueck wrote. “Worse, it will deny our veterans the many benefits modern healthcare technology has to offer.”

“The problem with modernization is it doesn’t come with a magic wand, and there’s no easy button,” Glueckc continued. “Modernization requires change and some short-term pain for the long-term benefits of a modern technology infrastructure, a modern user interface, and a modern set of workflows.”