From Reset to Rollout: Can the VA EHRM Program Finally Deliver?

House Subcommittee on Technology Modernization

2025-02-24

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Summary

The meeting addressed the status and future of the Department of Veterans Affairs' (VA) Electronic Health Record Modernization (EHRM) program, a critical initiative to replace its legacy health record system with a commercial solution from Oracle [ 00:15:32-00:15:32 ]

. Following a period of significant challenges and a comprehensive program reset, the VA announced its intention to resume deployments in mid-2026, beginning with four facilities in Michigan [ 00:16:07 ] [ 00:16:14 ] . Witnesses from the VA, Oracle, the Government Accountability Office (GAO), and the Office of the Inspector General (OIG) provided insights into the program's progress, persistent issues, and future outlook [ 00:20:59 ] [ 00:21:39 ] [ 00:22:00 ] [ 00:22:09 ] .

Themes

EHRM Program Status and Challenges

The VA's Electronic Health Record Modernization (EHRM) program has faced significant issues since its initial deployment in 2020, including system outages, patient harm, inefficient technology, budget overruns, and reduced patient volumes [ 00:15:32-00:16:00 ]

. These problems led to an indefinite pause in deployments in April 2023, granting the VA and Oracle time to rectify a long list of identified problems [ 00:16:07 ] . VA recently decided to restart deployments in mid-2026, targeting Ann Arbor, Battle Creek, Detroit, and Saginaw in Michigan [ 00:16:14-00:16:14 ] . Oracle asserts that the system has been dramatically improved since its initial deployment, citing over 3,000 functional changes and reliable performance, with user satisfaction reportedly trending in a positive direction . However, current surveys indicate that 69% of users remain dissatisfied with the system, and 75% believe it does not maximize their efficiency [ 00:17:28-00:17:33 ] .

Cost and Schedule Concerns

A significant concern is the absence of a current, reliable integrated master schedule and an up-to-date cost estimate for the EHRM program [ 00:17:52 ]

. The only independent cost estimate available, now three years old, projected the program's cost at over $32 billion, more than double the VA's original $16.1 billion estimate [ 00:18:00-00:18:12 ] . The GAO emphasizes that Congress cannot rely on these outdated figures due to substantial changes and delays within the program [ 00:41:41 ] [ 00:41:49 ] . With the program nearly seven years into a 10-year contract and implemented in less than 4% of medical centers, there is widespread skepticism regarding the feasibility of deploying to the remaining 160 sites by the contract's end in May 2028 [ 00:17:24 ] [ 01:30:32 ] . While VA acknowledges the need for both a revised master schedule and a life cycle cost estimate, the iterative development of these documents, starting with Michigan, raises questions about their timely completion .

Recommendations and Oversight

Both the OIG and GAO reported numerous outstanding recommendations for the VA, addressing critical areas such as patient safety, program management, and system accessibility . GAO noted that only one of its 18 recommendations has been fully implemented . Specific unresolved issues include difficulties with scheduling changes and missed appointments, as well as critical problems in pharmacy operations, which still necessitate manual safety checks and additional staffing at sites using the new EHR . Both oversight bodies advocate for an Independent Verification & Validation (IV&V) test, an IT best practice, to comprehensively assess the system's operational suitability and identify all deficiencies . While VA believes its internal reviews and user feedback sufficiently cover these concerns, GAO emphasizes the importance of an independent, end-to-end evaluation [ 00:45:10 ]

Workforce Impact

Concerns were raised about the potential impact of recent VA workforce reductions on the EHRM program's progress . The VA's EHRM Integration Office experienced losses from probationary employee terminations and staff opting for deferred resignation programs [ 00:46:45 ]

. These reductions add to existing vacancies within the office, raising questions about the program's capacity to manage future deployments successfully [ 00:47:07 ] [ 00:47:19-00:47:45 ] . VA acknowledged that the successful implementation of EHRM relies not solely on the program office staff but also on extensive collaboration with the Veterans Health Administration, the Office of Information Technology, and various vendor partners .

Future Prospects and AI

Oracle outlined plans to migrate the VA system to its cloud infrastructure, aiming for improved performance, access to next-generation technologies, and enhanced cybersecurity . This migration is intended to facilitate the integration of advanced AI capabilities into the EHR . Examples include clinical AI agents that can generate notes from patient-doctor interactions and assist providers with patient summaries, identifying care gaps, and suggesting research candidates . Oracle committed to providing a new cloud-based EHR infused with AI to the VA at no additional cost . A core principle for AI integration is maintaining a "human in the loop," ensuring providers retain control over clinical decisions and that patient consent is obtained when AI is used in their care [ 01:35:53-01:36:05 ]

Tone of the Meeting

The tone of the meeting was largely serious and concerned, reflecting deep skepticism and frustration regarding the EHRM program's past performance [ 00:16:00-00:16:07 ]

. Congressional members and oversight bodies consistently pressed for accountability, detailed plans, and transparent communication on costs and schedules [ 00:17:04-00:18:15 ] . While VA and Oracle representatives maintained an optimistic outlook, highlighting improvements and future potential, their assurances were often met with pointed questions about concrete evidence and statistical probabilities of success . The urgency for "getting it right" rather than "fast" for the sake of veterans' healthcare and VA staff morale was a recurring theme, particularly in the closing remarks .