WASHINGTON, DC – VA is in the process of renegotiating its agreement with Oracle-Cerner over its new electronic health records (EHR) system, and legislators on both sides of the aisle are concerned that the new contract be more favorable to the VA and hold the EHR manufacturer more accountable for ongoing problems with the system.
Since October 2020, the system has been introduced at five hospitals and 22 community-based outpatient clinics, and is in use by about 10,000 VA employees. The rollout is on hold until at least June 2023, however, as Oracle-Cerner and VA officials address technical and system performance issues, some of which have had direct, negative impacts on veteran care.
“[10,000 employees] sounds big, but in a system as big as the VA, that’s not where we need to be,” noted the Senate VA Committee chairman, Sen. Jon Tester (D-MT), at a hearing last month examining the rollout. “Clearly the tools in the Oracle system aren’t working, or at least not working as intended… Within VA, we’ve seen a lack of clear goals and strategy, and unstable leadership, while the contractors have been what I believe is abusing the taxpayers. We know the previous administration didn’t do the VA any favors by issuing a $10 billion no-bid contract.”
Those 10,000 users are also generally dissatisfied with the results of the rollout. A user survey found that only 6% agreed that the system enabled quality care and 4% agreed that it made them as efficient as possible. According to Tester, those are among the lowest scores ever seen on a major federal IT acquisition.
But while some Republicans have crafted legislation that would cease the EHR Modernization program entirely and have those facilities already using it switch back to the VISTA legacy system, Tester said “that’s not in the cards.”
“All options but one are on the table to fix this EHR,” he declared. “I’m not going to ban the effort to modernize VA’s healthcare records.”
While VA and Oracle-Cerner have made efforts to address ongoing issues, Tester said that the new contract needs to put stricter terms in place going forward, including ones which include severe penalties for poor performance.
To date, Oracle-Cerner has refunded the government approximately $325,000 of the $4.4 billion the company it’s been paid for the project–an amount that Tester suggests is paltry compared to the number of system crashes, as well as the documented evidence of incomplete system technology and inadequate training programs.
“If Oracle won’t agree to those terms, then VA should be ready to roll up its sleeves and negotiate an entirely new contract or find a different team of partners,” he declared.
Carol Harris, Director of Information Technology and Cybersecurity at the Government Accountability Office (GAO) agreed with Tester’s assessment of the weakness in the current contract.
“I think it’s fair to say that Oracle-Cerner has not performed as well as it could have, especially given the scope of system issues and the lack of timeliness to resolve them,” Harris said. “Clearly, I think the contract as currently written has not sufficiently motivated Oracle-Cerner to perform better. Just looking at the ticket resolution timeliness alone.”
However, Harris noted that blame also falls on VA and its lack of experience overseeing contacts of this scale.
“For 40 years they’ve been in the business of building systems like VISTA, and it’s a completely different skill set in building IT versus buying,” she explained. “I think the department has struggled to make this transition. That’s evidenced by its past failed attempts to replace VISTA with other commercial products, as well as what you’re seeing right now.”
One option that the Government Accountability Office GAO has recommended is a third-party evaluation of the program.
“It’s objective, it’s comprehensive, and it would allow VA to systematically catalog the major issue and then address them point-by-point,” Harris explained.
VA leaders testifying at the hearing said that the department might be agreeable to that. Mike Sicilia, Executive Vice President of Oracle, added that third-party evaluations are common practice in the private sector.
Sicilia also noted that these kinds of post-rollout issues are not uncommon.
“Modernization at this scale is never easy,” he told the committee. “The initial DoD rollout was similarly challenged in the first two years, only completing four deployments, then taking a two-year pause to improve governance and fine-tune a standardized baseline enterprise system.”
As for the VA project, Sicilia said, “I am more optimistic than ever that we are on the right trajectory and we can get this program on track on budget and on schedule.”
Asked why VA seems to be having more serious challenges adopting the system than DoD, which is in the process of adopting the same Oracle-built EHR, Sicilia said “there’s no simple answer” but that “VA does offer a more complex range of services.”
As for where VA’s EHR stands today, Neil Evans, Acting Program Executive Director of VA’s EHRM Integration Office, explained that DoD healthcare data is now available to VA staff, but that this is only the first step in a larger goal.
“We need to get to the point where the data is not just available but computable,” explained Evans, who had stepped into the role only three weeks prior to the hearing. “So the colonoscopy that was done eight years ago triggers a reminder to me to order a new colonoscopy at the 10-year mark. That I don’t have to go look it up in a digital repository somewhere.”
“It’s much more than a record,” he added. “It’s what drives the workflow. It’s what supports how clinicians think about patient care. I think it’s important to understand the depth of the change.”
The current contract between VA and Oracle-Cerner expires May 16.