WASHINGTON, DC — The Trump administration has announced that it will move ahead with VA’s existing plan to restart the electronic health record modernization (EHRM) rollout in spring 2026, beginning with four hospitals in Michigan.
According to VA officials, the department and the new EHR’s designer, Oracle, have improved the system and the installation process to the point where they believe new installations will not be plagued by the same instability as previous ones. The rollout has been on pause since April 2023.
Legislators expressed skepticism, pointing to the ballooning costs, incremental rollout and dozens of outstanding complaints from facilities where the system is already live as proof they have cause to worry. Also, according to watchdog agencies, VA’s lack of an updated cost estimate and a revised schedule will hamper the department and Congress’s ability to judge success.
When VA signed the original EHR contract with Cerner, since bought by Oracle, in 2018, the estimated cost of the project was $16.1 billion with a 10-year timeline for the new system’s installation across VA’s entire healthcare system. Seven years later, the system has been implemented in only 4% of VA medical centers at a cost of $12.7 billion.
An independent cost estimate of the program conducted three years ago by the Institute for Defense Analyses put the cost of implementation at $32.7 billion over 13 years. This came prior to the 2-year pause, and experts say it can no longer be relied upon, though it’s likely closer to the actual cost than the VA’s original estimate.
“VA has been in reactive mode during this reset period, putting out fires with no real plan for how to move forward strategically,” Carol Harris, the Government Accountability Office (GAO) director of information technology, told the House VA Technology Modernization Subcommittee last month.
Any reliable plan is dependent on an updated cost estimate and installation schedule, she explained. “Congress and VA senior leaders are relying on estimates that are severely outdated and incomplete.”
Harris also noted that VA has yet to conduct an independent verification and validation (IV&V) assessment of the EHR, which GAO recommended it do in 2023. This kind of operational review is considered best practice in the private IT sector and would allow VA to better understand how the new EHR is functioning in the facilities where it’s been installed.
“[This is an] evaluation of the system end-to-end to determine if the system is operationally suitable. … It answers the question of whether or not the EHR will meet system needs,” she explained. “It’s one of the reasons DoD was able to successfully deploy the Oracle/Cerner system.”
According to Neal Evans, MD, acting director of the EHRM integration office, an independent review isn’t necessary, since the department has spent the last 2 years answering those questions for itself.
“We’ve had a lot of attention in a very similar fashion to what an IV&V would do with our staff and staff from Oracle health spending a considerable amount of time on the ground at our live sites observing workflows from end to end and categorizing what the issues are,” Evans said. “Those issues are the change requests [submitted by facility staff] that we were working through during the reset.”
There are approximately 1,800 requests still to go through, he added.
Staffing also was a concern for legislators, who questioned whether Evans’s office had been impacted by the recent purge of probationary federal employees.
The EHRM Integration Office is set up for 330 staff members, 250 of whom were in place prior to the firings, Evans said. Of those, eight were fired during their probationary period, and 16 signed up for the deferred resignation program.
Asked whether he was confident VA can move forward in light of these staffing changes, Evans said, “It’s important to recognize that it’s not just the staff of the EHMR office who are going to be the folks who actually make this happen. … We’re confident that we are entering Michigan having learned a lot, [though] that doesn’t mean we can let up one bit with regard to our vigilance.”
