WASHINGTON, DC — VA has renewed its contract with Oracle Health to support its electronic health record modernization project. The 11-month extension will place emphasis on not only improving the much-beleaguered EHR, but on holding Oracle accountable when goals are not met.
The contract renewal follows a year of heavy criticism directed at the technology company for failing to meet its obligations to fix issues with the EHR in facilities where it’s been implemented.
At the same time, Congress is working on legislation that could put a hard deadline on VA and Oracle to right the project and require VA to come up with alternative solutions. It also would include language directing VA to sunset the project if performance goals are not met.
In 2017, VA first announced its intention to replace the aging VISTA EHR with a new system developed by Cerner, which was already being installed in military medical facilities. The following year, VA signed a $10 billion contract with the company to begin a decade long project to install a version of the system at all 171 VA medical centers.
That original contract has since been heavily criticized by legislators and watchdog agencies for its lack of appropriate performance metrics and methods for VA to hold the company accountable if any problems arose.
The rollout began in 2020 at the Mann-Grandstaff VAMC in Spokane and immediately encountered significant problems, some of which led directly to patient harm. While VA and Cerner worked to fix the issues, some of the problems persisted into subsequent facility rollouts.
In 2022, Oracle purchased Cerner for $28 billion. At the time, Cerner was seen as a company with great potential for growth, in part because of its contract with VA. Oracle inherited the existing problems with the EHR, which persisted through 2022 and into 2023 when VA called a halt to all future deployments until those problems could be solved.
It also reconfigured its contract with Oracle, requiring it to be renewed every year following an evaluation of the company’s progress.
This is the second yearlong extension of the contract.
According to VA, this year-by-year approach has substantially increased accountability, including minimizing outages, resolving clinician requests and improving interoperability with other healthcare systems.
“Executing the second option period of the contract allows VA and Oracle Health to continue to drive forward on the goals of the reset and future deployments,” declared VA Deputy Secretary Tanya Bradsher in a statement.
Legislators remain skeptical as reports continue to come in from the six facilities where the new EHR has been implemented that problems are still unresolved and where staff surveys show record-low morale. Republicans on the House VA Committee have been lobbying for months for VA to ditch the project and revert all facilities back to VISTA, and they might eventually get their wish.
The VA EHR Reset Act, originally introduced last year, has been wrapped into a larger piece of legislation currently being considered in the House and Senate. The Reset Act would give VA 90 days to create national standards for the implementation of the EHR, creating hard performance metrics, the absence of which has frustrated legislators and watchdogs since the rollout began.
The legislation forbids VA from expanding the system to new facilities until those six current facilities are operating at a level equal to or greater than they were when using VISTA. It also requires VA facility directors to sign off on the expansion, stating that they believe their facility is able to handle the new system.
Most critically, it requires the VA secretary to present alternatives to the Oracle EHR. And, if the EHR has not been shown to provide demonstrable improvement in the facilities where it’s been installed within two years of the legislation’s passage, the VA will be required to move to one of those alternatives or go back to the VISTA legacy system.
The Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, the sweeping legislative package that the Reset Act is now a part of, pulls in a number of high-profile pieces of legislation introduced over the last year. The package as a whole has extensive bipartisan support, as well as the backing of veterans’ service organizations, making it likely that some version of it will pass.
VA Secretary Denis McDonough has told legislators that he expects the department to begin moving forward with the rollout in 2025. How this legislation might impact this plan, especially if the full EHR Reset language is included, is unknown.
