Oracle pushes back against calls to end VA project to modernize health records

The Department of Veterans Affairs has endured plenty of setbacks as it attempts to modernize its electronic health records system, and a House Republican is now pushing to scrap the project.

U.S. Rep. Matt Rosendale, a House Republican, has introduced legislation to end Oracle Cerner’s project to revamp the VA records system. Oracle contends that simply jettisoning the project would be foolish.

After citing a variety of technical and systems issues, the VA said last fall it is delaying the rollout of the new record systems to other facilities until June 2023. The new system has been installed in five facilities. The VA said it is working with Oracle to address the issues, including those affecting patient safety.

Rosendale argues that it’s time to move on. A member of the House Veterans’ Affairs Committee, he was recently named chairman of the Subcommittee on Technology Modernization. The first bill he has introduced as chairman of the subcommittee is the legislation (H.R. 608) to end the project.

“The Oracle Cerner electronic health record program is deeply flawed – causing issues for medical staff and posing significant patient safety risks,” Rosendale said in a statement. “We cannot continue to further implement this inadequate system at the expense of billions of dollars in government funding. We must hold the VA to the high standard of care promised to our veterans and be good stewards of taxpayer dollars.”

Lawmakers in both parties and federal watchdogs have criticized the project, which has a price tag of $16 billion, and some estimates suggesting it’s higher. The VA awarded the project to Cerner in 2018, and Oracle acquired Cerner last year.

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Oracle has acknowledged the bill and similar sentiments from a few members of Congress. Oracle says it is working with the VA to address the problems but said the legislation to kill the project “is the wrong approach and will take VA and healthcare for our nation’s veterans backward.”

If the VA did drop the project, it would mean reverting back to an electronic record system that was installed in the 1980s, Ken Glueck, Oracle’s executive vice president, wrote in a Feb. 3 essay.

Most VA facilities rely on the old Veterans Health Information Systems and Technology Architecture, dubbed VistA, which is actually 130 separate systems implemented at medical centers ­across the country, Glueck wrote.

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

The modernization effort has had problems, he acknowledged. He said the first deployment of the new system in October 2020, in the height of the pandemic, “was a mistake” in hindsight. It was unnecessarily frustrating for staff to learn a new electronic health record system while caring for an influx of COVID-19 patients.

However, Glueck also notes that the same Cerner technology is being implemented successfully within the Department of Defense, along with thousands of hospitals around the world.

“So, if it works at the DoD and at hospitals across the United States, then why can’t it work at the VA? Of course, it can—and it is,” he wrote.

The VA has said a key goal of the project is to provide one single health record for individuals from the time they enter the military through their lifetime.

Oracle is making substantial progress to resolve the issues with the new system, Glueck wrote. The most severe outage incidents have been reduced by 67% since June, and Oracle has a dashboard tracking congressionally requested items.

Oracle is also planning a free, modern update to the Millennium EHR into a web application. “In plain language that means we intend to move Millennium to a cloud-based application that will have a modern web-based user interface, be mobile friendly, allow for voice recognition and include machine learning-based clinical decision support and analytics,” Glueck wrote.

Democratic and Republican lawmakers have voiced dissatisfaction with the project, and the VA’s Office of Inspector General has delivered stinging criticisms.

The inspector general released a report in July, which found the new system at the VA’s Spokane hospital failed to deliver more than 11,000 orders for clinical services between October 2020 and June 2021. The report identified 149 adverse events for patients.

Deputy Secretary of Veterans Affairs Donald Remy, who oversees VA’s EHR program, said in a statement last fall that the new system won’t go out to other facilities until all the problems are resolved.

“We are delaying all future deployments of the new EHR while we fully assess performance and address every concern,” Remy said.

Oracle acknowledges that “even one instance of patient harm is unacceptable” and said the company expects to be held accountable for a system designed to serve the nation’s veterans. But Glueck said a modernization project of this size is going to entail challenges.

“We are working collaboratively with our dedicated partners in the VA to drive this effort forward,” Glueck wrote. “We are proud of the work we are doing, and we intend to exceed expectations. Our veterans deserve no less. Pulling the plug now ensures snatching defeat from the jaws of victory.”