New Congress, new hearings of the House Committee on Veterans’ Affairs Subcommittee on Technology Modernization on the EHRM, and a new chairman. Rep. Tom Barrett’s (R-Mich. 7th CD) opening remarks for the 24 February were more than an introduction of him as a new Congressman and subcommittee chairman. He is a 22-year Army veteran, a patient of the Battle Creek MI Medical Center, and had used the Montgomery GI Bill to pay for his college education. What he was less than sanguine about was the Oracle Cerner EHR–the problems, the budget, the timing for the restart, and whether all medical centers can be cut over by 2028, the contract’s end.
It’s seven years into VA’s original 10-year contract with Cerner, then Oracle. The implementation is in less than 4% of VA’s medical centers–only six including the joint MHS-VA Lovell Medical Center in Chicago. The contract in May 2023 was modified to five years of annual renewals expiring in May 2028. Rep. Barrett questions whether all the problems have been fixed or on the way to be fixed in order to meet the previous VA Secretary, Denis McDonough’s pronouncement last year that the VA would restart the Oracle implementation in spring 2026 [TTA 18 Dec 2024–the original statement was within FY 2025].
Two more open questions are cost and timing. Congress has no current schedule, nor a cost estimate for the entire project. The last independent cost estimate is three years old and $32.7 billion–more than double the original estimate of $16 billion.
The hearing confirmed that the homework is not done yet and not ready to be turned in, in Rep. Barrett’s words. During the hearing, the committee pressed VA about both those issues. The Government Accountability Office (GAO)’s Information Technology and Cybersecurity Director Carol Harris cited another estimate above $50 billion, which was contested by Oracle Health’s EVP, Seema Verma (former CMS Administrator during Trump 45), who believes that with the progress made during the hiatus, that the costs would be less and the Oracle EHR is much improved from the near-disastrous five original implementations. But Neil Evans, the acting program executive director of the EHRM Office, stated that the implementation would not be completed by the contract end in May 2028. Moreover, the EHRM Office still has to develop a detailed integrated master schedule and updated life cycle cost estimate. Both were emphasized as needed by acting VA Inspector General David Case. A hearing with few revelations, other than VA and Oracle need to get a move on. House Committee press release, NextGov/FCW The full two-hour hearing is on YouTube here. Hat tip to HIStalk.
Updated 27 Feb: Additional information from the GAO, EHRM Office and Oracle Health’s Seema Verma testimony from Healthcare IT News 27 Feb:
- GAO (Carol Harris): The VA still has to address over 1,800 requested configuration changes, along with the cost and schedule and the continued user dissatisfaction with the system. Improvements: trouble tickets resolution timeliness thresholds were met since the implementation of financial consequences in September 2023, and that many but not all patient safety and pharmacy issues have been closed–and should be before further deployments.
- EHRM Office (Neil Evans): A series of complex projects are moving forward, dubbed “Big Rocks”. These include standardizing user roles, improving new EHR user training for new users and addressing coordination between clinicians and pharmacists.
- Oracle Health (Seema Verma): Presented plans to scale the EHR to the remaining 164 (sic) locations. She pushed for faster implementations, stating that the current pace is unacceptable. They are investing into automating implementations that would reduce manual testing efforts, user onboarding and training. She recommended to VA that they use “web-based tools” to gather site-specific information faster. On “Big Rocks” projects, Oracle worked with VA on pharmacy, referrals, Quick Orders, and other aspects of the EHR.
And what about accessibility? Last June, Laurette Santos, a visually impaired clinical social worker at VA’s White City, Oregon, facility, sued VA in the DC Federal Court on the Oracle EHR violating accessibility standards. These have been part of every Federal contract since the Rehabilitation Act of 1973, specifically in Section 508. She has standing in court as a VA Visual Impairment Services Team (VIST) Coordinator since 2019 and user of the Job Access With Speech (JAWS) screen reader application within VistA. There is no Oracle equivalent. TTA 8 July 2024
Updated 26 Feb: VA has not been exempt from the firings of probationary employees. 1,000 were terminated on 13 February followed by another 1,400 this week. They were categorized in the VA release as “non-mission critical includ(ing) DEI-related positions, among other roles” and “bargaining-unit probationary employees who have served less than a year in a competitive service appointment or who have served less than two years in an excepted service appointment.” The estimated savings of $83 million annually will be redirected towards care and services for VA beneficiaries. What’s often not mentioned in press coverage is that there are 40,000 probationary employees across VA, the vast majority are in mission-critical positions such as benefits and services for VA beneficiaries–and that VA has open 300,000 mission-critical positions exempt from hiring freezes. Another buffer is that a Senior Executive Service (SES) or SES-equivalent leader in a dismissed employee’s chain of command can request that the employee be exempted from removal and that those in the deferred resignation program are also exempt. The Hill is notable for what is included and excluded.
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