A surprise development not making the VA nor Oracle happy–and another monkey wrench for the committees. The National Association of Veteran Affairs Physicians and Dentists (NAVAPD), a national VA association that represents VA’s 20,000 doctors and dentists, sent a letter in mid-October to chairs and ranking members of the House and the Senate Veterans’ Affairs, Appropriations, Oversight and Government Reform and Homeland Security and Governmental Affairs panels. It recommends that the Oracle Health EHR rollout be paused until “critical concerns about patient safety, system performance, cost, and long-term feasibility are independently evaluated”.  In addition, they cite concerns involving clinical workflow disruptions, delayed referrals, patient safety incidents, and rising program costs.

The letter, disclosed on 29 October, specifies that actions be taken by the committees before deployments continue:

• Pause further deployments: Suspend additional Oracle EHR implementations while continuing to fund patient care, system maintenance, and the correction of safety problems at existing sites.
• Require an independent safety assessment: Evaluate patient safety and operational readiness at facilities already using the system, with meaningful input from frontline physicians, dentists, and nurses.
• Strengthen transparency and accountability: Require regular reporting of patient safety incidents associated with the system.
• Evaluate alternatives: Conduct an independent comparison of the costs, risks, and feasibility of continuing the Oracle program versus modernizing the VA’s existing Veterans Health Information Systems and Technology Architecture (VistA), including the potential use of AI-assisted software development tools.
• Increase financial oversight: Require additional documentation and justification of proposed contract cost increases.

Surprisingly, the full text letter states that that the venerable VistA EHR still runs at all of VA’s 170 medical centers—including the sites transitioned over to the Oracle EHR. VistA is still used for longitudinal chart review. The letter also states that VistA is “currently best suited to meet our institutional mission.” which is not exactly a ringing endorsement of change. The dislike of a new EHR runs deep in this group but the workflow flaws are still many in the Oracle system. Another small surprise in the letter is this statement: “One recent analysis, which incorporates AI coding capabilities, estimates that modernization and maintenance of VistA would cost $1–2 billion over the next decade.” This is a group very much advocating continuing to use VistA with bolt-on, AI build/assisted software.

Even without this, it is already leading to a situation where VA clinicians use two EHRs for different purposes that don’t speak to each other.  Which wasn’t the intent.

A response was requested by 23 October. That was not disclosed.

The NAVAPD summary and full text letter to the committees. NextGov  Hat tip to our anonymous ‘eye on VA’.

So where is VA and Oracle now? The Oracle system has been rolled out to only 19 of 170 medical centers and associated clinics. The 2026 portion has ended with go-lives 24 October in the Alaska VA Healthcare System and the Louis Stokes Cleveland VA Medical Center. The Cerner, then Oracle rollout started disastrously in 2022. VA has also requested a $17 billion increase in budget for Oracle’s EHR development, from the original $10 billion, to cover both current costs and the three-year extension to May 2031 in the 2027 Military Construction, Veterans Affairs, and Related Agencies Appropriations Act. Both Mike Sicilia and the mighty Larry Ellison have been subpoenaed and have agreed to appear before both House and Senate committees on 19 November and 10 December, respectively. TTA 17 Sept

Oracle raised $20 billion for its AI data center plans in the past two weeks. In its new role as Data Center Builder and Landlord, Oracle’s raise consisted of “concurrent offerings of US$10b in common stock and US$10b in senior notes to fund heavy AI and cloud infrastructure spending. This included multiple tranches of fixed rate, senior, unsecured bonds with coupons between 7% and 8.65% and a US$10b equity sale at US$116 per share.” The further analysis in Yahoo Finance from Simply Wall St isn’t simple but comes down hard on the risk that Oracle is taking on the buildouts, “You have to believe its huge AI and cloud buildout converts a US$638b backlog and multicloud database momentum into durable, cash generative usage.”  Most of Oracle’s contracts are with OpenAI. Meaning that if AI demand trails off, or (as Ed Zitron has opined) if OpenAI goes bust, Oracle is in trouble plenty [TTA 19 Aug].