VA finally gets tough with Oracle Cerner–when things are not peachy at the latter. The Oracle Cerner EHR contract with the Department of Veterans Affairs (VA) was renewed with 28 key performance metrics attached to monetary credits. Instead of another five-year term, there are five one-year terms that allow VA to revisit the contract annually. It was not a ringing vote of confidence in the relationship, with good reason, as the EHR implementation has ground embarrassingly to a halt over five years with only five deployments in VA medical centers, of 166 centers plus their medical clinics [TTA 26 Apr, 18 Mar].

The renegotiated contract holds Oracle accountable in four key areas, according to a VA update document obtained by Bloomberg Government:

1. Reliability: Minimizing outages (time when the system crashes completely), incidents (time when one component of the system isn’t working), and interruptions (time when the system is operating slowly) of the system.
2. Responsiveness: Quickly and reliably resolving help tickets and clinician requests.
3. Interoperability with other health care systems: Ensuring that VA can quickly and reliably access patient health records from private sector hospitals when necessary, so we can provide informed, world-class care to those we serve.
4. Interoperability with other applications: Ensuring that the EHR system interfaces with VA’s website, mobile app, and other critical applications, so Veterans have a seamless and integrated health care experience.

With 28 performance metrics that if not met will result in Oracle paying a monetary credit to the VA, there’s a big monetary incentive for Oracle. For instance, in the VA update document, they claim that Oracle would have paid approximately a 30-fold increase in credits for the system outages, which is only one of the metrics. “The amended contract lays the groundwork for VA and Oracle Cerner to resolve the EHR issues identified by the “assess and address period” and optimize EHR configuration for future sites.” Becker’s, Healthcare IT News

The contract negotiations were a hot button in recent weeks for both the House and Senate veterans’ committees, with multiple bills proposed and hearings. The 9 May hearing by the House Subcommittee on Technology Modernization Oversight (Committee on Veterans’ Affairs) was no love-fest, with chair Matt Rosendale (R-MT) once again concluding that the best thing for the VA would be, as he proposed in his bill H.R. 608, to cut Oracle loose and start over. VA obviously did not agree, being between a rock and a hard place, but this hearing put Oracle’s Mike Sicilia on the hot seat about the EHR’s pharmacy software to support the VA’s role as both prescriber and prescription filler–which he previously committed to having fixed by this past April. Carol Harris, Director, Information Technology and Cybersecurity, Government Accountability Office (GAO), responding to Rep. Rosendale’s questions, described a system that is not fully functioning and puts veterans at risk with failings by both Oracle and VA. In the current state, VA users are extremely dissatisfied. The present workarounds and ad hoc processes outside of the system are not sustainable and are set to fail. She also pointed out that VA needs to set goals for what constitutes user satisfaction with clear and objective measures before future deployments. VA must take a leadership role in change management beyond what Oracle does in the deployment. Hearing on YouTube (2.01:50) Witnesses and support documents

Over at the Senate, the majority and minority patted themselves on the back about the new contract enough to herniate a disc. The majority statement is a press release about chairman Jon Tester (D-MT). The minority statement from Jerry Moran (KS) tartly described the new contract as a “step in the right direction, but fixing the current EHRM program will require a major overhaul” which of course his bill would address.

The added scrutiny comes at a bad time for Oracle Health with turmoil reportedly festering within the Cerner acquisition. Oracle has laid off 3,000 workers, pausing raises and promotions. Don Johnson, who once was a successor to CEO Larry Ellison, departed from leading Oracle Health and AI. Reportedly, Dr. David Feinberg who briefly headed Cerner prior to the sale, is now a ‘ceremonial’ chairman of Oracle Health. Cerner’s signature buildings in Kansas City are being sold and emptied. If Mr. Ellison wants to transform healthcare, he needs to start at home, rebuilding Cerner-Oracle Health rather than decimating it, and fixing VA as Job #1. Business Insider

Additional recent coverage: 28 April, 20 April, 19 April, 31 March