Planning for April–but are the problems that derailed it three years ago solved? The US Department of Veterans Affairs is still stoutly maintaining an April start date for resumption of its EHR Modernization (EHRM) rollout. In last week’s updated schedule issued by the EHR Modernization Integration Office (EHRM-IO), the new strategy is to keep the rollouts within a fairly tight geographic area in the same VA region, or in VA-speak, VISN, and roll out every two months. Thus the first four systems are VISN 10 in Michigan: Detroit, Saginaw, Ann Arbor, and Battle Creek (system) in April. Two months later in June, an additional four in VISN 10 will roll out: Dayton Ohio, Chillicothe Ohio, Cincinnati, and Cincinnati-Fort Thomas Kentucky. Another three in VISN 10 will start in August and the last two for the year, Louis Stokes-Cleveland in VISN 10 and Alaska (Anchorage) in VISN 20, will be started in October.
And the reservations are… At the end of January, the VA’s Office of Inspector General in their FY 2025 report on VA’s Management and Performance Challenges detailed five major challenges in the agency. While healthcare services was #1, that section concentrated on staffing and community care delivery coordination, touching on the veteran scheduling/appointment problems that are part of the EHRM, including the Veterans Self-Scheduling (VSS) process.
Most of the EHRM discussion was in #4, information systems and innovation. The VA was scored on using existing systems and incorporating emerging technologies to manage veterans’ medical records, benefits determinations, financial disclosures, and education documents. EHRM and its major performance incidents were detailed first, along with Caseflow (claims and appeals) lacking an enterprise governance structure. The system failures also affected patient care, with clinicians being unaware of critically important patient data and communication breakdowns between VA and community care providers leading to delayed diagnoses and treatment. The OIG also noted a background of decades old cybersecurity and data-integrity problems, with critical vulnerabilities that allowed staff bypass of security protections that left about 3.3 million veterans’ records unencrypted at one facility. In implementing the OIG’s recommendations on the EHRM:
Regarding VA’s ongoing electronic health records overhaul, VA strengthened the contractor agreement by enhancing performance credit clauses (provisions that establish financial penalties if the contractor fails to meet performance standards) and tighter incident metrics. It created limited real-time system dashboards to help monitor performance at sites going live with the system. However, there remain 32 OIG recommendations that are not fully implemented as VA resumes system deployments. (Editor’s emphasis)
The original ten-year Cerner agreement to replace the venerable but non-interoperable VistA eight years ago (May 2018) was a $10 billion contract, later revised to over $16 billion. After the failures of four years ago, it was rewritten at the five-year point in 2023 to, frankly, bring Oracle Cerner to heel. The 2020 and 2022 implementations were disastrous: Mann-Grandstaff (VISN 20) in October 2020 and four more in 2022. The only 2024 implementation was joint with the DOD Military Health System at the Lovell Federal Health Care Center in Chicago, which went relatively smoothly. A year ago, continuing the rollout looked questionable [TTA 26 Feb 2025]. Now VA has committed to a timeline for 13 health systems/centers this year. Not accomplishing it, and smoothly, will be a bottle of black ink all over VA–and Oracle.
Further complicating matters is Oracle Health’s uncertain status. Will it be cashed out to build AI Datacenters? It depends on an uncertain funding environment and the generosity of banks. And doesn’t relieve the new owner of this Federal contract. [TTA 5 Feb]
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