Several leading Democrats on the House Veterans’ Affairs Committee voiced their concerns on Tuesday about the amount of money spent to modernize the Veterans Affairs Department’s electronic health record system, as bipartisan criticism of the beleaguered project continues to mount.
During the committee’s first oversight hearing of the 118th Congress, Rep. Mark Takano, D-Calif.—the panel’s ranking member—used his opening remarks to underscore that “the EHR modernization program is on its fourth director in five years, and continues to burn money and disrupt care.”
The rollout of VA’s new multi-billion dollar Oracle Cerner EHR system, known as Millennium, has been plagued by patient safety concerns, ballooning costs, delays and system disruptions since it was first deployed at the Mann-Grandstaff VA Medical Center in Spokane, Washington in 2020. A July 2022 report from the VA’s Office of Inspector General found that the new software deployed at Mann-Grandstaff routed over 11,000 orders for clinical services to an “unknown queue” without alerting clinicians, resulting in “multiple events of patient harm.”
VA announced in October that it was delaying future deployments of the new software until June 2023 to “fully assess performance and address every concern” with its implementation. Last month, VA also announced that it was delaying a planned go-live of the EHR system at the VA Ann Arbor Healthcare System—scheduled for June—until later this year or 2024.
GOP leaders on the House committee have taken particular issue with the growing cost of deploying the new EHR software at all of VA’s medical facilities, with the initial estimate of $10 billion over 10 years increasing to $50 billion over 28 years, according to a cost estimate conducted by the Institute for Defense Analyses. Thus far, the new software has been implemented at five facilities across the VA’s national network of 171 medical centers.
Rep. Mike Bost, R-Ill., who chairs the panel, and nine GOP lawmakers introduced legislation in January that would halt rollouts of the new EHR system at additional VA medical centers until the software meets certain verification standards. Rep. Matt Rosendale, R-Mont., chair of the panel’s Technology Modernization Subcommittee, also introduced legislation in January—co-sponsored by Bost—that would terminate the project if VA “cannot demonstrate significant improvement” in the system’s deployment.
Democrats have criticized the EHR system’s deployment, but have largely refrained from calling for an end to VA’s modernization project. Takano previously voiced opposition to “completely canceling the EHR program without a viable solution to replace it,” and committee Democrats are reportedly working to draft a “comprehensive” bill to revamp the system’s rollout.
The VA, for its part, is continuing to move forward with plans to deploy the new EHR system, despite ongoing delays and operational setbacks.
In written testimony submitted to the committee, Dr. Shereef Elnahal—VA’s undersecretary for health—said the department “is committed to continuous improvement of the electronic health record and associated health information technologies, even while executing ongoing deployments across the health care system in the years to come.”
“VA continues to develop and finalize a new deployment schedule and remains fully committed to implementing a modernized electronic health records system, in service of providing the best possible care for our veterans,” he added.
But other watchdog officials who appeared at the hearing expressed less optimism about VA’s efforts to address challenges related to the EHR system’s rollout.
Gene Dodaro—U.S. Comptroller General and the head of the Government Accountability Office—told the committee that, while there have been “glimmers of progress” in working with VA to address challenges, the department as a whole is “an unwieldy, highly decentralized organization, where efforts to bring about positive change are extremely difficult to happen.”
“There’s a need for a much more disciplined management practice to ensure the effective implementation of the electronic healthcare record system,” Dodaro added.
Rep. Sheila Cherfilus-McCormick, D-Fla.—ranking member on the committee’s Technology Modernization Subcommittee—asked Dodario if GAO had “an estimate of the VA’s expenditures on failed EHR modernization efforts before the current Cerner EHR project.”
“We are very concerned that the total cost for the EHRM project remains to be seen, and it would be helpful for the committee to know the running total for taxpayer spending on past EHRM modernization efforts,” Cherfilus-McCormick added.
Dodario said GAO estimated that the cost “is over $1.7 billion dollars for failed predecessor electronic healthcare record systems that either failed, or did not come to fruition.”
When pressed by Cherfilus-McCormick about how VA is using the rollout delay to streamline future deployments of the new EHR system, Elnahal said that the department is “looking specifically at the system configuration issues, but also people and process matters that led to our need to disclose to tens of thousands of veterans that their care may have been delayed or affected by the implementation of this system.”
“In the coming weeks, we’re going to be releasing the results of that work to include not only Oracle Cerner’s responsibility to fix the configuration of the system, but also our own in making sure our people and process matters continue to improve,” Elnahal added.