VA delays Oracle Cerner EHR project

The Department of Veterans Affairs (VA) is currently using one of healthcare’s oldest electronic health record systems – and it looks like the venerable VistA will be sticking around for at least a little while longer. 

VA leaders have announced an indefinite pause to new deployments of VistA’s replacement: the $10 billion Oracle Cerner EHR that has been in the works since 2017.   

After years of close Congressional scrutiny and multiple delays due to the enormous complexity of replacing a decades-old, custom-built system with an off-the-shelf option, the Oracle Cerner EHR is currently being piloted at five VA locations in Washington State, Oregon, and Ohio. 

Even on a small scale, the new system is not working as expected. In March, VA officials confirmed that the EHR is directly linked to six cases of “catastrophic harm” leading to the avoidable deaths of four veterans in Spokane, WA and Ohio, prompting a Senate committee to yet again threaten to pull the plug on the entire contract. 

At the end of April, the VA acknowledged that it needs even more time to “reset” the project and will pause all new deployments, barring one, until the department is confident that the EHR is safe and effective for daily use. 

“For the past few years, we’ve tried to fix this plane while flying it – and that hasn’t delivered the results that Veterans or our staff deserve,” said Dr. Neil Evans, Acting Program Executive Director, Electronic Health Record Modernization Integration Office. “This reset changes that.” 

“We are going to take the time necessary to get this right for Veterans and VA clinicians alike, and that means focusing our resources solely on improving the EHR at the sites where it is currently in use, and improving its fit for VA more broadly. In doing so, we will enhance the EHR for both current and future users, paving the way for successful future deployments.” 

As part of the reset, the VA is “amending” its contract with Oracle, which purchased Cerner for $28 billion in 2022. The reworked agreement will “increase Oracle Cerner’s accountability to deliver a high-functioning, high-reliability, world-class EHR system,” according to the VA press release. 

“We’ve heard from Veterans and VA clinicians that the new electronic health record is not meeting expectations – and we’re holding Oracle Cerner and ourselves accountable to get this right,” said VA Secretary Denis McDonough. “This reset period will allow us to focus on fixing what’s wrong, listening to those we serve, and laying the foundation for a modern electronic health record that delivers for Veterans and clinicians.” 

For its part, Oracle has been upbeat about its inheritance of the massive task. In February, the company wrote a lengthy defense of the project after lawmakers introduced a bill to permanently terminate the VA EHR modernization.   

“The problem with modernization is it doesn’t come with a magic wand and there’s no easy button. Modernization requires change and some short-term pain for the long-term benefits of a modern technology infrastructure, a modern user interface, and a modern set of workflows,” said Executive VP Ken Glueck.  

“Moving from customized, one-off workflows to standard, commercial-off-the-shelf workflows is always hard to implement … and always worth doing. A modernization project of this scale and scope necessarily involves time to untangle the decades of customized processes established in support of VistA, which inevitably involves challenges. This should be a surprise to no one.” 

But it remains to be seen whether or not the new Oracle team can overcome deeply rooted issues in the VA’s shifting technical infrastructure – as well as its cultural and organizational ecosystem. The Government Accountability Office (GAO) and the VA itself have both recently released reports noting significant problems with change management and decision-making that have created unwanted bottlenecks in EHR workflow and care team communication. 

For example, a March 2023 report from the VA identified 30 patient safety issues related to data input and processing problems, such as mismatched provider and care location records and the need for staff to update medication lists at every visit because updated medication information did not carry over to a patient’s next appointment. 

In the same month, GAO cautioned that the VA is only partially consistent with leading practices in organizational change management. According to the report, the Department currently lacks a clear vision for change, struggles with effective communication, and is unable to fully assess readiness to make changes or evaluate the impact of its activities on user satisfaction. 

“VA’s 2021 and 2022 surveys showed that users were not satisfied with the system’s performance or training,” GAO stated. “About 6 percent of users agreed that the system enabled quality care. In addition, about 4 percent of users agreed that the system made them as efficient as possible. Further, VA has not established targets (i.e., goals) to assess user satisfaction.”  

“Until it does so, VA lacks a basis for determining when satisfaction has sufficiently improved for the system to be deployed at additional sites. Such a basis helps ensure that the system is not deployed prematurely, which could risk patients’ safety.” 

At the moment, next steps for the EHR modernization project are unclear. The VA will need to work closely with Oracle and with Congress to decide its next steps while ensuring that the new system is safe and effective for veteran healthcare. 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at jennifer@inklesscreative.com.