Top Republican lawmakers are ready to pull the plug on a beleaguered health IT project being deployed at Veterans Affairs (VA) hospitals unless significant improvements are made to fix technical glitches.
Mike Bost, R-Illinois, chairman of the House Committee on Veterans’ Affairs, introduced a bill Friday called the VA Electronic Health Record Modernization Improvement Act that would require the VA and Oracle Cerner to "demonstrate significant improvements in the EHR system before installing it at additional medical centers."
Going a step further, Congressman Matt Rosendale, R-Montana, who was named chairman of the subcommittee on technology modernization within the House Veterans' Affairs committee, introduced separate legislation Friday that aims to terminate the VA's multibillion-dollar EHR modernization program if improvements are not made.
An Oracle representative could not be immediately reached for comment about the proposed bills.
The Department of Veterans Affairs is working with health tech company Cerner, now owned by Oracle, on a $16 billion project to modernize its electronic medical records system.
Federal lawmakers have serious and growing concerns about patient safety issues related to the new medical records system.
The VA has pushed off deployment of its new EHR system to additional medical facilities until June 2023 to address outages that have plagued the software at current sites. Watchdog reports found that the new EHR system had caused nearly 150 cases of patient harm at a Spokane VA hospital.
"I have traveled across the country and seen and heard firsthand the impact the Oracle Cerner product has had on VA providers and veterans. It has crippled the delivery of care, put veteran patient safety at risk, and stressed an already overwhelmed healthcare system,” said Bost in a statement.
His proposed legislation, H.R. 592, would require VA and Oracle Cerner to demonstrate that the EHR is safe and effective before installing it at additional VA medical centers.
Specifically, each VA medical center’s director, chief of staff and network director would be required to certify that the EHR system has been correctly configured for the site, that the staff and infrastructure are adequate to support it and that it would not negatively impact safety, quality or current wait times, according to a fact sheet (PDF) about the bill.
Under the proposed bill, VA and Oracle Cerner could not commence go-live preparations at additional medical centers until the VA secretary certifies that the EHR system has achieved 99.9% uptime and technical fixes have been made.
The VA signed a $10 billion deal with health tech company Cerner in May 2018 to move from the VA’s customized VistA platform to an off-the-shelf electronic health records system. The goal was to align the country’s largest health system with the Department of Defense, which has already started integrating Cerner’s MHS Genesis system.
Software giant Oracle closed its nearly $30 billion deal to acquire Cerner last June and inherited the company's beleaguered VA tech project and is working to fix the problem-riddled system.
VA has spent roughly $5 billion of taxpayer money to implement the Oracle Cerner EHR system at five of 171 medical centers, where it has badly disrupted operations for veterans and VA providers, according to Rosendale.
The EHR system "has created unacceptable levels of productivity losses, patient safety risks and staff burnout" at the five small and medium-sized hospitals where it's been deployed since 2018, according to Rosendale, who is one of nine co-sponsors of Bost's bill.
Rosendale and Bost point to a recent user survey by KLAS Research that showed an overwhelming 78% of Oracle Cerner EHR users at VA disagreed or strongly disagreed that the system enables them to deliver high quality care—the lowest rating for any EHR system surveyed.
Last year, an independent life cycle cost estimate found that the cost to implement the system had more than doubled, from $16.1 billion over 10 years to between $33.6 and $38.9 billion over 13 years, Rosendale said.
Rosendale's bill, called the VA Electronic Health Record Modernization Termination Act, would, within 180 days, abolish the Electronic Health Record Modernization Integration Office, transfer remaining activities to the Veterans Health Administration or the Office of Information and Technology, according to a fact sheet (PDF).
It would also revert all medical centers using the Oracle Cerner EHR to VA’s existing EHR platform called the Veterans Health Information Systems and Technology Architecture, or VistA.
The proposed legislation also would gradually wind down the Oracle Cerner contract by preventing the Secretary from exercising any options on the company's contract.
"The Oracle Cerner electronic health record program is deeply flawed—causing issues for medical staff and posing significant patient safety risks,” Rosendale said in a statement. “We cannot continue to further implement this inadequate system at the expense of billions of dollars in government funding. We must hold the VA to the high standard of care promised to our veterans and be good stewards of taxpayer dollars.”
Oracle executives vowed to lawmakers during a hearing in September that the company would get the troubled project "back on track."
Testifying before the House Committee on Veterans’ Affairs Subcommittee on Technology Modernization, Mike Sicilia, executive vice president of Oracle Industries, told lawmakers that the database giant has the tech muscle necessary to right the ship.
Oracle plans to "rewrite" the Millennium EHR as a cloud application with new capabilities within the next six to nine months in order to fix stability issues and ensure better performance for clinicians, Sicilia testified.
But House lawmakers warned last summer they would consider scuttling the multibillion-dollar project unless officials show progress in the coming months.
"Cerner has to fundamentally improve and we have to set a deadline. If we don't see major progress by early next year when VA says they intend to roll Cerner out to larger sites, we will have to seriously consider pulling the plug," Bost told Oracle executives during a July hearing.
Bost added, "I hope the situation can somehow be turned around but everyone involved in this needs to understand the consequences are real, and that there are no blank checks here."
Pausing deployment of the new EHR at future sites is not enough, Bost said.
"The Oracle Cerner system should not be implemented at any more VA sites until the VAMC leadership certifies that the medical center is ready," he said in the statement.