Oracle plans to 'rewrite' VA's Cerner EHR system to fix outages amid increased scrutiny from Congress

Tech giant Oracle promised lawmakers this week that it would revamp the beleaguered Cerner computer system being deployed at Veterans Affairs (VA) hospitals.

The company acquired Cerner only months earlier and is now focused on righting the ship on the $16 billion medical records system project that has been plagued by delays, leadership turnover and infrastructure problems since it kicked off in 2018. 

VA signed a $10 billion deal with health IT company Cerner in May 2018 to move from the VA’s customized VistA platform to an off-the-shelf EHR to align the country’s largest health system with the Department of Defense (DOD), which has already started integrating Cerner’s MHS Genesis system.

The VA has pushed off deployment of its new EHR system to additional medical facilities until 2023 to address outages that have plagued the software at current sites. Recent watchdog reports found that the new EHR system had caused nearly 150 cases of patient harm at a Spokane VA hospital.

“Just one vet harmed is one vet too many,” VA Deputy Secretary Donald Remy told a Senate Appropriations subcommittee Wednesday. “And right now, the bottom line is that the Cerner system is not delivering for veterans in the ways that it should. Not even close. It needs major improvements."

Remy told members of the subcommittee on military construction, veterans affairs and related agencies that the VA won’t proceed with future EHR go-lives until it addresses patient safety issues and persistent outages.

Oracle closed its nearly $30 billion deal to acquire health IT giant Cerner in June and has now inherited the company's VA tech project and is working to fix the problem-riddled system.

Mike Sicilia, executive vice president, industries at Oracle told lawmakers that the tech company 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.

A beta version of the cloud application version of the EHR will be available in 2023, he noted.

"We believe our acquisition will reinvigorate this program and deliver on the promise of a single longitudinal health record from enlistment and active duty service at DOD to retirement and elder care at VA," Sicilia said.

"We believe we can deliver a system that will leapfrog existing commercial EHRs and deliver for our service members and veterans the gold standard for modern healthcare technology," he said.

Cerner's EHR has been deployed at five medical centers to date, and work is underway at over 40 medical centers for upcoming deployments, Sicilia said.

"We know we have a lot to prove with deployments next year at larger, more complex sites. We view the next year as a key window for building momentum and turning the corner," he said.

Oracle has shifted 2,000 Oracle employees onto the VA EHR implementation since it completed its acquisition of Cerner, Sicilia said.

“This is the most important effort we have going on at the company,” he said.

As Oracle moves forward, the timeline and cost of the project remains murky.

Sicilia told the subcommittee that Oracle would provide the system "rewrite" as a “cost-free upgrade under the current contract." Oracle executives say that the EHR contract, which is $10.7 billion, can proceed on time and on budget.

The VA has maintained that the total cost of the program will be roughly $16 billion over 10 years.

However, an independent cost analysis from the Institute for Defense Analyses pegs the cost of the project to be $33.6 billion to implement over 13 years. The total cost, including life cycle costs to implement and maintain the EHR, will reach $50.8 billion over 28 years, according to the analysis.

"There are notable differences between the IDA cost analysis and the VA's 2019 cost projection of $16 billion," Brian Rieksts, a research staff member with IDA’s analysis and research division, told members of the subcommittee.

Veterans Health Administration undersecretary for health Shereef Elnahal, M.D., told lawmakers he has "deep concerns about the system as it's functioning for frontline employees" after a recent visit to see how the EHR functions at a Columbus, Ohio, VA facility.

"I saw folks struggling with this system, deeply. Among the most concerning things that I saw was a phenomenon whereby our front-line clinicians, when they put in an order, or were trying to interface with the system, they were not confident in many cases, and in many clinical settings, that those orders were actually getting where they needed to go on behalf of their veterans. So there was a lot of manual reworking and rechecking," he said.

Problems with the EHR systems were contributing to burnout, and leadership told him that employees were leaving their positions, Elnahal told lawmakers.

"Staff told me that this system was stressful to use and leadership told me that folks are leaving, in part because of the difficulty of the workflows," he said.,

In a review earlier this year, the VA Office of Inspector General found that the new EHR sent thousands of orders for medical care to an undetectable location, or "unknown queue," instead of the intended care or service location, effectively causing the orders to disappear without letting clinicians know they weren't delivered.

Sicilia told lawmakers Oracle delivered a fix to the unknown queue problem Aug. 1. 

Lawmakers have grown increasingly frustrated with the VA project. In August, House lawmakers warned they would consider scuttling the multibillion-dollar project unless officials show progress in the coming months.

"We're into this damn near five years," said Sen. Jon Tester, D-Montana, during the hearing Wednesday. "Truthfully, we haven't done a damn thing. I mean, we've implemented it and it's been a train wreck."

Tester, the Senate VA Committee chairman, said the VA has spent between $7 billion and $9 billion on the contract so far.

"To be honest with you, from where I've sat, I don't know that we've got a return on investment to speak of at all," he said.

To increase transparency, the VA is now required to submit regular reports to Congress about the performance of the project, including incidents that risk patient safety.