An Oracle executive vowed to get the Veterans Affairs' troubled health IT project "back on track" as House lawmakers warned they would consider scuttling the multi-billion-dollar project unless officials show progress in the coming months.
The VA's beleaguered $16 billion technology project has been plagued by delays, leadership turnover, and infrastructure problems since it kicked off in 2018. The 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 cost of the project has since ballooned by several billions of dollars and the cost may still rise.
Testifying before a House Committee on Veterans’ Affairs Subcommittee on Technology Modernization last week, Mike Sicilia, executive vice president of Oracle Industries, took the first steps to assuage lawmakers' mounting concerns about the project and assure them that the database giant has the tech muscle necessary to right the ship.
"The VA [electronic health record modernization] rollout is clearly behind schedule, below expectations, and on the same course as so many other programs that go over budget. But let me also say that with Oracle’s acquisition of Cerner we believe we can get back on track, exceed expectations and keep our costs in line," he said.
"We hope to have the Committee’s support over the next nine months to demonstrate that we can deliver, and then earn your trust and long-term support so this program can benefit all our nation’s veterans," Sicilia said.
Oracle closed its nearly $30 billion deal to acquire health IT giant Cerner in June, and has now inherited the company's beleaguered VA tech project and is working to fix the problem-riddled 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. Two weeks ago, the department scrubbed a scheduled go-live of its new medical records system in Boise, Idaho, that was set for that week.
On the heels of new watchdog reports that the new EHR system had caused nearly 150 cases of patient harm at a Spokane VA hospital, House lawmakers made it clear in no uncertain terms that the project was at a critical turning point.
"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," said Rep. Mike Bost, R-Illinois, ranking member of the House Veterans Affairs Committee.
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."
Oracle plans to move the Cerner application to a cloud data center within the next six to nine months, which will deliver better performance and stability for the end-user, Sicilia told lawmakers.
Oracle will move the EHR to the cloud data center at no cost to the Coast Guard, DoD or the VA, he said.
"Candidly we anticipate this change alone will be the single most important change we make in terms of system reliability. It will also provide a scalable, modern platform for us to deliver the kind of future releases users have come to expect like mobility and predictive analytics," he told lawmakers.
Oracle is an enterprise software company and a cloud service provider with more than 40 years of experience building and developing advanced, mission-critical, secure and performant technology around the world for governments, critical infrastructure, and commercial enterprise, Sicilia said.
"While I fully appreciate substantial challenges exist—all of which are legitimate—the fact is that more is working than is not. Rollouts to date have been largely successful, and much of the functionality is performing," he told members of the House committee.
Through Oracle's acquisition of Cerner, VA, the DoD and the Coast Guard gained a "vastly more resourced technology partner overnight to augment Cerner," he said.
To date, the new EHR has been fully deployed for the Coast Guard and is deployed at more than half of DoD medical facilities. At the VA, the EHR is deployed at five medical centers and their associated facilities.
When fully deployed across the VA healthcare system, 171 medical centers will go from using 130 different versions of the current VistA EHR to using one single enterprise-wide EHR that is interoperable between the VA, DoD and Coast Guard, Sicilia noted.
Federal lawmakers have serious concerns about patient safety issues related to the new medical records system. An inspection by the VA Office of the Inspector General (OIG) found that the system failed to deliver more than 11,000 orders for specialty care, lab work and other services at Mann-Grandstaff VA Medical Center, the first VA facility to roll out the new technology.
The OIG review 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.
The criticism from House members came amid the second tense hearing for VA health records officials within a week.
During a Senate Veterans Affairs Committee July 20, lawmakers grilled department leaders over new delays in the project and reports that the $16 billion price tag could more than triple in coming years.
The Oracle Cerner Millennium EHR system originally estimated to cost $10 billion and later revised to $16.1 billion, could increase to more than $50 billion in 28 years, a military new sites, Stripes.com reported.
An independent review by the nonprofit Institute for Defense Analysis estimated the implementation of the electronic health record system would cost nearly $39 billion in 13 years. The estimate also included more than $17 billion to sustain the system.
Sicilia said Oracle was prepared to bear any "significant cost overruns" in the project and remain within the existing budget envelope.
"We intend to deliver the EHR system across the entire VA for the amounts contemplated in the current contract under the current scope," he said.
During the House hearing last week, Dr. Terry Adirim, director of the Electronic Health Record Modernization Integration Office, countered the cost overrun estimates, saying they are based on the assumption putting the system in place will take more than 10 years.
“We are still in the process of planning for a 10-year deployment and we should have a schedule out sometime in the fall,” she said.
Rep. Matt Rosendale, R-Montana, said the Oracle Cerner EHR system is "fully dysfunctional" and "not safe or suitable to roll out anywhere else."
Current committee Chairman Mark Takano, D-California, said the committee will work with the VA Secretary and the Deputy Secretary to hold program officials accountable and demand fixes before deploying to any more medical centers.