Written by Nihal Krishan
The rollout of the Department of Veterans Affairs’ new electronic health records system has been a “total mess” from which IT vendor Oracle Cerner has been able to profit, according to a senior Republican.
Rep. Matt Rosendale, R-MT., said that VA Secretary Denis McDonough should take responsibility for major flaws and ongoing risks to veterans associated with the platform.
“It’s a s*** show. They’ve made a total mess out of it,” the lawmaker told FedScoop. “Meanwhile Cerner is profiting off this debacle. They’re profiting from it. This is unacceptable. It’s a little game of disaster.”
Rosendale, who is the House VA Subcommittee on Technology Modernization Ranking Member, added that it was incumbent on McDonough to hold everyone involved in the EHR program accountable.
“At the end of the day Secretary McDonough has to take responsibility for it because he’s in charge of the VA. So it’s up to him to hold everyone else accountable,” he told this publication outside a House hearing Wednesday on the issue.
The senior Republican’s trenchant criticism came after lawmakers from both parties aggressively called out rampant issues with the cost, transparency and reliability of the VA’s electronic health record (EHR) system rollout during the House hearing. They were speaking at a House committee on Veterans’ Affairs hearing Wednesday on patient safety and the electronic health record modernization program.
Multiple Congressmen speaking at the hearing were angry that despite internal VA reports from October 2021 showing that the EHR system had major flaws and ongoing risks that could harm veterans, Secretary Denis McDonough and the VA continued to launch the system in medical facilities in multiple states.
Rosendale also accused the VA’s Executive Director of the EHR Modernization Integration Office at the VA Terry Adirim, and her staff, of contradicting themselves during their interactions with him and during hearings in Congress.
The implementation of the VA’s new EHR system on an Oracle Cerner developed platform to medical centers around the country will be delayed from its original estimates by at least one to two years and the system rollout is far behind where it was expected to be at the moment, a top VA executive said during a Senate hearing last week.
The EHR system rollout issues have in some instances, including at the center in Spokane, Washington, caused major harm in which a veteran at risk for suicide did not receive treatment because records disappeared in the computer system. This system error occurred due to technical issues with what’s known as an “unknown queue,” that has caused nearly 150 instances of patient harm, according to the VA’s Office of Inspector General (OIG).
The Institute for Defense Analyses, a nonprofit research entity, puts the life cycle cost of the EHR system at $50.8 billion over 28 years, while the VA’s original rollout implementation tag was about $10 billion over 10 years, but some Congressmen are even skeptical of these estimates.
“The new [IDA] estimate says the cost could be as high as $63 billion if everything goes wrong, and I see a lot of things going wrong,” said Rep. Mike Bost, R-IL, a member of the House VA Subcommittee on Technology Modernization.
“Cerner says the rollout would be 13 years instead of 10, but even 13 years seems like a best case scenario given all the issues,” said Bost.
Oracle-Cerner said during the House hearing Wednesday that problems with the VA’s current cost estimates are due to the federal government assuming the EHR technology stands still. However, the company took responsibility for the VA EHR software being too complicated and cumbersome, requiring extensive staff training which typically shouldn’t be the case.
Adirim from the VA during the House hearing Wednesday attributed some of the increased EHR rollout costs to Oracle-Cerner contract modifications regarding pharmacy enhancements that went above and beyond the baseline of the original contract because they were “technically considered enhancements,” not fixes to the system, Adirim said.
Rep. Rosendale, however, said that Oracle Cerner was getting paid more money for their contract while veterans continued to get poor service at medical facilities where the EHR system has been rolled out without permanently solving latent issues with reliability and stability.
Former VA leaders who have experience with EHR systems have also observed deep entrenched issues with the agencies ongoing rollout and its ballooning costs.
“If you don’t have discipline, if you don’t control costs tightly and if you don’t even know what your costs are, you’ll get sucked for every dollar the government has. Like with Cerner. That’s how this game works,” said Roger Baker, chief information officer (CIO) and assistant secretary for information and technology for the Veterans Affairs Department from 2009 to 2013.
“The VA doesn’t know how much things cost and it has no clue how to do so, it would be like me trying to estimate what it could cost to build the Empire State Building,” he said.
Baker added that the VA had repeatedly shown management and execution issues with the EHR rollout due to their lack of prioritization on the day-to-day experience of doctors and staff within VA hospitals while instead focusing on trying to expand the rollout to as many medical facilities as quickly as possible.
Adirim declined to comment further after the hearing.