Beyond Go-Live: VA Electronic Health Record Modernization Status Update
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House Veterans' Affairs U.S. House of Representatives
Follow its sittingsMike Bost
Sidebar. No amendments were filed. Does any member wish to offer an amendment to the resolution? Hearing none, I now recognize Ranking Member Takano for a motion.
All those in favor say aye.
Aye.
Mike Bost
Those opposed no. In the opinion of the chair, the ayes have it. Its resolution is agreed to and Representative Goodlander is appointed to the subcommittees on Health and Technology Modernization. We will now take a brief recess to bring our witnesses forward to start the full committee. And the business meeting is adjourned, by the way.
Committee will come to order. Without objection, the chair may declare a recess at any time. Good morning. Thank you to our witnesses for being here as we conduct a status check on VA's EHRM program. Last year, the Subcommittee on Technology Modernization held several hearings to review how VA plans to execute its strategy for 2026.
As of today, the EHRM platform has been deployed across 11 sites under the accelerated market-based rollout. We are here today to ask how well that strategy has worked. We need to understand that VA has learned, what VA has learned before the next wave of developments in 2027. It is well known that I have been skeptical of the deployment of this system from the very beginning. Past deployments were filled with cost overruns and patient safety issues.
And to be clear, I still have concerns, but I also recognize the progress that has been made to modernize and improve the VA health record system. I'm glad to see the VA leadership taking these problems seriously. But that does not mean our oversight will stop. This is a multi-billion dollar, years-long effort. Congress needs transparency.
Veterans deserve accountability. I understand we are not done with the 2026 deployment yet. Cleveland and Alaska are still scheduled to go live in October. As VA prepares for the next sites, our goal today is simple. We need a clear picture of where this program stands.
We need to know what it will cost going forward. We need to know if the VA is ready for what comes next in 2027. VA recently extended its contracts with Oracle because the original price tag was not enough to complete the rollout. We have seen this story before. Time after time, this committee has learned that VA's first price tag is rarely the last one.
For years, we've been asking legitimate questions about the full life cycle cost of this program and have still not received those answers. Before Congress funds additional work, veterans and taxpayers deserve to know why costs are rising faster than planned. We can talk about all the IT systems, contracts, and technical terms, but at the end of the day, this is about the veterans sitting in an exam room. And it's about making sure the medical professionals caring for our veterans have the best tools they need to provide the best healthcare in the world. With that, I again welcome our witnesses and I look forward to the testimony.
I now recognize Ranking Member Takano for his opening comments.
Mark Takano
Well, thank you, Chairman Bost. The subject of this hearing could not be more timely. Unfortunately, sir, this hearing as structured falls far short of this committee's Article One responsibilities. VA's electronic health record modernization program is potentially the largest modernization effort in the history of VA, but this hearing, I'm afraid, does not meet the moment. You know, and I've shared, you and I have both shared a skepticism about the progress and about the effort to implement this system.
Now, I'm going to say, sir, if you were serious about oversight, you would have invited all key stakeholders. And instead, you invited the Deputy Secretary of VA to come and claim success on behalf of the Trump administration. I had to ask you for the prime contractor, Oracle Health, to be invited so that they could explain why we're hearing from the news, not VA or Oracle. We didn't hear about from VA itself or Oracle that the current contract has tripled to 27 billion dollars. Let me say that again: 27 billion dollars.
The original EHRM contract was for 10 billion dollars. That's a staggering increase. Now, Oracle originally accepted the invitation to be here, but then later decided they didn't want to come, citing timing constraints. Mr. Chairman, you chose to do nothing about it. And it seems that you thought it was acceptable to let Oracle skip what is probably the most consequential conversation to date about the project.
You thought it was acceptable to let Oracle off the hook when it comes to accountability and when the dollar value of their contract has tripled. I beg to differ. There's nothing acceptable about this situation, this scenario.
And as of today, Mr. Chairman, you have not shown that you are willing to compel Oracle to show up. You did not invite any independent watchdog to testify. I mean, VA is going to be able to grade its own work before us today. No other independent voices, you know, are going to be able to advise us, you know, about the claims he's going to make in his statement and our questions that, and the questions and the answers to the questions we ask. Instead, I had to request that the Government Accountability Office be here to provide information about the many ongoing problems with this program.
And Mr. Chairman, I've done everything in my power in the minority to make this hearing reflect serious oversight of this massive modernization effort. I'm going to show you that on August 20th, your own staff sent an invitation to Oracle Health at my request. On August 25th, I sent you a letter sharing my concerns about the lack of key witnesses not being invited to this hearing. And I thought those witnesses should include Accenture, the Inspector General, and the GAO. I have not received a response to the letter I sent you on August 25th.
On August 26th, Oracle emailed that it accepted the invitation to testify. So they accepted. I mean, they should be here to explain this 17 billion dollar augmentation. In the same email chain on August 27th, they reneged on that acceptance, citing, quote, "time constraints and the two-panel structure," end quote. On August 28th, I sent a letter to Oracle telling them that their refusal to appear was not acceptable.
And finally, on August 31st, Oracle responded in a letter reiterating their refusal to appear. Mr. Chairman, I ask unanimous consent to enter all these documents into the committee's record.
Without objection.
Mark Takano
Now, behind me, you know, I think you and I have always, as you say, we share the skepticism. The original contract with Cerner was 10 billion dollars. I was skeptical that that contract ceiling would hold, especially given the impacts of COVID and the multiple pauses that have happened. However, a 17 billion dollar increase is unreasonable. A 17 billion dollar increase with no advance notice to the authorizing committee is a huge problem for me.
Here we have on this document a copy of the justification for Oracle's amended contract. And look at all these redactions. Guess what those redactions are. Those redactions are how much the taxpayer will be shouldering in order to shore up Oracle's bottom line. I have a problem with this.
And in fact, the VA trying to hide this increase, the VA indicates to me that the department person sitting at that table knows that this is a problem. We shouldn't be surprised, though. This is the least transparent administration I've dealt with in my time in Congress. They're even less transparent than the first Trump administration, which is saying, which is really saying something. Committee Democrats have dozens of requests for information that the department has been sitting on for months.
Just been indifferent to our requests. When we get, we do get responses from the department, they rarely address the questions we ask. Additionally, the administration has created a culture of fear, which has prevented VA employees from talking to Congress, which is a federal employee statutory right. And some would say if they're an employee of the federal government, it's their duty to tell Congress when something's up.
Now, under the guise of taking care of veterans, Secretary Collins and Deputy Secretary Lawrence have leveled one attack after another on the federal workforce, many of whom are veterans themselves. This administration has stripped employees of their collective bargaining rights, forced people out of positions, and overwhelmed the department with political appointees to the point that career employees, people for whom taking care of veterans is their life's work, have had to leave VA. None of this is acceptable. Now the Deputy Secretary would have you believe that everything is wonderful, that the EHRM deployments are going smoothly, that this administration has fixed everything. Now this ignores the fact that VA has had to spend the last two years working to right the ship.
It ignores the fact that most of the issues with this program were caused by the first Trump administration's desire to rush into a sole source contract, a sole source contract with Cerner without doing any of the critical pre-work that would have prevented all of these issues. Now we're in this mess because of the Trump administration, and we're going to go deeper into a twenty-seven billion dollar hole because of the Trump administration. Now proper requirements development before go-lives would have prevented years worth of pauses, and it would have prevented so much pain and frustration on the part of veterans and VA employees. Instead, improper political pressure forced the department into a program that it wasn't ready for. Now they're doing it again.
After three years in reset, VA resumed and accelerated deployments without completing the independent operational assessment GAO recommended so that VA could verify that the system is suitable and effective in VA's actual clinical environment. VA and Oracle can point to improved uptime, better ticket management, and eleven deployments this year, but system-wide uptime is not the same as clinical usability, safe workflows, restored productivity, or successful veteran patient outcomes. Without testing, without testing to verify that all of the issues have been addressed, this leadership team has introduced a schedule that would require more than sixty go-lives in the next two years, and we're hearing rumors that they want to add even more. I'm concerned that this pace is unsustainable, and I'm not convinced that there are enough qualified people to support an effort of this magnitude, and from what we're hearing from a few brave VA employees, it's already not going well. Employees in Michigan, Southern Ohio, and Indiana are telling us that the, that many of the issues identified by the first six sites still have not been fixed.
They also share that they and their colleagues are struggling with a system that they weren't sufficiently trained to use, struggling to teach themselves how to use a system that wasn't designed to support their work, and don't feel like they have enough support or resources to make sure veterans receive the care they deserve. They're also hearing a very, a very concerning things about missing referrals in the EHR in the Michigan, Ohio, and Indiana facilities. Missing referrals means the risk of delayed care for veterans. Is this the next iteration of the unknown queue? I think many of us remember the issue of the unknown queue.
Whether it's the technology or leadership, this program is currently not working for VA or veterans, especially for veterans with accessibility issues. There is at least one lawsuit against VA and Oracle citing the fact that the system is not accessible for blind and low-vision employees. Visually impaired VA employees, many of whom are veterans, are being prevented from doing their jobs by a technology that does not support them doing the work. And instead of VA and Oracle attempting to fix that, VA is hiring additional people to operate the computer for the employee. After more than eight years, VA and Oracle still haven't managed to make EHRM a system that meets the needs of VA employees and veterans.
Now Oracle has not proven it is capable of being the vendor for this contract. It is time for VA to evaluate whether a new vendor is needed to lead the EHRM program. Today, the Deputy Secretary must explain the nearly 17 billion dollar ceiling increase, produce the cost and schedule information Congress has repeatedly requested, and tell us when an independent assessment will verify VA's claims. I will not allow the Deputy Secretary to grade his own work. And Oracle must appear publicly before this committee to answer for its performance and how the additional billions of dollars it will receive will benefit veterans.
Now, here's this other poster here. And now I want you to pay attention, this is testimony or a statement by Michael D. Sicilia, the CEO of Oracle Health. And, you know, something is wrong here. What he says here is, well, Congress needs to act and it needs to start by asking questions of both VA and Oracle about this program. When Oracle testified before this committee in June of 2022, its Chief Executive Officer told us something different than what we're hearing or seeing now.
As you can see in this excerpt, he said that if there were cost overruns, Oracle was, quote, prepared to bear those costs. Oracle was prepared to bear those costs if there were cost overruns. What has changed? Why does Oracle need 17 billion dollars more to get the job done when this program has already dragged on for eight years? These things do not add up.
We need answers and not excuses. I yield back, Mr. Chairman.
Mike Bost
Thank the ranking member. You know, the committee has been and has not been passive in oversight of this program. We've been conducting oversight on EHRM for years through hearings, briefings, site visits, document requests. The oversight work continues. The ranking member invited Oracle exactly as our rules allow.
Unfortunately, due to scheduling conflict, Oracle could not attend. The ranking member then invited GAO at the last minute and they will be testifying today. We are also expecting a bipartisan GAO report to be released on this issue in October of this year. Today, the Deputy Secretary is sitting in front of this committee and I expect him to provide direct, focused answers. Because when it comes to this program cost, performance, and path forward, the buck stops with the Deputy Secretary.
And I promise the ranking member that oversight of this issue will continue after this hearing today. This is not a check-the-box activity. This is our committee fulfilling its responsibility for robust oversight of VA, which we have done for years and will continue to do on this issue. It's the one issue that we've actually agreed pretty well on. But yet you're coming up and saying, oh no, we're not doing it.
We had people that we invited, they chose not to come and could not come. We did not force them. We will hope that we can have some time where we can hear from them later. Today we're going to have this hearing.
Mark Takano
Where Oracle originally accepted and then suddenly they don't accept, and I think we could have been a little more insistent together to make sure that Oracle, I mean, it's kind of ridiculous.
Mike Bost
Well, I was pretty insistent, and the way it is right now, they are a private company, and we did argue and we did try to get them there. But we do have who we have before us now, and we will have the other panel next, and we will continue with the work that we have laid out today. So thank you very much. We will now turn to our witness testimony. Testifying before us today is the Honorable Dr. Paul Lawrence, Deputy Secretary at VA.
Accompanying the Deputy Secretary is Dr. Neil Evans, Program Executive Director of the EHRM Integration Office. Will the witnesses please stand? Will you please raise your right hand? Do you solemnly swear that the testimony you are about to provide is the truth, the whole truth, and nothing but the truth? Thank you.
Let the record reflect that the witnesses have answered in the affirmative. Now I now recognize Deputy Secretary Dr. Paul Lawrence for five minutes to deliver your testimony on behalf of the Department of Veterans Affairs.
Paul Lawrence
Chairman Bost, Ranking Member Takano, and distinguished members of the committee, thank you for the opportunity to update you on the momentum behind VA's electronic health record modernization program. As the chairman has pointed out, Dr. Neil Evans, our program director, joins me. When I came into this role, the program had sat largely dormant for nearly two years. Thanks to President Trump's leadership and Secretary Collins' leadership, we were able to accelerate deployment of the electronic health record. The program is back on track, the system is stable, strong, and reliable.
Performance is no longer aspirational, it's a reality. We're delivering real, measurable results for the veterans we serve. Right now, the system is supporting more than 35,000 in-users and serving approximately 617,000 veterans at 17 VA medical centers, nine new-one clinics, and 165 remote service locations. Let me hit a few highlights. In April, we deployed in our facilities in Michigan: Ann Arbor, Battle Creek, Detroit, Saginaw.
In just the first three days of operation, our Michigan team scheduled more than 3,400 appointments and migrated 1.2 million active prescriptions at success rates above 99.5%, completing cutover ahead of schedule. On the fourth day, Ann Arbor completed an open-heart surgery using the electronic health record. In June, we successfully deployed in our Southern Ohio facilities: Cincinnati, Chillicothe, Dayton, and Fort Thomas. Southern Ohio's success proved that Michigan wasn't a fluke. On Southern Ohio's first day using the new system, Cincinnati successfully completed gallbladder and shoulder surgeries.
On the second day, they completed an unscheduled appendectomy. At the end of August, we successfully deployed in our facilities in Indiana: Fort Wayne, Marion, and Indianapolis. Consistent with the trends we saw across Michigan and Ohio, feedback from Indiana has been encouraging. On the very first day after deployment, Indianapolis completed three procedures, including one surgery.
At every site, we are closely watching return to normal productivity. Several facilities have already met or exceeded pre-deployment benchmarks. In October, we are scheduled to complete this year's go-lives in Cleveland and Anchorage. And looking ahead to next year, we plan 26 more sites to go live. With the exception of Anchorage, I have visited each of the 13 sites to go live in 2026 three times, and I'll be back in Anchorage later this month.
And I've already visited 10 of the sites that will go live in 2027. During my visits so far, I have engaged more than 1,200 VA team members. I'm spending time with the executive leadership team, the change leadership teams, the chiefs of medicine, and super users. I'm monitoring progress, I'm listening to issues, and I'm asking what help I can provide. I can report that our teams are motivated and energized about their deployments, and I'm always impressed with their talent, their commitment, and their very strict mission focus.
And I'm also meeting monthly with senior leaders from Oracle and our major subcontractors to hold them accountable and to strengthen our collaboration. For too long, this committee has heard false promises. What's different about my appearance before you is that I presented results. And what's also different now is that our leadership is focused, engaged, and accountable, and the results reflect that. In short, we have momentum.
With our proven execution model and this committee's continued strong support, we will continue to deliver a modernized EHR for our veterans, clinicians, and staff. Thank you, and I welcome your questions.
Mike Bost
I thank you for your testimony, and we're now going to go to questions. I'd now yield myself five minutes for questions. Dr. Lawrence, the VA expects to reach the original Oracle contract ceiling in early fiscal year 2027. Did VA leadership expect this when it committed to the new schedule, or was the accelerated rollout driving the higher cost?
Paul Lawrence
The costs were stipulated in the document we gave you in September of last year, explaining what would happen during the remaining period of time. We hit the ceiling as planned. The contract extension and the ceiling modification reflect us hitting the ceiling and the costs we predicted in the documents we gave you last year.
Mike Bost
Have you concerns that how confident are you with the fact that that 17 billion to this program will be the finished rollout?
Paul Lawrence
I'm very confident. What I can tell you, because I wasn't here in the past that's already been described, what I can tell you is since I showed up at the end of March, we have spent exactly the money you have allowed us. We have deployed in the schedule exactly as we said we would. We have had serious conversations with our contractors that this is the money available to do the things we need to do. The Secretary's been very clear about the importance of this mission.
I'm very confident that is the money we need.
Mike Bost
Okay. A complete life cycle cost estimate should include the program's historical cost, its full operating and sustainment cost, and an assessment of future risk. The estimate VA provided to Congress does not include that full picture. When will Congress receive a complete and reliable estimate that includes all of these costs and tells taxpayers and the what this program is actually going to cost us?
Paul Lawrence
Yeah, there must be some confusion because we have that numbers and I'm surprised you don't because we tried to share that with you directly. And I know coming out of the hearing in Tech Mod in December, that was the request to provide not only to you, but I believe GAO, and I might be mistracking on that. But we have those numbers and we'll just figure have to figure out how to get them to you.
Mike Bost
Well, I'm going to tell you and then I'm going to veer off of my questions here because I've dealt with this issue so long.
When some of the, I don't agree with everything that the ranking member said, but I guarantee you the statement that they said that they would eat the cost, they were going to do it when Oracle took over, that's exactly what they said. They said, oh, we should be able to do this. I can remember them sitting in my office and said, if you have a problem with something and you can't clear it up in 30 days on an issue, they obviously don't know what they're doing. That's what they said in my office. And this has been, and I know you're here to tell us and I want to hear, and we have several questions that are going to come up from everybody, but this has been the biggest boondoggle I've ever seen.
And I know that's not, this was before you got here, okay? And the frustration that we feel on this committee and the subcommittee as well is beyond measure. And I know you know that already, you knew it when you took it over. When staff noticed a migration problem with the new system, they filed what was called a trouble ticket, which could relate to a patient safety concern. Can you assure the committee that these tickets are being resolved, not just closed to keep peace with this program?
Paul Lawrence
Absolutely, absolutely. And I will tell you what's going on right now with the Indiana deployment is we are resolving tickets very fast. We are paying a great deal of attention to those tickets that are identified as patient safety issues. We've identified those, none of them have gone into the category of critical patient safety issues. We resolve them quicker.
There are fewer tickets in Ohio than there were in Michigan. There are fewer tickets in Indiana than there were in Ohio. And that's the learning of what's taking place. That's the familiarity of our team with the workflows and the system and their understanding that it is safe and it works and we need to train them better. And let me, let me, Dr. Evans jump in here because I know this is something you and I spend a lot of time on.
Neil Evans
I agree. I would use the example of Indiana where day 12 post-go-live and more than 75% of tickets, trouble tickets that were submitted have been closed. And we do not close tickets without validation from the submitting end user. So we don't close tickets until the individual who raised the issue says this has been fixed satisfactorily.
Speaker 12
Real quickly, because I'm short on time, what metrics is VA using to determine when a site has returned to normal after you turn up?
Neil Evans
After we turn up, we have 15 measures that we are looking at to return to normal operations. These are, for example, the throughput in the emergency department. How many ambulatory care visits are completed at the site? How many surgeries are completed? Inpatient care volume.
So it's looking at the sort of how care is delivered. We look at a pre-go-live baseline that is the average of care delivered the year prior and two years prior. So we're looking at 25 and 24.
Mike Bost
So my time's expired, but if you would, could you get that list of 15 to our staff so we know what we're looking at each time? Thank you. Ranking Member Khanna, you're recognized for five minutes.
Mark Takano
Thank you. Dr. Lawrence, in between your roles between the two Trump administrations, you were employed as a consultant with a number of different companies, is that correct?
Mark Takano
Thank you, sir. Were you, you were a consultant for BDR Solutions LLC between 2023 and 2024, correct?
That's correct.
Mark Takano
Are you aware that just a week ago, BDR Solutions LLC was awarded a contract with the VA for the IT services it provides?
I was not aware of that.
Mark Takano
You were not aware. Now that you are also a consultant for, you were also a consultant for Steerbridge Strategies in 2023, is that correct?
Thomas Lawrence
That's correct. And as you know, when somebody becomes a federal government employee, they sign an agreement.
Mark Takano
Sir, I only have short time. And Sturbridge Strategies later went on to be awarded a contract to conduct a pilot for AI-assisted disability benefits tool in 2024, is that correct?
If what you say is true, then it's correct.
Mark Takano
Okay. Another one of your clients, CGI, was awarded a contract in January to support the FMBT project, a modernization effort that you oversee, is that correct?
Mark Takano
Thank you. Now, these are just three examples from your past work history, and there are certainly more. And at least a few of these organizations actively had contracts with VA to the tune of hundreds of millions of dollars awarded since Donald Trump took office. How much did you make off of all these private consulting roles?
Speaker 18
I don't remember the exact number, perhaps you have it in front of you.
Mark Takano
I do. Luckily we have the math from your financial disclosures. It appears to us that you made over a half million dollars. While I'm not here necessarily to debate the righteousness of all these contracts, I do want to narrow in on one of these. Last year, Accenture Federal Services, your former employer and client, was awarded nearly a half a billion dollar contract to be the EHRM systems integrator with a questionable history of performance in this work.
Now my question to you is, were you or other officials at VA aware that Accenture was removed for failure to perform as a subcontractor to Leidos, the EHR systems integrator for DOD?
Acquisitions are done by our acquisition.
Mark Takano
So yes or no question, were you aware or not that Accenture was removed for failure to perform?
I was not involved in the acquisition.
Were you aware or not, sir?
Paul Lawrence
I was not involved in the acquisition and therefore by definition I was unaware.
Mark Takano
Mr. Under Secretary, were you aware that Accenture was removed for failure to perform as a subcontractor to Leidos?
I was not involved in the acquisition.
Mark Takano
You're not responsive, sir. Either way, you see how this looks. You are accountable, you are the accountable official. I know we did this in law, we made this position you're in the accountable person for this program. You enabled billionaire tech firms to get billions more with the knowledge of their poor performance, or I'm going to assert that you did.
And you don't know the basics about the contracts you work with. My Republican colleagues here talk about a lot about fraud and mismanagement, but I was shocked when they remained silent about when the Washington Post and the Wall Street Journal accused disabled veterans of defrauding the government. But I'm not surprised that many seem to be turning the other way as far as the Trump administration is concerned. Now your answers today make it abundantly clear just how far the pay-to-play mentality seems to be seeping into the department. And rather than provide quality care to veterans in a competitive market, this administration would rather fund itself and their billionaire buddies.
So I have a great example as a comparison. On the one side, VA prepares to send an additional 17 billion dollars to Oracle, owned by Larry Ellison, on top of the 10 billion they've already blown through in eight years. On the other hand, veterans and military retirees are told that the Major Richard Star Act, which costs 13 billion dollars, is just too expensive to pass. So y'all can throw 17 billion dollars at Larry Ellison, whose company already said that they would eat the cost if they had cost overruns, but you can't find 13 billion dollars to take care of combat veterans who want to get concurrent receipt of their VA benefits and their military pensions. I find this unacceptable.
Jack Bergman
Thank you, Mr. Chairman.
330 years ago, the Salem witch trials were going on, just so you know. But that's really all that means is that was 330 years ago. 30-plus years ago, I was involved with the operating room equipment business and watched the transition of the Da Vinci, introduction of robotic surgery, and saw how new technology was trying to be introduced for the right reasons, but there was pushback because this is not the way we've always done it. So let's focus forward here and see what's gone right rather than getting into things that may not or will not provide better outcomes for veterans. Dr. Lawrence, you personally visited all 13 sites scheduled for deployment this year, including four in Michigan.
Michigan was the largest single-wave deployment in EHRM history: Ann Arbor, Battle Creek, Detroit, and Saginaw, all at once. Tell us what you saw on the ground. More importantly, what did Michigan teach you about executing a transition this complex as you head towards full deployment in 2031?
Paul Lawrence
What I saw on the ground in Michigan was a highly motivated team that very much was embracing the new electronic health record. Through the training, they realized how much easier and better it was going to be to provide care for our veterans. They realized that our old system was antiquated, required too many clicks, too many references to other screens, too many chances for typos as information was entered over and over again. They were concerned, given that in the previous administration they got waved off at the last minute, so they were apprehensive but comforted knowing that they had a lot of help on the go-live day as well as the two weeks afterwards, at-the-elbow support, super-users who had been extra-trained. That was really informative.
Yes, along the way we found some things that we needed to emphasize better, part of which was, you know, do a bunch of work up front so it doesn't result in manual work afterwards. So that affected our training in Ohio and Indiana, as well as really appreciating the role of the super-users to augment the training when we actually turned the system on.
Jack Bergman
Yeah, so in any implementation process, no matter what business you're in, you're going to find that in that initial implementation, things never go 100% right. The question is how do you mitigate those little mistakes that occur naturally, pop up, and then you fix them. Okay, let's go forward here to Michigan goes statewide in 2027. That means that Iron Mountain, which is in my district and would be a rural but in some cases remote facility. Every VA, every facility VA has deployed to this year has been a mid-sized or larger one.
So now you're going to have that small market area. Iron Mountain is the small hospital serving veterans across the entire Upper Peninsula and Northern Wisconsin. What specifically changes in your deployment model for a facility like that?
Paul Lawrence
Certainly. Iron Mountain is very, very special, but it's not unique in the sense that Saginaw has a very similar footprint, not quite as large, not quite as, but very similar, hospital with a lot of CBOCs. What's different about Iron Mountain is the CBOCs are far away, and when we go live in January of 2027, it is likely to be very difficult weather conditions. So our team there has to be prepared to go there and provide assistance far from the hospital and stay for long periods of time. So we're very attuned to that.
We're very attuned to when the care is going to be provided in these remote facilities and what time, you know, time of the year it's going to be. So we're very much attuned to that. We've checked on the technology to make sure it works, we've augmented that, and we very much have our team ready to go. So I expect Iron Mountain will go live on January 15th as planned, to wit I will go visit them once again to make sure we understand the footprint and the complexities of it.
Speaker 16
Okay, any comments on how community care relates to all of this as how we basically introduce it, fine-tune it, ensure that the front-line operators have the confidence to do things differently, because that's what they're going to have to do?
Paul Lawrence
The do things differently is true for so many of our providers because the system is different and that's what the training is about. But the concept of community care is very similar and easier in the new system. Information transfers seamlessly out and more importantly, when something's been done to our veterans, the information comes back so our providers have it all there. It's very similar process. It's just using different technology.
Speaker 25
Thank you, Mr. Chairman. Um, thank you, uh, Dr. Lawrence for being here. Um, my first question is goes back um to I think the chairman's question in terms of um what are the life cycle costs and you said that's already been submitted to the committee is my understanding, right? Is that what you said?
That's correct.
Paul Lawrence
So can you I I don't have that and um
Certainly, let me tell you about it. Okay, so with the addition what the document we gave you in June 30th of last year gave the cost through go-live completion 2031 of about 37 billion dollars. We then were asked what is the sustainment cost? We gave an estimate of approximately 1 billion dollars. Please don't hold me if I don't have it exactly right.
So adding it for the remaining time, 11 more years, got to about 48 billion dollars.
So 37 plus 48?
Paul Lawrence
Okay. So is the deployment plus the sustainment for the period of time that syncs up with I believe some of the GAO estimates. Okay, and I presume you've given that to the committee and it's
Speaker 23
Yeah. Okay. All right. Those those exact numbers. I mean you're quoting the exact numbers that that are in the report.
Paul Lawrence
Uh, give me a little plus or minus if I don't remember exactly right, but that's it.
Speaker 23
Okay. All right. And um so I mean GAO, who we rely on um for independent assessments and certainly non-political assessments if you will, you know, has said that VA still lacks that update. So that's where I'm coming from because I haven't seen anything else. Um, the, you know, the GAO will also say that um we need life cycle cost estimates and we also need a reliable integrated master schedule.
And so in or we need those two things to have the appropriate oversight and be able to monitor this as it goes through to 2031 when it is scheduled uh to be completed. So we know the beginning time and the ending time, but we don't really have anything sort of in between.
Paul Lawrence
Sure. I'm I'm concerned about that too. We spent an awful lot of time collaborating with GAO, working closely, inviting them to our trips, uh, demonstrating the um system to them and providing them information. Our schedule is well known, the costs are well known. So we're going to have to figure out why this is.
Neil, you work with them all the time. What
Neil Evans
I think we've delivered the schedule. So you were asking about the integrated master schedule. We've delivered the schedule that we delivered the schedule for deployments through 2031 last September, September 30th, 2025. The questions are around the integrated master schedule, that is what is happening every week, every day between now and then from a deployment schedule. We have the integrated master schedule for all of the 26 sites and the 11 active waves where we're currently deploying and are building out the full integrated master schedule and anticipate demonstrating those dashboards and providing a view to the GAO of that within the next month or two.
It's very soon.
Speaker 23
Okay. And and okay. Let me move on. So of the 17 billion dollars, how much of that is tied to demonstrating improvements in system performance, clinical satisfaction, patient safety, accessibility, etc.? So I'm assuming that the 17 is is to ensure that you complete the rest of the cycle here.
I'm wondering if a portion of that is you've identified certain areas that need improvement, how much of that is dedicated to that?
Neil Evans
I don't have the exact figure for the amount that goes to optimization. What I'll say is this. Within that figure are the costs to deploy. So to we we will train, for example, over 500,000 individuals when you consider VA employees plus the trainees, over 120,000 trainees who come through VA every year. We will train more than 500,000 folks.
We will deploy all of the equipment and run the go-lives, etc. We will operate the system. And there is within that money and the there are funds to optimize, to continue to improve the system. That is change requests and the like.
Speaker 23
Okay. I still am a little confused on how how we're going to oversee all of that, but I will move on. You mentioned training. You know, we're hearing reports from VA employees that the training's not going so well from their perspective. And we're also hearing that there are a lot of people who are leaving the VA for a number of different reasons.
So, you know, my concern is, you know, how are we going to improve the training and secondly, so that employees are satisfied, because that's a huge indicator for us. And at the same time, how do you manage people leaving the organization, training people leaving the organization or people who have left the organization? And then patient care is just over here somewhere where, you know, we already our wait times are already too long and if they are so focused in on training, they're not focused in on patient care. And so there's an obvious trade-off here that I don't think is going to work too well. And so that's a big, big concern for me.
Paul Lawrence
In terms of in terms of training, we pay great deal of attention to our training and the satisfaction. Though I'd love to hear specifics around what you're hearing to better understand, because we know that some training works for some people and it doesn't. We've augmented the training in two different ways in response to the feedback we've gotten from our team. One is to introduce something we call adoption training, where afterwards we have very customized training where we walk through the system with certain providers. So, for example, anesthesiologists get on a call and train anesthesiologists who are using the system, share screens and explain how that works.
So we have very customized training to our specialized medical people who may need more because of the complexity. That has been very well received. We've also in an effort to make the information easier for folks to obtain faster, which is introduce an AI chatbot where you can ask questions about workflows where it goes only to the sources of information we've put so you can more quickly get it as opposed to having to search for it. So we're very concerned about getting folks the right information. That's been a huge success since it was introduced about a month ago, about 115,000 questions.
And we're paying attention to the questions to make sure they get answered, but also to see what they're asking about to see how that reflects us to change the training.
We're very sensitive to what you said, which is highly skilled providers cannot be away from their patients very long. The training has to be very, very efficient and very precise. We can't ask them to leave patients for 40 hours like we can an administrative person. And the final thing is what happens when providers leave or we have new providers is we train them on the system just like they would learn any other system when they went to another hospital group.
Speaker 23
Hiring is a big issue within this, it takes time for that to happen. I do think there's an issue here around patient care and the delay of patient care and the wait times to get that care, but I'll yield back. Thank you.
I'd love to talk to you more about that.
Mike Bost
For the purposes of the committee's knowing and understanding, Dr. Lawrence, what you sent us was a preliminary estimate. It is not a GAO recommended official estimate on the price. We do not have that. So with that, Representative Luttrell, you're next. You're recognized.
You came late.
Speaker 40
Mr. Lawrence, Mr. Evans, Dr. Evans, good to see you again. Explain to me the initial cost of the EHRM was $10 billion for a 10-year lifespan, and now we've bumped it up another $17 billion. Can you explain to me the conversation between Oracle and the VA, and by all means, please put it in crayon so I can understand it.
Speaker 58
I was not here, so I cannot give you that information, and I don't know that you were involved, so I don't know that... No, I was not involved with the initial discussions on price.
Speaker 45
All right, so we got a crew in front of us that can't explain to Congress why we bumped up $17 billion on a contract that was initially supposed to cost $10 billion. From the way that I understand and what the ranking member stated was that the CEO of Oracle said that they would eat the cost, any over-expenditures of this project. Is that correct?
Speaker 59
I read a quote on the board that said that. I don't know where that came from.
It came from their mouth. Excuse me, I heard that.
Paul Lawrence
I can't validate it, so if you ask me if it's correct... Then I believe you. But it is inaccurate to state people in front of you do not understand the program. What we do understand is what I do understand is what took place when I showed up on March, late March of 2025, which was we had a schedule, we had a set of money that was, you know...
Speaker 45
Now, Congress gave you $10 billion, not you, the VA and Oracle to get this project completed. And then it went into a freeze, then we're an increase to $17 billion. But I'd like to submit something for the record from investor.oracle.com, Mr. Chairman. It says Oracle announces record Q4 FY26 results driven by cloud infrastructure and cloud applications. The net profit for 2026 was $17 billion.
Record remaining performance obligations grew of 85 billion in Q4. Record Q4 earnings per share went up 21%. Record Q4 total revenue was 19 billion. Record Q4 total cloud revenue was 9.9 billion. So my question is, if the CEO of Oracle said that they were willing to eat the cost on the EHRM per the contract, why is the taxpayer spending an extra $17 billion?
Paul Lawrence
I'm not going to be able to answer that. I do not understand the history you're talking about. I understand the situation we faced when we came in and what we did based on Secretary McDonough's instructions as to execute the program for our veterans.
Speaker 56
So Secretary McDonough told you if Oracle walks up and says we need an extra 17 billion... hold on, I'm not finished yet.
Speaker 40
If... so Oracle came in and said we need an extra $17 billion to complete the project that most likely won't be completed by the end of the actual contract.
Speaker 55
That's inaccurate. So explain to me again, you can put it in crayon if you like.
Paul Lawrence
Certainly. The ceiling for their contract was expiring. We would have no legal document to do business with them without extending the ceiling of their contract.
Speaker 46
So in in order to extend the ceiling, they asked for another 17 billion dollars?
Who's we?
Speaker 53
Why did the VA need 17 billion dollars if so Oracle asked the VA for 17 billion dollars.
No. No.
Then where's the 17 billion dollars going to?
Paul Lawrence
We produced a schedule of what it would cost to complete the deployment to 2031, the schedule we were just talking about. In there are costs for software.
Paul Lawrence
No, it it may go to Oracle. It's a time and materials contract. We increase the ceiling, each task has to be negotiated underneath the ceiling. So 17 is the maximum.
Speaker 52
Where did the 17 billion, who initiated the 17 billion dollar number, Oracle or the VA?
Paul Lawrence
We asked for a proposal, so let me just if you'll let me finish. Can I finish? We estimated what it would cost to complete the deployment through 2031. Of that, some require some of it is for the services that Oracle provides, software as well as some training and some other things. Okay, coming to the conclusion of this contract, the the ceiling, we asked them for a proposal.
This is the part where our acquisition team kicks in, broadly because I'm not involved in this. They get independent estimates of what it should cost. We negotiate, that's where the 17 billion dollars came from.
Speaker 45
So that that came from Oracle. Okay, so that's a yes. So my second question is why didn't the VA, hang on for a second. Why didn't the VA negotiate back to Oracle on why can't you complete the project with the 10 billion we gave you?
Paul Lawrence
Again, this is the part I'm not going to be able to tell you. Acquisition is done by a separate group. I have no involvement of that, neither does Neil because of the way the government is structured.
Speaker 38
In your position you're not allowed to ask the acquisition officer what's going on?
Speaker 45
That's how the structure of the government works, that a seated secretary can't ask an appropriations officer where that money's going?
Paul Lawrence
We get a broad discussion of how it takes place, the negotiations are done by a separate team.
Speaker 44
And nobody at the VA said hey, why are we adding on another 17 billion dollars of taxpayer money?
Speaker 51
I don't know that for a fact, I don't know what took place in the acquisition conversations.
Speaker 37
So who do we need to talk to that would know the answer to that question?
Speaker 47
We could probably arrange a briefing for your team on some confidential.
Speaker 41
We could probably arrange a briefing for your team on some confidential.
Gentleman's time has expired.
Gentleman's time has expired.
Speaker 40
I mean if I said hey I'm probably going to give the VA some money you think the veterans in the United States veterans would be pissed off about that?
Gentleman's time has expired.
Yes sir.
Representative Pappas you're recognized for five minutes.
Speaker 54
Thank you Mr. Chairman, this issue is incredibly important to every member on this committee. We've been working for it for on it for years and we've got to make sure there's maximum transparency and accountability for veterans, for VA employees, and for taxpayers. I want to zero in on the training question that Representative Brownley was asking about because this system is only going to be effective and be able to be fully implemented if the people using it are receiving sufficient training and can incorporate that into their daily workflows as they take care of veterans. Now since 2018 VA's obligated about 6 billion dollars to the program's contract, included in that is virtual only training at 15 to 25 hours per position. We've heard some comments from frontline employees that I think are concerning and I would like you to address them.
Multiple facilities that have asked for someone to deliver training in person that weren't those requests were denied, staff that finished Oracle's training modules left feeling with a left feeling unconvinced about the fact that they understood the basics of the program, and new hires who are left unable to document patient care for two to four weeks. I appreciate you talking about some augmented training steps that the department has taken, but I also want to focus on what Oracle's role here should be.
We're paying them a significant amount of money, included in that is ensuring that they're providing adequate training. And I'm wondering, a decade and six billion dollars later and with this increase in the ceiling to 17 billion dollars, if we're getting good bang for our buck from Oracle on training. Because I've learned that VA staff picked up the slack, has created their own training program, the National EHRM Supplemental Staffing Unit, which they've done on their own time, and they say it helps more than anything that Oracle has been providing. So can you talk about how you measure success with respect to training and whether you feel like Oracle is just going through the motions on this and if they need to step up to the table in a bigger way on this? I know that one of the measures for deciding whether a site is ready to go live is if 80% of staff have completed training, which is a metric Oracle cites in their statements to show that training is working.
But is the focus, should we be focused on completion rate or should we be focused on competency and whether the staff feels confident that they'll be able to utilize the system and incorporate that into their workflow?
Paul Lawrence
Let me start and you jump in here. Um, I think both, and I think what happens is what you see and we talk about this is to go live, we ask the medical center director, are you comfortable your team is trained to execute and provide medicine? And the answer has been yes before we've gone live in each of those. And 80% is the minimum we shoot for, we'd have some facilities that get 100% of the folks trained. And the hours vary based on position and specialty.
And the feedback, again from my visits when we go out is, here's what we like, here's what we don't like, here's how it's augmented, right? So we have additional training. But by and large, when you see us getting to normal and when you see our team providing the kind of services I talked about, open heart surgery and the like, those are indications that the training is successful. Could it be better? Yes, of course, we spend a lot of time thinking about that.
We're balancing time like we talked before, the providers to their ability to do this, right? And so we're listening carefully to what they're telling us, but yes, by and large the training has been good. Neil, you want to?
Neil Evans
I agree. I mean, we spend a considerable amount of time, so 100% agree with you that there we are going to listen to users and continue to improve training. I'll say a couple things with regard to where training fits in an overall adoption strategy. We've mentioned GAO several times. GAO advised us at the beginning of the reset to say you need a comprehensive change management strategy that thinks about how do you take an end user who's been using Vista CPRS for many years and walk them through the journey of understanding not just how to use the software, but how this is going to impact the daily work that they do.
The Federal EHR is a role-based system. There are more than 300 roles and there's unique training for each of those roles. And we are working to improve each one of those training tracks with Oracle. You mentioned NSSU, the National EHR Supplemental Staffing Unit. We are hugely proud of what they have done.
They provide training and support for only a handful of roles. There are many, many roles that NSSU does not provide support for. That is where we introduced learning labs, which is in-person opportunity to practice that comes after training. We're getting great feedback about that. So the short answer is we are going to continue to work to make training better and more efficient for all users, not just for our clinicians in primary care, mental health, etc.
Thank you. I yield back.
Derrick Van Orden
Thank you, Mr. Chairman. Last night I got together with my colleagues Mr. Bergman and Mr. Luttrell with just about every veteran service organization we could get together and we started talking about stuff and it got contentious for a while. I'm going to ask you a question. What is the Veterans Access Act, the Major Richard Star Access Act, the Love Lives On Act, the Coordinated Care for Senior Veterans and Wounded Warriors Act, the Hope for Brave Act, the Optimizing the VA Workforce Veterans Act of 2025, the Vital Act of 2025, the Honor Act, the Precision Brain Health Research Act, the Veterans Caregiver Reduction Reemployment and Retirement Act, the Veteran Spine Trauma Access to New Devices Act, the Disabled Veterans Dignity Act, the Fallen Service Members Religious Heritage Restoration Act, the Fisher House Availability Act, the Veterans Disability Exam Modernization and License Probability Act, the Caring for Veterans and Strengthening National Security Act, the Veterans Community Care Scheduled Improvement Act, the Sherry Bailey and Eric Edmondson Veterans Benefit Expansion Act, the Justice for All ALS Veterans Act, the Reducing Arbitrary Barriers to Apprenticeship Act of 2026, the Vet PAC Act, the Link VA Act, the Rep VA Act, the Supporting Rural Veterans Access to Healthcare Act, the Critical Access to Veterans Care Act, the Avert Crisis Act, the Ensuring Vet Success on Campus Act, the Servicewoman and Veterans Menopause Research Act, the Improving Veterans Access to Healthcare Act, the Improving Access to Care for Rural Veterans Act, the End Veteran Overdose Act, the Veteran Service Dog Assistant Veterans Act, the Recovery Act, the Assistance Act, the Fairness of Veterans Education Act, the Ensuring Veterans Final Resting Place Act, and the Denison-Lois-Korfalski Act, the Veteran Support Act, the Delivering Dignity to our Veterans Act, the Clear Communication for Veterans Act, the Travel Act, the Veterans Mental Health and Addiction Therapy Quality Care Act, the Caring for our Veterans Act, the SAVE Act, the Molly R. Loomis Research for Descendants of Toxic Exposed Veterans Act, the TAP Promotion Act, the Lactation Space for Veteran Moms Act, the Review Every Veteran's Claim Act, the Vet Opportunity Act, the Veterans National Traumatic Brain Injury Treatment Act, the Simplifying VA Forms Act, the Protecting Veterans Access to Telemedicine Service Act of 2025, the START Act, the Expanding Act for Online Veteran Student Act, the Representing our Seniors at VA Act, the Blast Overpressure and Research Mitigation Task Force, the ETS Act, the VA Fiscal Management Modernization Act, the CRUISE Act, the VA Contacting Procurement Act, the Leasing Infrastructure Act of 2025, and the Modernizing All Veterans and Service Act, and the BEACON Act of 2026. What do those all have in common?
They cost 17 billion dollars to fund. This is corruption. This is corruption. How many years you've been doing this Cerner garbage? How many years has this project lasted?
Speaker 30
The project originated in 2000, well, it's a complicated answer. The project originated...
Derrick Van Orden
It's not complicated, and you better be mindful, sir. You are addressing Congress and we have a direct constitutional oversight of your job.
Paul Lawrence
Respectfully, I'd like to explain. VA's contract began with Cerner, I believe in 2018, but I'm not precise because I wasn't there.
Speaker 33
Okay, all right, that's too long, good, fine. How much is the total cost of this project been?
Speaker 29
Those are numbers you should have been, that should have been on the top of your head. You know what this hearing's about. That is inexcusable. How much does this project cost?
Neil Evans
The, we are approaching a 10 billion dollars as was the initial ceiling as we mentioned, which will come in fiscal year 2017. And then there's the cost for infrastructure improvement.
Speaker 28
Can you, can you tell me how many of our medical residents train in a VA facility?
There are multiple electronic health records used.
The market leader, yes.
Speaker 31
Epic. Why do civilian hospitals only use Cerner when they can't afford Epic?
I don't know.
Derrick Van Orden
Because it's not user-friendly. And stuff like this happens all the time and you know it by now.
So if I had my druthers, you would sever this contract with Oracle because that person lied to us. They said they'd pick up any extra nickel over that $10 billion. They said that. And when me and Mr. Takano agree on something, you better pay attention. So that's reality.
So they said that and you need to hold them accountable. And like I said, the 62 acts that we were arguing for two hours last night with our VSOs trying to get to the bottom of this, we can't find the money other than these pay-fors that can affect future generations of veterans, which we don't want to do, but we have to take care of our catastrophically injured people now. We really do. But all of that money could be taken care of if you guys could figure out how to run a damn electronic medical record. This is absurd.
This is absurd. And with that, I yield back.
Nikki Budzinski
Yeah, thank you. I would just start out by saying I add my voice exactly to Congressman Van Orden's point here, that you ask a question, what's the final cost on this project, and they stutter because they don't know and that ultimately this is just a blank check for Oracle. So I'd like to ask just a few questions here and these are kind of yes or no questions. Do you know the full amount, we say 17 billion, what is the full amount of taxpayer dollars that you're asking taxpayers to pay for on this program right now in addition to the 10?
Speaker 61
In addition to 10, we told you it's 27 billion additional dollars to complete the deployments.
Nikki Budzinski
No. It's, I have the number. It's $17,581,649,588 taxpayer dollars that you're asking for in addition to the $10 billion that you've been authorized. You've not even been authorized for that 17 billion. And you tried to redact it and we found out because reporters released the fact that it was 17 billion, so there's a total lack of transparency on this.
So a few questions that I have for you, Dr. Lawrence, these are yes or no questions. Just to be clear, these funds are all going directly to Oracle?
Speaker 63
There's a little confusion here, I think. So the document that got redacted is the Oracle...
Speaker 64
Okay, I don't have a lot of time, so it's yes or no. Is the $27 billion in total, if you get this 17 billion, is that all going to Oracle?
No, it's not.
Speaker 62
No. So the 27... It's very difficult for me to explain the complex math, which I don't think we're, I think we're talking over...
Speaker 67
But I think what you're hearing is the frustration of a committee that we're asking very clear questions about, we have a responsibility for the taxpayers that we represent to get answers, and a bunch of gobbledygook regarding $17 billion that you can't answer is malpractice. So let me get back to, these are yes or no questions. This $27 billion, that doesn't even account for the $439 million to Accenture, yes or no?
The $27 billion is the addition to the 10...
Speaker 64
So you're not answering the question again. It's just, it's really frustrating. So this $27 billion is also not going to be included in projects like sustainment, programmatic cost, infrastructure cost, none of that is included in this $27 billion.
Speaker 66
That's not correct. The $27 billion is the addition to the $10 billion. It includes the Oracle contract and as Dr. Evans tried to explain when was asked a few minutes ago, it includes other things like what you're talking about, training, infrastructure.
So all of that will be in the cost.
That's correct.
Speaker 67
All of that will be in the cost. Okay. I just want to point out again, I think ranking member made this point, is that the beneficiary, you know, Larry Ellison, the eighth richest man in the world that is the founder of Oracle, it's really ironic to me that this administration can find out of their back pocket $17 billion but not for our veterans, $13 billion for the Major Richard Star Act. Or let's just set aside, we've been asking as Democrats to extend the ACA tax credits so 8,000 of my constituents can maintain their health insurance, but there's no money to be found for them, but there is money to be found for Mr. Ellison and Oracle on a failed project.
You have had eight years at the VA to execute on this, and quite frankly, this is all just overrun costs. You're not managing this project, and so you're coming at this by just throwing more money, and I'll start where I began, which is this is a blank check for Oracle, and it is unacceptable. So a few other questions. Despite previously testifying that Oracle could provide this program on schedule and on budget, these recent contract modifications show that this statement, which was provided as you stated to the committee in 2022, is quite simply a lie. In fact, you have allowed Oracle to get away with saying that these costs are overruns and are due to unanticipated complexities, and that's a quote.
Who's role is that to identify and manage those complexities with a vendor like Oracle? Is that your job?
Paul Lawrence
In 2022, 2023, and 2024, that was another team. That was their job to manage those complexities.
So you're passing the buck.
Paul Lawrence
I'm pointing out what happened. And so when I showed up in 25, we discovered those problems existed, we discovered we were running out of money, and we're dealing with them. The testimony I gave today and the results I'm reporting today are of success of our team righting the ship and now delivering electronic health record, which I agree with you, stumbled for too long. So we are in the process of delivering results.
Speaker 67
I'll tell you, I'm the ranking member of this subcommittee on tech and modernization. One of the other issues we've been raising is the fact that this administration failed until I think March to nominate a CIO, even though there was so many big projects that were happening. So welcome to the team, and I'm glad that you're finally on this, but we are demanding accountability on this full project. The second question I have is, are VA and Oracle going to come back to Congress in another two years and ask us for more money? Is this the end of the gravy train for Oracle?
Speaker 67
That's it. It's all going to be completed. Because I do just want to say that there are 170 health clinics over the eight years that the VA has been tasked with implementing this project, only 17 have been executed on. That is ridiculous, and I yield back.
Representative Mace.
Nancy Mace
Good morning, and thank you, Mr. Chairman. Mr. Lawrence, so this program started what, 2018?
If you'll bear with me for one second.
No, I just, what year did this program start?
Paul Lawrence
VA started our part of the program in 2017. Recall this is a joint program with DOD, so that's important.
Speaker 77
Okay, and then they've asked for another $17 billion, so then we're at $27 billion is the math total so far for the program through 2031?
Paul Lawrence
Well, no, it's going to be $37 billion. So you described the Oracle part of it. There's additional costs, so the total is 10 plus 27.
Speaker 75
I can't do the math in my head. It's 37 billion divided by 17 and a half million veterans. That's the math.
Speaker 76
What's the math? Someone do the math for me on that. And how many, so how much has been spent so far?
$10 billion.
Speaker 71
And have there been detailed reports about the implementation at those 17 sites provided to Congress?
Paul Lawrence
So 11 have been done by this team since April.
So we've experienced what those have gone on. There's a host of GAO reports and IG reports about the six that were previously implemented, primarily by another team in the previous year. So there's a host of those things, which we've studied and incorporated learning in the go-forward deployments. We have plans to finish the deployment in all 170 sites by 2028.
Speaker 70
What are some of the lessons learned from the implementation at the first 17 sites?
Paul Lawrence
Listening to our team, providing sufficient change management, providing sufficient training, understanding the importance of the patient safety issues which came up in the previous attempts.
Speaker 70
How many safety incidences were there in the first 17 sites that this was implemented in?
Neil Evans
There have been no critical patient safety items found for the last 11 sites that have gone live since the beginning of the year.
I'm asking about the first 17.
I would have to get you that information.
Neil Evans
It's not zero. We ask, one of the things that we do with this program is we encourage and frankly train all of our end users about how to raise their hand. We would rather have over-reporting about patient safety concerns so that we can identify where patient safety issues are that we can address.
Speaker 82
The math is just over $2,000 per patient. How does this compare to the average implementation of electronic records in the private sector at a private or commercial hospital?
I'd have to get you the information. I don't know.
Paul Lawrence
What have taxpayers gotten out of this? What are they going to get out of another 27 billion? Why is it costing 27 billion more?
Speaker 80
As we indicated, uncertain results in the $10 billion to get six sites, but now to complete the program...
Paul Lawrence
It's exactly what I said. The six sites delivered uncertain results to our veterans, a small fraction of the results we promised.
Speaker 71
Is it because the VA wasn't tracking data? How do you have uncertain results? This is software that should be tracked in real time.
Paul Lawrence
Certainly. We understand that, but what I'm talking about, the vision of what was supposed to happen was we were supposed to provide a seamless connection with the Department of Defense across all 170 medical centers. By doing six prior to the Trump administration, we have delivered a small fraction of those results we promised. Our attempts now are to get all the remaining sites on board so that we have seamless interface with the Department of Defense.
Nancy Mace
Have there been complaints about the use of this software, that it being numerous clicks in the software just to get to a single piece of data?
Speaker 82
What's the average number of clicks to get through to a single piece of information?
Paul Lawrence
No, no, I'm sure there are complaints about it. I'm conceding that there might be somebody who is complaining, but the vast majority of the feedback we get, to include direct feedback, fewer clicks, fewer screens, saving me an hour every day.
Speaker 90
What's been the improvement though? I mean, from what was the original average number of clicks to where are we today?
I don't know.
Neil Evans
During the reset, we spent a considerable amount of time listening to our end users and then adjusting the configuration.
Speaker 70
Are we using AI at all within this implementation to make it better, more improved for the physicians treating our veterans?
Neil Evans
Yes, you heard Dr. Lawrence mention earlier that we released a new AI chatbot, VA Chatter we call it, which allows clinicians, frontline staff, our schedulers...
Speaker 88
How does it compare, the AI we're using at the VA, to what Oracle and Cerner offer in the private sector?
Neil Evans
We are deploying the same technology that is available in the private sector.
Maggie Goodlander
Thank you, Mr. Chairman. Thank you to our witnesses for being here today.
Mr. Deputy Secretary, I wanted to start with you. You testified earlier in this hearing that you do in fact have updated independent total life cycle cost estimates for this. Can you share those numbers with me?
Paul Lawrence
Certainly. If I said what you said, I might have misspoke, because I didn't mean to imply...
Okay, could you clarify for the committee?
Paul Lawrence
I meant to say we have a life cycle cost estimate of what we believe it's going to cost to implement this program. I did not use the word independent.
What is the... what is the estimate?
Paul Lawrence
It's about thirty-seven billion dollars to complete the deployment, and then to sustain it, to line up with the GAO timeframe, another eleven billion dollars, for a total of forty-eight billion dollars.
Maggie Goodlander
Forty-eight billion dollars. Okay, and when do you expect to have an independent assessment? Will you commit to getting this committee an independent assessment by the end of this month, by the end of the fiscal year?
Maggie Goodlander
Well, that's very disappointing, Mr. Deputy Secretary. I want to ask you about a document that I found through a link from a news article, FedScoop. It's an August 11th, 2026 document entitled Justification for Other Than Full and Open Competition. This is a document that is redacted in key parts throughout. And I want to ask you, Mr. Deputy Secretary, did you inform the committee directly about the new estimate for this contract?
And why did you redact this document?
Paul Lawrence
I don't know the document about which you're referring, so I'm sorry if I can't comment on that. We provided, as we indicated earlier, the committee our estimate of what it would cost, the thirty-seven billion dollars and the addition, or maybe not the addition, back in September of last year.
Maggie Goodlander
And then why in August of this year, just last month, did the department renegotiate and up the ante for Oracle?
Paul Lawrence
Certainly, our contract was expiring, we were hitting the ceiling at the end of it. In order to continue to do business with them, we had to alter the contractual documents.
Maggie Goodlander
Mr. Deputy Secretary, it's been established in this hearing on a bipartisan basis that Oracle has had committed to eating the costs, any additional costs for this contract. So why... why are you asking American taxpayers to bear the burden here?
Paul Lawrence
Yeah, I have to run that down. I still don't understand that part of that, so I'm not going to give you a very satisfying response to that answer. I've got to figure out what was promised and see how our acquisition folks dealt with that.
So you have no answer for the committee at this time.
Maggie Goodlander
And you commit to informing this committee why in an extremely unusual move your department redacted key numbers that this committee, the Congress, and the American people as a whole deserve to know. Do you commit to explaining to us why that happened?
Paul Lawrence
So I commit to explaining to you why that happens. And I don't think it's unusual in highly sensitive acquisition information for things to be submitted, nor for certain groups of people to not understand the mechanics of how those acquisitions happen. That's how the law, the federal acquisition law, sort of sets in motion these sort of things. So I'm happy to make sure you have sufficient explanation.
Maggie Goodlander
Yeah, this is a very basic transparency issue, Mr. Deputy Secretary. And this was a highly unusual move. We're talking about billions of dollars. American taxpayers are being asked to foot for this, maybe for no reason at all if a commitment was made by Oracle. And this is basic transparency that every American deserves.
Dr. Evans, I want to ask you as a practicing physician, I was really struck reading the testimony from the Nurses Organization of Veterans Affairs, NOVA, in which they made clear, and I'm quoting here from their written testimony, that across all go-live sites, patient safety event reporting peaks at three times the baseline and remains elevated up to one point seven times the baseline through twenty-four months with no return to the pre-Oracle Cerner baseline. So can you tell us about this very unusual and disturbing statistic on patient safety event reporting?
Maggie Goodlander
But can I ask actually more specifically, was the VA aware of this statistic and this state of play before you requested a 17 billion dollar increase and set a 2031 acceleration target?
Neil Evans
I'm very much aware of it. Patient safety is our clinical... patient safety is our priority. And so we want individuals, I don't care who it is, any VA employee, if they have a concern about something that may be a patient safety concern, they need to raise their hand and bring it to our attention so our patient safety professionals and our teams can evaluate that.
Absolutely. Absolutely, Dr. Evans.
Neil Evans
The difference between reporting and substantiated patient safety findings is very, very different. We want to see an increased reporting rate and that is what is good and best practice during a change of this type.
Gentlewoman's time has expired.
Thank you, and I yield back.
Gregory Murphy
Thank you, Mr. Chairman. You know, when I came on this committee close to seven years ago, I was very upset about the lack of speed seven years ago in implementing this electronic medical record system. In my medical institution, we started this 22 years ago. And to be disappointed is an understatement on how I feel now. This is just an example, in my opinion, a bipartisan example of the absolute disastrousness of bureaucracy.
I think it was an absolute disaster that this Oracle was picked, or its predecessor was picked in the first place. I think it was a ridiculous thing. Cerner's not meant for large institutions, especially the largest hospital system in the nation. And I look at the comparison to go-lives, and I've been involved a lot in personal go-lives, and I have to push this back on Oracle itself. There's no reason the CEO of the company needs to be involved at a go-live at an institution.
There's none. They don't need to be there. In fact, they need to be as far away as possible because the physicians and all the people go crazy on the first few weeks of these go-lives. So I have to say I'm just despondent at the ridiculousness of now a request for more and more money for them to do a job they should have been done... they should have done a decade ago. And I don't know where the accountability goes.
I don't know where in a room where you sit down and say, "What the hell is going on?" "What the hell is taking so long with these individuals?" Because I guarantee you, when I was chief of staff of my institution, those are the exact words I would use. I would hope that you would be just as equally irritated, despondent, and outraged at the lack of movement that's happened with this. I want to know why.
Why do you think it has taken so long for the VA to do this? Now, let's just be fair here. There've been multiple administrations that have occurred with this. So this isn't all just on this administration right now. The Biden administration, the same damn slowness occurred there.
What is taking so long for these places to go live?
Paul Lawrence
There's a series of answers that were well documented in GAO reports and IG reports. So accept that. The reality of the situation is when I showed up in March, the charge was complete this. This is an important tool to have, as you understand. That was the charge going forward.
So we understand those things to help us inform the way we're going to do it: better training and the like. But that's where we are. The schedules we have are to complete the remaining of the 170 hospitals to fulfill the vision. You're right, past could have been different for a whole lot of reasons, but that's not where we are. Here's where we are.
We have a schedule, we have an estimate of the costs. It's very solid. Working closely with Oracle. We have our teams going, as witnessed by the fact that the go-lives are going so well in 2026. It's our intention to roll it out per the schedule to complete by 2031.
Gregory Murphy
So why are they, why is it so slow? I mean, I'm going to just play devil's advocate here. Epic has done twice as many in two years. What does Oracle say to that?
Gregory Murphy
Again, I'm not pushing it on any administration, because the Biden administration is just as culpable, if not more so, for the slowness that occurred during the last administration. I just want to see results. I just want to see what the hell is taking so long for this to happen, because I've been involved in these process intimately myself, and I just don't understand what is taking so long.
Neil Evans
I completely understand. 13 sites and all of their associated clinics going live this year. 26 sites and all of their associated clinics going next year. I mean, we are significantly increasing the pace. 28, 30.
We moved from a single going one hospital at a time to a multi-wave approach. Every wave where we go live, we're going live with 8,000 to 12,000 end users and accelerating that path forward.
Gregory Murphy
Is that the problem? We don't have enough end users to teach people? Is it a hardware problem? Is it recalcitrance on the providers at the VA? Is it all of the above, and which buttons need to be pushed harder to get this done?
Neil Evans
We currently have 11 waves and it's probably close to 40 sites that are in active preparation for go-live. There is a significant lead time, as you're well aware, of the need to do the infrastructure improvements, make sure that we have everything set up for the hospital to succeed, acquisition timelines...
Gregory Murphy
Let me ask you one question real quick. Are you allowing each institution to have their own picks, or are we doing something standardized throughout the entire VA?
Standardized, standardized.
All right, so it should even be faster.
Neil Evans
Correct. And that is the only way we are achieving wave-based deployments and now deploying at the pace that we are. Effectively next year we're going to be having a go-live wave every 8 to 12 weeks throughout the entire year and through the rest of the program.
Gregory Murphy
Well, I mean, look, I know you're working as hard as you can. I put a lot of burden on their company for them coming back and asking for more money to do a job that they should have done a decade ago. I think personally that's ridiculous, and I would hope that the VA would push back hard as hell against these individuals and say you didn't do your job a decade ago, let's do your job now. So thank you, Mr. Chairman, I'll yield back.
Maxine Dexter
Thank you, Chair Boss, for holding this hearing, for your dedication to transparency and oversight, and thank you to our witnesses for being here today. Members of Congress share responsibility for ensuring the billions of dollars being spent on VA's modernization of its EHR are used effectively. Last month, the VA, as we all have heard, announced it was increasing the ceiling on Oracle's contract to manage the VA's electronic health records from 10 billion to 27 billion, nearly tripling the contract size. And this was a no-bid sole-source contract extension with no competition allowed and established clear performance, clearly poor performance. My home state of Oregon also had a disastrous experience with Oracle when it contracted to create Oregon state-based health insurance marketplace, and our own experience feels eerily familiar to what we are hearing today.
And as a former VA doctor, I've heard complaints about Oracle's performance in real time from VA physicians. As members of Congress, we have a responsibility to conduct oversight and make sure this decision was made on the merits and is responsible use of taxpayer dollars.
Mr. Lawrence, do you know how much Oracle stock price rose at the opening of the market after VA announced the tripling of the contract ceiling?
No, I do not.
Maxine Dexter
It was 3% and some market analysts attributed this directly to the VA announcement. Mr. Lawrence, do you personally hold any Oracle stock?
No, I do not.
Speaker 97
I'm glad to hear that. How about President Trump? Does he own and trade any Oracle stock?
I do not know.
Maxine Dexter
The most recent data we have is from the first quarter of this year and it shows that Donald Trump while serving as president has been buying and selling millions of dollars worth of Oracle stock. When agencies award billion dollar no-bid contracts to companies that President Trump invests in, that raises a question about corruption. Congress needs to investigate. But that's not the only questionable part of this contract. Not only is Donald Trump an investor in Oracle, he has been a beneficiary of massive political contributions from Larry Ellison, the founder and chairman of Oracle.
Mr. Lawrence, how much did Larry Ellison contribute to Trump's reelection campaign?
I do not know.
Maxine Dexter
He gave 45 million and he has given millions more to groups supporting Trump since then. Now look at, let's look at Oracle's record. The original contract was given to Oracle during President Trump's first term and it has been plagued with problems from the start as we've heard today. Again, my home state of Oregon had an equally unacceptable experience with Oracle and in fact sued them for fraud, which Oracle settled for 100 million dollars. Ms. Carol Harris from the Government Accountability Office is here and will testify today.
Last December, she testified that GAO had made 10 priority recommendations that the VA had not yet implemented. And I quote, quote, until VA fully implements the priority recommendations, future deployments risk prolonging management challenges and users will likely not be positioned to achieve optimal usage, unquote, end quote. The GAO is here to ensure we are being good stewards of taxpayer dollars. From their outstanding recommendations, I have a hard time believing this 17 billion increase in the contract will be used properly and is the best in the best interest of our veterans. And here's the important context.
These questions about Oracle's contract are happening in an administration that is the most corrupt administration in history. In just his first year in office, President Trump increased his net worth by over 2 billion dollars and contracts and loans worth hundreds of millions of dollars were awarded to companies with ties to Trump family members. I am not saying this contract is corrupt. That is not my job here. But there are plenty of red flags to raise concern.
A 17 billion dollar no-bid contract extension has been given to a company that our president invests in, whose founder has contributed heavily to our president, and that company has a terrible record of past performance using taxpayer dollars. That's why we need to investigate. And that is why Mr. Chairman, pursuant to clause 2K6 of rule 11, I move that a subpoena be issued to Larry Ellison, the executive chairman of Oracle, and Mike Sicilia, the CEO of Oracle, to provide testimony at this hearing. I seek recognition to explain my motion. Mr. Chairman, may I be heard for my motion?
You can explain your motion.
Thank you. Immediate options recognized, okay, I'm sorry. I'm sorry, I'm trying to find, I wasn't necessarily expecting to be recognized right away. Okay, sorry. I am moving to subpoena Larry Ellison, chairman and chief technology officer of Oracle Corporation, and Mike Sicilia, chief executive officer of Oracle.
Chair Bost wrote a letter inviting Oracle to testify today and Oracle declined to attend. I do not take this step lightly and I do not believe any member of this committee would. We are here because we care about the same thing. Making sure veterans receive the care they were promised and making sure taxpayers get what they are paying for. When the vendor responsible for a taxpayer funded contract going from 10 billion dollars to roughly 27 billion will not sit at this table and answer our questions, all of us are being prevented from doing our oversight duties.
I agree with my colleague Congressman Van Orden that this sounds like it could be corruption. Oracle has still not provided a complete and comprehensive cost estimate for this contract and it is not sufficiently documented that the additional funds already committed are being used effectively. A closed door private roundtable cannot replace congressional oversight that happens here in this hearing room. Oracle needs to appear before this committee in this room in a formal setting to answer our questions. I'm asking my colleagues to join me in this motion.
This is not about one company. It is about the committee's authority to do a job veterans and taxpayers expect of us. A system that works for veterans and a contract taxpayers can both trust and requires that the people responsible show up and answer for it. I ask for your support to my colleagues. And I yield back.
Thank you Mr. Chair.
Mike Bost
The chair at this time holds the gentlelady's motion in abeyance until the end of the hearing, which is a common practice of the committee to allow today's witnesses to be heard and then we will deal with the okay. Representative Ciscomani, you are recognized for five minutes.
Juan Ciscomani
Thank you Mr. Chairman and thank you to Dr. Lawrence and Dr. Evans and Mrs. Harris also for being here today to testify on this important issue. Thank you Mr. Chairman and thank you all for your time and answering our questions. Veterans across the country rely on the VA every day, including to keep their health records accurate and secure. The rollout of electronic health record modernization at VA medical centers is a real opportunity to improve the experience and as a member of the Appropriations Committee as well besides being a member of this committee, I take programs of this size and the cost of them very seriously. Real progress has been made.
Recent deployments have gone on more smoothly than earlier ones, I'll say that. And it's clear that VA is taking this seriously. But it's important that these lessons carry forward so future deployments continue to improve rather than repeat the past mistakes as well. So I'd like to start with you Dr. Lawrence on this issue of the of the deployment. As you evaluate new deployments and where they will be located, what are the most critical lessons learned from the 2026 deployments and how is VA making improvements to system to the system and to the deployment process going forward?
Paul Lawrence
Certainly. One of the big lessons learned was to do things in a market basis to sort of all the sites in Michigan, for example, tend to serve our veterans, they cross cross site care. And so as a result doing all things together so that they all the veterans in the area are on the same record is really important. The other thing is getting out and listening to our providers directly so that's resulted in me going to the sites to talk to them and hear about their concerns in the system. The other thing is as we talked about earlier, standardization.
There was one version of the record, not like before where there was a lot of customization, we're we're stopping that. Training obviously matters, but the other thing we're discovering too is how much knowledge sharing is taking place naturally in our system. Providers, medical center directors are hearing how good this is and they are going to the live sites to learn to see the deployments in Northern Indiana two weekends ago, there were representatives from 12 sites that will go live in the future to see what's going on and to see the system in place because they've heard how good it's it's so we need to enable the knowledge sharing and give more folks exposure.
Juan Ciscomani
And what metrics is the VA using to determine whether a deployment has been successful before moving to the next site?
Paul Lawrence
Well, there's a whole series of metrics: have you done the training, is the infrastructure in place, is everybody ready? The most important is the conversation with the medical center director: is your team ready? And by and large, those have been not only ready, we want it earlier.
Speaker 102
Certainly, if we had patient safety issues. We are concerned patient safety.
Juan Ciscomani
Let me ask one more question on this, given that the Cochise County VA, Cochise County is in my district in Southern Arizona, clinic is Sierra Vista, serves a significant veteran population in my district, the most dense veteran population in the state of Arizona. In my district, I've got about 80,000 veterans in my district. So what is the current timeline for the modernization deployment at the Southern Arizona VA healthcare system site, and what steps are being taken to ensure that rural and satellite clinics like Sierra Vista are not left behind as the system is rolled out at the larger medical centers?
Paul Lawrence
Sure, give me a second to look up the date for your site, the site, your area. But let me tell you about the satellite clinics and the CBOCs and the like. That is done all together with the facility, the corresponding hospital. That's done all together, so the rollout takes place with the hospital and the corresponding CBOC. That's done as one initiative, one effort.
So folks come to the hospital, teach and train and be with them when they go live, and they go to the remote site. So part of what happens in the deployment is we figure out where the remote sites are, what type of medicine is provided there, what hours is it open, and who needs to be there when they go live to help them, so they get just as much help as they can possibly have as if they were at the main facilities. We already have for Tucson and all associated facilities, the community clinics, the pre-deployment work started in May of 2026. We then start the prepare the end users, the adoption support, the training, that all starts in May of 2027, and go-live is currently scheduled May of 2028.
Juan Ciscomani
Well, I would like to fit in one more question, but I'm going to be over time, so I'll be respectful of everybody's time. Mr. Chairman, I yield back. Thank you.
Mr. Chairman?
Speaker 23
I'm not sure if Ms. Dexter's amendment or offer is or needs a second or not, but if it does need a second, I want to second her motion.
Speaker 103
Thank you. We'll let the parliamentarians figure that one. And if you're accepted and if necessary, I thank you for volunteering that. Mr. Conaway, you're recognized for five minutes.
Herbert Conaway
Thank you, Mr. Chairman, and thank you, ranking member, for this hearing, and thank you, Dr. Lawrence and Dr. Evans, for presenting yourself to us today. I want to start out my own comments by saying that I share the outrage of many on this committee for the cost overruns and the delay of the most expert care that can be provided to our veterans. I'm a physician myself. I have been involved in about one small transition to electronic medical records and three others in larger hospital systems, and they're always difficult. But the numbers involved here and the delays involved here and just as dishearteningly, I think is the word that's been used, the stink of corruption that seems to be involved in this deployment is something that every American ought to be concerned about.
I appreciate the chairman trying to bring a light to this situation, but clearly a lot more needs to be brought forward to this committee and the American people. I wanted to ask, as you think about these large deployments and these contracts, do you believe that the government has sufficient capability to properly assess the costs that are being presented for technology such as Oracle and other companies bringing very complex solutions to government problems? Do we have enough person power to properly assess whether or not we're being sold a bill of goods?
Paul Lawrence
Um, I think our acquisition team is really very, very good, from more broadly speaking. Also, we get help on complicated matters like this from what's called a Federally Funded Research and Development Center, FFRDC. This is something set up coming out of World War II, company that doesn't compete for services but supports the government. So I believe between the combination of two, we have sufficient horsepower to deal with the issues in front of us.
Herbert Conaway
And so why do you think that we're dealing now with this now ballooning number, and yet so much of the system not being, not receiving the kind of technology that inures to the very best of patient care for our veterans?
Paul Lawrence
Everyone agrees with your assessment that it's disappointing how we got here. I do not know how the past happened. I wasn't here, as was pointed out early, others were. But the reality of it is here's where we are. The charge coming into this administration was go deploy the system in the remaining of the remaining 170 hospitals.
And that's what we set out to do since March of '25 when I got here. And what we're reporting on today is the success we've had in the 11 sites on time as we said we would.
Herbert Conaway
Thank you very much. I want to move on. Dr. Evans, you mentioned that safety is a top priority. Now we've heard from our community and the Veterans Affairs that some 300 dermatology patients have had their referrals cancelled at a VA facility, and that facility was using the Oracle system. And many of these patients had cancer diagnoses and of course suffered delays of care as a result.
This doesn't strike me as providing the very best and working to ensure patient safety. Can you explain how this happened and what steps are being taken to deal with this particular situation of these dermatology consultations being cancelled and other situations like this that have arisen?
Neil Evans
Dr. Conway, I would love to have information on that. If the committee could share what you have heard about specifically to dermatology referrals, we would be happy to look into that.
Herbert Conaway
Thank you, and we'll get more information to you so that you can get that information to us. Under this contract, and I think for the first time in the VA's history, you're authorizing AI as part of the chatbot that you've mentioned. What steps are being taken to ensure that this system, this AI system, is securing the protected information that veterans are providing as they use this AI chatbot?
Neil Evans
The AI chatbot is not used for personal health information or personally identifiable information. It is a chatbot that end users can use to ask questions about how do I use this electronic health record in the care of the patient. So for example, how do I properly place a dermatology referral, as you just mentioned? So it is a means to supplement in-person end user support.
Herbert Conaway
Thank you. I have to move on to another question as my time is running out.
One of the other things that we heard from the field was that physicians are having a difficult time, and maybe it doesn't rest with them, but having a difficult time directing patients to the right dispensary or pharmacy to get medications that they've provided. Now, is that a situation that should occur? That is, if I write a prescription to a veteran for a particular medication, I have an expectation it's going to be available to them, just as if I, you know, in the private sector. Sometimes they go to the pharmacy and they say they don't have it and they have to find it. But do you recognize it as a problem that there's not enough feedback to determine where the veteran needs to go when they leave the office to pick up the medicines that have been prescribed for him or her?
Neil Evans
This is one of the significant enhancements that we are achieving by implementing an enterprise-wide electronic health record. When I'm in clinic on Friday seeing patients in primary care, I will be able to write prescriptions that can only be filled in person at the Washington DC VA pharmacy, which is right there in the lobby of the Washington DC VA. I cannot electronically write a prescription that could be filled at the Baltimore pharmacy if my patient happens to be there for convenience. By moving to an enterprise system, we will be able to direct prescriptions to the location where the veteran wants to pick them up. Or, of course, we prefer and most veterans prefer to receive them by mail.
But this is actually what you just highlighted there is actually one of the real advantages of the federal EHR. We will now be able to give veterans the choice of where to pick up the prescriptions, and it will be as simple as the provider choosing that pharmacy from the drop-down list to say, let's fill it in Tucson, let's fill it in Baltimore.
Speaker 106
Thank you. Representative Kiggans, you're recognized for five minutes.
Jennifer Kiggans
Thank you. Thank you, Mr. Chair, and thank you for our witnesses for being here. I represent Virginia's second congressional district, so we have the Hampton VA not too far, and do you have any type of timeline for rollout just for Hampton VA? It's one of our bigger VA facilities down that area, and just out of curiosity.
Paul Lawrence
While Neil looks that up, I want to claim pride and ownership. My son did his residency at the Hampton VA Medical Center five, six, seven years ago. Unbelievably great training, so I'm not surprised by the quality of care that goes on there.
Jennifer Kiggans
The current go-live is scheduled for October of 2030.
2030. Okay, great. Thank you. I appreciate that and look forward to it. I know how hard it is to roll out electronic charting as a geriatric primary care nurse practitioner, having sat through two CCRCs, continuing care retirement communities, where we integrated with electronic charting, going from paper charting to electronic charting back in the day.
It was a long process, over a year in both facilities. To end up with, there's obviously a lot of great things that come with electronic charting that you've been discussing. But one of the things that I remember and that was most helpful to me as a provider was being able to sit with the, they brought in a whole mobile home and they had computers and we were doing charting with the tech reps or with the company reps, in this case maybe Oracle or, you know, who sat with us and said, what is going to help you? What is going to help you to write this note, to be able to prescribe that medication? And I just thought it went a long way, so much so that I always would call them.
They stayed on campus for over a year, and I could call them and have them sit right next to me and they could take that, you could tweak it right there or show me how to do it or bring it back and tweak it, you know, in the program side. So are we doing that as well? Because I care about providers and we struggle and we talk about provider recruitment, retention in this committee, and I know how great electronic charting can be but also how frustrating it can be. So what are we doing to be helpful to providers in that space?
Neil Evans
Absolutely, we're doing that. That is a best practice for electronic health record rollouts as you yourself experienced. Two things I would highlight. Before go-live, we introduced, in the first six sites we did not do this with the exception of FHCC, we introduced what we call learning labs, which is exactly what you describe. It is the month before go-live where we sit, we bring the team together, and we work and we actually practice workflows.
For FHCC we had nine scenarios, we had more than 90 scenarios we worked through the teams with, so essentially everybody has an opportunity to participate in a learning lab. Post go-live, there's adoption support, so Oracle Health staff providing adoption support as well as what we call the pay-it-forward program. These are 100, at each site, each wave we've had almost 180 plus folks who are at the existing sites who come forward and are your colleagues from other VA sites who travel to where you are and sit side-by-side with you during the go-live to make sure you understand how to use the system based on their learning.
Jennifer Kiggans
Good. Good, that was actually my next question, was what are we doing to take some of the changes and not have to relearn them at every facility. So that's very good news to hear. And can you tell me, I don't know if you talked about it a little bit yet or not, but does this system at all or does it have the potential to communicate with TRICARE for active duty military? And how, that's such a big disconnect for me personally as a TRICARE family, representing a lot of TRICARE people, that we have all these people leaving active duty and getting them enrolled into the VA system, just a big disconnect.
How does that work with this system?
Neil Evans
Two things. Number one, it is the very same system that the DOD is using for care. So any care documented by the military health system to include any records that they may retrieve from care delivered in the community is in the very same system. So a progress note written by a provider in the DOD carries the very same weight as one written by the VA provider that's next door to you. They're all in the same, it's all one.
Second, we are now exchanging health data through our joint health information exchange with greater than 90% of the hospital systems in this country and countless clinics, I think it's over 300,000 clinics. And so one of the other things that is a significant improvement is the ability to integrate data from community providers who may be delivering care to somebody through their TRICARE benefit and ingest that information again as a first-class citizen document. That is, you know, it is the care is around the patient, not around the location of care.
Jennifer Kiggans
Well, that continuity of care piece, I mean, that was a huge source of frustration providing community primary care if I, for my large veteran population, if I wanted to know what they were doing at the VA hospital, they had to print it out, they'd ask their VA doctor, print it out and hand-carry it to me because it was a source of frustration we couldn't get those VA notes. So whatever we can do to partner with that, I'm not currently practicing, but I look forward to hearing about this implementation, especially in a place like Hampton Roads where we have so many veterans who use this VA healthcare system, but being able to liaise with our community partners cannot be overstated, just the importance of that for continuity of care. But and then my last question is there, although I'm over time, can I ask one last question? Is that will there be yearly visits to or with some frequency, maybe every year, every two years, to come back to sit with the providers again? I know at some point they'll wrap up and they'll say you're on your own, but is there any plans to revisit so that if there are remaining questions years later?
Neil Evans
There is support for a year post go-live that is provided from a contractual standpoint. And of course, one of the big things that we have done as part of the reset is to really beef up our informatics teams at the facilities to provide that at-the-elbow support in perpetuity. The last thing I would say is that 10% of our workforce are super users. So when we train folks to go-live, we train 10% of folks to be really, really good and support their colleagues. We are committed to maintaining that workforce in perpetuity.
Super users don't become less super the day after go-live.
Mike Bost
No one else seeking recognition. This panel is excused. Dr. Lawrence, thank you for being here. Dr. Evans, we do have our second panel. We're going to, we'll still work on that.
So we have a second panel to come up. I hope you'll stay around for the second panel. Thank you.
All right. We thank you for waiting around. Ms. Carol Harris, Director of IT and Cybersecurity from the Government Accountability Office, I ask you to please stand. If you would raise your right hand, do you solemnly swear under penalty of perjury that the testimony you are about to provide is the truth, the whole truth, and nothing but the truth?
I do.
Mike Bost
Thank you, let the record reflect that the witness has answered in the affirmative. Ms. Harris, you're now recognized for five minutes to deliver your opening statement. People are going to be moving in and out, but we'll get it on the record that way.
Harris
Sure. Thank you, Mr. Chairman, Ranking Member Takano, members of the committee. I want to thank you for inviting us to share our observations about the VA's recent work on the EHRM program. The department initiated this program in June of 2017 to replace the legacy Vista system and has to date deployed the new EHR to 17 of its medical centers. According to VA, it will hit the $10 billion ceiling of the current Oracle Cerner contract before the end of the year with 17 months left on the contract.
In light of this situation, VA modified the contract, adding three more years, moving the end date from 2028 to May 2031, and increasing the ceiling to $27 billion. Over the past five years, we've issued five reports on VA's efforts to deploy its new EHR system. These reports describe the challenges in VA's implementation of the new system and include 18 recommendations, 12 of which we have marked as priority because of the critical impact that they have on strengthening successful future deployments. While VA has taken actions to address our recommendations, it has not fully implemented 14 of them. And this morning, I'll highlight three key points from our work.
The first is this: VA needs to produce a reliable cost estimate and schedule. Last September, the department shared an updated total life cycle cost estimate that included 37.2 billion to go-live at all 170 sites by 2031 and another 19.3 billion to operate and sustain the system for another 10 years, bringing the total cost to $56.5 billion. As of today, we have yet to receive an underlying analysis to support this figure. Furthermore, VA has stated this estimate does not include relevant costs incurred by VHA or OIT, which makes this figure incomplete and therefore unreliable. A credible estimate is imperative to understanding the full magnitude of VA's investment.
We have also yet to see an updated integrated master schedule, and without this, we can't know whether 2031 is a realistic end date. Consequently, as the department increases its deployment momentum, more information critical to controlling risks and informing congressional oversight is needed.
We have seen a much smoother deployment than what we have seen with the initial six rollouts. However, we do feel that there is still more work that needs to be done. We've reported on these gaps in VA's organizational change management activities for EHRM. We've also reported that users express great dissatisfaction with the new system and that VA did not adequately identify and address system issues. And so we have 10 priority recommendations to address these issues in those areas.
As of today, VA has partially implemented one of the 10 priority recs and continues to work towards implementing the remaining nine. So, for example, VA has taken steps to remove users' barriers to change through the use of innovative learning labs as Dr. Evans had discussed and an increase in the number of super users at each of those sites at 10%. That is something that we are very supportive of. And during my time in Michigan in the lead-up to the go-live, I did hear positive feedback directly from users on these specific actions. However, more work is needed.
Among other things, VA has yet to meet established user satisfaction goals for the use of the new system. And finally, to my last point, this is something that we have not really talked about in this discussion with the first panel, but something that I think is important, which is that VA ought to be making plans for turning off the legacy Vista system. You know, we can't lose sight of this piece of the modernization puzzle because a legacy environment is extremely costly to maintain and very difficult to secure from a cybersecurity perspective. Vista's annual cost is not well tracked within the department, but it is in the hundreds of millions of dollars. And it will be difficult to turn off because Vista does provide numerous functions beyond what the Oracle Cerner system is intended to do.
So I would urge you to press VA on their plans and timeframes for decommissioning Vista. And so moving forward, again, it will be critical for VA to address the 12 priority recommendations as soon as possible. Doing so will position VA to more effectively deliver modern health record system our veterans do deserve. And that concludes my statement. I look forward to your questions.
Mike Bost
Thank you. And as I said, I appreciate your patience. Ms. Harris, I've got a couple questions and then we'll pass on to the other members that might have questions. Provided the life cycle cost estimate labeled preliminary is what we received. In GAO's opinion, is this a reliable, comprehensive cost estimate or not?
Harris
No, it's not. So it is excluding costs associated with VHA and OIT, the Office of Information Technology. For example, they are the ones that bear the brunt of the infrastructure costs. So to deploy the Oracle Cerner system, you have to make sure that the facilities themselves are ready to implement from a technology standpoint, making sure that all the networks and everything else is brought up to date. So those costs could potentially be very significant and that's something that is missing from that $56.5 billion estimate.
Mike Bost
Wow. Okay. When VA has relied heavily on Vista platform for various items, VA accelerates deployment, how costly is it to decommission Vista?
Harris
Yeah. So with decommissioning Vista, we don't yet have a cost estimate associated with even just operating Vista annually.
It is in the hundreds of millions of dollars. The best that we've been able to do over like a two fiscal year period was like two billion dollars and we were only able to verify one billion of that number as just an example. So it is, it's a little bit of a black box, but we do know that it needs to be decommissioned as, you know, once Oracle Cerner is fully deployed because otherwise you're carrying two very large health record systems and that's just not sustainable from a taxpayer perspective.
Representative Brownley, do you have questions?
Speaker 23
Thank you, Mr. Chairman. Thank you for being here and particularly being here at the last minute, so we appreciate that very, very much. I was just going back through an email because you mentioned Michigan. And it was brought to my attention that there were 13,000 consults or referrals that were transferred into the EHR system into an unknown queue. The referrals in this queue only list the veteran's name and demographic information, not what the referral is for, where the patient needs to go, or who specifically they need to see.
It's disturbing to learn that over 1,500 of those initial referrals were for mental health care, so obviously a big concern. I was made aware that the health care workers were told by management that it would take 32 weeks with two specialty nurses per department working on the unknown queue to process all of the referrals in the queue. Does that, are you aware?
Harris
Yeah, we have heard similar issues in terms of referral management still being a challenge at Michigan and the other deployed sites. Consistent with what you're hearing, we've heard the need for greater manual intervention and workarounds to ensure that referrals, you know, get to where they need to be. So those are issues that we are currently working through right now as we do our work for you.
Speaker 23
Very good. So the number that you spoke about in your testimony, 56.5 million dollars.
Billion.
Harris
I'm not quite sure, but we received the same letter that you received, which is what Mr. Lawrence had cited from June 30th of last year. And it did include the 56 and a half billion. It also included 48, but as part of that letter, it said there was an additional eight billion in sustainment costs that was necessary, which would bring it back, would bring it up to 56 and a half billion dollars. But in that same letter, interestingly enough, they themselves stated that the VHA and OIT associated cost data is not included in this cost estimate.
Speaker 23
Very good. So I just wanted to talk about sole source contracts for a minute. So I know that there are reasons why the federal government would have a sole source contract. In this case, where there are other options, I'm not sure I understand why there would have been a contract negotiated by that. Is there, are there regulations around that that were broken?
Harris
You know, I'm not the best expert to comment on whether it was appropriate or not to sole source this particular contract. But what I do know is, you know, predating 2017, DOD and VA had been struggling with this notion of interoperability. I mean, there were multiple attempts at trying to get this interoperability between the two systems.
And I think ultimately there was a decision made to use the same system to basically answer that that big problem of interoperability. And so I I believe that could have been the reason why VA chose to go with the system that DOD had already awarded the contract for, which was for Cerner at the time.
Speaker 23
Okay. Um, and my understanding too that the original Cerner contract was um an IDIQ contract, which is indefinite delivery, indefinite quantity. And then sometime along the way, the contract changed um to include a time and material clause so that, you know, so what what they committed to in the in the beginning of the $10 million, no matter how long it took, it was going to cost $10 million, no matter what the materials were, etc. Then that changed, the VA changed that contract to a a time and material. Do you know why that happened?
Harris
Um, I I believe it may have been because of the performance at Oracle Cerner or Cerner at the time. Um, they were they were struggling in in timely ticket resolution is is one area that I know that my team has has definitely taken a look at where the Cerner folks were not meeting the timeframes that were specified in the contract. Um, and so that was I believe one of the issues that played into why the contract was restructured.
Speaker 23
You mentioned interoperability. Can you talk a little bit about where we are on that?
Harris
I mean, I think that the system that VA is deploying is the same system that DOD has fully deployed at this point. So, you know, theoretically...
Speaker 23
Well, the commitment was it was going to be compatible with the community too.
Harris
Correct. And um we're still working through the the issues associated with community care. Um, my understanding is that, you know, um what Mr. Lawrence's comments in terms of the it is the same in term- community care processes are not necessarily different in the new system environment. So we still have work that we need to do to evaluate. But is the- are they communicating with the community in these locations where they have already instituted the program?
Yes, I believe so. Um, I do know for example with the scheduling piece of things, there are 14 additional systems that VA schedulers must use um in the new system to be able to schedule appointment with the community care for example. So there are some inefficiencies that that VA will have to deal with in in that aspect for example. But we still need to do a comprehensive review of all the impacts to community care. But as far as DOD and VA are concerned, the the records should be interoperable because they are on the same system.
Thank you. I yield back.
Mark Takano
Well, I was going- Mr. Chairman, I would just going to defer and and to Mr. Takano so I could organize my thoughts since I'm next. So can I still do that?
You can. Mr. Takano, you're recognized.
Mark Takano
Thank you, General. Uh, Ms. Harris, thank you so much for joining us today, um especially on such short notice. A hearing on this monumental project with lifecycle cost estimates reaching over $50 billion and likely higher would not be um true oversight without GAO at the table. Um, has VA provided you a complete and accurate lifecycle cost estimate as of today?
Harris
No, they have not. I mean, they've re- we've we've seen the top-line numbers, but we have not seen any underlying information to show the basis for that estimate. We've not- we don't have any of that.
Mark Takano
That's incredible to me because this has been a project that's been um you know, eight years, nine years in the in the making.
What is missing from the estimate that you received?
Harris
At least from VA's own disclosure, costs associated with VHA and OIT. So, on the OIT end of things, that would be the IT infrastructure to ensure that the sites themselves are able to, to implement the, the new system.
Mark Takano
Is there a federal definition of what a LCCE includes? Does VA's most recent LCCE comply with that?
Harris
No, it doesn't. What you would expect from a life cycle cost estimate, both in terms of OMB's definition and also with IT best practice, it would be every single element included. That would be a full, everything associated with development and also with operations and sustainment. And as part of development costs, that would also be the underlying infrastructure costs as well.
Mark Takano
So there's a federal definition of the life cycle cost estimate. It's, it's clearly defined in government practice. And VA has not fulfilled, you know, has not produced a document that, that conforms to this definition.
That is correct.
Mark Takano
Has VA developed an internal, the internal capacity and skills to be able to develop complete and accurate, um, life cycle cost estimates?
Harris
You know, we have not delved into the, the program support workforce associated with the cost estimators and schedulers and other engi-, you know, engineering and technical staff, like architects, for example, for the EHR program. So right now, it is unclear to me how many cost estimators are on the EHR program or schedulers. But I will say that for programs of this magnitude, because I've done a number of space programs, for example, you have like an in-house staff of, you know, at least 10 to 15 people for, for a program of this magnitude.
Mark Takano
Mr. Chairman, I would hope that on a bipartisan basis that we could, uh, you know, demand that VA, uh, get its act together. We need to find out, uh, if they have the appropriate staffing to be to actually even do the life cycle cost estimate. Um, I think you would agree with me that this is crazy, all this time, we still don't have a life cycle cost estimate. Um, thank you, Ms. Brownlee. I think we're all in agreement.
So, what you're saying is that VA has not done the necessary work to truly give us and the American taxpayer and the American people an idea of how much this program will cost. Is that correct?
Harris
That's correct. I mean, we have an outstanding recommendation or outstanding request with VA to provide us with the underlying documentation. It's been over a year at this point. And typically, if we haven't received it, I, you know, I have red flags about whether it exists.
Mark Takano
And yet we know, we know from the amended contract that, uh, they have put a new ceiling of $17 billion without a life cycle cost estimate.
Harris
Yeah, typically what you would want to see is a program estimate independent of what the contractor has developed. So it's unclear to me whether the 27 billion or the, the additional 17 billion is an estimate that was, that was, um, sourced from Oracle or if it was sourced from VA. We don't have any insight into that. But typically, in an acquisition process, the government will have its own estimate to compare whatever costs a vendor will provide.
Mark Takano
It could have, I, we just don't know.
We don't know. And certainly it's the job of the oversight committee, the authorizing committee to do this, to make sure that this happens and to sort out how the acquisition process, um, worked. All right, um, I yield back, Mr. Chairman.
Jack Bergman
Thank you, Mr. Chairman. You know, I'd like to address Ms. Brownley. You dusted off a brain cell that I haven't thought about in 20 years because when I was recalled to active duty in 2003, as you mentioned about how DOD and VA struggled with interoperability, I was in the middle of that on the uniform side back in 2003, 2004. So here we are 20-some years later and the keyword here is interoperability in any set of agencies that have, in this case, dealings with service members and then veterans. Okay, so thanks for dusting off some old thoughts.
I may need an extra beer tonight based on that. Ms. Harris, your testimony notes that VA has not implemented a VA-specific change management strategy to formalize how it will improve frontline staff readiness. Can you tell us how an effective change management plan could impact the training and the site readiness in future deployments? Because there's going to be more. You've got initial rollout, then secondary and tertiary until you've got everybody up to speed.
And what strategies from this past year should VA include in that plan, or maybe something that stands out as they should stop doing, exclude from the plan? Thoughts?
Harris
Yeah, so VA has produced a change management strategy that we have seen as in response to our recommendation. However, we are still holding the recommendation open in that particular case because we want to make sure that what is contained in there will be effective. And so we need to see how Indiana goes and we want to see how the two other deployments go for the remainder of the year to see whether or not their plans for improving training and ensuring that each of the sites are basically they have a standard approach to the way that they are changing their business process, that that is effective. And so I will say like with the training piece, one thing that I have heard overwhelmingly across all the sites is that the Oracle training is not good.
It's not what?
Speaker 115
It's not good. The learning labs that VA has implemented, those are all good things. The additional increase in the number of super users, all very positive. But the overwhelming sentiment is that the Oracle training, when the Oracle folks come in and they show you how to use the system itself, that has not been effective for the majority of users.
Harris
Okay, okay, and thank you. I mean, that kind of data is I think very, I know it's very valuable. Thank you. On site readiness, what differences do you expect between the 2026 deployments and next year's?
I think it's going to be interesting because when you look at Michigan and Ohio, they actually had been preparing for the cutover to the Oracle Cerner system before this big reset happened in 2023. And so they have had actually multiple years to prepare for this change. So now we're seeing Indiana and we will see with these additional sites that have not had that length of runway, the effectiveness of VA's actions to ensure that those sites are appropriately ready.
They did.
Jack Bergman
Okay but the lessons learned the lessons observed the lesson and the changes in the next rollout.
Harris
It may look different and I wouldn't be surprised by that because the runway that Indiana had was not the same as what what Michigan had in comparison. So I think time will tell how how effective VA has been in implementing that those change management strategies.
Jack Bergman
So in comparing and contrasting first rollouts current rollouts future rollouts it's going to be important that we that we if you will adjust our our optics to see that there has been change doing things a little differently based on different criteria not get caught in evaluating always by the same criteria initially that may have changed.
Absolutely that's exactly right.
Representative Budzinski.
Nikki Budzinski
Thank you Mr. Chairman and I just want to echo what others have shared which is appreciation for you Ms. Harris and GAO and their important role I think as really a steady and independent hand as as the ranking member on tech modernization how important the GAO is to providing that oversight. So thank you for that. I actually you know it's disappointing the Deputy Secretary didn't stick around but I I did want to talk a little bit about I mean some of this you have 18 recommendations is it correct and only four of them have been closed.
That's correct.
Nikki Budzinski
Okay to the VA. Some of my questions actually are are similar to what General Bergman just asked specifically about the training and I wondered Ms. Harris if you would be willing to spend a little bit more time on especially because it's been an identified issue I too have heard this from VA employees that the training is lacking how could you could you speak a little bit more specifically about how that could improve. And then my next question related to that is are you seeing the VA take any next steps to make those adjustments to make improvements in the training.
Harris
Yeah so the Oracle training that is delivered right now is not adequate based off of the feedback that we have received unanimously across all of the sites. So part of that issue is that it's it's not it's not helpful to them because it's not role-based necessarily it's just you know here's the system here's what you do and it's not it's not effective when you know you're a nurse going in and okay you know exactly what you need to do and that's why these these learning labs are so helpful because you're actually in like an a scenario like an an actual environment okay this this scenario comes in this is how I need to to do my job in the system and you're actually clicking buttons and then it will respond to you okay this your your order has now gone to you know somebody else and and then from there you see okay now here's the next step from that response now I have to do X. So that is actually been very helpful we've seen we've heard very positive things about the learning labs because it is you know a it's not a live environment but it's it's it's sandbox but it's it's an actual virtual scenario.
Speaker 113
Is that can I ask is that staff intensive or to set those up or who runs those.
Harris
I don't know whether it's staff intensive but it is run by VA that is my understanding. I'm sure Dr. Evans can provide more information about that but we do know that that they have a very positive response to that.
I do- I have heard just anecdotally that sometimes those learning labs are not available, like they go down from time to time, and so that's not- so some users have not been able to take full advantage of that because of those situations. But again, I don't- I can't generalize that, but I do know that that is something that is effective. But I do think VA need to explore more what Oracle needs to do to improve that training that Oracle provides just on the system itself.
Nikki Budzinski
Okay, that's helpful. You know, the other things, and I think we've talked about this a lot in the subcommittee, is just, you know, the OIT team and this endeavor with the EHRM, there's just more and more coming at them. They've sped up the go-live schedules, and is there the staff capacity, is there the capacity to ensure moving forward that all of these go-lives that are now being really expedited in a pretty rapid pace, that the resources are there to make them successful? And I just wondered if you could spend a minute just talking about kind of how you view that, do you think that- do you have concerns with that as well, share any thoughts.
Harris
Yeah, I mean, at this time we do have concerns about the acceleration relative to the current resources that they have. I'm concerned about staff burnout, especially like with the NESU, for example, they- I mean, right now they say that everything is fine and they are- they have put in place- I won't say workarounds, but like they're doing more like virtual intervention versus in-person to kind of give those traveling nurse corps a, you know, a break so that they can be with their families. But I would also say that, you know, with- with- with the system itself, again, VA needs to- the VA workforce needs to be evaluated. We're currently looking at it, but I do think the acceleration will- will spread them very thin. And so, for example, with Oracle Cerner, they're there at the sites for I think one to two weeks after, you know, all of the go-live work is done, and then they leave.
And we have heard anecdotally from folks that, you know, it- they wish that they were there for longer, and when you accelerate that pace, they most likely, you know, will be there for a shorter amount of time. But- but again, all of that, we need more information from VA as to their plan of action for when the acceleration takes place.
Okay, thank you. I yield back.
Dr. Dexter.
Juan Ciscomani
I apologize, I apologize, I went the wrong way here. Representative.
Thank you, Mr. Chairman. Ms. Harris, the GAO reported VA had not fully implemented the data quality performance measures. Have unresolved data quality issues affected continuity of care or patient safety during this past year's go-lives?
Harris
We have heard some data migration issues occurring in Michigan, for example, where there has been an increase in manual intervention to make sure that- that the data is there. For example, with referral management, I believe that referrals, the- the information there was- the most current information about a patient was not easily accessible for the clinicians. And so they've had to have manual interventions to make sure that that was more apparent. And I know VA is working on that issue currently.
So I would say that with data, you know, the data quality, that is something that VA is, you know, they are aware of it and they are currently managing that issue.
Juan Ciscomani
Thank you. And based on this year's deployments, what additional oversight mechanisms beyond GAO's recommendations should Congress consider imposing to ensure transparency during the accelerated deployment?
Harris
I mean, I think continued hearings like this has been very effective to ensure that VA and Oracle Cerner are held accountable to the plans that they have in place. I think that would be a very effective measure for sure. But also, I think your assistance in getting GAO the underlying cost and schedule information, if that does exist, I think we would appreciate your help and partnership in that.
Juan Ciscomani
Okay. Another quick question here. As of yet, VA has not submitted or has not submitted or built the integrated master schedule yet. How important is it for Congress to view this product in order to understand milestones specifically and keep contractors accountable on performance metrics?
Harris
Well, it's very important for GAO to see that and have our in-house schedule experts take a look at the integrated master schedule that the VA has produced. I did have a, you know, offline conversation with Dr. Evans after the first panel and did come to agreement that it would be helpful for our experts to sit with their scheduling experts to take a look at the schedule together in real time. But it is very important that we receive that because otherwise we cannot know whether the completion date of 2031 is actually reliable or whether it will push to the right.
One more. GAO recommends VA to establish independent operational assessments before each go-live, and to our understanding, VA has not shown GAO a complete review yet. How has the lack of this assessment impacted 2026 deployments and what should the committee be concerned of as VA accelerates their modernization implementation?
I mean, VA agrees with this recommendation in principle, but instead of actually doing a formal operational analysis, which is what DOD did in deploying the MHS Genesis, which is the Oracle version within DOD, instead of performing that analysis, what they are doing is, you know, they have more boots on the ground, I believe is what Dr. Evans would probably characterize it as, in identifying issues in real time as best they can leading up to go-live. There's much more intervention, I think that's how VA would probably characterize it, as their mitigation or substitute for an actual analysis. This way, once go-live hits, they believe that they are in a position to know all of the issues that will occur at go-live. Do I think that that's sufficient? Time will tell if that is.
Again, we want to see more results from Michigan coming out as well as, you know, Ohio and Indiana to see whether or not that is an effective way to go. But I will say that having that operational analysis for MHS Genesis on the DOD side of things allowed them to ramp up and escalate very quickly and do so successfully.
Speaker 116
Well, thank you very much for your time. Being able to fit in four questions and still have ten seconds over is not common for any committee hearing, so I appreciate your concise and direct answers to the questions. And with that, Mr. Chairman, I yield back three seconds.
Representative Budzinski.
Maggie Goodlander
Thank you, Mr. Chairman, and thank you, Ms. Harris, for being here today.
So I just want to ask what is a realistic timeline for the VA to produce you know I'm looking at this very reasonable list of priority recommendations in your judgment what is a realistic timeline for the VA to produce an updated independent total life cycle cost estimate and a an integrated master schedule.
Harris
I mean to to develop an a comprehensive reliable cost estimate it could take months to do. We have no visibility into the work that they did to arrive at the 56 and a half billion number but typically for a program of this size and magnitude one would expect quality information coming out of perhaps you know six months worth of work.
Maggie Goodlander
Thank you for that. In light of this has has VA given you a reason for not producing these two most basic submissions for anyone to be able to evaluate this this line of effort.
Harris
I mean from what I have seen I I think VA believes that what they provided to us is the the comprehensive full-on life cycle cost estimate.
In their letter from 2025.
Harris
In their letter. I mean they keep citing that letter the contents of that letter as we have a cost estimate. There may be things that have been lost in translation as part of our request of the underlying basis for those those numbers but but I mean yeah you we would expect whatever they used to produce those figures that's what we wanted to see. I thought we were very clear in our request for that.
Maggie Goodlander
It seems pretty clear to me. I mean crystal clear in fact. Can Congress or the American taxpayer meaningfully evaluate whether a 27 billion dollar 17 billion dollar increase in the overall contract ceiling is necessary or reasonable or even adequate without this underlying.
No. No.
Maggie Goodlander
Is it common practice to redact critical numbers from a contract modification.
Harris
No once a contract modification has been completed we typically see the the full numbers. There shouldn't be anything procurement sensitive at that point.
Maggie Goodlander
So this decision to to redact key numbers in this contract modification of August 11th 2026 highly irregular in your judgment.
Maggie Goodlander
Ms. Harris I I want to ask look your your list of priority recommendations are all seem very reasonable and important to me and pressing but as you think about what matters most for patient safety are there particular recommendations that you would highlight for this committee that we should be focusing on. We will be focusing on all of them but in your judgment what are the most important with respect to patient safety.
Harris
I think that the training piece is is critically important as well as you know the the organizational change management metrics that we expect to see and we expect VA to continue to monitor so that they are meeting the goals that VA have outlined. And if the actions that they are taking are not I mean if if if they are not meeting those goals then VA should be evaluating whether the current actions that they have taken are actually effective or if they need to pivot. Um as Dr. as General Bergman said I you know we need to continually um refocus and and alter and and tailor where necessary.
So we want to make sure that VA hits those targets. So for example, with user satisfaction right now, there have been improvements from the initial rollout of like 7% of users saying that it's allowing them to enable high-quality care, and now we are at about 36%. But VA's own target is 56%. And so we want to make sure that VA is able to hit that, especially if they're going to accelerate the deployment. Hitting those numbers sooner rather than later is a good thing.
Maggie Goodlander
Ms. Harris, did you have the opportunity to review Oracle's written testimony for this hearing today?
I have not.
Maggie Goodlander
As you sit here now, are there questions that this committee should ask of Oracle? And if so, what questions do you believe are most pressing?
Harris
Well, I do think that understanding the basis for the $27 billion total ceiling is important. I think understanding from them exactly what they intend to do to ensure that it will not go over that number and that they will deploy by 2031 is important. And if there are risks that they believe or if there are cost drivers or risks to those deployments, what those are. Because if again, if the costs are driven up or if the deployment's pushed to the right, I mean, that impacts the taxpayer. And so we need to know and you need to know in order to effectively oversee the contractor as well as VA.
Representative Kiggans.
Jennifer Kiggans
Thank you, Mr. Chair. Ms. Harris, VHA is undergoing a significant reorganization of its central office, affecting reporting lines at its central office. As reported previously in the GAO's high-risk listing for VA healthcare, senior executives in VHA's Office of Digital Health and Strategic Investment were designated with co-leading IT initiatives. In the VHA's new organizational structure, what components and offices remain involved with the EHRM effort and will be responsible for ensuring accountability for VHA needs?
Harris
I wish I could answer that question. It's still we still don't know. We're still waiting on VA to outline what that is.
Do you know when we might know by?
Harris
I don't know. Hopefully they will have that soon because a change of that magnitude, obviously combined with an accelerated deployment, you would think that that information should be done should be received sooner rather than later.
Jennifer Kiggans
Great. We'll be watching for that. And then also, the VA has an array of systems and tools that comprise the complex environment that supports scheduling appointments, managing referrals, and monitoring wait times. Schedulers at the facilities that have the new Oracle Health system have an additional set of 14 scheduling systems and tools available to them. In its accelerated deployment of the new EHR, how is the VA ensuring the EHR integrates with other legacy systems or tools, such as those used for scheduling medical appointments?
Harris
We still have work that we need to do to fully evaluate that. I am concerned with the higher number of systems because the VA schedulers are already having to deal with dozens of systems on the legacy system side of things. So having to do both during the transition period or even just within the Oracle Cerner, like once go-live has already been made, dealing with 14 systems is quite complex. So how VA intends to deal with streamlining that process so that veterans can get into their appointment, you know, have access to the healthcare that they need efficiently and quickly is very important. So definitely a very large question for VA.
Jennifer Kiggans
But ultimately, you are hoping that this will improve the scheduling system obviously and some of the challenges we're seeing with the legacy system. This new EHR, the new scheduling is going to be better than anything we've been using traditionally.
Harris
Exactly. That's the goal. I mean, in the legacy system it is a very labor and resource intensive process. So with the new system we would hope to see it more streamlined and less intensive, but given that they're having to deal with 14 systems, I don't know if that is going to answer the problem of labor and resource intensity.
Jennifer Kiggans
Right. And I'm sure there'll be a period of growth and adjustment always requires, it's not really, it's hard to get a perfect rollout. So we'll be patient and we look forward to hearing about health outcomes just going forward and seeing how they have moved in the positive direction of reducing wait times and just ease of scheduling.
Harris
Right, absolutely. Because I mean, as what we have heard from, you know, we've not heard direct patient safety issues, but we have heard access, like having timely appointments still as an issue that we've heard from, you know, from the work that we've done in Michigan and Ohio, for example.
Jennifer Kiggans
But you mentioned patient safety and so a lot of those when we think of things like allergy and test results and your medication list and whatnot, those really key cornerstone vital to patient safety, those things are solid. We're not having any issues.
Jennifer Kiggans
Okay, good. I appreciate that. And let's see, I have one other question. The VA continues to maintain the legacy environment that we talked about, the VistA environment, which comes at a high price and requires ongoing updates to maintain operations and securities. What are the department's plans and timelines for decommissioning the VistA?
What challenges are impacting these efforts?
Harris
We don't know VA's plans for decommissioning VistA. I think it's very important that you all press VA on the game plan for decommissioning it because the legacy environment costs hundreds of millions of dollars on an annual basis to maintain. It's getting more difficult to secure. So we want to make sure that once all the deployments are complete, that we are not carrying VistA for a very long time. We want to make sure that that's turned off as quickly as possible.
Maxine Dexter
Thank you, Chair Bost, and also the ranking member for again holding this hearing and thank you again. I just want to echo my thanks and gratitude for Ms. Harris, your work helping us have transparency and accountability with the GAO office. There is clear misalignment of priorities when the VA is pouring billions into a mismanaged contract while simultaneously letting go of physicians and staff. And as members of this committee, it is our job to protect veterans as well as protect taxpayers from fraud, waste, and abuse. It is offensive and completely unacceptable that Oracle pulled out of this hearing.
How can we hold an oversight hearing on this rollout without the prime vendor in the room? So I'm grateful to you, Ms. Harris, from the Government Accountability Office, for your help providing needed oversight. Ms. Harris, back in December, you testified that GAO had made 18 recommendations as discussed with you by my colleagues and the VA had not yet implemented the majority of them. And to quote you from then, quote, "Until VA fully implements the priority recommendations, future deployments risk prolonging management challenges and users will likely not be positioned to achieve optimal usage." Ms. Harris, do you stand by that testimony today and does GAO remain concerned about the risk to veterans' healthcare and the taxpayer of proceeding with the future deployment of the Oracle system?
Harris
I do stand by those statements. I also think that from December of 2023 to today, VA has made some very important progress. I don't want to discount that for sure.
The rollouts have been much smoother than the initial rollouts. There's no doubt about that. And I am very pleased that Mr. Lawrence, for example, does, you know, he's been to every single one of those sites. He, you know, there are like weekly conference calls. And just with my time in Michigan, the executives there have been very appreciative of the senior-level leadership there presence.
So I, you know, I do want to make sure that I say that. But I also think that, you know, there's still a significant amount of work done that needs to be done. The cost estimate is very alarming to me. We need to get more transparency and visibility into that. So moving forward, that as well as, you know, ensuring that the pace at which they're doing this.
Yeah, that's why we need to see the integrated master schedule because we want to make sure that they have the resources necessary to carry this out. Otherwise, this 2031 date, I mean, who knows if that's reliable or not.
Maxine Dexter
I totally agree with you on that and thank you for, you know, giving the VA the due that it has with the work they've improved upon.
In panel one, Dr. Evans stated that the VA did deliver the full integrated master schedule and comprehensive cost estimate. I think we've established that that's not true, is that accurate?
Harris
That's right. What they provided to us was a list of sites and the dates that they intend to complete. That's not a schedule.
Maxine Dexter
Okay, great. And since 2020, the GAO has issued multiple reports on the EHRM rollout. Across those reports, GAO's made those recommendations we've talked about. And I think we've also established that you are not confident in the cost estimate that we have currently.
That's right.
Maxine Dexter
Today I heard Mr. Lawrence talk about the additional 17 billion for a total of 27 billion and mentioned an additional 11 billion. Have you seen something with that documentation or with that information?
Harris
We do have that letter that they sent to you all as well as they sent that same letter to us.
Is that the September 2025 letter?
Correct.
Okay, great.
Harris
Just that 11 billion from that letter is those are the sustainment costs. So it's the development costs of the 37.2 plus the 11, which got you to the 48. However, in that same letter, there's an additional 8 billion for sustainment costs. So their actual total cost that they are projecting is 56 and a half billion. But again, in that same letter, they state that that's incomplete.
Maxine Dexter
Okay. And just being mindful of time, Ms. Harris, in light of everything you've seen, do you think the increase of 17 billion dollars is a good use of taxpayer dollars?
Harris
I mean, we need more transparency into into the estimate itself. I mean, certainly our veterans deserve a modernized health record system. There's no doubt about that. But we need to make sure that that the project controls in place are solid.
Maxine Dexter
Great. And Ms. Harris, are these concerns that I share with you sufficient to warrant a pause of the program so that the VA has time to produce a reliable cost estimate?
Harris
I don't know if a pause is necessary, but certainly it's worth exploring whether we go slow to go fast.
Speaker 117
Great. Thank you very much. With that, my time's expired, I yield back.
Mike Bost
Thank you. Ms. Harris, thank you. We appreciate you, as each member's said, thank you for being here today. I'm going to have you're dismissed to go. We are going to the committee is going to go into a short recess because as we have a motion we were not intending to vote today.
So we're still trying to figure out, are we going to bring out buttons, are we going to go to the old system, and how do we do that, along with talking with the minority to figure out where we're going to go with this. So if everybody can just stand by.
Meeting come to order. Before us we have the amendment on the subpoena resolution. It is now in order to consider the motion for the subpoena offered by Representative Dexter. The clerk shall report the motion.
Mike Bost
I ask unanimous consent the further reading of the motion be dispensed with. Without objection, so ordered. Without objection... I'm missing a page. All those in favor say aye.
Mike Bost
The question now occurs on agreeing to the Dexter subpoena. All those in favor say aye.
Mike Bost
All those opposed no, and in the opinion of the chair, the ayes have it. The motion is agreed to and without further consideration... Mr. Chairman, I request a roll call vote, please. Motion to... a roll call vote being requested, the clerk shall call the roll.
Mr. Chairman.
Mr. Bergman, aye. Ms. Mace.
Speaker 132
Mr. Chairman, just I want clarification. What is the motion we're voting on?
Okay, alright.
Dr. Miller-Meeks.
Dr. Miller-Meeks, aye.
Dr. Murphy. Dr. Murphy. Mr. Van Orden.
Mr. Van Orden, aye. Mr. Luttrell.
Mr. Luttrell, aye. Mr. Ciscomani.
Mr. Ciscomani, aye. Mr. Self.
Mr. Takano, aye. Ms. Brownley.
Ms. Brownley, aye. Mr. Pappas.
Mr. Pappas, aye. Mr. McGarvey.
Mr. McGarvey, aye. Ms. Ramirez.
Ms. Ramirez, aye. Ms. Budzinski.
Ms. Budzinski, aye. Mr. Kennedy.
Mr. Kennedy, aye. Dr. Dexter.
Dr. Dexter, aye. Dr. Conaway.
Dr. Conaway, aye. Dr. Morrison.
Dr. Morrison, aye. Ms. Gluesenkamp Perez.
Ms. Gluesenkamp Perez, aye.
Mike Bost
There are 19 ayes and 0 noes. The subpoena motion is agreed to and without objection the motion to reconsider is laid on the table. Once again, I thank everybody for being here today and I ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extraneous materials. Without objection, so ordered. This hearing is adjourned.