Ready, Set, Go-Live: Assessing VA’s EHR Modernization Deployment Readiness

1[House Hearing, 119 Congress]2[From the U.S. Government Publishing Office]34                READY, SET, GO-LIVE: ASSESSING VA'S EHR5                   MODERNIZATION DEPLOYMENT READINESS67=======================================================================89                                HEARING1011                               before the1213                SUBCOMMITTEE ON TECHNOLOGY MODERNIZATION1415                                 of the1617                     COMMITTEE ON VETERANS' AFFAIRS1819                     U.S. HOUSE OF REPRESENTATIVES2021                    ONE HUNDRED NINETEENTH CONGRESS2223                             FIRST SESSION2425                               __________2627                       MONDAY, DECEMBER 15, 20252829                               __________3031                           Serial No. 119-403233                               __________3435       Printed for the use of the Committee on Veterans' Affairs3637               [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]3839                    Available via http://govinfo.gov40                              ______4142                 U.S. GOVERNMENT PUBLISHING OFFICE434462-607                    WASHINGTON : 20264546                     COMMITTEE ON VETERANS' AFFAIRS4748                     MIKE BOST, Illinois, Chairman4950AUMUA AMATA COLEMAN RADEWAGEN,       MARK TAKANO, California, Ranking51    American Samoa, Vice-Chairwoman      Member52JACK BERGMAN, Michigan               JULIA BROWNLEY, California53NANCY MACE, South Carolina           CHRIS PAPPAS, New Hampshire54MARIANNETTE MILLER-MEEKS, Iowa       SHEILA CHERFILUS-MCCORMICK,55GREGORY F. MURPHY, North Carolina        Florida56DERRICK VAN ORDEN, Wisconsin         MORGAN MCGARVEY, Kentucky57MORGAN LUTTRELL, Texas               DELIA RAMIREZ, Illinois58JUAN CISCOMANI, Arizona              NIKKI BUDZINSKI, Illinois59KEITH SELF, Texas                    TIMOTHY M. KENNEDY, New York60JEN KIGGANS, Virginia                MAXINE DEXTER, Oregon61ABE HAMADEH, Arizona                 HERB CONAWAY, New Jersey62KIMBERLYN KING-HINDS, Northern       KELLY MORRISON, Minnesota63    Mariana Islands64TOM BARRETT, Michigan6566                       Jon Clark, Staff Director67                  Matt Reel, Democratic Staff Director6869                SUBCOMMITTEE ON TECHNOLOGY MODERNIZATION7071                    TOM BARRETT, Michigan, Chairman7273NANCY MACE, South Carolina           NIKKI BUDZINSKI, Illinois, Ranking74MORGAN LUTTRELL, Texas                   Member75                                     SHEILA CHERFILUS-MCCORMICK,76                                         Florida7778Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public79hearing records of the Committee on Veterans' Affairs are also80published in electronic form. The printed hearing record remains the81official version. Because electronic submissions are used to prepare82both printed and electronic versions of the hearing record, the process83of converting between various electronic formats may introduce84unintentional errors or omissions. Such occurrences are inherent in the85current publication process and should diminish as the process is86further refined.8788                         C  O  N  T  E  N  T  S8990                              ----------9192                       MONDAY, DECEMBER 15, 20259394                                                                   Page9596                           OPENING STATEMENTS9798The Honorable Tom Barrett, Chairman..............................     199The Honorable Nikki Budzinski, Ranking Member....................     3100101                               WITNESSES102                                Panel I103104Dr. Neil Evans, M.D., Acting Program Executive Director,105  Electronic Health Record Modernization Integration Office, U.S.106  Department of Veterans Affairs.................................     5107108The Honorable Seema Verma, Executive Vice President, Oracle109  Health and Oracle Life Sciences, Oracle Corporation............     7110111Ms. Carol Harris, Director, Information Technology and112  Cybersecurity, U.S. Government Accountability Office...........     8113114                                APPENDIX115                    Prepared Statements Of Witnesses116117Dr. Neil Evans, M.D. Prepared Statement..........................    31118The Honorable Seema Verma Prepared Statement.....................    33119Ms. Carol Harris, Director Prepared Statement....................    45120121                       Statements For The Record122123The American Legion Prepared Statement...........................    63124125                READY, SET, GO-LIVE: ASSESSING VA'S EHR126                   MODERNIZATION DEPLOYMENT READINESS127128                              ----------129130                       MONDAY, DECEMBER 15, 2025131132  Subcommittee on Technology Modernization,133                    Committee on Veterans' Affairs,134                             U.S. House of Representatives,135                                                    Washington, DC.136    The subcommittee met, pursuant to notice, at 3:01 p.m., in137room 360, Cannon House Office Building, Hon. Tom Barrett138(chairman of the subcommittee) presiding.139    Present: Representatives Barrett, Luttrell, and Budzinski.140141           OPENING STATEMENT OF TOM BARRETT, CHAIRMAN142143    Mr. Barrett. All right. Good afternoon. The Subcommittee on144Technology Modernization will now come to order. I want to145thank our witnesses for joining us.146    We continue our oversight of the U.S. Department of147Veterans Affairs (VA) Electronic Health Record Modernization148(EHRM) Program. I was actually joking with some friends back149home recently. They were asking me what it is like my first150year in Congress, and I was telling them a little bit about the151work we are doing on this subcommittee. I said, before I came152here, I did not even--I could not have even told you what153health record system the VA had and now I spend far too much of154my waking hours thinking about it. But appreciate the work that155we have done on this committee and for the witnesses that are156here today.157    Right now, of course, we are at a pivotal moment. I think158we are down to 117 days until the new system will be launched159at 4 of the medical facilities in my home State that serve the160veterans, of course, from my district, but across Michigan and161parts of other states as well. This timeline is locked in and162the countdown is on. The question remains, when the switch is163flipped in April, will the system deliver and will it do what164we need it to do? Are we going to run into snags like we have165in the past?166    For millions of veterans relying on VA hospitals and staff167supporting them, this is not something that is theoretical. It168is real, it is happening, and we have to do it right. As I said169before, the veterans that we serve and that the Department is170going to serve have the right to be a little bit unaware of the171nuance of which health record system the VA is using. They want172it to work right, be able to schedule their appointments, go173see their specialists, and move on with their day in a timely174way.175    Veterans expect more than just promises. They expect safe176and timely care. We all expect systems that support our177doctors, not work against them. Technology should be a tool178that opens doors, not a barrier that adds more steps, more179clicks, and more frustration. We heard about some of that180earlier in this committee term when we saw that providers were181getting frustrated with some of the interfacing with the system182they have.183    When we first met on this topic in February, VA was just184emerging from a very long pause. While progress has been made185since then, we know that significant work remains before we go186live. VA has standardized over 1,000 workflows into a national187baseline, with Michigan being the first to use it. VA has188tightened their timeline, and for the first time since the189pause, we saw large system updates roll out this August without190disrupting care. These are meaningful, good signs, but we191cannot ignore other red flags that are warnings.192    Behind the scenes, many tools slated for Michigan have193never been tested on a large scale. Thirty-four new complex194clinical workflows will debut there for the first time. VA195plans to test across four sites simultaneously, a strategy that196leaves really no margin for error and something that I have197concerns about the risk associated with that.198    We need assurance that this plan is feasible in the real199world, not just on paper or in a computer laboratory. We need200to know that the lessons of the past have been learned and not201just observed and acknowledged. The user experience also202remains a concern. While satisfaction is slightly up, more203attention is needed.204    The committee has heard from physicians that the critical205function system remains unstable. We hear from VA pharmacists,206I know that is a very unique role that the VA has, that tools207for monitoring drug interactions are still a major pain point.208VA staff are now burdened with more manual processes to ensure209patient safety with drug interactions. We need to know where210these issues stand today so Michigan clinicians and veterans211are not left holding the bag on day one.212    Finally, we must address the sheer scale of the cost. This213program began in 2018 with a $10 billion price tag. It quickly214ballooned far beyond its original expectations, and the latest215estimate stands at $37 billion. We cannot keep writing blank216checks that risk taxpayer money and slows down or, worse,217endangers delivery of veteran care.218    I am encouraged by the momentum we have seen. I am219encouraged by the commitment of my friend Secretary Collins and220the Trump administration team, but encouragement only goes so221far as reality sets in. We need proof and we need transparency.222The clock is ticking down for Michigan for this to go live and223the time for promises is over. The only acceptable result is a224flawless Go-Live because our veterans cannot accept failure.225    Thank you, again, for being here today. I do want to say it226is never my intention to take gratuitous shots at anybody227appearing before this committee, but we do have a role to play228in oversight of what is taking place, and we intend to229vigorously and robustly carry that forward.230    With that, I will yield to Ranking Member Budzinski for her231opening statement.232233      OPENING STATEMENT OF NIKKI BUDZINSKI, RANKING MEMBER234235    Ms. Budzinski. Thank you, Mr. Chairman, and I agree with236you. Thank you to our witnesses for being here today. It seems237we are bookending this year with EHRM hearings, and I look238forward to hearing how the program has improved and how the239Department has prepared to resume Go-Live activities.240    To start, I do want to address an article that I read over241the weekend about Secretary Collins' plans to eliminate 35,000242positions from the Veterans Health Administration (VHA). I am243disappointed that we had to learn about this through the media244and not from the Secretary himself. Something this significant,245I believe, warrants proactive communication with Members of246Congress.247    The Department is quick to say that most of these positions248are vacant, but the word is ``most'' and they do not use249``all.'' The VA workforce is already stretched too thin.250Eliminating positions does nothing to help veterans who in many251places, like my district, are waiting months for appointments.252In fact, these actions threaten to undermine VA's ability to253deliver timely care.254    Only at the VA can veterans expect to receive care from255providers who have a deep understanding of their unique256experiences. That is irreplaceable. If Secretary Collins is257serious about keeping veterans at the center of everything, VA258healthcare must continue to lead the way. VA must be fully259staffed and resourced. The continued efforts of this260administration to bleed VA dry will make it harder for us to261honor the service of our Nation's veterans.262    Their efforts to outsource veterans' care will also have263dire impacts on the success of the EHRM program. Today we are264117 days from VA's EHRM Go-Live at 4 VA medical centers in265Michigan. After the program was reset for 3 years, the266Department made the decision not only to restart, but to267accelerate the Go-Lives in an effort to finish almost on268schedule. I am sure the chairman is anxious about this. I know269I am. There are VA facilities around my district that are270scheduled to go live right after the Michigan sites.271    The veterans of Michigan's 7th District and Illinois' 13th272District are next to be impacted by EHRM. We need assurances273that Oracle and VA have fixed the issues that are still274plaguing the first six sites.275    At the time of our last hearing on EHRM in February, the276Department had dozens of outstanding recommendations from VA's277Office of the Inspector General and the U.S. Government278Accountability Office (GAO). According to GAO's testimony, it279has not changed. Our goal is to ensure that we are setting VA280up for success. However, what I have heard in the past year has281not convinced me that VA is ready for launch at 13 facilities282in 2026. I have raised many questions with VA and Oracle, but283the answers do not give me confidence. In fact, I worry that we284are spending billions of dollars while simultaneously setting285this program, particularly the six sites that are already live,286up for failure.287    I need both VA and Oracle to tell me what they have done to288address concerns raised by VA employees and veterans at the289first six sites, such as prescription errors and incorrect290alerts. For veteran patients, the consequences of these errors291range from discomfort to death. We must know the catastrophic292errors in the system are not putting veterans' lives at risk.293    I also want to hear what state the system is going to be in294when EHRM goes live at the next four sites. Earlier this year,295we learned that VA was looking for an EHRM systems integrator.296I was hopeful that this might be a positive change in the297program rollout. There are a lot of questions about this298contract, which was awarded to Accenture in November, and how299it is going to work. In fact, Ranking Members Takano and300Blumenthal sent a letter to Secretary Collins shortly after the301award was announced and have yet to receive a response.302    What will Accenture actually do to make EHRM more303successful? Is it a true systems integrator or is it a304continuation of the role currently held by Booz Allen Hamilton?305How will Accenture be effective given its lack of authority306over the Oracle Prime contract?307    Unfortunately, the more I hear about this contract, the308more it seems to be a replacement for VA's program management309contract, not an actual systems integrator. In September,310Deputy Secretary Lawrence informed me that VA estimates the311life cycle cost of this program to be $37.2 billion, but it312seems like this estimate has changed quite a few times. VA313originally told Congress, as Chairman Barrett mentioned, they314needed $10 billion for the entire program.315    Shortly after that, they came back and asked for an316additional $6 billion for VA's program costs. In 2022, VA317contracted with the Institute for Defense Analysis to conduct a318true life-cycle cost estimate, which shifted the estimate for319the project to almost $50 billion. Now the Deputy Secretary is320backtracking and saying that it is only going to cost $37.2321billion.322    I am concerned that nobody actually knows what the bottom-323line cost is. I need to hear today that VA has a grasp on this.324The American taxpayers and veterans deserve transparency.325    Finally, I want to address a recent article in the326Washington Post about VA's EHRM program. I believe this article327highlighted real concerns from Department employees about the328system, concerns expressed from a place of worry for patient329safety and provider burnout. I wish the Department would take330these concerns seriously and use that feedback in their change331management efforts.332    I find it very troubling that the Department instead seems333to be minimizing the concerns raised. Their framing of the334story takes their usual tack: blame everything on the previous335administration. I will be honest, I think there is plenty of336blame to go around. Of course, it was the first Trump337administration that rushed VA into a sole-source contract with338Cerner before either was ready.339    Ultimately, we should not be pointing fingers. We need to340have the difficult conversations to make sure that both Oracle341and VA are accountable to Congress, to VA employees, and, most342importantly, to veterans. We need to ensure that this new EHR343supports VA's provision of world-class healthcare.344    Thank you, Mr. Chairman, and I yield back.345    Mr. Barrett. Thank you, Ranking Member Budzinski.346    I will now introduce our witnesses. From the Department of347Veteran Affairs, we have Dr. Neil Evans, acting program348executive director of the Electronic Health Record349Modernization Integration Office. Did I say that correctly,350Doctor? All right, very good. From Oracle, we have Hon. Seema351Verma, executive vice president and general manager of Oracle352Health and Life Sciences. From the GAO, we have Ms. Carol353Harris, a familiar face to this committee, the director of354Information Technology (IT) and cybersecurity at GAO.355    I will ask the witnesses to please stand and raise your356right hands. Well, your right hand.357    [Witnesses sworn.]358    Mr. Barrett. Thank you. Let the record reflect that all359witnesses have answered in the affirmative.360    Dr. Evans, you are now recognized for 5 minutes to deliver361your opening statement on behalf of VA.362363                    STATEMENT OF NEIL EVANS364365    Dr. Evans. Thank you. Good afternoon, Chairman Barrett,366Ranking Member Budzinski, and distinguished members of the367subcommittee, including Mr. Luttrell. I want to begin by368thanking Congress and this committee for the opportunity to369testify today and for your continued support of VA's electronic370health record modernization efforts. VA remains committed to371successfully implementing a modern interoperable Electronic372Health Record (EHR) system , which we refer to as the Federal373EHR, and we intend to implement that across the entire VA374enterprise.375    As was mentioned, since our last hearing in February, VA376has made significant progress toward meeting that goal. In377March, VA announced its plans to deploy the Federal EHR to nine378additional VA medical centers and associated clinics in Ohio,379Indiana, Kentucky, and Alaska by the end of calendar year 2026.380Those were in addition to the four previously announced medical381centers in Michigan slated for deployment, bringing the total382number of planned deployment sites in 2026 to 13. That383encompasses more than 100 physical locations, when clinics are384considered in addition to the medical centers, and will involve385transitioning more than 27,000 VA employees from Veterans386Health Information Systems and Technology Architecture (VistA)387to the Federal EHR in this coming year.388    In addition, we have begun deployment work at 7 additional389facilities, with 19 more on the way, all with planned Go-Lives390in 2027. Furthermore, as evidence of our commitment to full391implementation of the system across the VA enterprise, we392recently shared a schedule with this committee outlining our393plans to complete deployments of the Federal EHR at all VA394medical facilities as early as 2031.395    Based on lessons learned, VA will now be using a market-396based approach for deployments, with multiple medical centers397working together and going live simultaneously in each398deployment wave. This approach allows us to scale up the number399of deployments, enhance efficiencies, and improve the sharing400of best practices within and between markets.401    Now, I would like to bring our focus back to the near term.402As was mentioned, we are only 117 days, less than 4 months,403away from our planned Go-Lives in Michigan, and less than a404year away from the remainder of our deployments across all of405Veterans Integrated Service Network (VISN) 10 and Alaska. The406title that you chose for this hearing is apt: ``Ready, Set, Go-407Live.'' Teams at all the 2026 sites have been preparing408diligently for upwards of a year. The gun has already gone off,409Go-Live dates are imminent, and we are on track for successful410deployments.411    Contributing significantly to VA's current momentum has412been leadership ownership of this project at all levels of our413organization, starting at the very top. Since assuming their414roles, Secretary Collins and Deputy Secretary Lawrence have415prioritized attention to this critical project and have taken416significant steps to ensure that all stakeholders are aligned.417Dr. Lawrence has been talking to site and VISN leaders weekly418and has made multiple visits to sites scheduled for Go-Live in4192026, where he has made it a priority to listen to fellow420veterans and VA staff talk about their experiences and421expectations, and to respond quickly when adjustments are422needed. Just as important, leadership and staff at both the423individual sites and the VISN level are encouraged by the424program's direction and newfound momentum and are perhaps the425most important drivers behind our current progress.426    As for the system itself, VA and Oracle Health have made427significant strides in assuring the Federal EHR is performing428reliably and meeting our expectations. As an example, as of429November 19th, Oracle Health Systems within the Federal EHR430maintained an incident-free time of 95.93 percent, exceeding431our agreement of greater than 95 percent for 21 consecutive432months. We are also delivering system enhancements, new433features and system changes that are responsive to the feedback434we are hearing from VA staff and are driving improved435standardization across the enterprise.436    For example, I know we have often spoken about the system's437pharmacy capabilities in this committee and we will be438delivering seven further pharmacy improvements before our Go-439Lives in Michigan in April. As another example, we just440released new system functionality called ``Seamless Exchange''441in September, reducing by more than 95 percent the volume of442external data requiring manual review and reconciliation by VA443clinicians.444    We are seeing evidence of the results of the change we have445made. We continue to administer the Federal EHR User Experience446Survey twice yearly and I am pleased that we have seen447consistent improvement survey over survey. Ultimately, our goal448is to deliver an EHR system that earns the trust of veterans,449clinicians, and staff. That means a system that works450efficiently, enhances care coordination, reduces administrative451burden, and improves health outcomes for veterans.452    With the partnership of this Subcommittee, we look forward453to continued and accelerated progress over the remainder of the454119th Congress and beyond.455456    [The Prepared Statement Of Neil Evans Appears In The457Appendix]458459    Mr. Barrett. Thank you, Dr. Evans. The written statement of460Dr. Evans will be entered into the hearing record.461    Ms. Verma, you are now recognized for 5 minutes to deliver462your opening statement on behalf of Oracle.463464                    STATEMENT OF SEEMA VERMA465466    Ms. Verma. Thank you. Chairman Barrett, Ranking Member----467    Mr. Barrett. Can you please use your----468    Ms. Verma. Oh, I am sorry.469    Mr. Barrett. Yes.470    Ms. Verma. Let us try again.471    Mr. Barrett. Thank you.472    Ms. Verma. Good afternoon, Chairman Barrett, Ranking Member473Budzinski, and members of the subcommittee. Thank you for the474opportunity to speak with you today about Oracle's work with475the VA's EHR Modernization Program.476    Since the last hearing, VA announced an accelerated477deployment schedule that will complete the full implementation478for all sites by 2031. Next year, the Federal EHR will go live479at 13 sites and we are preparing to launch at 26 facilities in4802027. I am pleased to report significant progress on the481accelerated deployment plan and that Oracle is confident that482we are prepared and fully aligned with the VA to meet this483goal.484    Most importantly, leadership engagement and ownership for485the EHR implementation has never been stronger. There is clear486direction from the highest levels and a deep sense of487accountability across all partners.488    We also want to recognize and commend VA leadership for489their clear commitment to standardization across the490enterprise. Their decisive leadership has strengthened the491program and demonstrated a shared determination to deliver a492unified, high-performing EHR for veterans.493    Overall system performance is strong, the system is stable494and there is notable decrease in interruptions to end users. We495have met or exceeded the 95 percent incident-free time496requirement for 21 consecutive months and we have been free of497any systemwide outages for 8 consecutive months. These498improvements are a direct result of the coordinated effort499between Oracle and VA. Together we have formalized our incident500review process and implemented proactive monitoring and501targeted upgrades.502    We have optimized the EHR to improve veteran health503outcomes, enhance provider productivity, and strengthened504financial performance results. With these optimizations,505productivity has increased at all facilities and cash506collections exceeded Fiscal Year 2025 goals, achieving 180507percent of target.508    Last, as Dr. Evans referenced, we have expanded Seamless509Exchange to all Federal EHR facilities. Seamless Exchange510compiles and deduplicates patient data from multiple sources.511This reduces the volume of external data that requires manual512review and enables improved medical charting and decision-513making efficiency.514    Finally, we have strengthened every part of our deployment515methodology with a focus on improving staff readiness. This516includes enhanced training and change management, both virtual517and in-person, that allows end users to not just learn about518changes, but to actually try the system out in advance of Go-519Lives.520    We are modernizing the underlying infrastructure through521the migration of the Federal EHR to Oracle's cloud. This move522will not only provide better system performance and security,523but will also allow VA to adopt modern tools, including our524clinical Artificial Intelligence (AI) agent. The clinical AI525agent reduces clinical burden and supports safer, more526efficient care, all while ensuring the provider remains at the527center of decision-making.528    Our work does not end here. With VA's commitment to a529commercial solution, they will continue to benefit from530Oracle's ongoing innovation, including our new Voice-First531Ambulatory EHR, recently certified by U.S. Department of Health532and Human Services (HHS). With this certification, ambulatory533clinics across the United States, including the VA, can begin534planning for the adoption of our transformative EHR. Unlike535other EHRs, Oracle's was built from the ground up on a secure,536modern cloud. This allows for streamlined clinical workflows537and automation of manual tasks so providers can spend more time538with patients.539    Oracle continues to lead on data interoperability. We have540taken the White House Interoperability Pledge and have recently541been designated as a Qualified Health Information Network, or542QHIN, by HHS. This achievement will enable broader and more543secure exchange of patient data records across disparate544systems as veterans receive care from multiple sites and545multiple providers. Our QHIN will streamline connectivity,546enhance data accessibility, and help ensure that every care547provider has timely, comprehensive information to support548better outcomes for veterans everywhere.549    In closing, as we move into 2026, we are confident and550prepared to deploy the Federal EHR under the accelerated551deployment schedule. This will bring a unified health record to552veterans, which we can all agree brings incredible opportunity553to improve their experience with the VA and the health of our554veterans.555    Thank you and I look forward to answering your questions.556557    [The Prepared Statement Of Seema Verma Appears In The558Appendix]559560    Mr. Barrett. Thank you, Ms. Verma. The written statement of561Ms. Verma will be entered into the hearing record.562    Ms. Harris, you are now recognized for 5 minutes to deliver563your opening statement on behalf of the GAO.564565                   STATEMENT OF CAROL HARRIS566567    Ms. Harris. Thank you, Chairman Barrett, Ranking Member568Budzinski, Congressman Luttrell. Thank you for inviting us to569discuss the readiness of VA's EHRM program.570    In June 2017, the Department initiated this program to571replace the legacy VistA system and has since deployed the new572EHR to six of its medical centers at a cost of about $12.7573billion. The rollout of the system has been met with poor user574satisfaction, change management issues, and slow resolution of575trouble tickets, among other things. Given the magnitude of576user concerns, VA paused deployments in April 2023 to improve577the system and address those concerns.578    On December 2024, VA announced it would resume deployment,579starting with four Michigan sites in April. By the end of 2026,580VA plans to complete another nine sites under an accelerated581deployment schedule and roughly 170 more throughout the Nation582by 2031.583    Over the past 5 years, we have issued five reports on VA's584efforts to deploy its new EHR system. These reports describe585actions taken by the Department and identify challenges with586key planning tools critical for program oversight. We also587reported on challenges experienced with the initial588deployments, such as the ones I just noted.589    To address these challenges, we made 18 recommendations, 12590of which we have marked as priority because of the critical591impact they have on strengthening successful future592deployments. While VA has taken action to address our593recommendations, it has not fully implemented 16 of them. I594will highlight the 12 priority recommendations here.595    The first two are that VA needs to produce an updated cost596estimate and schedule. The latest independent cost estimate of597roughly $50 billion does not reflect the many changes and598delays to the program. I know you have said that they have599provided you with an updated estimate of 37 billion. We have600not received that estimate, and so I would ask the Department601to provide that to us so we can review it. The updated estimate602is imperative to understanding the full magnitude of VA's603investment.604    We have also yet to see an updated integrated master605schedule. Consequently, as the Department increases its606momentum to complete 170 total site deployments by 2031, more607information critical to controlling risks and informing608congressional oversight is needed. Additionally, more work is609needed to demonstrate results of VA's actions to address user610concerns and system issues.611    In May 2023, we reported on gaps in VA's organizational612change management activities for EHRM. We also reported that613users expressed great dissatisfaction with the new system and614that VA did not adequately identify and address those issues.615We made 10 priority recommendations to address change616management, user satisfaction, system trouble tickets, and617independent operational assessment deficiencies. VA concurred618with those recommendations, and, as of December 2025, VA has619partially implemented 1 of the 10 priority recommendations and620continues to work toward implementing the remaining 9.621    For example, VA partially implemented the recommendation to622address users' barriers to change. To do so, VA developed plans623to address user concerns about the new system identified in a624strategic review of the program. However, VA has not yet625adequately demonstrated that corresponding improvement projects626have fully addressed underlying barriers.627    VA has also not yet approved and implemented a VA-specific628change management strategy to formalize how it will improve the629readiness of end users to adapt to working in the new EHR630system. Further, VA has no plans to conduct an independent631operational assessment or an Independent Verification and632Validation (IV&V) test to determine whether the system is633operationally suitable. Without an IV&V, the Department634increases the risk of deploying the system prematurely, thereby635posing unnecessary risks to patient health and safety.636    Moving forward, it will be critical for VA to address the63712 priority recommendations along with the other 4 open ones as638soon as possible. Until these are fully implemented, future639deployments are at risk of prolonging challenges like those640experienced in the initial deployments. Doing so will position641VA to more effectively deliver a modern health record system642our veterans deserve.643    That concludes my statement. I look forward to addressing644your questions.645646    [The Prepared Statement Of Carol Harris Appears In The647Appendix]648649    Mr. Barrett. Thank you, Ms. Harris. The written statement650of Ms. Harris will also be entered into the hearing record.651    We will now proceed to questioning. I will recognize myself652for 5 minutes.653    Ms. Harris, thank you. You mentioned some of the cost-654associated considerations and concerns that are out there, what655the true price tag of this is going to be. Dr. Evans, is this656something that you can furnish through the Department over to657the GAO for them to review that life cycle cost analysis?658    Dr. Evans. Yes, we provided that to this committee on659September 30th and we certainly can provide it to the GAO.660    Mr. Barrett. Okay, appreciate that. Then, anecdotally, so I661go to predominantly the Battle Creek VA Hospital near my662district for most of my care, occasionally go to the Lansing663Outpatient Clinic there. I will usually ask the folks that I664interact with kind of their thoughts on this coming up. They665are all well familiar with it. I mean, there are posters up,666you cannot pull into the driveway of the hospital without667seeing this announcement of the, you know, unrolling of a new668electronic health record management system. I do not advertise669to them the, you know, role that I have on this committee of670oversight of this process. I will just kind of get their671opinion as to how it is going.672    I would say it is not great. There is a bit of a mixed673opinion. Some of them feel like they are not fully ready for674the new system at this point. Dr. Evans, can you walk me675through? I mean, I understand we are not going to train people676on this prematurely, but do you have confidence, does the677Department have confidence that the end user, the people that678are actually interfacing with this program, are going to be679well equipped to deal with it at the time that we go live?680    Dr. Evans. In short, yes, but let me give you some----681    Mr. Barrett. Yes.682    Dr. Evans [continuing]. comfort behind that answer. For the683four sites in Michigan, we just completed last month super user684training. Super users are folks who are in every department of685the medical centers in Michigan, who will be the kind of686experts in the Federal EHR for their peers. I think there was687over 400 folks who went through super user training. I do not688have the exact number here, but it is a sizable number. The689super users are going to basically help the end users when they690start their training. For the average user, so that is somebody691who has not been selected as a super user, they start their692training February 1st, so the beginning of February.693    With super user training, we have introduced a lot of694changes to how we do training and how we support adoption for695the Michigan Go-Lives. We had 96 percent of those we expected696to complete super user training completed super user training.697On average, they rated the classes four out of five. We had a698lot of direct feedback that this was significantly better than699the first time. For those who had gone through this before,700before we paused at the Michigan sites, they said, yes, this701has been much better.702    In addition for the super users we have added, and for all703end users, something called learning labs. This was a success704at Captain James A. Lovell Federal Health Care Center (FHCC).705Learning labs are when we finish classroom training or what706is--well, it is delivered virtually, virtual instructor-led707training. After that we do a learning lab which is where users708can come together and practice using the system in the sandbox709together with their colleagues and see exactly how it works.710    We had 13 scenarios at FHCC in North Chicago when we went711live there, got a lot of great feedback about that. We have now712built 98 scenarios and went through those learning labs with713the super user, got a lot of great feedback about it. I would714say that the end users should expect their confidence to start715to grow as they get into training in February and learning labs716in March.717    Mr. Barrett. Okay. Thank you.718    Then the Ms. Harris, the IV&V test that you pointed out, is719that the one I think you had mentioned to me separately, that720the kind of four parallel testing going on instead of721sequential testing, is that part of the IV&V or is that a722separate test that would be required?723    Ms. Harris. Well, given the change in the strategy for724testing with this market-based approach where they are going to725be basically simultaneously testing at four sites, it will make726it more difficult to do an IV&V, which is that end-to-end test.727    Mr. Barrett. That is a separate then----728    Ms. Harris. Yes.729    Mr. Barrett. Okay.730    Ms. Harris. Yes.731    Mr. Barrett. Both are, in your opinion, complicating--could732lead to significant risk?733    Ms. Harris. I do believe so. I think that the simultaneous734testing at the four sites, it will take a tremendous amount of735resources. To deal with the issues that come up inevitably with736a Go-Live, to be able to handle it at all four sites737simultaneously could be, you know, significantly risky for the738Department.739    Mr. Barrett. Ms. Verma, when I get back to my next order of740questions, I will have a question for you about that.741Beforehand, I want to yield to Ranking Member Budzinski for 5742minutes for her questions.743    Ms. Budzinski. Thank you, Mr. Chairman.744    Dr. Evans, VA's plan to accelerate EHRM deployments will745rely on sufficient--on having sufficient manpower. In the746history of this program, the Program Office has never really747been fully staffed. I have a couple quick questions. How many748open positions do you currently have in the Program Office?749    Dr. Evans. Just over 100. That is also because we just had750a new signed org chart which increased the number of positions751that we are authorized to hire. We are now actively hiring to752fill the additional positions that we have added to the Program753Office docket.754    Ms. Budzinski. Your plan is to fill all of those positions755then?756    Dr. Evans. Absolutely.757    Ms. Budzinski. Okay. How will your current staff levels be758able to not only resume Go-Lives, but support for the four Go-759Lives at one time--but support up to four Go-Lives at one time?760I guess that would be taking into account the hundred that you761would be adding.762    Dr. Evans. Yes, we will be--we are--so we are actively763hiring. In addition, at the sites that are going live, there is764active hiring going on. There are 510 positions in recruitment.765Actually, I think 163 of those folks are already on board at766the sites that are going live to support operations locally.767Plus, we are hiring in the Program Office. Then, of course, we768have a significant amount of help from our contract partners,769Oracle, Booz Allen, and Accenture Federal Services, as you just770heard.771    Ms. Budzinski. Okay. You have significant hiring that needs772to happen, though there are a lot of vacancies in the Program773Office.774    Dr. Evans. There are vacancies in the Program Office in775part because we are expanding the size of the Program Office.776From the perspective of our ability to execute to the Go-Lives777in April in Michigan, we are confident that our current778staffing is sufficient to get us there.779    Ms. Budzinski. Okay. Ms. Verma, the scope of what Oracle780and VA are planning to do is almost unprecedented. The number781of simultaneous Go-Lives and the time between the waves will782require a massive pool of contractors to support all of these783facilities, as Dr. Evans has mentioned. How is Oracle going to784ensure that these people understand the system and the VA well785enough to be helpful?786    Ms. Verma. Sure. First, I would say that Oracle does787implementations all over the world for systems. You know, this788amount and the number of sites is not unusual for Oracle as a789worldwide company in terms of the deployments. That being said,790we also continue to add more staff to our teams to make sure791that we can scale with the deployments as well. I think this is792not an unusual thing for our company. We feel very well793prepared to deal with the expansions and the challenges of794something of this scale.795    Ms. Budzinski. Can I just--drilling down just a little bit796more beyond just having the bodies, the VA itself is unique in797its mission and culture. When someone were to hit the ground,798what is Oracle doing to make sure that that additional capacity799understands the uniqueness of the VA and its challenges?800    Ms. Verma. Sure. Well, there are requirements around801training, and then there are also some Federal certifications802that are required as well. It is not like we interview somebody803and put them on the ground. There is some training that happens804internally, and then there are, also, like I said, the Federal805certifications and some required training that the Federal806Government requires as well around security as well as the807specific needs around the VA.808    Ms. Budzinski. Okay. Dr. Evans, as I mentioned in my809opening, I have serious concerns about the Secretary's plan to810eliminate 35,000 positions at VHA. In a Department that has811been chronically understaffed, where veterans sometimes wait812months for appointments, how can these cuts--how will these813cuts impact your program?814    Dr. Evans. They will not. As I just mentioned, we are815hiring additional staff at the sites where we are going live816with the Federal EHR over the course of calendar year 2026, 510817additional staff. Currently, recruitment is ongoing. I do not818anticipate any issues.819    Ms. Budzinski. Okay. Then just to go to the life cycle cost820estimate questions, does the VA have a definition for life821cycle cost estimate, Dr. Evans?822    Dr. Evans. What we provided to the committee was what we823call a program cost estimate. It is the estimated cost for us824to complete deployment of the Federal EHR across the enterprise825by 2031 and to operate that Federal EHR. That is, to support,826or what some might call sustainment, to support that EHR at the827existing sites that have gone live. That cost estimate, that828program cost estimate includes all money spent in the EHR829appropriation to date and our estimate of what it will take to830get to the finish line of finalizing deployment. Again, not831just finalizing deployment, but finalizing deployment and832supporting the operations across this timeline.833    Ms. Budzinski. Can I just interrupt? Does that break down834then program versus contract expenditures, like the details, or835is it just a top line number?836    Dr. Evans. It does. It does break down. We broke it down837into four categories. One is implementation costs, so you can838think of that as the cost to actually deploy the system. The839second category being site and system operations. That in many840ways is the cost of running the system, the hosting of the841system, help desk support, the operational support. The third842being infrastructure. I think we have talked about this in this843committee before, that a significant part of the spend here has844been an uplift of the IT infrastructure to support the new845modernized EHR. That has sort of had to occur in parallel with846the EHR rollout. Then the fourth we call office operations, but847it is really the staff, both government staff and contract848staff, necessary to deploy the EHR.849    Ms. Budzinski. Okay, thanks.850    Mr. Barrett. All right. Thank you.851    Mr. Luttrell, recognized for 5 minutes.852    Mr. Luttrell. Thank you, Mr. Chairman.853    Dr. Evans, what is the dollar sign on sustainment for this854software once EHR is implemented in all 170 sites and running?855    Dr. Evans. I do not have a number for you that is specific856to sustainment, but what I can tell you is that our estimate in857the final year when it comes to system operations, which I858mentioned----859    Mr. Luttrell. After 2031, moving forward, what are we going860to have to pay for this?861    Dr. Evans. Yes, I would estimate it is--our, again, our862estimate for the operations in the final year that we estimated863was 2.1 billion.864    Mr. Luttrell. Annually?865    Dr. Evans. Correct.866    Mr. Luttrell. Ms. Verma, if we have four sites that are867going to go live in April, I am sure Oracle's hovering over the868top of those four sites. If those four sites going off of what869Ms. Harris laid out for us, if those four sites fail, are other870sites, will we continue to move forward and fire up those other871sites? Or is it an all-stop evolution?872    Ms. Verma. I cannot speak exactly, you know----873    Mr. Luttrell. Oracle is not doing contingency planning on874if these sites fail----875    Ms. Verma. First----876    Mr. Luttrell [continuing]. in 117 days?877    Ms. Verma. Yes. First off, I would say that we are focused878on a successful deployment. We are doing----879    Mr. Luttrell. Are not we all?880    Ms. Verma [continuing]. everything we can to make sure that881that happens: training and support, testing of the system,882making sure that the teams are adequately supported. You heard883about super users----884    Mr. Luttrell. Yes, ma'am. I got you. I am just worst-case885scenario, that is the kind of guy I am, worst-case scenario,886these four sites do not go like they should. What is the887contingency plan that day?888    Ms. Verma. Well, you know, when something goes live and889there is a deployment, there are teams in place, there is890elbow-to-elbow support. We have war rooms. If there is an issue891that is going on, we are rapidly able to assess what the892problem is and fix it.893    The other thing that over the last few years we have been894doing a number of optimization projects. Right? You heard about895our capability block updates?896    Mr. Luttrell. No, I got it. Yes, ma'am. If those four sites897fail, is Oracle going to continue to move on the other sites898that need to be activated or is it----899    Ms. Verma. Yes, that is a decision I think that we would900discuss with the VA and figure out the appropriate course. Like901I said----902    Mr. Luttrell. We have not had that discussion yet?903    Ms. Verma. We have not had that discussion. Our discussions904are focused on successful implementations. Because of the905previous experiences, right, we have gone through a number of906deployments, there has been a lot of lessons learned. If we907look at the past deployment that we had at Chicago, again, that908went very well and we continue to learn, we continue to do909upgrades. In these last few upgrades as well as in Chicago,910those have gone successfully well. We have no reason to believe911that there would be a total failure of the system because we912have not seen that in our--you know, the last few projects.913Whether it is our optimization projects or the Go-Live at914Chicago.915    Mr. Luttrell. Well, I hope, you know, I hope that does not916happen. We have been waiting 10 years for this thing to work917correctly. Just from my experiences in the past, if you are not918contingency planning on the worst-case scenario when it shows919up, we are in a lot of trouble. Fair enough?920    How are the sites chosen? We have these four in Michigan921that are being activated. We had Chicago earlier. We have six922sites online, if I am reading this correctly. How are the923specific sites? Is there connectivity currently between sites924that we are going live on so it is an easier lift? Then the925sites that are kind of expanded out in like where I live, they926are going to be the last ones to get a shot at it? Mr. Evans?927    Dr. Evans. Yes, I can answer that. Let me just--I will928answer that question about how the sites are selected. I want929to quickly correct the record on your sustainment cost930question. I do not have a definitive estimate for the cost.931What I was giving you there was the potential cost of932operations. We do not have the sort of nailed down number for933what it is going to cost yearly.934    Mr. Luttrell. Well, I appreciate you saying that because935eventually the Secretary is going to have to come back to the936committee and ask for a substantial amount of money to sustain937the EHR.938    Dr. Evans. Correct.939    Mr. Luttrell. I mean, we are almost 50 billion into it and940it is not even working.941    Dr. Evans. Right.942    Mr. Luttrell. That is going to be a very interesting943conversation.944    Dr. Evans. Right. There will be--and part of that945conversation is also what money comes off the books as we do946not have to sustain, you know, legacy technology that we will947be able to shut down at that point in time.948    Coming back to how sites were selected, we started, we949spent a lot of time looking together to say what sites have the950highest level of readiness to move forward? Part of that was951based on where we had already made investments. The sites that952are the earliest sites in our schedule that we provided to you953through 2031 were the sites where oftentimes we had started954deployment activities and we had already made an investment and955we could save resources essentially by getting restarted there956earlier. We had already done the infrastructure upgrades at957those sites. We were ready to roll.958    We chose to move forward, as I mentioned, with a market-959based approach. One of the things that we have learned, lessons960learned, is that it is better for sites in a region to all be961using the same electronic health record. That is, if you take a962look in Michigan, there are a lot of interdependencies between963the VAs there. You look at Ann Arbor as an example. I think it964is more than 20 percent of the patients they see in Ann Arbor965have a primary care provider elsewhere in Michigan, for966example, in Battle Creek or Saginaw, and come there for967specialty care. Having those sites on the same----968    Mr. Luttrell. Mr. Chairman, can he keep going? Is it Okay?969    Mr. Barrett. Yes, I will allow you to finish the question.970    Mr. Luttrell. Thank you.971    Dr. Evans. Same electronic health record allows us to have972some efficiencies. We were looking by market, going one VISN at973a time. We are going to complete by the end of 2026, VISN 10974and then we will go to VISN 12 and 23 and beyond from that975based on the schedule.976    Mr. Barrett. All right, thank you. I am going to recognize977myself for 5 minutes for another round of questioning.978    Ms. Harris, I started to ask you about the kind of979simultaneous testing that is going on, that is, you know, the980GAO has raised as a concern. Ms. Verma, what do you feel is a981counterpoint to that? What can you do to convince me and the982GAO that doing this in a simultaneous fashion is the983appropriate way to do it without just hitting a deadline for a984date, without thinking through the risks associated with it?985    Ms. Verma. Sure. Well, first of all, we strongly support,986you know, robust testing. That is an important part of an987implementation. When you do testing, that is when you may see988things that you did not anticipate. Agreed that it is a very989important part of an overall deployment.990    I think it is important to recognize in this situation is991that the system is live in six sites today. Since we have992implemented in those six sites, we have also done a number of993optimization projects. In--when we do those optimization994projects, we go through a big process of testing the system. We995do that with the VA. Then what we have also more recently996implemented is that instead of waiting till the end to do997testing, we kind of do it on an ongoing basis. We show them the998optimization work. I think we have had very strong robust999testing. We feel confident that the system that we have in1000place around testing is working. There have been improvements.1001    I think an IV&V vendor at this point would just add to1002costs and not necessarily add anything new. We have had now1003successful implementations through our optimization work that1004shows that the testing is working. There are times when we have1005done testing, we have picked up things, we have delayed in some1006cases when we realized we needed----1007    Mr. Barrett. Right.1008    Ms. Verma [continuing]. to spend more time on it. I think1009at this point, the IV&V vendor is----1010    Mr. Barrett. Laying aside the IV&V, just doing all four1011sites simultaneously instead of one after another does increase1012the risk if something is discovered that needs action. Correct?1013Increases the risk of potential problems, would it not?1014    Ms. Verma. Right. This is more of a scale issue. When we1015know we have four sites, we make sure that there are adequate1016teams on the ground to do elbow testing. We also have a war1017room so that our teams are actively monitoring what is going on1018on the ground.1019    Mr. Barrett. Right. That is when it goes live, correct,1020not----1021    Ms. Verma. Not even before that. Even before that. Right?1022That is when Dr. Evans and I spoke about hiring enough staff to1023make sure that we can scale so that we are testing, we are1024supporting those sites as that is going on. It is just a matter1025of scale. The process is the same around testing, around1026training, around supporting. It is just a matter of having1027enough staff to do it. This is a----1028    Mr. Barrett. Each of these are very unique in their1029application. Each of these VA hospitals, they are not----1030    Ms. Verma. Correct.1031    Mr. Barrett [continuing]. you know, cookie-cutter stamped1032out. These are very, very customized to their unique situation.1033Doing them all four together, to me, elevates the risk that1034there is going to be problems that arise or issues that are1035overlooked, or we are batching these all together and then we1036are going to have them all go live nearly simultaneously1037without a lot of, you know, without a lot of consideration for1038what happens if, as Mr. Luttrell pointed out. I think those are1039the things that we have to bear in mind.1040    You know, not to discredit what you are saying, but it1041feels like a lot of that is, you know, we have these things1042and, you know, we are a big company and we can do that. I do1043not think that Oracle has had a project like the one that the1044VA is undertaking right now. Would you agree with that?1045    Ms. Verma. I think we feel very confident that we can do1046this and we can do it at more than one site at a time.1047    Mr. Barrett. I would expect and hope that you would be1048confident in it, for sure, but.1049    Ms. Verma. We are very confident. We feel very confident in1050doing that. I agree with you that every VA is different, which1051is why we have had teams on the ground. It is not like we are1052turning on the system quickly. We have been in these sites, we1053have been doing assessments of the site so we can understand1054what they have on the ground, what are the differences between1055each site. We have a plan for each site, and we have adequate1056staff and support for each of those sites.1057    Mr. Barrett. Ms. Harris, do you feel like these commitments1058by Oracle are satisfactory to the overall concerns that the GAO1059raise?1060    Ms. Harris. I mean, in taking a look at the previous1061history of the initial six sites, particularly in the five, I1062mean, when they went live, Oracle Cerner did have a difficult1063time in addressing those ticket--resolving those tickets in a1064timely manner. I know that they did a lot of streamlining in1065that process so that they would be able to meet their1066contractual marks for completing or resolving those tickets,1067you know, against their contractual obligations.1068    I think, again, when you are doing it for simultaneous1069ones, I mean, there is a tremendous amount of resources that1070are going to go toward ensuring, for example, that ticket1071resolution is done, you know, under the contractual obligation.1072That alone, I think, is very risky. It is going to take a1073tremendous amount of resources that I am not quite sure is1074sustainable for multiple sites at once.1075    Mr. Barrett. Okay. Last question. Is that something that1076was at the request of the VA or Oracle to do these four1077simultaneously?1078    Dr. Evans. If I may.1079    Mr. Barrett. Either one of you. Go ahead, Doctor.1080    Dr. Evans. Yes. It was VA. VA asked to do this. I would say1081I would like to kind of take us back a step. One of the parts1082that we have talked about in this committee that is super1083important for us to succeed is to standardize our workflows.1084One of the things we have done over the last year is establish1085very clearly what the Federal EHR baseline is.1086    As a reminder, this system is one instance, one system to1087support all of these medical centers. Part of being--locking1088down a baseline will actually streamline our ability to do1089testing because some of that variation that you are mentioning1090from one site to the next becomes less and testing becomes much1091easier at scale when you are testing against a standardized set1092of workflows and a standard baseline.1093    The other--the second thing is that we are--you know, as1094our----1095    Mr. Barrett. Sorry, I got to yield to the ranking member.1096We will come back for more questions, time permitting.1097    Ranking Member Budzinski is recognized for 5 minutes.1098    Ms. Budzinski. Thank you. I actually just want to pick up1099on some of your questions about readiness. I was curious, Dr.1100Evans, because I think you and Ms. Verma have talked a lot,1101pointed to North Chicago as the example of how--of readiness. I1102am curious of how well the readiness is going there and the1103development since its Go-Live. That is a unique case, as we1104know, though, because that was with U.S. Department of Defense1105(DOD). Can you speak, though, to the other sites that have1106already gone live as well and just, you know, what is happening1107at those sites as it relates to readiness?1108    Dr. Evans. Sure. At the sites other than FHCC, which are in1109Spokane, Walla Walla, Roseburg, White City, and then also1110Columbus, Ohio, I would say overall we have--we are tracking1111numerous metrics at those sites. You heard Ms. Verma mention1112about the revenue capture. We are doing very well with regard1113to appropriate revenue capture. Productivity at all sites at1114Roseburg has returned to greater than the 2019 pre-pandemic1115baseline productivity.1116    We continue to hold a problem management forum with live1117site representatives every single day, every single workday1118where issues are surfaced, we address those. We have done a lot1119of work to work down the ticketing backlog for significant1120change requests, reduced that by well over 40 percent, and are1121being quite responsive to the sites with their needs. Frankly,1122they can escalate anything any day at our 10 a.m. meeting.1123    We are seeing definite improved operations with the EHR at1124those original five sites. At FHCC, likewise, it is pretty1125similar performance.1126    Ms. Budzinski. Can I just ask, on those sites, how are you1127measuring then productivity and how it has changed at those1128sites?1129    Dr. Evans. For the productivity at those sites we are1130looking at something called Relative Value Units (RVU), which1131is a mechanism, it is an industry standard for measuring1132productivity. It is captured through billing encounters or1133encounters that sort of capture the documentation or the work1134that was done at the time of visit. We look at RVUs per1135provider.1136    Ms. Budzinski. Okay. I would like to shift to Ms. Harris.1137We talked about the testing. I also just wanted to circle back1138to your testimony about the GAO recommendations more broadly1139that are still open. What do you think are some of the most1140concerning of those that are still open today?1141    Ms. Harris. I think one of the most concerning ones is1142change management. VA still has yet to have an approved1143informal policy in place there. As part of change management,1144there is training as well. When you take a look at the first1145five sites as well as FHCC, those are vendor-led trainings. At1146all of those sites they have--the feedback has been that those1147vendor-led trainings had failed to prepare them for their1148specific roles and workflows. I think it is important for VA to1149take a more leader--to take the leadership role in that1150training. Again, we have those open recommendations there. That1151is vitally important.1152    Ms. Budzinski. Okay. Dr. Evans, in addition to those1153recommendations that Ms. Harris identified, I think there are115428 open from VA's inspector general as well. What is the plan1155and timeline to close them?1156    Dr. Evans. With regard to the GAO recommendations, we take,1157of course, all of the GAO recommendations seriously. Of the 171158open GAO recommendations, I do want to highlight that for 8 of1159those, nearly half of those, VA has made very significant1160progress. GAO has asked to keep those recommendations open1161until after we get past some of these initial Go-Lives in1162Michigan specifically.1163    For example, there is an open recommendation about making1164sure that our contractor staff and the VA is using the right1165terminology. This was a recommendation from 2020. We fully1166implemented that recommendation. GAO asked us to wait to see1167how things go in Michigan to close that recommendation.1168    Ms. Budzinski. Can I just interrupt? I am running out of1169time. Ms. Harris, would you agree with that? I did note that1170some of the recommendations do say partial, but many of them1171just still say open. Is there more to the story from what Dr.1172Evans is saying?1173    Ms. Harris. There has been action taken on many of the1174recommendations, for sure. The one that Dr. Evans noted is not1175one that we do consider to be priority. It is important, of1176course, but certainly all 12 of our priority recommendations,1177those are still--the majority of them is not in the situation1178that he had mentioned. However, I will say they have done work,1179but we do need to hold some of those open to ensure that the1180actions that they have taken are effective, because we will see1181those results at Michigan.1182    Ms. Budzinski. Okay. I yield back.1183    Mr. Barrett. Thank you.1184    Mr. Luttrell, for 5 minutes, sir.1185    Mr. Luttrell. Thank you, Mr. Chairman.1186    The six active systems say that the system itself has1187proven difficult to use and is not well-suited for VA1188workforce--workflow, excuse me. Staff have reported slow1189performance, excessive clicks, data loss, and a cumbersome1190documentation process. All six facilities that implemented the1191new system have faced increased workloads due to workaround1192processes, burnout, staffing shortages. The report goes on1193about talking--speaking on because of the weight of the1194implementation of this, morale is down.1195    There have been system updates. There has been a1196standardization and readiness improvements, and the user1197experience apparently went from 7 percent in 1922 to 33 percent1198in 1925. These are the six sites that are currently working1199under the system, Oracle system, and you are about to add four1200more.1201    Mr. Evans, you said in your previous statement that all1202the--you are doing Michigan because Michigan is the same. We1203are going to do Washington because Washington is the same. You1204come down to Texas, Texas is Texas. Now, if you have these1205particular sites that are having these issues, you are going to1206add these other sites on board that are different, and then you1207are going to try to complete the entire system. That is an1208extremely heavy weight.1209    I am curious, Ms. Verma or Dr. Evans, what does that even1210look like? If the current system does not work effectively at121133 percent and we are about to add 4 next year or 4 in April,1212and then what is the number in 2027, please?1213    Dr. Evans. Twenty-six sites.1214    Mr. Luttrell. Twenty-six in 2027. You see where I am going1215with this? Walk me through it.1216    Dr. Evans. I do. First of all, I think we have--just to1217give you a sense for the change, over the course of the reset1218we were introducing--we introduced over 1,500 functional1219changes, that is changes responsive to end users, where end1220users said, hey, the system needs to work better in the1221following way.1222    Mr. Luttrell. Just on these six sites, the active sites.1223    Dr. Evans. At the six sites, 1,500 changes over the course1224of the reset. That was more than 50 changes on average a week1225that we were introducing responsive to their feedback. That is1226not--beyond that, thousands of other changes that were1227introduced as part of block upgrades, which are platform1228upgrades, where Oracle's improvements to their base platform1229are being introduced to the VA, there has been a significant1230amount of improvements to the user experience.1231    I think the data that you were quoting, the 33 percent, is1232from our end user experience survey. You know, I believe that1233we are seeing direct line improvement. That is as we pay1234attention to end users, as we address the change requests in a1235standardized way at the national level that is responsive to1236our clinical communities, and as we deliver those in a way1237that, as Ms. Harris mentioned, is rolled out in a way where1238users feel supported, where they get adequate communication,1239where they get training to the changes, we are seeing1240confidence improve. Now, it is not where I want it to be, but1241we are seeing confidence improve at the six live sites.1242    Mr. Luttrell. Are the four active sites in Michigan, this1243implementation, has this been handed off to them, so you will1244not be surprised when something like this populates after they1245go active 117 days? They are not going to say, hopefully not, I1246should not--I am not going to call it a mistake, but they are1247not going to have the same issues that the current sites are1248having because everything that we have learned off the current1249six sites has been pushed over to the four sites are going to1250go active in April?1251    Dr. Evans. That is correct. All of the improvements that1252the six sites--that we have learned from the six sites and,1253frankly, from our lessons learned working with the DOD and1254working with Oracle and commercial customers about what best1255practices are, all of that value will be delivered to Michigan.1256    Mr. Luttrell. Hopefully.1257    Dr. Evans. Yes, it will.1258    Mr. Luttrell. I yield, sir.1259    Mr. Barrett. Thank you, Mr. Luttrell. I will recognize1260myself for another 5 minutes.1261    I know this issue of change management and everything is1262difficult. Dr. Evans, I think I shared with you that I think as1263a classification, physicians tend to be a little bit stubborn.1264I think you agreed with me. Then I think physicians within the1265VA might be a particularly stubborn bunch. With that being the1266case and laying that aside, who is ultimately responsible for1267that change management? Is it Oracle, is it VA, or is it1268Accenture? Like, who is responsible for that part of this?1269    Dr. Evans. I mean, at the end of the day, VA is1270responsible. This is our healthcare system. This is the VA1271healthcare system. This is our project to implement a new1272electronic health record.1273    One of the things that we--as we during--you know, as we1274sort of sat before we started to accelerate deployments, we1275said we need a new change management strategy. We worked that1276out. One of the big pieces of that is that it is VA leaders1277standing in front of their peers that kick off this process. We1278introduced a new event. It is the Change Leadership Team,1279Executive Leadership Team onboarding event. We do it in every1280market. It is led by VA leaders who are speaking as peers to1281their staff to say, this is what the change will feel like.1282This is what it is going to be.1283    I can own a little bit of stubbornness as a primary care1284provider in VA, as you pointed out, but I will say this, my1285experience is that VA clinicians, they circle around the1286veteran. If you are delivering a better experience to the1287veteran, that is a worthwhile change to adopt. Part of this is1288building a real sense of the why. Why is there value in us1289coming together around a single electronic health record that1290supports veterans wherever they are, where the care surrounds1291the veterans, regardless of what physical geographical location1292they walk into in a VA? I am not seeing objections from our1293clinical staff or our administrative staff when they understand1294that why and when they are adequately supported.1295    We own it, VA owns it. I am very grateful as well for the1296contractors who are supporting us in executing that change1297management tasking.1298    Mr. Barrett. Okay. Then the surveys that you are1299undertaking, you know, Mr. Luttrell pointed out you guys went1300from 7 percent to 33 percent. Congratulations, you are more1301popular than Congress finally. With that being the case, do you1302feel the survey methodology is accurate or is it one of those1303things that tends to attract more negative response bias?1304    Dr. Evans. Yes, it is a good question. We get about 201305percent participation in the surveys on average when we send1306them out twice a year. That is actually a good response rate1307for a survey with when we are asking busy folks in the medical1308centers to take their time out to do the survey.1309    Point number two, the survey methodology, the survey1310questions that we use are a standardized set of questions used1311by many healthcare systems, both in the private sector as well1312as in the Federal Government and are comparable with the DOD.1313Those questions, I do believe that they are robust questions1314that we can learn from and from which we can look at other1315health systems that have engaged in a similar transition and1316track our progress accordingly.1317    Mr. Barrett. Okay. Do you feel that VA end users, as they1318are being trained on this, have adequate, you know, authority1319to raise their concerns without feeling like they are being--1320you know, that there is going to be not punishment, but just,1321you know----1322    Dr. Evans. Absolutely. I mean, it is an anonymous survey.1323We expect----1324    Mr. Barrett. Yes.1325    Dr. Evans [continuing]. complete honesty on the survey.1326    Mr. Barrett. Okay. Switching briefly, because I have only1327got about 1 minute left. I know we talked, Ms. Verma, a little1328bit about some of the pharmacy-related implementation and1329things like that being a unique role that the VA has and some1330of the drug interaction pieces. I guess, where do you see1331Oracle integrating into this to make sure that we can resolve1332that going forward for the understandably unique way that the1333VA does the pharmacy role?1334    Ms. Verma. Sure, and you are absolutely right. Right? We1335are taking an off-the-shelf solution and bringing it to the VA,1336and the VA has some very specific and unique needs. I think1337that there has been some points that we have implemented or1338some projects that we have implemented that have really1339upscaled the level of safety, things like opioid prescribing.1340We have also improved communication between pharmacies and the1341providers if a drug's not available, to have that conversation1342so that they make sure that what is being prescribed is1343available. We are seeing some definite improvements. We are1344seeing some providers out there that have a level of1345productivity to pre-deployment.1346    That being said, I think we would recognize that we--that1347this is an area of continued focus where we want to make sure1348that we have adequate training. We also sent--you know, our1349Chief Executive Officer (CEO) went to go visit one of the1350centers and specifically looked at pharmacy because we do know1351that this is going to be something that we are going to1352continue to improve.1353    I think we have made progress. I would also acknowledge1354that this is an area that we continue to focus on at the1355highest levels of Oracle and we continue to make improvements1356and we have conversations about this on an ongoing basis.1357    One of the things that I really appreciate the leadership1358doing----1359    Mr. Barrett. I am going to have to cut you off in just a1360second. I apologize.1361    Ranking Member Budzinski for 5 minutes.1362    Ms. Budzinski. Thank you. Ms. Verma, Oracle has been1363touting its effort to build a new EHR. I think you have gone as1364far as to say that Cerner's EHR is equivalent to crumbling1365infrastructure. Is this crumbling infrastructure the product1366that is being deployed at VA?1367    Ms. Verma. We are making improvements to the Cerner system1368that is being implemented in the VA. We took the Cerner system.1369You have heard about all the different optimization projects1370that we are doing. We are also introducing a lot of AI agents1371that will sit on top of the Cerner system to help it, you know,1372to help it provide, you know, the best experience for providers1373on the front lines.1374    Ms. Budzinski. How much of this is informed by lessons1375learned at the VA?1376    Ms. Verma. I think a lot of it is informed by lessons1377learned. One of the things that we appreciate is that the1378leadership today is very active in terms of visiting the sites,1379seeking input from providers and understanding what are the1380pain points, and then communicating it to us. We meet very1381frequently with the VA, almost every 2 weeks, there are weekly1382meetings with the Secretary. In those meetings we are1383identifying where are there opportunities for optimization?1384    We have executed on a lot of these projects. You have heard1385of the capability block updates that we have been doing. Those1386represent the optimization projects and I think that is why we1387are starting to see better results in terms of the experience1388of providers. I think the sentiment overall is increasing as1389well in terms of the positivity.1390    Ms. Budzinski. We have spent a lot of time today talking1391about cost, and I am just curious how you would respond, you1392know, hearing this, is this going to all lead us down the path1393of additional cost from Oracle's perspective?1394    Ms. Verma. Yes, so I have not reviewed any of the new1395estimates that have come out, but I think that is something1396that we are very cognizant of with--of cost. I think that some1397of the more recent changes that we have made, the first one I1398would say is the standardization. You know, having a system1399where you had six different sites requesting different types of1400changes, those kinds of things contribute to increased cost. We1401are very excited about the changes that we have heard about in1402terms of moving to standardization. That is going to make the1403cost more predictable and more sustainable.1404    That being said, it is always, you know, foremost on our1405minds. This is why Oracle agreed to move the Federal system to1406our cloud to make sure that we had, you know, greater security1407and performance. We are doing that at our cost as well. We1408advise the VA. One of the things that we really advocated for1409was the standardization because we also knew that not being1410standard would contribute to increased costs.1411    I think the pause in and of itself has not helped in terms1412of cost because you are maintaining two systems. Moving forward1413I think will also help make sure that we are using taxpayer1414dollars appropriately and efficiently.1415    Ms. Budzinski. You have talked a little bit about in your1416testimony, obviously, AI. Is AI capability included in VA's1417contract with Oracle and is there additional cost to that?1418    Ms. Verma. It depends on which AI agent. There is not a one1419size fits all approach. We are bringing the brand new EHR to1420the VA. We are not charging for that, you know, new ambulatory1421system, but there are--there will be some AI agents that are1422included inside the EHR and there are some that are additional,1423and the VA will have to assess those and decide which ones that1424they want to use.1425    Ms. Budzinski. Okay. Ms. Harris, can I just ask you, in1426your testimony, you had flagged, we were talking about the1427overall cost in the beginning of this hearing, and I did not--I1428wanted to get to you, but could you--I think you had flagged1429some concerns around that number, the 37 billion. Could you1430speak to that?1431    Ms. Harris. Yes. Well, we have not seen the 37 billion1432number. As soon as our office receives that, we will, you know,1433certainly do a deep scrub of that and then get back to you on1434that. I will say the independent cost estimate that is out1435there is--the total life cycle cost is roughly $49.8 billion,1436so roughly $50 billion. You know, we are going to have to go1437through the differences.1438    That number also is outdated because it does not reflect1439the changes in the delays, including the pause. That is also1440something that we will have to take a look at, but we will1441certainly do a comparison there of that.1442    Ms. Budzinski. Okay. Thank you, when you get that.1443    Ms. Verma, if I could just ask again, going back to Oracle1444Health Software and specifically the veterans' data, is it1445being used to train the AI that Oracle will use for its1446commercial clients?1447    Ms. Verma. Absolutely not. We do not have any data rights,1448so we do not use that data to train our models. No.1449    Ms. Budzinski. Okay. Will VA receive credits of some sort1450for the benefit Oracle has derived from the information?1451    Ms. Verma. We do not use their information for any of our1452training for AI models.1453    Ms. Budzinski. Okay. Okay. Ms. Harris, your testimony1454indicated the VA has not instituted plans to conduct an1455independent operations assessment to evaluate the suitability1456and effectiveness of Oracle's EHR. We have been contemplating1457the need for such an evaluation. What do you think this should1458entail and what do you think should--who should conduct it?1459    Ms. Harris. Yes. I think that given this approach to go1460live at four sites at Michigan, once that takes place, I think1461that there should be an IV&V after that looking at all four1462sites to do that systematic cataloging of those defects, and it1463should be an independent third party that goes in and does that1464review.1465    Again, I cannot stress enough the reason why Military1466Health System (MHS) GENESIS was so successful in their1467deployments, you know, we have spent a lot of time with them. A1468large part of that was because of the IV&V test that they1469performed.1470    Mr. Barrett. Sorry. Thank you very much.1471    Mr. Luttrell, for 5 minutes. Then we will do closing.1472    Mr. Luttrell. Thank you, Mr. Chairman.1473    The VA did not--Dr. Evans, I do not know how long you have1474been in the VA, but I was curious, we did not negotiate into1475our contract with Oracle any kind of AI footprint? What I heard1476her say is we are just going to get to the baseline. This is1477like when my 8-year-old comes up and wants to buy a video game.1478Hey, we can get the baseline model. Then when you are inside,1479you got to buy everything else to get it where it needs to be.1480It kind of sounds like where we are at. You do not have to1481answer that question. I just wanted to say that out loud.1482    We have six sites that are currently on Oracle. Right, Ms.1483Verma? The rest, 160-plus, are still on, what, VistA, Dr.1484Evans? We have spent roughly about a billion dollars on1485software across the board. Correct? Some of the VA facilities1486use software that other VA facilities do not use. Some have the1487highest level of software advancements inside their facilities1488and some do not. We have to pay for it all, whether or not we1489even use it or not. Like my little facility in Conroe, Texas,1490still uses some software that helps VistA, but DeBakey does1491not, but we still have to fund the whole thing and it is almost1492a billion dollars if I am correct. I may be off on that, but I1493think it is almost a billion dollars.1494    Ms. Verma, when Oracle activates on every single site, do1495we have the ability to tell everybody else, hey, we do not need1496you anymore? I think your button is off.1497    Ms. Verma. Yes, Okay. I think it is going to depend on1498every site. My----1499    Mr. Luttrell. No, it cannot depend on every site----1500    Ms. Verma. Well----1501    Mr. Luttrell [continuing]. because the whole purpose of us1502doing this with you guys is that every site is the same.1503    Ms. Verma. Yes. My----1504    Mr. Luttrell. It says that multiple times.1505    Ms. Verma. Yes. My expectation would be that with a new1506Oracle EHR that they should be able to use our system and that1507should address the needs that they have. I do not know1508whether--you know, every single site and what they have, but I1509would anticipate that this EHR with the standardization that we1510are bringing, that it should be able to meet the needs of any1511hospital or clinic across the country.1512    Mr. Luttrell. I hope so for $50 billion. We are going to1513have to have a conversation with everybody saying, hey, look,1514we implemented this at $50 billion, plus the dollar sign, Dr.1515Evans, of what sustainment looks like. Then, hopefully, at the1516end of the day, we do not have to say we have to continue to1517pay for everything that is in VistA because we already have it1518in the system and then we are going to pay for Oracle on top of1519it. Are we going to have to have that conversation?1520    Ms. Harris, what do you think about that? Does that sound1521reasonable? This is kind of the math problem I am drawing out1522in my head, but it is where we are. The slide deck that they1523brought to my office 1 day, it shows every single software that1524we pay for. We have one software program that only one VA uses1525and we still pay for it because they have to have it for some1526reason.1527    What do you think about that, Dr. Evans?1528    Dr. Evans. I think that you are--this is a very important1529point. As we move forward, the Federal EHR, think of that as1530the operating system for the hospital, will be the same at all1531hospitals. Not all hospitals offer the same clinical services.1532For example, we are going live in Michigan. For the first time1533we will be implementing Radiation Oncology. There is some1534unique software that is necessary to support a radiation1535oncology clinic and operation that will not be needed at every1536site.1537    One of the real advantages, one of the reasons why, when1538you hear me and us and VA talk about what we call the Federal1539EHR baseline, we think that is so important, is because we are1540going--we are publishing, it is published right now on our1541website, these are the software systems that we will support1542and can support connected to the Federal EHR. By definition, it1543also means there are those that we will not support.1544    Mr. Luttrell. Every system that we have in place currently,1545once Oracle activates in all sites, they are going to come1546running to you guys and say, you have to use this?1547    Dr. Evans. Well, again----1548    Mr. Luttrell. We are already here.1549    Dr. Evans. No, no, we are making the decisions now as we go1550from site to site around what the standard is going to be.1551    Mr. Luttrell. I am sorry, I am still under the impression1552that every site is going to be the same.1553    Dr. Evans. Not every site has the same clinical services.1554    Mr. Luttrell. I understand that.1555    Dr. Evans. When we go to a site----1556    Mr. Luttrell. Every site can have what Oracle is populating1557and the 6 sites that have are active and 4 sites are coming up1558and the 27 next year will be the exact same. Correct? I have1559that in my little satellite campus in Conroe.1560    Dr. Evans. I will give you an example. Bedside monitors,1561when you walk into an intensive care unit, the thing that is1562hanging up above the bed with the Electrocardiogram (EKG) on1563it.1564    Mr. Luttrell. Yes, sir.1565    Dr. Evans. That is not a core part of the electronic health1566record. That is a biomedical device. It has software that runs1567it that we will need to plug into the electronic health record.1568One of the ways we will be able to manage cost is by1569standardizing which of those devices we can support. It should1570be a limited number in order to be able to manage the EHR in a1571more cost effective way across the enterprise.1572    Mr. Barrett. Thank you. I apologize, we are up against a1573bit of a hard stop for the committee. We are going to move on1574to closing statements.1575    Okay. I will go to Ranking Member Budzinski for her closing1576statement first.1577    Ms. Budzinski. Thank you, Mr. Chair. Thank you.1578    I agree that we need to give veterans and VA employees the1579modern tools that the new EHR can offer. Those tools have to1580work for the VA, and I just do not believe that we are there1581yet. I do not want to be a pessimist, but I do not feel like I1582am leaving this hearing having my mind changed on this point.1583    Dr. Evans and Ms. Verma are quick to point out that the new1584administration is driving increased momentum and leadership1585involvement in the project. I am concerned that the1586administration's involvement is only moving the program forward1587faster, not better. There are so many recommendations from the1588GAO and the Inspector General, as well as Congress, that will1589continue to sit unheeded. I have no confidence that the next1590round of Go-Lives is going to be any better than the last.1591    I would implore Secretary Collins and the Trump1592administration to pay attention to their own words and put the1593veterans at the center of everything. Anything else puts the1594health and safety of our veterans at risk.1595    Thank you and I yield back.1596    Mr. Barrett. Thank you, Ranking Member Budzinski.1597    I was actually voted most optimistic of my high school1598graduating class. Mostly because I thought it was the Lions'1599year every year. Again, we find ourselves on the edge of not1600even making the playoffs perhaps.1601    In my old age, I have moved from an optimist to more of a1602realist. I think the issue before our committee is what is the1603real assessment of where we are at and what we need to do to1604prepare going forward. I think a healthy amount of question,1605concern, and even a little bit of skepticism is appropriate for1606our committee to feel given the past performance of how this1607has gone and what we need to be prepared for.1608    I can tell you with candor what I will not accept if we1609fast-forward the tape 117 days from today is if things do not1610go well and do not go as necessary to protect the health and1611benefit and welfare of the veterans that we serve, is finger-1612pointing and blame between, you know, various different1613vendors, the Department, and who had what, and musical chairs1614as to where things land.1615    This committee, our work here is not going to tolerate1616that. If there are differences between opinions as to what1617needs to take place, I encourage you to resolve those. If you1618need help from this committee to do that, I am very willing to1619be the person to step into that role and, with the ranking1620member, to assist in doing that. We need to absolutely make1621sure that we have a no-fail mindset going into this Go-Live 1171622days from today.1623    When I was at my last appointment in Battle Creek for a1624physical, they sent a follow up that was a few months into the1625future, and it happened to land on the week that this Go-Live1626is. You know, I am comparing my session calendar with when I1627can be back home. I am like, well, I am available on this date.1628They are like, oh, no, we are getting a new electronic health1629record system. We hare not scheduling appointments on that day.1630    I know that they are taking it seriously. I just want to1631make sure that the tools are going to be there for the end1632user, the practitioners, the doctors, the medical assistants,1633the nurses, and all the other various people involved in this1634from front to back are going to be ready for this as it comes1635up. I am hopeful and encouraged that you pointed out the super1636users have begun getting their training now, but then the more,1637you know, rudimentary kind of day-to-day users are going to be1638getting that and at a point that is appropriate for them.1639    I have concerns about the, you know, simultaneous testing1640going on, as we pointed out in the questioning, and I want to1641make sure that that is done appropriately. I think there are1642questions that the committee has that are still unresolved and1643a few more that Mr. Luttrell raised as well.1644    We want to be partners in this, not antagonists. We do not1645want to slow you down. We do want to maintain the appropriate1646level of accountability to make sure that this goes as well as1647we need it to.1648    With that, I think I have some disclaimers I got to say1649here at the end. I ask unanimous consent that all members have16505 legislative days to revise and extend their remarks and1651include extraneous material. Without objection, so ordered.1652    With that, this hearing is adjourned.1653    [Whereupon, at 4:26 p.m., the subcommittee was adjourned.]16541655=======================================================================16561657                         A  P  P  E  N  D  I  X16581659=======================================================================16601661                    Prepared Statements of Witnesses16621663                              ----------16641665                    Prepared Statement of Neil Evans16661667    Good afternoon, Chairman Barrett, Ranking Member Budzinski, and1668distinguished Members of the Subcommittee. Thank you for the1669opportunity to testify today about the initiative of the Department of1670Veterans Affairs (VA) to modernize its electronic health record (EHR)1671system.1672    I want to begin by thanking Congress and this Committee for your1673shared commitment to Veterans and for your continued support of the VA1674Electronic Health Record Modernization (EHRM) efforts. VA is committed1675to successfully implementing a modernized, interoperable Federal EHR1676system across its enterprise. Implementation of the Federal EHR system1677will facilitate unprecedented ease of transition from Department of War1678(DoW) to VA and quality of care coordination between the agencies. VA's1679focus is keeping Veterans at the center of everything we do. Veterans1680deserve high-quality health care, which means health care that is1681timely, safe, Veteran-centric, evidence-based, and efficient. The EHR1682is, and will remain, a key enabler of VA's ability to deliver the1683comprehensive health care Veterans deserve.1684    The Federal EHR will provide a framework for improved enterprise1685standardization of evidence-based health care delivery, positively1686impacting patient care quality and safety. The Federal EHR will support1687simpler integration of other modern health information technologies and1688infrastructure to provide a more coordinated experience for VA staff1689and clinicians as they care for Veterans. The modernized EHR will also1690support improved interoperability with the rest of the American health1691care system. In addition, the adoption of a single system used by VA1692and DoW will help simplify health care delivery for providers in both1693Departments, benefiting patients who receive care in both systems or1694who are transitioning from DoW to VA for care.1695    Since our last hearing in February 2025, VA has continued to build1696on previous milestones to achieve the mission objectives set for the1697EHRM program. In March, VA announced its intention to deploy the1698Federal EHR to nine sites in Ohio, Indiana, Kentucky, and Alaska by the1699end of calendar year 2026, in addition to four previously announced1700sites in Michigan. This brings the total sites to go live in calendar1701year 2026 to 13, with all sites in Veterans Integrated Service Network1702(VISN) 10 going live by the end of calendar year 2026, supporting1703better coordinated care across the entire regional network. VA aims to1704complete deployment of the Federal EHR to all VA medical facilities as1705early as 2031.1706    VA closed out Fiscal Year (FY) 2025 on target in meeting deployment1707activity milestones to ensure timely go-lives in 2026. Based on the1708lessons learned from our prior VISNs 20, 10, and 12 deployments, VA is1709using a market-based approach for future deployments to scale up the1710number of concurrent deployments, enable staff to work more1711efficiently, and increase the sharing of best practices by frontline1712staff and the Federal EHR community. Training schedules and course1713loads were adjusted to better support end-users and patient scheduling.1714VA also provided Congress with an updated long-term cost estimate for1715the EHRM program, along with a timeline for deployments through 2031.1716To demonstrate VA's commitment to successfully meeting that timeline1717within the expected cost, we have augmented our team by contracting a1718systems integrator to help coordinate deployment activities. We have1719always relied on the expertise of our government contractors. We need1720their functional and technical expertise and resources, working1721together with the government, to execute our programmatic goals and1722deliver on VA's promise to our Veterans.1723    VA has made significant strides in stabilizing its systems, with1724improved performance metrics demonstrating system reliability. As of1725November 19, 2025, Oracle Health-owned systems maintained an incident-1726free time (IFT) of 95.93 percent, exceeding the Service Level Agreement1727(SLA) requirement of 95 percent consistently for 21 consecutive months.1728Ten of the 12 months in Fiscal Year 2025 were free of any system-wide1729outages. At the conclusion of Fiscal Year 2025, the system had1730experienced more than 200 consecutive days without any outages.1731    The momentum demonstrated this year can be attributed to increased1732VA leadership involvement under this new Administration. Since assuming1733their roles, Secretary Collins and Deputy Secretary Lawrence have1734prioritized attention to this critical project and have taken1735significant steps to assure alignment across all stakeholders in1736support of the accelerated implementation of the system in support of1737Veterans. Dr. Lawrence has been talking to site and VISN leaders weekly1738and making multiple visits per month to sites set to go live with the1739system in 2026, making it a priority to listen to fellow Veterans talk1740about their experiences and expectations. During visits across1741Michigan, Ohio, and Indiana, he has met with executive leadership1742teams, change leadership teams, super users, and frontline clinicians1743to discuss preparations for the 2026 deployments and to review how1744recent improvements have helped frontline staff. While these visits are1745ongoing and will continue, the feedback has been positive. Leadership1746and staff at both the individual sites and the VISN level are1747encouraged by the program's direction and newfound momentum and are1748confident in this administration's path forward.1749    VA has continued to listen to and engage with Veterans and1750clinicians about their experience with the Federal EHR, and is seeing1751meaningful success with deployments, according to results of the most1752recent Federal EHR User Experience survey completed in Spring 2025. For1753the first time since the survey's inception, at least half of survey1754respondents felt positive about some aspects of the Federal EHR system.1755On November 21, 2025, we completed our Fall 2025 survey and look1756forward to sharing those results when they are available.1757    VA is continuing to move forward with a modern, commercial EHR1758solution in close coordination with our Federal partners, including DoW1759and the Federal Electronic Health Record Modernization office. This new1760Federal EHR system will empower Veterans to receive care that is more1761seamlessly coordinated across the enterprise. It will help providers1762more holistically understand injuries or illnesses that Veterans1763suffered years ago, so that they can provide those Veterans with the1764best possible care today. It has the potential to further streamline VA1765operations and most importantly, it will improve the Veteran1766experience.1767    Ultimately, our goal is to deliver an EHR system that earns the1768trust of Veterans, clinicians, and staff. This means a system that1769works efficiently, enhances care coordination, reduces administrative1770burden, and will improve health outcomes for Veterans. We are not1771simply continuing business as usual; we are committed to getting this1772right. The responsibility we carry is immense, and we will not rest1773until this system delivers what our Veterans and providers truly need.1774With the activities and improvements that are now underway, VA leaders1775are optimistic about the success of our Federal EHR system optimization1776efforts and the eventual full implementation of the system throughout1777VA.1778    With the partnership of this Subcommittee, we look forward to1779continued and accelerated progress implementing the Federal EHR across1780VA over the remainder of the 119th Congress and beyond. We are only 1171781days away from our planned go-lives in Ann Arbor, Battle Creek,1782Detroit, and Saginaw, Michigan, with many more sites following quickly1783thereafter.1784    This concludes our testimony. We look forward to responding to any1785questions that you may have.17861787                   Prepared Statement of Seema Verma17881789[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]17901791                   Prepared Statement of Carol Harris17921793[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]17941795                       Statements for the Record17961797                              ----------17981799               Prepared Statement of The American Legion18001801    Chairman Barrett, Ranking Member Budzinski, and distinguished1802members of the subcommittee, on behalf of National Commander Dan K.1803Wiley and more than 1.5 million dues-paying members of The American1804Legion, we thank you for the opportunity to offer our statement for the1805record on the Department of Veterans' Affairs' modernization efforts.1806    The American Legion is guided by active Legionnaires who dedicate1807their time and resources to serve veterans, service members, their1808families, and caregivers. As a resolution-based organization, our1809positions are directed by over 106 years of advocacy and resolutions1810that originate at the grassroots level of our organization. Every time1811The American Legion testifies, we offer a direct voice from the veteran1812community to Congress.1813    As the United States Department of Veterans Affairs (VA) resumes1814rollout of the Electronic Health Record Modernization (EHRM) program it1815is important to note that the VA began the EHRM program to make1816critically needed updates to the VA's software systems. VA's current1817electronic health record (EHR), the Veterans Health Information Systems1818and Technology Architecture (VistA), is extremely outdated and simply1819cannot serve current or future veteran needs.1820    Though the name VistA was adopted by VA in 1994, the system itself1821can date its origins back to 1977.\1\ While it was a triumph of its1822age, this decades-old system lacks many modern features available to1823civilian hospitals. The VA's new EHRM, Oracle Cerner Millennium, is1824intended to bring new, modern capabilities to the VA such as more1825accurate and faster tracking and identifying of potential health risks,1826scheduling features that would improve on wait times, and a seamless1827experience across different hospitals and departments.\2\ The EHRM1828program, as intended, will provide veterans with an easily updated1829health record that follows a veteran for life, from the time of their1830service in the Department of War (DOW) through their time in VA1831healthcare. The American Legion strongly supports these goals.\3\1832---------------------------------------------------------------------------1833    \1\ Allen, Arthur. n.d. ``A 40-Year `Conspiracy' at the VA.'' The1834Agenda. Politico.com. https://www.politico.com/agenda/story/2017/03/1835vista-computer-history-va-conspiracy-000367/.  Unless otherwise noted,1836all cited hyperlinks accessed March 28, 2023.1837    \2\ Communication, IT Strategic. 2022. ``What Veterans Need to Know1838about How VA's Health Record System Is Changing--VA EHR1839Modernization.'' Digital.va.gov. July 21, 2022. https://digital.va.gov/1840ehr-modernization/resources/fact-sheets/what-veterans-need-to-know-1841about-how-vas-health-record-system-is-changing/.1842    \3\ ``Resolution No. 83: Virtual Lifetime Electronic Record.''18432016. https://archive.legion.org/node/329.; ``Resolution No. 12:1844Implementation of the MISSION Act.'' 2022. https://archive.legion.org/1845node/14050.1846---------------------------------------------------------------------------1847    However, the rollout has not gone as intended. The deployment of1848this new system began in 2020 at Mann-Grandstaff VA Medical Center in1849Spokane, WA, and was almost immediately inundated with issues.\4\1850Several of these issues were severe, such as veteran data being1851migrated to the new system with outdated prescriptions and emergency1852contact information, or dropping prescriptions altogether. Problems1853with further rollout sites led to the program being put on pause in1854April 2023, with one exception allowing for a rollout to the Captain1855James A. Lovell Federal Health Care Center (FHCC) in Chicago, Illinois.1856---------------------------------------------------------------------------1857    \4\ VA OIG Details Continued Deficiencies with VA's EHRM.'' n.d.1858www.meritalk.com. https://www.meritalk.com/articles/va-oig-details-1859continued-deficiencies-with-vas-ehrm/.1860---------------------------------------------------------------------------1861    The American Legion visited the Lovell FHCC in August 2025 to1862review how the facility has adopted and implemented the new electronic1863health record system. The results we saw reflected a marked improvement1864from prior rollout experiences at other locations. Facility staff1865reported zero instances of critical harm, and no veterans' health1866seriously affected due to problems resulting from the rollout. Staff1867further reported that VA had provided ample staff to assist with the1868rollout, complemented by Oracle employees who spent significant time at1869the facility assisting with the process. All the departments with which1870we spoke to reported being generally pleased with the new software, and1871the facility has since been able to return to near-normal staffing1872levels. TAL is hopeful that Lovell FHCC's successes can be duplicated1873in future rollouts.1874    Staff at the Lovell FHCC reported that the software itself has1875significantly improved operations at the facility. Medication ordering1876systems are tied together so, for example, once a pharmacist scans out1877a medicine, the logistics team is immediately informed so that they can1878order more. Tasks take fewer clicks than with the previous system,1879reducing the amount of time to perform routine functions. Total patient1880records from every medical center department are immediately available1881at a single click. These and many more updates to the system help1882Lovell FHCC provide the world-class, modern healthcare that veterans1883have earned.1884    For these successes to be duplicated, it is critical that1885facilities with upcoming rollouts are provided with the same level of1886support, training, and oversight. Specifically, VA and Oracle must1887commit increased facility staffing during rollouts similar to the1888levels provided to Lovell FHCC during the transition. Software changes1889led to planned and unforeseen complications, and the increased staffing1890helped ensure that veteran health and safety was not lost in the1891change-management process. A lack of adequate vendor support from1892Oracle would undermine the VA staff's ability to properly do their1893jobs, potentially risk lives, and any system downtimes could force1894staff to rely on time-consuming paper records, slowing processes to a1895crawl and impacting health and safety. When this happened during1896previous rollouts veterans were directly harmed, including six veteran1897deaths in Spokane, WA.\5\ Lovell FHCC's successful roll-out shows that1898adequate staffing and preparation by the vendor and by VA are necessary1899and will lead to success. The American Legion National Staff routinely1900attends briefings from Oracle to track progress, and we have been1901assured the Millennium EHR deployment at new sites will not face the1902same difficulties and setbacks as at the first six sites. Oracle has1903committed to the necessary investments needed to ensure the deployment1904of the EHR at new sites will be more stable. Also, the system has1905extensive updates, enhancements, and simplifications to improve1906usability. Oracle report targeted EHR optimizations, designed to1907address VA's unique needs in the areas most critical for a successful1908expansion. TAL urges Congress, VA, and Oracle to ensure adequate1909staffing augmentation and robust technical support for all future1910deployments in order to duplicate the successes seen at Lovell FHCC.1911---------------------------------------------------------------------------1912    \5\ Donovan Smith and Desmond Butler, Orion. ``VA Staff Flag1913Dangerous Errors Ahead of New Health Records Expansion.''1914Spokesman.com, December 3, 2025. https://www.spokesman.com/stories/19152025/dec/03/va-staff-flag-dangerous-errors-ahead-of-new-health/.1916---------------------------------------------------------------------------1917    The American Legion's position and outlook on the upcoming EHRM1918rollouts remains positive. The rollout at Lovell FHCC was an overall1919success, but VA and Oracle must heed the important lessons learned1920there and put them to future use. Absent the same level of preparation1921given to Lovell FHCC, future EHR rollouts should not be expected to1922achieve comparable results. Oracle must strengthen all aspects of their1923deployment methodology, with a deliberate emphasis on improving staff1924readiness. Significant improvements must be made in testing and1925aligning Change Management (CM) through increased training and1926communications.1927    Similarly, VAMC leadership must take ownership of the EHR1928deployment at their sites, while continued oversight from Congress and1929stakeholders remains essential, particularly as EHRM rollouts1930accelerate. TAL urges Congress to conduct regular oversight hearings1931with Oracle and VA stakeholders to ensure transparent, ongoing updates1932throughout the deployment process.1933    Chairman Barrett, Ranking Member Budzinski, and distinguished1934members of the subcommittee, The American Legion thanks you for your1935leadership on this matter and for allowing us the opportunity to1936explain the position of our more than 1.5 million members. The American1937Legion stands ready to work with the subcommittee on changes as they1938develop, and we look forward to sharing the feedback we receive from1939our membership. For 106 years, The American Legion has never shied away1940from the responsibility of being a voice for veterans, and we will not1941start now. For additional information regarding this testimony, please1942contact Ms. Bailey Bishop at The American Legion's Legislative Division1943at b.bishop@legion.org.19441945                                 [all]