The 40-year effort to create an interoperable electronic health records (EHR) management system between the Departments of Defense (DOD) and Veterans Affairs (VA) may be close to being resolved.  The latest developments, which include a proposal to move the DOD’s and VA’s joint EHR system to the cloud, should result in greater efficiency and effectiveness for the entire process, as long as some members of Congress who are resisting this idea stay out of the way.

In 2008, Congress directed the two agencies to develop a joint interoperable health record system by September 30, 2009.  By March 2009, DOD and VA managed to share and use certain health information for some servicemembers, including pharmacy and drug allergy data.  The agencies increased the exchange of such data to more than 27,000 patients, an increase of approximately 9,000 patients, between June 2008 and January 2009.  But full interoperability was not achieved.

After several starts and stops to create a new VA EHR, DOD and VA agreed in March 2011 to create a new joint iEHR to be fully implemented by 2017.  After spending more than $1 billion on the new system, the two departments announced on February 5, 2013, they were terminating the program due to its excessive costs. By June 2017, the VA decided to phase out the VistA EHR and adopt DOD’s new system, known as MHS GENESIS, being developed by Cerner.  DOD expected the MHS GENESIS system to be operational at four DOD sites by the end of 2017, and the announcement was a promising step in providing a fully interoperable solution to veterans’ EHR modernization.

A July 8, 2021, VA Office of Inspector General (OIG) report on the Cerner EHR roll-out at Mann-Grandstaff VA Medical Center in Spokane, Washington acknowledged the complexities of implementing an EHR in the largest healthcare system in the U.S.  The OIG noted that the governance structure of the EHR deployment unit did not have representation from the Veterans Health Administration (VHA), which possibly contributed to the failure of clinical training requirements at the facility. 

On June 7, 2022, Cerner was purchased by Oracle for $28.3 billion.   At the July 20, 2022, Senate VA Committee hearing, Oracle Executive Vice President Mike Sicilia, noting that some of the technology in the Cerner EHR system is 20 years old, announced plans to move the Cerner EHR project to a modern, hyperscale cloud data center in the next six to nine months.  He explained that, “While I fully appreciate substantial challenges exist – all of which are legitimate and understandable – the fact is that more is working than is not.  Rollouts to date have been largely successful, and much of the functionality is working.”  He also said that moving to the cloud alone will provide a scalable, modern platform to deliver future releases like mobility and predictive analytics, with built-in security from the start.

Some members of Congress have expressed a desire to end the Oracle-Cerner EHR project, like House VA Committee Ranking Member Mike Bost (R-Ill.).  He said that Congress “has to set a deadline” for the EHR system rollout, and if there isn’t major progress by early next year, “we will have to seriously consider pulling the plug.”  He plans to introduce legislation that could include “reorienting or completely halting the project.”

On August 1, 2022, VA appointed a senior medical leader from VHA, Dr. David Massaro, to lead the VA’s Electronic Health Record Modernization (EHRM) initiative.  Dr. Massaro will help to ensure that clinical issues are addressed in the development and training stages of the project and coordinate modernization across all VA offices to help the VA provide high quality patient care throughout the process.

While congressional angst over the program is understandable, particularly with further delays and increases in cost, with the new management structure at the VA, a new company proposing significant positive changes to the EHR system, and with DoD expected to complete its full deployment of MHS GENESIS by the end of 2023, now is not the time to pull back or cancel the VA EHRM project.  Congress, DOD, and the VA need to buckle down and work with Oracle to ensure their veterans’ healthcare is enabled by effective technology. Afterall, they ARE the mission.