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▶ 0:07:39all right good afternoon the first technology and modernization subcommittee hearing of the 119th Congress will come to order want to thank the witnesses for being here today to discuss the electronic health record modernization program at the VA appreciate your willingness to participate and help in this conversation um before we get to the business of today's hearing I want to First congratulate and welcome my fellow midwesterner representative Nikki bazinsky from Illinois I'm becoming the ranking member of the subcommittee we had a uh a great meeting in
▶ 0:08:09my office a few weeks ago and uh participated in a round table earlier already and really appreciate your partnership in this effort uh your uh position as ranking memb is a testament to your hard work for veterans and the Goodwill you have built with your colleagues on both sides of the aisle and look forward to continuing to build that relationship together our work on this committee will not always be easy but our mission is critical and that's why I'm deeply honored to chair this subcommittee and Lead The house's oversight over va's it systems infrastructure and modernization
▶ 0:08:41projects by way of background I served 22 years in the United States Army before retiring and becoming one of the thousands of veterans in Michigan that received their healthc care and benefits from the VA I personally go to the VA uh uh the Battle Creek VA Medical Center I use the Montgomery GI bill to pay for my my college and I understand what veterans in Michigan and across the country need and expect from the VA I'm going to use my leadership position here to make sure that va's it systems are working for all veterans
▶ 0:09:11and employees of the VA and ultimately making the VA a more effective and efficient organization whether you are making Primary Care appointments filling a disability claim applying for education benefits none of that happens successfully without good reliable and secure it systems perhaps the largest undertaking on this committee will be oversight of the va's electronic health record uh in in the efforts that are going into that today it's the backbone
▶ 0:09:42of va's healthcare operations the electronic health record modernization program is va's Project to replace its homegrown electronic health record system with a commercial off the shelf EHR from Oracle this subcommittee has spent hundreds of hours over the last several years conducting oversight over the program and exposing and reviewing and analyzing its issues and its problems while I'm new to this conversation I spent considerable time looking into
▶ 0:10:12this issue I understand how important it is for us to get this right these consistent problems include system outages patient harm poorly functioning technology budget overruns reduce patient volumes and more because of these problems former secretary mcdna put the program in an indefinite pause in April of 2023 to give VA and Oracle time to fix a long list of problems with the system the secretary decided right before Christmas that VA was going to start
▶ 0:10:42the program up again in the spring 2026 at an arbor Battle Creek Detroit and Sagen in my home state of Michigan two years ago VA told this committee they had a lot of homework to do before they put this system into another Medical Center now VA is getting ready to turn in their homework I appreciate the opportunity to meet with both Oracle and VA several times before this hearing to discuss the problems that have plagued the system for years while I'm not convinced that they have fixed all
▶ 0:11:12of the problems I want to hear today from EA from VA and Oracle directly to this subcommittee that progress has come out of the last two years as the new chairman of this subcommittee I'm going to examine the facts consult my colleagues on this sub committee and make my own judgments based on what progress has been made here are some of the facts as they stand today first VA is nearly 7 years into the original 10-year contract and the Oracle EHR
▶ 0:11:42has been implemented in less than 4% of medical centers second according to latest surveys 69% of users are dissatisfied with the system 75% of users believe the system does not maximize their efficiency I told someone earlier that the approval rating is less than that of Congress and that is a hard thing to do third Congress has not received a schedule nor an up-to-date cost estimate to evaluate this program's current state
▶ 0:12:13the only independent cost estimate we can rely on for what it will cost VA to implement this program is already three years old it was over $32 billion that's more than double va's original estimate of 16.1 billion given the these facts VA needs to demonstrate how this system has improved and explain why this program can succeed before starting up again I have confidence in the Trump Administration and secretary Collins will to write the ship for veterans and their
▶ 0:12:43families and I intend to work closely with him to deliver results is my commitment to this subcommittee and the stakeholders here that I will be firm but fair in the oversight we provide thank you all again for being here today I look forward to your testimony and I look forward to achieving the accountability that all of us should expect with that I yield to ranking member bazinsky for her opening statement thank you very much Mr chairman and I want to start out um
▶ 0:13:13as well congratulating you on your chairmanship of this subcommittee on technology and modernization and to say genuinely how much I look forward to working with you on this issue um you know in addition um I'm working on this issue as a ranking member because I think it is so important that we're ensuring that veterans and VA employees have the access um to state-of-the-art technology that supports the delivery of healthcare and benefits for our veterans um I also want to thank the witnesses for being here today to discuss
▶ 0:13:43the future of ehrm this project um and for coming in a couple of weeks ago to help me get up to speed um on a lot of these issues um we had a robust discussion about the history and the current status of this project which I really appreciated and I look forward to working with all of you to support the progress that has been made to ensure that the ehrm um moves forward in a safe and a Smart Way um in almost two years since the VA announced its reset
▶ 0:14:14of the ehrm program we have worked in a bipartisan and by camera way uh with VA and Oracle to move the needle on this project in December as the chairman mentioned uh VA announced its intention to resume go live activities with the first deployment happening in mid 2026 I want to take this time to outline some of my concerns many of them that I share that the chairman has actually already outlined about the lack of progress being made
▶ 0:14:45um by both VA and Oracle on a series of issues that ultimately impact um our mission here which is to address in the betterment of Veteran health and safety last month VA briefed my staff that there was still dozens of outstanding recommendations from the va's office of the Inspector General and the government accountability office recommendations that VA acknowledged it needs to fix and yet has been as has little been made on progress on those issues
▶ 0:15:16it seems to me that these recommendations need to be addressed before any other goal lives are allowed to occur I hope to hear from VA about how it intends to address these open issues before its planned resumption of go live next summer I think that's important I'm also concerned about the roll out of the 3B bidirectional interface intended to fix major issues with how Oracle supports va's Pharmacy operations I understand that 3B was deployed this weekend but it sounds
▶ 0:15:46like it's suffering from some of the same issues that the system did during its initial go lives the training substandard and behind schedule and staff are concerned that the solutions won't meet their need needs the 3B solution was meant to solve problems that were identified at man grand staff the first site to go live in 2020 yet here we are almost four years later and I'm concerned that this is still not fully ready the lack of these fixes has caused
▶ 0:16:16VA pharmacy to hire additional people and use onerous workarounds to accomplish the same task they did in Vista uh these fixes are desperately needed but they need to be done right and we cannot afford any more half measures also I have some major concerns about how the recent reduction in forces Force actions um at the department are going to impact va's ability to move this project forward I know that secretary Collins says these actions will not impact
▶ 0:16:46veterans access to healthc care and benefits but I don't see how cuts to a historically understaffed VA don't impact veterans and specifically the implementation of this proog this program and our uh look ahead to these go lives potentially in 2026 I have questions about how many people in the ehrm integration office were terminated under the probationary employee Purge how many opted to take the fork in the road and how many others may
▶ 0:17:16have been purged through other methods I also have questions about how the hiring freeze is impacting ehrm I expect the VA has a plan to compensate for these um vacancies in this crucial program and I need to hear about that plan today my biggest concern is we continue overseeing the ehrm program is ensuring that veterans health and safety Remain the top priority throughout this implementation however va's track record has not always aligned with
▶ 0:17:47this commitment also oftentimes prioritizing speed over execution VA rushed into this contract accepting a false assumption that it had to be on the same system to be interop aable with DOD it rushed into system configuration without doing the standardization work needed to make the transition smooth it rushed to go live even though we were in the middle of a pandemic and all the VA staff were already overworked it then rushed to move on from its initial failures VA even allowed DOD
▶ 0:18:17to rush them into another go live just as DOD could finish its Pro just so DOD could finish its project we cannot allow VA to rush into the resumption of goli activities using the same old Playbook they've used up until this point the department must focus on improving their protocols training and efficiency on the front end before hastily implementing another go live I want to say though we should be working toward this go live I'm not I'm not um I have all of these concerns I think it's important they
▶ 0:18:47be articulated but I do want to get to a point where we can see this being successful but I need to hear meaningfully how these concerns are being addressed before we can do this um the focus should be on improving staff training for example to ensure that the tools and skills to be able to use the software most efficiently the focus should be on establishing a structured project management timeline something that I think the chairman has also brought up with benchmarks and deadlines that must be met to push the project to the next step and eventually go live
▶ 0:19:18the focus should be on implementing A system that maximizes efficiency within the VA and allows providers to have seamless communication with other elements of the Care delivery system we quite simply owe it to Veterans and VA employees to ensure that they have the resources and Technology they need for high quality safe and effective care so I look forward to this conversation and thank you very much Mr chairman I yield back thank you ranking member bazinsky and uh I'd like to introduce
▶ 0:19:48our Witnesses from the Department of Veteran Affairs we have Dr Neil Evans acting program executive director of the electronic health record modernization integration office did I get all that right sir all right uh from Oracle we have the honorable SEMA Verma Executive Vice President and general manager of Oracle health and Life Sciences um from the government accountability office we have Miss Carol Harris the director of it and cyber security at GAO and from the office of Inspector General
▶ 0:20:18we have Mr David case the acting Inspector General of vaig um I ask the witnesses to please stand and raise your right hands do you solemnly swear under penalty of perjury that the testimony you about to provide is the truth the whole truth and nothing but the truth thank you and let the record reflect that all Witnesses have answered in the affirmative Dr Evans you are now recognized for five minutes to deliver your opening statement on behalf of
▶ 0:20:49va thank you good afternoon chairman Barrett ranking member binski and distinguished members of the subcommittee I want to thank Congress and this subcommittee for the opportunity to to testify today VA recognizes and appreciates your shared commitment to Veterans and your support for va's electronic health record modernization efforts this testimony comes at a pivotal moment with new leadership at VA there is renewed commitment to ensuring that every aspect of our EHR modernization effort is
▶ 0:21:19re-evaluated secretary Collins made it clear in his confirmation hearing that the status quo is not acceptable every previous decision policy and process must be thoroughly reviewed to ensure that it aligns with our core Mission providing veterans with the highest quality Care through a system that works for them not against them accordingly VA remains committed to implement implementing Modern interoperable Health Information Technologies across the entire VA healthare system the federal EHR
▶ 0:21:49which is the set of Technologies we are deploying through our electronic health record modernization efforts Works in concert with biomedical devices and other critical health information Technologies and these together will serve as key enablers behind va's ability to deliver Comprehensive highquality Health Care to Veterans for many years to come between 2020 and 2022 VA deployed the system at five VA medical centers 22 community- based outpatient centers and 52 remote VA sites
▶ 0:22:20that serve those clinical locations for example call centers telea Health hubs and More in April of 2023 veteran and staff had made it clear that the system was not meeting expectations and with bipartisan support from this committee and consistent with recommendations shared by GAO and oig VA announced a comprehensive program reset cusing further deployments of the system and taking time to address issues that have been identified by users at active sites VA
▶ 0:22:50also identified the reset period as an opportunity to complete foundational Enterprise work necessary for long-term success operating a far more centralized set of Technologies than va's existing electronic health record and finally VA used the reset period to prepare for and then successfully complete a joint VA dood deployment of the federal EHR at the Captain James a level federal health care center in North Chicago Illinois just under a year ago in March of
▶ 0:23:212024 relying on a data-driven approach to assessing progress VA demonstrated improvements in system stability program processes veteran and VA staff experiences and finally Health System outcomes including quality clinical productivity and revenue management and in light of that demonstrated progress on December 20th of 2024 VA announced that it was going to restart Federal EHR deployment efforts initially at the four aforementioned Michigan facilities in Ann Arbor Battle Creek
▶ 0:23:52Detroit and Sagal I should add this VA acknowledges that there's is still improvement work to be done as you will likely hear from GAO and oig and we agree Improvement efforts are not stopping we are simply in addition to those Improvement efforts resuming deployment work in parallel examples of ongoing Improvement efforts include migration of the system to oracle's Cloud infrastructure for improved performance
▶ 0:24:23of the system and access to oracle's Next Generation Technologies establishment of an Federal EHR system Baseline and Associated processes which is a critically necessary step in support of improved standardization across VA which will help lessen staff frustration development delays deployment delays I'm sorry and cost further training improvements to better support user adoption standardization and consolidation of user roles in the system which will simplify training
▶ 0:24:53and everyday use of the system for VA staff completion of crosscutting project projects that we've called Big Rocks which include reassessing system design choices in order to deliver a better and more efficient user experience and there's much more meanwhile current state reviews the initial activities necessary to deploy the federal EHR have been in progress at the Michigan sites mentioned earlier since the first week of January and those are going well we're also working closely
▶ 0:25:23with VHA Health System leaders and with Oracle Health to determine deployment plans beyond the the Michigan sites these decisions will support the iterative development of a revised integrated master schedule in addition to updated cost estimates for this project through the leadership through the efforts of recent program re of the recent through the efforts of the recent program reset and through our collaboration within VA with our end users with leadership and with veterans and outside of va with DOD firm
▶ 0:25:54oversight bodies and our vendor Partners we are seeing movement yes even momentum in the right direction by sustaining these efforts our velocity should increase over time VA remains optimistic to realize the successful implementation of the federal EHR across VA and I appreciate this opportunity to testify and um am thankful for this committee uh for your commitment to serving veterans and look forward to working with you over the course of the 119th Congress um we look
▶ 0:26:24forward to responding to any questions you might have thank you Dr Evans the written statement of Dr Evans will be entered into the hearing record Miss FMA you're are now recognized for five minutes toiv your opening statement on behalf of Oracle members of the subcommittee thank you for the opportunity to speak with you today the va's EHR modernization program is at a turning point As We Begin work to restart deployments in Michigan the preparation will take
▶ 0:26:54place this year with the deployments occurring in early 2026 I say turning point because we have several factors that have come into alignment first a new Administration that is committed to accelerating second we have completed countless optimizations and improvements including with Pharmacy just this weekend that have improved productivity and are trending user satisfaction in the right direction third Oracle is making a number of Investments to make implementations go faster and smoother improving
▶ 0:27:25training and support while also investing in modern ganization of the EHR to provide a state-of-the-art experience for providers and fourth Oracle is migrating ba to our Cloud to unlock a slew of new technologies that VA can take advantage of while enhancing cyber security we believe the program is ready to accelerate deployments in 2026 we are working closely with secretary Collins Dr Evans and the VA team to figure out the right pace of deployments timing and schedule
▶ 0:27:55even meeting at the VA just a few hours ago as the committee considers the path forward I think the most important thing to recognize is that the program and the EHR deployed at the first five sites is in a vastly different state than it was nearly three years ago before Oracle acquired Cerner there have been many changes to address the challenges of the past my written testimony details perhaps painfully for those of you that read it all the way through the amount of change that Oracle has brought to the program
▶ 0:28:26it performs reliably without severe outages or frustrating crashes for users it has had more than 3,000 functional changes made during the reset to make the EHR easier to use simplify workflows and enhance functions like Pharmacy training has been overhauled the new training program worked very well and received High marks from the employees at leville federal health care center in Chicago when it successfully went live last year Revenue Collections and productivity are returning and in some cases even exceeding baselines
▶ 0:28:56from predeployment averages patient safety continues to be a top focus and we have instituted several new procedures with VA to make sure safety is always at the Forefront user filing tickets with potential patient safety concerns have dropped 80% since our acquisition of Cerner the EHR has new opioid tools Registries and clinical decision support tools that enable greater patient safety close care gaps and help improve outcomes finally
▶ 0:29:27when veterans receive care in the community their health records can be accessed by Community Care Providers and updated to ensure VA providers have a complete view of the Care received outside the VA system now there are still challenges and work that we will continue to do to improve the system to address the va's unique needs we expect the same of VA in terms of focusing on standardization quick decision- making and displaying a strong commitment to adopting the new eh all of this work will continue in
▶ 0:29:57parallel while while we prepare for the next round of deployments and none of the optimization work should slow us down looking into the future as we move this system to the Oracle Cloud we will have the ability to bring even more modern features to the EHR and eventually upgrade it to our new cloud-based EHR infused with AI The Narrative about this program is largely negative we understand that first impressions last and the first impression in Spokane and the other initial sites was not
▶ 0:30:27good but we are not Cerner that deployed at those sites the totality of updates enhancements Investments and Innovations to the EHR show that this is a dramatically improved system from what was originally deployed in Spokane in 2020 we are encouraged that everyone involved wants to see this program on a path to success or get it back on course as chairman boss and others have said because I know we all agree that those who have made sacrifices for all of us deserve modern technology
▶ 0:30:58to help make their experiences at the VA more efficient safe smooth and ultimately Aid the providers that serve them in delivering highquality care that improves the health of veterans Oracle stands ready and committed to getting this done on behalf of our nation's veterans thank you thank you Miss Verma the written statement of Miss Verma will be entered into the hearing record Mr casee you are now recognized for 5 minutes toiv your opening statement on
▶ 0:31:28behalf of oig chairman Barrett ranking member binski and subcommittee members thank you for the opportunity to discuss the oig's oversight of ehrm since April 2020 we have published 22 reports on va's modernization program more than half uncovered significant patient safety concerns such as problem with medication management Pharmacy operations and patient care coordination the others identified deficiencies in program and contract management
▶ 0:31:59including poor cost estimating and Reporting we have remained focused on ehrm during va's reset because an updated EHR has a central role in providing highquality Health Care to Veterans I want to discuss four main unresolved issues previously identified by oig teams that VA should address as it emerges from reset to the next wave of EHR deployments first while VA has addressed many oig identified patient safety issues more work work is needed to ensure
▶ 0:32:29that the Veteran's experience with a new eh fulfills its promise of timely access to seamless highquality care for example the new EHR has had serious issues with handling scheduling changes and missed appointments this includes VHA allowing mental health staff at new EHR sites to make fewer attempts to contact no- show patients compared to Legacy sites creating a different standard of care between sites VHA should address barriers created by software deficiencies
▶ 0:32:59without compromising patient care and engagement standards second in February 2024 I testified to this subcommittee about Pharmacy related patient safety issues facing every VHA provider while VA has made progress on some aspects of the pharmacy program critical issues remain unresolved for the foreseeable future Legacy EHR site leaders must have providers perform manual medication safety checks for patients who have received Care at a new e our site due to concerns
▶ 0:33:29with the automated process these manual safety checks are timec consuming and rely on the vigilance of pharmacist and Frontline staff facilities using the new EHR require greater numbers of staff and supplemental resources to manage the significant drop of productivity third it is essential that the new EHR system be consistently accessible in September 2024 the oig found that VA procedures lack sufficient controls to prevent resp respond to and mitigate Major Performance
▶ 0:34:00incidents while we recognize VA has improved system reliability there are still incidents occurring every month given the stresses the system will likely experience during the next deployments in larger facilities VA must be ready to handle any future instability and equip providers with the tools to continue working when the system is degraded or inoperative finally VA must develop and maintain an integrated master schedule to clearly track and project the program's cost cost to completion the 2026
▶ 0:34:30deployments are on a much larger scale with a greater number of variables and tasks to plan and execute also va's ability to train staff and resolve requests for help may be challenged additionally there may be many developments over the next year that could affect the schedule costs or the veteran and provider experience a reliable master schedule will enable VA to be fully transparent with Congress and their stakeholders about what needs to happen for the successful role out of the new EHR in Michigan and other
▶ 0:35:00sites Nationwide our recommendations on the integrated master schedule and project costs have been open for several years paused essentially because of va's reset given the restart VA should get them done without them costs will be uncertain risks may be not be mitigated and efficiencies could be lost as tasks dependent on other actions are not fully considered in conclusion ehrm success is dependent on va's transparency careful planning
▶ 0:35:31and the recognition and Remediation of patient safety issues updating the EHR is critical for vha's ability to deliver Health Care in the future and the oig will continue to focus our resources to provide VA with timely recommendations that help that can help them and Congress ensure this transition succeeds chairman Barett this concludes my statement I would be happy to answer any questions you or other members may have thank you Mr casee and the written
▶ 0:36:01statement for Mr casee will be entered into the hearing record and now we will go to Miss Harris and you are now recognized for five minutes for your statement thank you chairman Barrett ranking member binski and members of the subcommittee thank you for inviting us to testify today on the ehrm program this is va's fourth attempt at replacing its Legacy electronic health record system as requested I'll Briefly summarize our recent work on va's progress to implement the system and the challenges it faces moving forward as
▶ 0:36:31you know VA provides healthc care services to roughly 9 million veterans and their families and relies on the Legacy system called Vista to do so in June 2017 the department initiated the ehrm program to replace Vista and deployed the new system to six of its medical centers at a cost of about 12.7 billion the roll out of the system has been met with poor user satisfaction change management issues and slow resolution of trouble tickets among other things given the magnitude of user
▶ 0:37:01concerns VA pause deployment in April 2023 to improve the system and address concerns and on December 20th 2024 VA announced it would resume deployments to four Michigan sites in mid 2026 and this afternoon I'll highlight four key points from our work first VA lacks a strategic roadmap to get ehrm where it needs to go during the 20-month deployment pause it's a significant part of of va's improvement efforts focused on the more than 1500 system configuration changes
▶ 0:37:32needed to support user needs and standardized workflows VA also closed many of its highest priority patient safety enhancement requests these are all important accomplishments but there are still about 1,800 complex configuration changes and a number of user-driven projects that need to be completed for example referral management lacks functionality and intuitiveness for users and VA will be working to simplify the existing process and standardized referrals across the Enterprise and all this is to say
▶ 0:38:02that VA has been in reactive mode during this reset period putting out fires with no real plan for how to move forward strategically two pieces of information needed to inform such a plan are the cost and schedule estimates and this leads to my second point that unfortunately Congress and VA senior leaders are relying on estimates that are severely outdated and incomplete existing cost estimates range from VA 16 .
▶ 0:38:271 billion to an independent one of almost 50 billion and while the latter is more realistic neither reflects the many changes and delays to the program also planned system deployment at four additional sites results in about 94% of va's Total Medical Centers without the new system as of mid 2026 with two years left on the Oracle Cerner contract it is vitally important that VA update these estimates to inform decision-making another key piece of information needed to inform form
▶ 0:38:57a strategic road map is the results of an independent operational assessment or an ivnv test which we recommended VA 2023 an ivnv is an evaluation of the system end to end to determine whether the system is operationally suitable so in other words it systematically cataloges these deficiencies of the system and answers the question of whether or not the system will realistically meet Mission need this this test is considered an IT best practice and one of the reasons why by DOD
▶ 0:39:28was able to successfully deploy the Oracle cner system and now to my final Point va's user surveys continue to reflect General dissatisfaction with the system as of September 2024 about 70% of respondents were not satisfied with the system about half continued to disagree or strongly disagree that the system enabled them to deliver highquality care 75% disagreed or strongly disagreed that the system made them as efficient as possible and while there was a slight
▶ 0:39:58uptick in satisfaction compared to 2022 these numbers are still just too low moving forward it will be critical for VA to address these issues along with our other open eight recommendations as soon as possible doing so will position VA to more effectively deliver a modern health record system our veterans deserve and that concludes my statement I look forward to addressing your questions thank you Miss Harris the written statement of Miss Harris will be entered into the hearing record
▶ 0:40:29we'll now proceed to questioning and I recognize myself for 5 minutes um Miss Harris thank you uh again for your uh testimony and uh given all that's happened with this program since its last cost estimate in 2022 I know you mentioned this in your uh opening remarks but can Congress rely on the estimate of 32.7 billion over 13 years to fully me implement the Oracle EHR at VA and if not
▶ 0:40:59why not no Congress cannot reliably rely on this this estimates um there have been too many changes to the program there obviously was this program reset over a two-year period with additional work being done and none of that has been accounted for within the cost estimate so that estimate needs to be updated before we proceed because again when you take a look at how much has been sunk 12.7 billion already and we've only deployed to six sites you know if you were to just um multiply that across the
▶ 0:41:2994% of of medical centers that have not had the simp system I mean that could be in the hundreds of billions of dollars potentially thank you um uh second question for you GAO has been publishing reports about the ehrm program and making recommendations to VA on how to improve it since 2020 you've been involved in each of those uh how many recommendations have you made how many have been resolved I know you said there's number that are outstanding um but can you give us an update
▶ 0:41:59on the number of recommendations versus those that have been resolved so far so we've made a total of 15 recommendations in our previous work we have an additional three that we have with a draft report that's out for comment at VA at this time so that would be a total of 18 recommendations of those 18 one has been implemented which one was that and that one was related to I believe um data migration okay thank you um your most recent report said that the program has made incremental
▶ 0:42:30improvements but there's much more work to be done um can you is that related to those recommendations or do you have other thoughts on the incremental improvements that have been made I mean the incremental improvements have been related to those system configurations that VA has completed so roughly 1,500 complex configuration changes and I know that there have been more um that are not complex but that that have been made during this reset period but there's still a significant number of configuration
▶ 0:43:00changes that need to be made in addition to these user driven projects um that those are still outstanding um that need to be completed um before the the deployment um at Michigan in mid 2026 um I know you mentioned the um what I would cons consider lack of satisfaction or the um uh reports as they survey those that are interfacing with the system um anywhere from low 70s
▶ 0:43:31to low 80s are seemingly frustrated or or feel like the system isn't meeting their needs or obligations or desires um do you have any information as far as like an industry standard outside of government or in other Health Systems as far as the satisfaction among U folks with electronic health record systems we do have that information I don't have that with me at this time but I'm happy to to work with your staff in providing that but I do believe that the industry
▶ 0:44:01numbers for the Oracle Cerner system um it's higher than what we're seeing at VA and at DOD the the numbers are a little bit higher than V VA but but overall that they're not they're not super high compared to to others is my understanding okay thank you um in your opinion does va have a complete understanding of all the problems with the system and do they have a plan to resolve them I don't believe they have a complete understanding of all the of all the issues and
▶ 0:44:31that's why this IV andv test is so critical because it's a systematic look at the system once it's in the live environment and so when it's deployed then the testers going and they observe the users actually use the system from an end to-end perspective they catalog all those issues and that would be um you know a way for for VA to identify the comprehensive list of issues and then to prioritize from there so they have not done that they've done
▶ 0:45:02pieces of of those types of tests but not from an end to end perspective and quickly I only have about 30 seconds left how um I know it's the position of VA and Oracle that well we've got this in a live environment so we don't need that that end to-end review what would you say to that position that they seem to feel is testing it in a live environment I mean I would disagree with that it's an IT best practice it's also something that DOD did when they deployed their Oracle Cerner system and it was one of the
▶ 0:45:32reasons why they were able to successfully deploy okay thank you I'd now like to recognize ranking members bazinsky for your questions thank you Mr chairman um I had mentioned this in my opening I'm I am concerned about any potential impacts with the recent announcements of some of the position the workforce cuts to the VA um is that going to then imple affect the implementation or the go lives that we have coming up with the ehrm system
▶ 0:46:02so I think my questions are really for Dr Evans in this first round um did you lose anyone in the probationary um in the probationary employee Purge and if so how many um yes we did lose several employees um in the um with regard to folks who were let go who were in their probationary period I believe the number currently is eight eight okay and then how many people in the ehrm integration
▶ 0:46:32office um took advantage of the the fork in the road email that was sent U so 16 staff members um signed up for the Deferred resignation program okay and then how many vacancies did you have before these Cuts started our organizational chart is approved for approximately 330 staff and we're at approximately 250 50 okay and so based on that um can you kind of speak to how confident
▶ 0:47:03you are that you can move forward successfully with these Staffing changes or how does that impact um how you're looking at the potential for success for our next round of go lives yeah um so I think I'd start by saying first of all um this is a priority this as I mean as we've heard here in the room today our successful implementation of the federal EHR cross vaa is a priority of of the VA and is certainly a priority of current
▶ 0:47:33VA leadership um I it is important to recognize that it is not just the government staff of the electronic health record modernization integration office who are going to be the folks who actually make this happen I am super proud of every one of them and the work that they are doing uh to move this program forward they have been putting in a tremendous amount of effort over the reset and now as we are getting restarted in Michigan and Beyond
▶ 0:48:03they're doing a tremendous amount of work we also rely on staff from the veterans Health Administration from the office of Information Technology from several of our vendor Partners who work alongside of us and really across in the field at the visin right it takes many many more than the folks in the program office uh to successfully implement the EHR okay thank you um my next set of questions is really focused around the restart that was put into place and then obviously this recent news about
▶ 0:48:33going live with some sites in Michigan and mid 2026 um my question just to start again with Dr Evans is just can you talk a little bit about how confident you are um given what you've shared and and what has already really been shared with the panel that the VA and Oracle are ready to deploy this system and that we we will not hear the same concerns that the first six sites raised yeah I um I think uh good
▶ 0:49:04program management and sort of a realistic approach to implementing I mean this is I I think we should step back and and recognize that this is a really complex transformative change we are changing effectively all of the information technologies that support healthc care delivery at our sites um I feel confident that we are in a much better place um and completely agree with uh the fact that what we are deploying the product
▶ 0:49:34we are going to be deploying in Michigan the set of Technologies and how they are configured to meet va's needs that is it is an entirely different set is very different than it was with the initial sites and so I do feel confident uh that we are entering Michigan Having learned a lot having listened to our end users U but that does mean that we can let up one bit with regard to our vigilance of how do we deliver with excellence in Michigan so I think U maybe
▶ 0:50:04drilling down a little bit more like are there metrics that you're using that give you the confidence to say that yes we established a set of metrics um that we Ed to demonstrate our progress during the reset they were looking in four categories one was essentially how stable the system was the technical stability of the system the second category was looking at metrics um around the program processes that we use to support end users how well
▶ 0:50:34are we supporting the need for Change and for adjustment to the system and support for our end users the third um was around the veteran and um VA staff experience um around a host of ofli of pieces of the application and the fourth was around the actual impact of the system on Health System operations our Revenue collections uh healthc Care Quality Etc we've been tracking those metrics through the reset and we will continue to track them as we move forward I'm run
▶ 0:51:04out of time so I yield back I have other questions sure thank you and we'll do another round after this uh Mr Latrell thank you Mr chairman Miss Harris you look like you want to respond to that what Dr Evans just laid out for us sure I mean I there there's been a tremendous amount of work that was done during the program reset period um there's no out about that there a lot of very important accomplishments but at the same time there's still a very large amount of work that needs to be completed with regard
▶ 0:51:35to the continued um changes to the system the the configuration changes as well as these user-driven projects that in combination with what they are doing in parallel which is getting these four sites ready uh to go live I mean that's going to take a tremendous amount of resources we know within like the fhcc for example in Chicago that um that there were some resources that were redirected from that system work to get the sites ready so our concern is
▶ 0:52:05in the absence of a a an integrated schedule as Mr Case has been talking about um as well as a cost estimate to really know what it's going to take to get to that go live um it's just a big unknown thank you m m Dr ens why didn't the VA conduct an ID idv test or assessment idv yes an ivnv thank you um I think considering it it it worked for the dod I'm curious why
▶ 0:52:35yeah it's a good question um I first of all I I think we've spent we've had a lot of attention in a very similar fashion to what an ivnv test would do um with our um and frankly staff from oracal Health spending a considerable amount of time on the ground around at our life sites observing workflows from end to end and categorizing where the issues are and those issues are the change
▶ 0:53:05requests that we have been working through during the reset and you heard of the fact that there are 1,00 still that we are working through at the moment um those are the change requests that have with that assessment have problem solved instead of doing it the way that we did conduct it I only asked that because we failed miserably would that assessment have solved that problem I mean I don't think that it would because we're help me out with the numbers here
▶ 0:53:36on A10 billion project we're 12 and a half into it projected to go to 50 billion so here's what I would say is I think that with regard to identifying the issues that we need to fix I think we have had an awful lot of help from our end users and frankly from our staff in identifying what those issues are that we need to fix I would welcome a third-party assessment of what additional issues might be discovered but I don't think we're
▶ 0:54:06going to find a a a significant set of surprise issues that we're not yet aware of I would imagine there's a whole laundry list of them considering what the oig just said Miss verman how long have you been in your position I've been in my position for about a year of course so CNA Oro bought this project from CNA or it's the best way to say that correct Oracle acquired acquired it and I'm sure they were very well aware of the problematic issues that existed inside the EHR we've
▶ 0:54:36gotten more fully acquainted with those yes I'm sure you are considering where we where we stand today what is your give me because you said update costs I'm curious what what is Oracle projecting the cost of activating the EHR not in 2026 but Downstream and all 172 facilities plus the satellite campuses you and not spoke about Dr whenever things up and running what are we going with considering we're well over our original budget so agree you know just from a taxpayer perspective and former government
▶ 0:55:06official sort of understand the need to really be very careful with how we're using resources and so just a couple of numbers I heard the the 50 billion dollar estimate I think that's an outside group that we haven't validated so we don't agree with that that estimate um you can't say you disagree with 50 billion and it cost 49 agree but I don't think it needs to go to that level I think there's a lot of opportunities for us to figure out how to run this program more efficiently the other thing I would say is that out of the um10 billion Oracle
▶ 0:55:36receive $5 billion so you there's some of the other estimates not all of that has gone to Oracle I do think that the way to make sure that we're using taxpayer dollars efficiently there's a couple of different things that we can do accelerating is really important um the longer the program goes on the more that it's going to cost there's also opportunities even things around standardization like we've heard a lot of discussion about that but when we standardize we also reduce the number of um additional configurations um
▶ 0:56:07even if we can get done some of the work around optimization that also will decrease some of the later on some of the additional work that happens um integ Sor M I apologize Mr chairman I don't are we doing okay forgive me I'll Circle back with you thank you Mr chairman thank you I've recognized myself again um Dr Evans ivnv you said essentially not to paraphrase what you said but more or less that your users have accounted for what that would
▶ 0:56:37do by utilizing the system and providing change requests to that to me not being an IT professional that sounds a lot like we're going to put it out there and even though we know it's not fully operating properly we're just going to wait for people to tell us where it's broken and wait for to then roll in for the fixes that do that if we had planned this from the beginning and done that thorough analysis that Miss Harris had described would it have that
▶ 0:57:08need for so many changes they are now backlogging the system that are putting us in the position of delay that we're in currently um I think so a couple things right when we look at the dod's experience deploying the EHR they had a very similar experience so though they did complete an operational test an OT exercise to determine the suitability of the system they did not do that until after it was already in production and was being used at
▶ 0:57:38several sites when they were having very very similar problems to va's initial problems um I I think we so that's Point number one point number two I completely agree with you right end users are one piece of the puzzle but bringing experts in who can um and observe and provide insights that and end user themselves might not be able to um sort of provide from the Foxhole in which they are um
▶ 0:58:08is valuable but we've been able to do that with experts from the program office from our Council uh experts at the national level in VA from Oracle Health uh from our research Community who has very uh carefully studied different parts of uh of our implementation so again I think we have learned quite a lot not just from enduser reports but also from external bodies who have looked at our implementation okay M Verma you said
▶ 0:58:38that you know a big portion of reducing costs is accelerating the implementation of this program and while I I suppose I agree with you that from a strictly cost standpoint if we were to just implement this everywhere maybe we could save some money but I don't think that you would have the confidence of this committee I'm not going to speak for the other members but C from my own perspective given the track record that's been out there so far asking us to endorse the idea of accelerating this when it has not proven to be adequate and that's putting it in the
▶ 0:59:08most diplomatic way I can what can you give us to reassure this committee that in fact accelerating is the appropriate thing to do when we are you know the last time we implemented this we had to go into an immediate freeze because it was so implemented so I think we're in a different place than where we were five years ago and even just the last 18 months if we look at the track record even in respects to to testing and and independent evaluation right if we look
▶ 0:59:38at the go live in um Chicago that that has gone well if we look at even this weekend I know time will tell um we'll get a better sense of the impact on our providers but I think if we just look at sort of in the recent history that that we've actually seen some good successful to wouldn't you agree that the go live in Chicago was done with a significant assist from the Department of Defense working in that regard as a spotter on the weight bench if you will I think that the the dod certainly
▶ 1:00:09helped but the the VA was there the VA LED that and I think there were a lot of lessons learned that will help them also take some of those lessons in in going forward there's still a lot of if we look at the history in terms of the impact that it's had I mean even on productivity there's some places where we've actually increased productivity in some places um we've also seen some of the the work that we're getting in terms of closing care gaps um some of the new tools that we've been able to provide for providers on the front lines that have actually helped them deliver
▶ 1:00:39more Safe Care in terms of um opioids for example um the clinical decision support so those are things that I think are definitely helping I I and I heard that in your opening remarks and I appreciate the the focus on that but I'm curious why you know we don't have to Mr case's point we don't of a standardized schedule as to when this is going to be implemented um to miss Harris's point we don't have that endtoend review and Analysis of what are the where the pitfalls and gaps are and if the answer is to go faster I don't
▶ 1:01:09think that a reasonable person would view that that is the most appropriate thing and I'm I guess with 15 seconds left how can you reassure us that that would be the case look we're committed to making sure that this works I think the history shows the recent history that things have improved the VA is paying for host in they're paying for a lot of things that they're not using and so if we look at where we've been just over the last 12 months I think things have started to turn around they have started to go well and so you know we're committed to getting the optimization work
▶ 1:01:39done as well as in parallel trying to advance some of the work in terms of of going forward at these other sites our version of what good looks like might be out of sync with one another but I'll be curious to to ask more but I want to recognize um ranking member bazinsky again for five minutes yeah thank you very much and I actually want to just kind of build on what you were talking about about accelerated deployment um what would it take for Oracle in the VA to be able to accomplish that if you could kind of further
▶ 1:02:09both Dr Evans and um Miss FMA if you could elaborate on that I think from my perspective one of the biggest things that we need to do is standardize right if we get to a sort of a standard set of configurations that's going to really help a lot I I I know you've said that a lot to interrupt you but I just I think one of the things that I've come to understand and and appreciate in some ways about the VA is every Clinic is different every cbox every and every you know and and the uniqueness of it that's a is that a bigger challenge within
▶ 1:02:39the VA than it is perhaps with the dod when you say standardization if we think about the original goals of the program right was to create a standard some standardization so that when U veterans go into one site they're getting a similar level of care a similar quality a similar standard of care and in order to do that we need to make sure we're all operating in the same way and that starts with having the you know the it configured in a way that is standard so that I think that in it of itself will create a lot of
▶ 1:03:10optimization even if we think about a lot of the configurations and a lot of the different requests because I think there is the expectation that we're going to do this in a bespoke way and that's actually contributing to uh more complexity and increased costs and increase difficulties with training and support if you're doing something different at every site and so you know when I say that I think we can go faster that is predicated on having standardization that is key to be able to go forward into it's not and I obviously I believe in this program so I think that I
▶ 1:03:40believe in the standardization concept that's what we're moving toward but I'm more asking you the unique challenges within the VA to moving to something that's standardized that is something a little different than the dod yeah I think one of the things that um and we've talked about this and been working on that is how can we you know do give more support to the providers on the front lines making sure that they have adequate training um I think that um the work that we did in Chicago was a good example of that not only did they have a lot of training in
▶ 1:04:10advance they also did elbow to Elbow training so that when it went live there were people circulating there that could give them support and that's not something that should just happen on the first day or the first three days right it still may take about you know even a month later um we find that a lot of the requ requests and a lot of the changes that people are requesting sometimes those are rooted in they may not understand how to use the system and if we actually give them more support and more training that they actually aren't going to um request a change in the actual system so I think that's
▶ 1:04:40also in piece of it the standardization and more support more training okay Dr Evans yeah I think um and I think the original question that you asked was how do we feel confident about the ability to accelerate what does that look like I think I'd start my remarks by saying that I just want to I mentioned it in my opening statement but I'd like to underline it VA is and agrees with the recommendation that we do need a revised integrated master schedule and a life cycle
▶ 1:05:10cost estimate regarding this program 100% agree and when we made the decision to start our work in Michigan we made that decision very explicitly we spoke to this committee about that decision to say we are making a decision to start moving towards Michigan with the understanding that we need to in parallel be working on the schedule the integrated master schedule for what things look like to get to Michigan what things look like to get to the sites thereafter to the end of
▶ 1:05:40this current contract and to the end of our delivery so we agree and are working on the schedule and I would and I think you know one of the things that I sense that you're trying to get at which I would very strongly agree is that the details matter when it mean when when when it comes to executing a complex project like this The Details Matter and that's what we capture in an integrated master schedule um we are at a very different spot in
▶ 1:06:10the program than when this program began many years ago and so sort of snapping the chalk line and starting to build that schedule iteratively uh we have heard that recommendation from both Joo and oig and we will do it that's great was going to be when my next question is getting that schedule it's great to hear that that's something you'd be open to just because I have only a few tens of just a few seconds left can I ask you really quick quickly Dr Evans about the 3B Pharmacy solution and that that was rolled out I know we've talked very briefly
▶ 1:06:41about it but can you generally just say how did it go this weekend uh it was rolled out this weekend the um the block upgrade which is twice a year we introduced significant software um upgrades to the federal EHR that occurs in February and August every year this block upgrade runs from the 21st to the 28th the go the the much of it was implemented over the weekend um there were a few small um issues addressed this morning but overall um it's a little too early to tell but it seems
▶ 1:07:11like things are going well with regard to 3B thank you Mr that's curious to hear what you just said about the pharmacy because Miss verman said it was going great which is it kind of works in Conflict here I my can you elaborate a little bit more Mr Evans on how that Pharmacy when it was activated this weekend because I'm going to go back to miss Verma because again
▶ 1:07:41I want to kind of unpack the suitcase on this sure um I think probably as you and the committee are aware it's been a long journey to deliver this particular Improvement when we first went live with the pharmacy um capabilities to support VA and again remember Pharmacy operations in VA are a little bit different than in a typical commercial Healthcare environment VA runs both the healthc care delivery organization as well as the pharmacy fulfillment organization both the pharmacy
▶ 1:08:11that's dispensing the medication and the providers and staff who are ordering those medications as we deployed pharmacy at the original sites the pharmacy Community came and identified initially a set of seven issues that they said were abs absolutely critical for us to deliver before we went live at a level one high complexity site of those seven uh capabilities one of them happened to be numbered three and proved the most challenging um we had hoped to have that delivered uh last February there were
▶ 1:08:42some issues with it and there's been a lot of work including a a very different approach to how we did development and testing and evaluation of 3B to get it delivered this week uh I just you know in the interest just of full transparency as with any we appreciate transparency yeah in in with any it go live when something hits the light of day you might find something you that you you may have done absolutely extensive testing and there may be some small issue that you identify which has been
▶ 1:09:12quickly fixed this morning and so that's what I'm talking about I would say overall it is great I would agree that it is great that we are live with 3B now and that we are going to be able to see how that works in the real world over the next week in the following weeks and that is good news M verman I know you you're representing your your company and and you're giving us a kind of a grandiose expectations of the that is currently happening um but we're in the
▶ 1:09:42basement we're in the basement we're at bot we're Rock bot we actually failed totally because we're in the pause can you give me a statistical probability of success in the next two years from Oracle because if it doesn't if it's not successful the only person that's going to be sitting here taking the punches is him but I want to hear from you in Oracle if you think where we I need to hear this out loud where we are currently when we go live in 26
▶ 1:10:12and then running in parallel with other facilities correct Mr Evans is that how you explain that to me in my office is that going to work listen we're we're committed to doing everything that we can right I I can't everybody says that that doesn't have a plan right well I think we do have a plan we've talked about a number of optimization projects that need to get done we're talking about how we Implement in Michigan we're going back and looking at Lessons Learned and how we can implement it in a way that supports end users with better training
▶ 1:10:42with better support so you're highly confident Michigan's going to fire up successfully I'm I'm confident yes give me a give me a I'm not going to give you a specific a specific number but I feel pretty confident about better than 50 I think it's going to be better than where I think we're going to be building on all the improvements that we have had over the you know with the optimization work and some of the Lessons Learned in terms of training we're also putting in a lot of time and effort to figure out how can we figure out how to optimize and how to make these go in a more smooth way so
▶ 1:11:13we're also building on a lot of the experience that we've had a lot of the challenges that we Face we've actually learn from those and so we feel comfortable going forward and that that this is going to be better and and I will say this if we just look back right in the recent if we just look at Chicago that has gone well right and that's the only implementation that was done by Oracle that has gone well and if we look at these recent code block releases this isn't the only one that we've done we've actually done several right we did one in August we did one
▶ 1:11:43last year and we've seen that those have gone smoothly and so if those hadn't gone smoothly I could understand that there would be some concern but if we look at in the last you know in the last year right um Chicago has gone well all of the last two to three code block releases that we've gone have gone fairly seamlessly yes there's little you know little bumps and things like that that we've been able to get through and they have gone largely successfully so if we look at the recent past and the turnaround in terms of orle coming in stabilizing the system
▶ 1:12:13a lot of the problems that we've had have been addressed the stability has been addressed we've been able to do a good go live and we've also been able to upgrade the system in several different areas successfully so those areas that's why I feel confident that our next go lives will go well and that we are capable of accelerating thank you Mr chairman I you back thank you sir um I will recognize myself again um so coming to Michigan 2026
▶ 1:12:44uh we have um level 1A complex facilities right an arbor in Detroit correct have any of these been rolled out in complex facilities up till now I can start with that so um the James level Federal Healthcare Center in North Chicago is a level one facility okay um so the short answer to that question is yes um I think I'll further answer your question that I'm very very impressed with the leadership teams at all four
▶ 1:13:14sites in Michigan I've met personally with each of them as we're getting things kicked off um and in part in answer to Mr latrell's question as well one of the levels of confidence that I feel in Michigan again is this is as much about it implementation whether the software works as it is the sort of personal and human sort of all of the staff at Michigan adopting getting used to working through the change of adopting this new system and uh I'm you know very
▶ 1:13:44uh proud of the work that the teams in Michigan are doing to prepare I think that should also sort of raise our level of confidence of success there okay what are Dr Evans what are some of the in complete big rock projects that you described in your remarks earlier right um one of those is an example of one of those is what we call position standardization uh the way the Oracle health record or what we call the federal EHR works is a user depending on what type of user they are
▶ 1:14:14has a different experience in the software uh so whether they're a social worker primary care provider a rheumatologist an endocrinologist which type of physician nurse Etc and more than 300 different roles configured into the system we've learned at our sites that um we there were probably too many roles that were chosen by VA when we started down this path um and have been consolidating and standardizing what can be done in those roles so we
▶ 1:14:45just completed um standardizing the roles for advanced practice registered nurses geriatric and extended care providers and social workers and took what had been 28 roles that's 28 different training programs 28 different sets of software capabilities to maintain and compressed them down to six and we're now starting with the nursing roles uh RNs and LPN there are more than 50 nursing roles and we anticipate compressing them down quite a bit again as we reduce complexity
▶ 1:15:15it will improve the sort of the efficiency of training and the user experience as well that's a that's a that's a an example of one that's very very important that are tracking towards making very significant progress towards prior to the Michigan GoLive okay are there any remaining big rocks that are showstoppers that if they're not done it will inhibit the ability to roll this out at the next phase in in Michigan no I wouldn't say that they are showstoppers okay um do you feel
▶ 1:15:46um right now I guess I can ask Miss FMA this is the system ready to go live today in Michigan if we want to like do you have confidence that we could do this right now if we chose to that's for you miss Verma oh I'm sorry Dr Evans um I'd say a couple of things right so if we look at the system that we have today we're making changes we're doing optimizations
▶ 1:16:17I think that this year we should continue to do that work around optimizations and so that when we do Implement with Michigan next year which is what we're slated to do that that will go well so and it'll and it should go better than the initial five because we will have identified what those optimizations are and what those need to be and so if we Implement those years those now that that will make Michigan go better next year so going back to when the initial roll out happened the number of facilities we've rolled out North Chicago the whole thing
▶ 1:16:47and the pause all of that today you don't have confidence that the system would be ready to go in its current state I think that we can Implement a system today anywhere however there are some opportunities to improve the experience and I think we've agreed with the VA to do that work and do the optimizations do that this do that before we go to another deployment but the system in it of itself yes that can be deployed anywhere I mean the the reality is our EHR
▶ 1:17:17is being deployed all over the year all over the world the dod is using it and so from a technology standpoint yes we can implement it but I think the VA and we agree that there is some optimization work that would make that deployment go in a much smoother better way and that it's worth making those Investments today okay I'm out of time on my question ranking member go ahead thank you thank you Mr chairman um I wanted to zoom out again to The Accelerated deployment
▶ 1:17:48uh that we had talked about that plan and I wanted to specifically get oig and gaos if Mr case and miss Harris could kind of could you also share with us your thought about um The Accelerated deployment idea by 2028 or 2029 yes uh to comment on whether it's feasible or will it work we need to see the schedule we need to see the master schedule how do we get from where we are now to where it is that they want to be whether it's
▶ 1:18:18on a in Michigan or some accelerated schedule show us the steps each way how long is it going to take what are the risks that it won't work what's the critical path how do you modify this if something doesn't work or is not timely and how much it will cost so to really assess the viability of any acceleration show us show us the schedule show us the details and then everyone Congress VA itself
▶ 1:18:49oig GAO can evaluate it and evaluate the risks so I think that's really from our perspective one of the issues and one thing we haven't talked about much here is so far is our first recommendation of our first report was for VA to assess what the impact was on productivity at sites and how to address that when it happens some loss of productivity is expected but how much what's the rigorous analysis
▶ 1:19:19of the loss of productivity not just what happened a level but there's we've got to be honest honest with ourselves we're going forward at four sites including two complex sites and how long will that be and what are the efforts and we haven't seen that analysis yet so we could close a recommendation could I just before we go to Miss Harris um the loss of productivity could something like improving our training get to to addressing some of those concerns that should be able to do it ma'am I me we did a report
▶ 1:19:49on the training at the early sites it was insufficient and uh since then my understanding is it's been improved but we have a new system we've heard that again it's a different system now and whether the new training that's going to be done will be effective in the new system that remains to be seen especially going forward at for sites could I just ask you Dr Evans because I know we've talked about the schedule and and obviously Mr casee just emphasized that as well but the importance of
▶ 1:20:19it that sounds like something the VA is committed to maybe um not maybe but to definitely putting together yes did I hear that right okay okay that's good okay can I ask you the same question Miss Harris absolutely and before I before I respond to your initial question I just wanted to add on with regard to the training we've heard a lot from Miss VMA regarding the training but the training really needs to Res the ownership of the training must reside at VA and many of the the pitfalls that they
▶ 1:20:49had with the initial five sites was they sort of relinquished that control to to to discerner to do that training when VA should be responsible for it because the VA users are the ones that know the Legacy system better than anyone else and what it takes to be able to train up on the new system and so um I my understand we made a recommendation that VA must improve their change management strategies no doubt training is a huge component of that my
▶ 1:21:20understanding is that they're still working on that but that should be finalized and and be very detailed before they go forward with with a go live and in addition just with regard to the the just are they prepared I mean they've got if they deploy in 2026 to to Michigan I mean and that's a huge if for all the reasons that Mr casea stated but you still have two years remaining on that contract with 160 sites it's impossible that the answer is no they're not going to be able to to deploy
▶ 1:21:50to to all the sites within the the remaining time of the contract but to get to to Michigan at least as Mr Cas said we need that integrated schedule and if they do deploy Mr Evans did mentioned Dr Evans mentioned something very important about about DOD which is you know they they did the ivnv after that initial wave of so it was multiple sites that they deployed to before they did the ivnv it could be a a very good test I think
▶ 1:22:20if they were to deploy to Michigan to have that ivnv done at at those four sites again an independent look not VA not Oracle cner to do that that review so that we can identify in full you know end to end what those issues are and just to go back to that point because I know we've talked about it a bit but you just hear from Oracle in the VA if the IV andv test like if there's some added value to a third party helping us take a review
▶ 1:22:50look under the hood I I feel like I've heard there's not necessarily opposition to that that could be maybe helpful that's a question I guess so what I would say is there's a cost to that so that should be part of the calculus here the second thing I would say is that if we look at the the more recent implementations in these code blocks the testing that we've done has worked well right we've actually made changes to the testing program we've given them different environments to help their Pro their internal process of testing and it's actually gone
▶ 1:23:20well so it could be that an ivv Maybe few years back would have been helpful but I think we're in a different place now and the testing program that we have has worked well if we just look at the recent past with the last two or three code block releases I think they've gone better um and I think if you are going to go forward with ibmv to think about the additional cost of that as well okay great I yield back thank you thank you Mr lell thanks sir Mr Evans what's
▶ 1:23:51the I don't really the best way to say this but like standard of success for Oracle and what that they need to meet in order to say hey look this Michigan's good we're moving we're moving which one whatever the which one's the next site I mean because we went into the to the pause because the standards were not met are they required to meet the standards that currently exist or have we increased those standards of success I think I mentioned earlier that we've worked on some metrics that we are following and
▶ 1:24:21actually frankly with Oracle Health we follow a lot more many more metrics than are actually on our uh the dashboard of the nine core metrics that we followed during the reset and that we will continue to follow as we move forward so we've def we've defined uh the thresholds for success for each of those with the exception of one that we are finalizing now after we did a um a burndown of of trouble tickets um and a resetting what the normal should should be so you may see that in a
▶ 1:24:52GAO recommendation that we need to set um our targets and thresholds we've set eight of the nine the ninth will be set momentarily that will be a measure of how we measure success but there are many others really to me so Oracle needs to meet those nine standards right before we consider Michigan a success and then we Flex to the next facility right and I think those standards are I mean these are many of some of the metrics are are operational metrics right
▶ 1:25:22it is how we measure quality of care our facilities it's access to care for veterans it's weight times it's let me all right let me break this down a little bit further my question is at what point in 2026 when Oracle activates Michigan MH there's going to be those checks in the box now if they get three out of the nine are they good to go and that's considered a success or do they have to have all nine which I would I would say Obviously you need all nine but I'm asking you I mean my my preference
▶ 1:25:52is that we're meeting our goals across the board now having said that um I I I would say it's we are deploying the federal EHR in Michigan right this is a partnership that VA and Oracle Health are going to need to do this together to success and frankly with the local leadership in Michigan and so we you know success here is a shared project I would say that is number one but number two um yeah I'd like us to see us meeting our goals across all the metrics
▶ 1:26:27if I'm still trying to dig an answer out of you guys my my my concern is that we that we kick the can down the road we we activate in Michigan and we only have a certain amount of successes out of those nine like hey look this good enough we're just going to go further and Michigan fails and then here we are all over again we have to go into another pause we're we're projections past well past $50 billion because of where we are currently there has to be a line by line
▶ 1:26:57check that says we are absolutely solid Michigan is good to go 100% and now we're moving on it in my opinion that's exactly where we are considering how many dollar bills are going to this project I don't know if you can answer that question or not um Mr Evans unless you want so so I mean in short I could say Yes um the system's got to be stable it's got to work for our end users it's got to work for the operations of our medical centers
▶ 1:27:28period and how we measure that is something that I meet with the committee staff on a monthly basis and we go through those metrics and we will continue to review those as we lead up to Michigan and frankly we're going to use those will you move out of Michigan is there a is there a a end date for Michigan we're like we we activate here we got two months and then we're going is so we go live at Michigan and then you know typically we're looking to see operations restored at the
▶ 1:27:58medical center in the 3 to four month time frame after a go live so three to four months at Michigan alone I I think I mean I think one of the things you're as we talked about earlier right we if we wait we have a challenge in front of us right we we we the longer VA operates as a Health Care system with two different electronic health records the more risk that we are taking on and so we have to balance the need
▶ 1:28:28to move forward towards a single electronic health record to support an integrated National Health Care system in VA and if we're going to move forward with the federal EHR which is our plan commitment desire then we can't just wait for Michigan to be over and spend another year deciding whether we were successful or not and so we're going to have to measure together as we move forward our success month to month it's one of the reasons
▶ 1:28:59why I meet with this committee every single month um it is because we need to be assessing our progress at that frequency so because if we don't start to do work at sites Beyond Michigan we'll get to the end of Michigan and we're gonna have another 18 months to wait for the next Gove what if Michigan Mom sorry Mr J I'm over but sure you know where I was going with that one yes and I will uh I'll come back to you in a moment um okay so M Harris I want to go back to your earlier Point um
▶ 1:29:29assuming we roll out in Michigan in 2026 that would give us how many sites have been uh um have had the new electronic health record implemented at that point 10 sites 10 sites and how many would remain 160 160 and it's your opinion uh and your testimony that it would be impossible to implement the remaining 160 by May of 2028 is that correct that's correct based on
▶ 1:30:00the the previous track record and and also based on the fact that um you know all of these sites have are are very bespoke they're they're customized and so the change management associated with each of these indiv individual sites I I don't think you can standardize that I I think some might take longer than others um and it's just very hard to predict but collectively within a 2-year time period considering took them you know basically you know six years six to seven years to implement a 10
▶ 1:30:30and you're talking 160 when you compare that to me there's no way they're going to get that all done right okay um Miss Verma obviously the next question for you is are we going to be through the next 160 sites by May of 2028 yeah I think there's a there's there's a lot of variables here right there's a technology piece there's a training piece there's a a people piece of this and so so there's also internal processes at the VA and so you know we've been I think a simple no would probably
▶ 1:31:00be the easiest answer we've been working with the VA around acceleration and how to do that and there's multiple things that need to be addressed in order for us to move faster and to move quicker and I think we're working towards that right but yes or no is it your position that this can be implemented by May of 2028 in technology perspective yes but there are other pieces of this that have to come along with the technology but we live in the real world that we live in we don't live in the just hit send on the computer and it works right understanding
▶ 1:31:30the real world conditions that we're in understanding we don't have a schedule to Mr case's Point Dr Evans do you feel that there's any possibility we can be implemented in the remaining sites by May of 2028 no okay Mr casee do you I don't see how it could happen I'd like to see what the plan is if they were going to do it okay M Verma do you feel that this is even possible I mean can we even pretend anymore like I said we're responsible for the technology standpoint and we've we've
▶ 1:32:00said to VA from a technology standpoint that may be possible but there's other pieces that go along and we'll acknowledge right that the VA whether it's standardization whether it's Integrations there's a lot of things that would need to happen to be able to meet that timeline we are committed to doing that however that there is also other pieces of it and we would need to work with VA on that and we're having discussions about that about what the timeline should be and what the schedule should be and what are the things that need to happen to be able to accelerate okay
▶ 1:32:30I think even with acceleration it's impossible to expect that we can be anywhere close to that by May of 2028 um now Dr Evans to follow up on Mr latrell's Point assuming we're in Michigan for several months I think he was getting to the point of what if it isn't good what if it isn't working what if the the checklist isn't adequate what if we're stuck in the position we were in the initial role out and what if these aren't going as well as we would like what happens then do we go into another standown freeze do
▶ 1:33:00we keep accelerating as Miss Verma has you know suggested what what do we do then yeah um it's uh an excellent question I would say this um I don't you know I think we have to succeed um and I think we should be looking I would have said that seven years ago too I mean we had to succeed then and we didn't leading us to where we are now so I I agree with you we have to but we have to acknowledge
▶ 1:33:30the track record that led us to where we are now for the you know reality in which we're facing right I I understand that and uh but I still believe that we need to succeed and we need to be working towards Michigan with the understanding that that is what we must do um so you know your question is a question of well what would we do if we did not succeed I think we'd be having some very hard discussions right here in this room most likely um but the
▶ 1:34:01where where I am working with our team and frankly where we are working in VA across the agency is to say this is something we must do and I'll tell you this um in Michigan they're enthusiastic the sites are enthusiastic in Michigan one of the things that I think you're well aware of in Michigan is that the sites in Michigan work in a very interdependent uh Specialty Care uh for veterans in who are receiving care in the Battle Creek or sgol system
▶ 1:34:31often is delivered through Detroit or Ann Arbor lab services are shared across the visin so the idea of the opportunity to move from four separate instances of an electronic health record supporting four separate VA medical centers that are trying to operate more and more like one they look at the opportunity here to have a single electronic health record for all four sites to support their sharing and care for veterans in the Michigan Market as a as a huge opportunity and I think you
▶ 1:35:01know we should feel some level of confidence when the sites are saying this is something we want and that we're for thank you rankie member bazinsky um I appreciate that I I wanted to actually shift gears a little bit to AI um as something that Oracle had um uh talked a little bit about in the written testimony can you explain um Miss FMA how AI is being used in this instance so
▶ 1:35:32a lot of the AI that we're going to be deploying will come in sort of the modernization um I will say from the from the outset with whatever AI that we do deploy is that providers and Physicians are always in control right this is not AI doing things but giving options and helping and supporting but decision making about clinical care and um you know all workflows there is a human in the loop so I'd start out by saying that I think what we've done um to improve the EHR sort of outside of va but that can be applied and we're willing
▶ 1:36:02to to provide to the VA for example um we brought something called our clinical AI agent right which can if the patient agrees and the doctor's on board with it you can have a listens to the patient doctor interaction it can generate a note so that's one of the first things that we've brought to the market the second thing that we're bringing is a brand new EHR to the market and that has AI infused across all of it so if you think about a physician coming into seeing a patient today in in really any
▶ 1:36:32EHR you have to do a lot of searching you know look at their Labs look at all their uh previous diagnoses and especially for a veteran where they have complex Health Care conditions and they have multiple comorbidities that's actually quite complex what AI can do is give them a summary of the patient it can detail here's all the the different things the other piece that AI can do is it can help actually provide guidance to the provider and say okay based on this veteran's health condition here are the care gaps that is actually
▶ 1:37:02we're actually bringing that in today but AI can also if the provider has questions bring me this or it has a specific question it can actually ask the EHR that and that just you know that's actually given the other thing that we can do with AI we can identify if there's research going on in the facility and is this patient a candidate for the re research that's going on in that facility as well um I would say that AI is also going to automate a lot of the manual work that we see going on with providers
▶ 1:37:33especially in the area of um our um um reimbursements and um collections in that particular area there's a lot of manual work that goes on with that today think about scheduling and administration and so that's where I think by applying some of this modern technology there's also some efficiencies to be gained by by the VA as well and it and it allows the providers to spend time with the patient and not doing a lot of administrative work and is this I mean that in that type of
▶ 1:38:03innovation is that covered under the current contract or will there be additional cost associated with that so there's some pieces like our clinical AI agent which are in scope in terms of the new EHR that that we have that we are bringing to the market we are committed to providing that to the VA at no additional cost so even though our contract specif if I Millennium um um our leadership has agreed that we would like to provide that to the veterans because we think that that's going to give the most optimal experience
▶ 1:38:33and it'll improve care and quality for veterans and that's the most important thing so we're committed to doing that and how does oracle look at quality and safety as it relates to this issue of AI and and Veterans and patient care sure so safety is a high priority we've got many uh systems and processes IES in place to assure that but I think the most important thing is that when we are deploying Ai and in anything that we deploy there's always a human in the loop right so this is supposed to be a tool
▶ 1:39:03it's supposed to be an assistant AI is not a decision maker so everything that we deploy and even if we look at things like we're providing the let's say the provider asks a question we will not only provide an answer to the question but we'll also identify the source of the data so let's say we're providing a summary of the patient's history and the summary that we provide will actually detail exactly where the data came from so it's not like the provider is is getting guidance and or
▶ 1:39:33getting a recommend whatever you want to call it they know exactly where that came from so I think the most important thing that we're doing is that the human is always in the loop in these processes that's how we're applying Ai and will the system require um informed consent from the veteran before AI is used during their appointment yes and that's completely up to the to the VA in terms of you know making sure that those consents and how they want to put those processes in place I think the most obvious one today that we're already using is around our clinical AI agent
▶ 1:40:03that generates the notes and in those situations the provider always asks the patient are they comfortable with that okay um just going back to something I'd asked about earlier not on AI but related Dr Evans when I was asking early on about some of the VA Cuts I'm thinking about cost to staff um do you that the VA might have to take on additional contracts to supplement for where some of the staff might have been cut in order to make sure that we're properly
▶ 1:40:33going live in March I think it's too I think it's too early to tell that uh we are still uh looking to make sure that we're optimizing how our current staff is deployed to meet the needs of the program okay I yell back thanks thank you LR thank you sir Dr Evans is then is all of the veterans healthc care data being moved into the Oracle Cloud yes um
▶ 1:41:04let me so the we have migrated data from the Vista systems and actually every day are still are migrating data from the Vista systems our electronic health record into what's called HDI Health Data intelligence it's an oracle product that will be hosted in the Oracle cloud and that data then supports is migrated into the Oracle electronic health record to support uh care delivery so that when the provider logs in
▶ 1:41:34uh you know the you know one of the challenges when you move to a new electronic health record is if you have to start over and find all the information and repopulate the new record with the information it's a significant burden on providers and staff nurses and the like to to do that population of the electronic health record so VA made a significant investment in partnership with Oracle Health to migrate a significant amount of data from our existing electronic health record Vista into the federal
▶ 1:42:04EHR uh which should help ease the transition Oracle controls in their Cloud well it's va's data well that hopefully God willing that stays this that stays the same does anyone Miss Burma is the data that's moved from the VA into the Oracle cloud is it Standalone and no one else can touch it correct that is a standalone so all the the data rights and
▶ 1:42:34everything specify that that's controlled by um the VA it's actually shared between the VA and the dod okay but other organizations that work with Oracle and work with Oracle cloud system they cannot access that data at all corre they do not have access to it it's completely Standalone completely Standalone okay thank you y back thank you uh Dr Evans um you said it takes sites on average several months three four months maybe to basically fully
▶ 1:43:04recover if you will and get back to full steam operations after implementing this do you feel that the sites that have already implemented this new electronic health record are fully recovered fully functional and fully operational right now yeah I think one thing I clarify with that is that what we have learned um thus far is that the recovery varies based on the specialty based on where the care is being delivered so for example
▶ 1:43:35urgent care and the ER recover their productivity almost near instantaneously which is important because we can't have volumes decreasing in Urgent Care on the er um whereas in primary care as an example um in part secondary to to perhaps some of the configuration decisions uh with the electronic health Rec in part secondary to the complexity of primary care having to deal with a patients entire Health set of health issues medication management
▶ 1:44:05for example productivity recovery lags in primary care and so it's not um it's not exactly the same across the entire medical center having said that we are measuring productivity across the entire medical center at each of our facilities we've seen a positive and approach roate Trend at all facilities um and they're for the most part at uh their preo live um levels of productivity actually pre- pandemic
▶ 1:44:35preo live levels of productivity so Spokane and the other facilities are nearing preo live productivity marks across the Spectrum yeah I don't have the exact numbers right here that is on our dashboard we share that regularly it's north of 85 %c uh across all facilities some are above 100% we can certainly share those numbers okay and I know you said earlier that we must succeed in this and I fully agree with
▶ 1:45:05you um we have not though given you know in the more more recent discussion just now given a lot of consideration for the cost and the cost of this is an unknown at this point and I think yes yes we have to you know we have to make this work but we also have to be mindful and knowledgeable about the cost that that's going to take and I think to the other um you know Observer standpoint that is something
▶ 1:45:35that remains an unknown yes I don't know if you can I can agree and as I mentioned earlier on that we are committed to building out the integrated master schedule the inter integrated master schedule is the foundation for building a life cycle cost estimate and how long until we can expect to see that I think as I mentioned our plan is to do that iteratively so the first phase that you will see is the integrated master schedule for Michigan that what is happening at this very moment in
▶ 1:46:05Michigan is what we call the current state reviews that will inform the the build of the integrated master schedule by April uh for the Michigan sites and then we will uh begin to plot out the schedule Beyond Michigan and build that integrated master schedule then to the the end of the contract um we are accelerating that effort I can't give you an exact date right now that will be finished but we understand how important that is to be able to build the life cycle cost estimate we uh are very aware of the importance
▶ 1:46:35of getting that information to you and frankly others uh that are at the end of the table here but if we're years plural into this and we still don't have the schedule and we're scheduling the how how can we expect to get that in a reasonable just to get our arms around and I mean our position here as members of this committee is to look at the effectiveness of this the oversight of it but also the cost of it and are we delivering a good
▶ 1:47:06value for the people that sent us here to spend their money on their behalf and we can't even do that without an analysis of what that's going to look like yeah I mean I mean and I know this I know I don't want to make a pro I'm making a promise in the sense that I can promise you that that work is going going on right now I was just in meetings looking at the analysis of cost to date our projections of what that cost looks like moving forward we are actively working on the life cycle cost estimate um
▶ 1:47:36and I look forward to keeping you up to date we understand that it is important for you to get that soon sooner rather than later okay thank you I um appreciate the um uh everyone here um to our Witnesses for appearing today to discuss the future of the electronic health record modernization program I understand uh members sorry ranking member bazinsky for your closing remarks oh thank you okay
▶ 1:48:06uh no thank you very much um I just I appreciate everyone's time in the panel's discussion and the thoughtful questions um from my colleagues I think one of the things that's very clear is that we all share a lot of really deep concerns about um our next go live date I'm encouraged hear Dr Evans talking about the integrated master schedule and working towards some real metrics that have been recommendations from the GAO and the oig um to address some of these concerns but that being said I think it is really
▶ 1:48:36important that we're not pressured into um this accelerated uh the VA I should say is not pressured into this accelerated timeline um of 2028 by anyone really just to avoid a potential contract extension because this really is ultimately about veterans health care and making sure that they're getting the health care that they deserve and it's being administered to them so I think we share collectively I have a lot of concerns I think we have some steps to address some
▶ 1:49:06of those and I look forward to continuing this conversation so thank you very much thank you Mr chairman thank you thank you for keeping me well behaved um and again I want to thank our Witnesses for appearing today thank you for the testimony that you provided uh I know that that many of you spent hours plural probably tens of hours hundreds of hours developing uh and analyzing this and as I stated at the beginning I am new to this committee and new to this Congress and new to
▶ 1:49:36this issue but I am invested in making sure that we deliver the outcome that we all should expect um I know you all understand when I say this is not just an IT system it has a lot of individuals and their health that depend upon this the productivity and the um the morale of the people doing the work as well as the outcomes for health for our veterans it directly affects all of them uh the veterans that I represent in Michigan's 7th congressional district are going to be among the first to
▶ 1:50:07find out if this system has fundamentally improved since the reset the facilities in in Battle Creek and an arbor specifically are where the majority of veterans in my district go for their health care um so I'm concerned by the talk of speeding up the pace of go lives considering that VA has only done one partially successful goli in the last 3 years with assistance again from the Department of Defense and with the complexity coming with the facilities in Michigan it gives me a great deal of concern for that it is
▶ 1:50:37far more important that VI does this right instead of fast if the plan is to continue fixing the systems problems while preparing to go live in Michigan and that is something that we need to be very mindful of the subcommittee expects VA and Oracle to show that they can get this right before veterans and VA staff in Michigan have to figure it out for themselves Dr Evans I'm encouraged by your remarks that the staff in Michigan are very excited about the opportunity that lies before them to integrate this together in the way that they've been interoperating to
▶ 1:51:07do in Michigan for some time now thank you again for all of you for participating today's hearing I want to thank the members of the committee for your uh questions and remarks as well I'll ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extraneous material without objection so ordered with that this hearing is
▶ 1:51:51adjourned for