▶ 0:21:38Testing one, two, three, 4. Okay, thank you. Bye.
▶ 0:23:08testing. 1 2 3 4 test
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▶ 0:25:41Testing one, two, three. Testing one, two, three. Hello. Testing one, two, three. Audio test one, two, three.
▶ 0:33:28Testing one, two, three. Test. Test. One, two, three. One more time. Testing. One more three. One, two. Test. Test.
▶ 0:39:58All right. Good afternoon. The subcommittee on technology modernization will now come to order. I want to thank our witnesses for joining us. We continue our oversight of the VA's electronic health record modernization program. I uh was actually joking with some friends back home recently. They were asking me what it's like my first year in Congress and I was telling them a little bit about the work we're doing on this subcommittee.
▶ 0:40:20I said before I came here, I didn't even I couldn't have even told you what health record system the VA had and now I spend far too much of my waking hours thinking about it. Um but appreciate the work that we've done on this committee and the for the witnesses that are here today. Um and right now of course we're at a pivotal moment.
▶ 0:40:38And I think we're down to 117 days until the new system will be launched at four of the medical facilities in my home state that serve the veterans of course from my district but across Michigan and parts of other states as well. This timeline is locked in and the countdown is on. But the question remains uh when the switch is flipped in April, will the system deliver and will it do what we need it to do? Are we going to run into snags like we have in the past?
▶ 0:41:06uh for millions of veterans relying on VA hospitals and staff supporting them. This is not something that is theoretical. It's real. It's happening and we have to do it right. And as I said before, the veterans that we serve and that the department is going to serve the right to be a little bit unaware of the nuance of which health record system the VA is using. They want it to work right, be able to schedule their appointments, go see their specialists, and move on with their day in a timely way. Veterans expect more than just promises.
▶ 0:41:34They expect safe and timely care. And we all expect systems that support our doctors, not work against them. Technology should be a tool that opens doors, not a barrier that adds more steps, more clicks, and more frustration. We heard about some of that earlier in this committee term when we saw that providers were getting frustrated with some of the interfacing with the system they have. When we first met on this topic in February, VA was just emerging from a very long pause. And while progress has been made since then, we know that significant work remains before we go live.
▶ 0:42:05VA has standardized over a thousand workflows into a national baseline with the Michigan being the first to use it. VA has tightened their timeline and for the first time since the pause, we saw large system updates roll out this August without disrupting care. These are meaningful good signs, but we cannot ignore other red flags that are warnings. Behind the scenes, many tools slated for Michigan have never been tested on a large scale. 34 new complex clinical workflows will debut there for the first time.
▶ 0:42:36VA plans to test across four sites uh simultaneously, a strategy that leaves really no margin for error and something that I have concerns about the risk associated with that. We need assurance that this plan is feasible in the real world, not just on paper or in a computer laboratory. We need to know that the lessons of the past have been learned and not just observed and acknowledged. The user experience also remains a concern. While satisfaction is slightly up, more attention is needed.
▶ 0:43:05The committee has heard from physicians that the critical function system the critical function system remains unstable. We hear from VA pharmacists. I know that's a very unique role that the VA has. That tools for monitoring drug interactions are still a major pain point. VA staff are now burdened with more manual processes to ensure PA patient safety with drug interactions. We need to know where these issues stand today so Michigan clinicians and veterans are not left holding the bag on day one.
▶ 0:43:36And finally, we must address the sheer scale of the cost. This program began in 2018 with a 10 billion price tag. It quickly ballooned far beyond its original expectations and the latest estimate stands at $ 37 billion. We cannot keep writing blank checks that risk taxpayer money and slows down or worse endangers delivery of veteran care. I'm encouraged by the momentum we've seen.
▶ 0:44:02I'm encouraged by the commitment of my friends, Secretary Collins and the Trump administration team, but encouragement only goes so far as reality sets in. We need proof and we need transparency. The clock is ticking down in M for Michigan for this to go live and the time for promises is over. the only acceptable result is a flawless go live because our veterans uh cannot accept failure. So, thank you again for being here today.
▶ 0:44:30And I do want to say it's never my intention to take gratuitous shots at anybody uh appearing before this committee. Um but we do have a a role to play in oversight of what's taking place and we intend to vigorously and robustly carry that forward. And with that, I will yield to ranking member Bazinski for her opening
▶ 0:44:48Thank you, Mr. Chairman. And I I agree with you. Um and thank you to our witnesses for being here today. Um it seems we are bookending this year with uh EHRM hearings and I look forward to hearing how the program has improved and how the department has prepared to resume go live activities. Um but to start, I do want to address an article that I read over the weekend about Secretary Collins's plans to eliminate physicians from the Veterans Health Administration.
▶ 0:45:17I am disappointed that we had to learn about this through the media and not from the secretary himself. Something this significant I believe warrants proactive communication with members of Congress. The department is quick to say that most of these positions are vacant. Um but the word is most and they don't use all. The VA workforce is already stretched too thin.
▶ 0:45:42Eliminating positions does nothing to help veterans who in many places like my district are waiting months for appointments. In fact, these actions threaten to undermine VA's ability to deliver timely care. Only at the VA can veterans expect to receive care from providers who have a deep understanding of their unique experiences. That's irreplaceable.
▶ 0:46:06If Secretary Collins is serious about keeping veterans at the center of everything, VA healthc care must continue to lead the way. VA must be fully staffed and resourced. The continued efforts of this administration to bleed VA dry will make it harder for us to honor the service of our nation's veterans.
▶ 0:46:27Their efforts to outsource veterans care will also have dire impacts on the success of the EHRM Today we are 117 days from VA's EHRM go live at four VA medical centers in Michigan. After the program was reset for three years, the department made the decision not only to restart but to accelerate the go lives in an effort to finish almost on schedule.
▶ 0:46:57I am sure the chairman is anxious about this. I know I am. There are VA facilities around my district that are scheduled to go live right after the Michigan uh sites. The Veterans of Michigan's seventh district and Illinois's 13th district are next to be impacted by EHRM. We need assurances that Oracle and VA have fixed the issues that are still plaguing the first six sites.
▶ 0:47:24At the time of our last hearing on EHRM in February, the department had dozens of outstanding recommendations from VA's Office of the Inspector General and the Government Accountability Office. According to GAO's testimony, it hasn't changed. Our goal is to ensure that we are setting V up VA up for success.
▶ 0:47:47However, what I have heard in the past year has not convinced me that VA is ready for launch at 13 facilities in 2026. I have raised many questions with VA and Oracle. But the answers do not give me confidence. In fact, I worry that we are spending billions of dollars while simultaneously setting this program, particularly the six sites that are already live, up for failure.
▶ 0:48:14I need both VA and Oracle to tell me what they have done to address concerns raised by VA employees and veterans at the first six sites, such as prescription errors and incorrect alerts. For veteran patients, the consequences of these errors range from discomfort to death. We must know that catastrophic errors in the system are not putting veterans lives.
▶ 0:48:42must know that catastrophic errors in the system are not putting veterans lives at risk. I also want to hear what state the system is going to be in when EHRM goes live at the next four sites. Earlier this year, we learned that VA was looking for an EHRM systems integrator. I was hopeful that this might be a positive change in the program rollout.
▶ 0:49:04There are a lot of questions about this contract which was awarded to Accenture in November and how it is going to work. In fact, ranking members Takano and Blumenthal sent a letter to Secretary Collins shortly after the award was announced and have yet to receive a response. What will Accenture actually do to make EHRM more successful?
▶ 0:49:29Is it a true systems integrator or is it a continuation of the role currently held by Booze Allen Hamilton? How will Accenture be effective given its lack of authority over the Oracle Prime contract? Unfortunately, the more I hear about this contract, the more it seems to be a replacement for VA's program management contract, not an actual systems integrator.
▶ 0:49:52In September, Deputy Secretary Lawrence informed me that VA estimates the life cycle cost of this program to be $ 37.2 billion, but it seems like this estimate has changed quite a few times. VA originally told Congress, as Chairman Barrett mentioned, they needed $10 billion for the entire program. Shortly after that, they came back and asked for an additional $6 billion for VA's program cost.
▶ 0:50:18In 2022, VA contracted with the Institute for Defense Analysis to conduct a true life cycle cost estimate, which shifted the estimate for the project to almost $50 billion. And now the deput deputy secretary is backtracking and saying that it's only going to cost $ 37.2 billion. I'm concerned that nobody actually knows what the bottom line cost is. I need to hear today that VA has a grasp on this.
▶ 0:50:47The American taxpayers and veterans deserve transparency. Finally, I want to address a recent article in the Washington Post about VA's EHRM program. I believe this article highlighted real concerns from department employees about the system. Concerns expressed from a place of worry for patient safety and provider burnout. I wish the department would take these concerns seriously and use that feedback in their change management efforts.
▶ 0:51:16I find it very troubling that the department instead seems to be minimizing the concerns raised. Their framing of the story takes their usual tact blame everything on the previous administration. And I'll be honest, I think there is plenty of blame to go around. But of course, it was the first Trump administration that rushed VA into a sole source contract with Cerner before either was ready. Ultimately, we should not be pointing fingers.
▶ 0:51:42We need to have the difficult conversations to make sure that both Oracle and VA are accountable to Congress, to VA employees, and most importantly to veterans. We need to ensure that this new EHR supports VA's provision of worldclass health care. Thank you, Mr. Chairman, and I yield back.
▶ 0:52:02Thank you, Ranking Member Bazinski. And I will now introduce our witnesses. Uh from the Department of Veteran Affairs, we have Dr. Dr. Neil Evans, acting program executive director of the electronic health record modernization integration office. Did I say that correctly, doctor? All right, very good. Uh, from Oracle, we have the honorable Sema Verma, executive vice president and general manager of Oracle Health and Life Sciences. And from the GAO, we have Miss Carol Harris, a familiar face to this committee, the director of IT and cyber security at GAO.
▶ 0:52:32I'll ask the witnesses to please stand and raise your right hands. Well, your right hand. Do you solemnly swear under penalty of perjury that the testimony you're about to provide is the truth, the whole truth, and nothing but the truth? Thank you. And let the record record reflect that all witnesses have answered in the affirmative. Dr. Evans, you're now recognized for five minutes to deliver your opening statement on behalf of EA. Thank you. Uh, good afternoon, Chairman Barrett, Ranking Member Visinski, and distinguished members of the sub commmittee, including Mr. Latrell.
▶ 0:53:00I want to begin by thanking Congress and this committee for the opportunity to testify today and for your continued support of VA's electronic health record modernization efforts. VA remains committed to successfully implementing a modern interoperable electronic health record system which we refer to as the federal EHR and we intend to implement that across the entire VA enterprise.
▶ 0:53:26As was mentioned, since our last hearing in February, VA has made significant progress towards meeting that goal. In March, VA announced its plans to deploy the federal EHR to nine additional VA medical centers and associated clinics in Ohio, Indiana, Kentucky, and Alaska by the end of calendar year 2026.
▶ 0:53:46Those were in addition to the four previously announced medical centers in Michigan slated for deployment, bringing the total number of planned deployment sites to in 2026 to 13. That encompasses more than 100 physical locations when clinics are considered in addition to the medical centers and will involve transitioning more than 27,000 VA employees from Vista to the federal EHR in this coming year.
▶ 0:54:12In addition, we've begun deployment work at seven additional facilities with 19 more on the way, all with planned go lives in 2027. Furthermore, as evidence of our commitment to full implementation of the system across the VA enterprise, we recently shared a schedule with this committee outlining our plans to complete deployments of the federal EHR at all VA medical facilities as early as Based on lessons learned, VA will now be using a market-based approach for deployments
▶ 0:54:43with multiple medical centers working together and going live simultaneously in each deployment wave. This approach allows us to scale up the number of deployments, enhance efficiencies, and improve the sharing of best practices within and between Now, I'd like to bring our focus back uh to the near- term.
▶ 0:55:03As was mentioned, we are only 117 days, less than four months away from our planned go lives in Michigan and less than a year away from the remainder of our deployments across all of Vizent 10 in Alaska. The title that you chose for this hearing is apt, ready, set, go live. Teams at all the 2026 sites have been preparing diligently for upwards of a year. The gun has already gone off. Go live dates are imminent and we are on track for successful deployments.
▶ 0:55:35Contributing significantly to VA's current momentum has been leadership ownership of this project at all levels of our organization, starting at the very top. Since assuming their role, Secretary Collins and Deputy Secretary Lawrence have prioritized attention to this critical project and have taken significant steps to ensure that all stakeholders are aligned. Dr. Dr.
▶ 0:55:54Lawrence has been talking to site and vision leaders weekly and has made multiple visits to sites scheduled for go live in 2026 where he has made it a priority to listen to fellow veterans and VA staff talk about their experiences and expectations and to respond quickly when adjustments are needed. Just as important, leadership and staff at both the individual sites and the vision level are encouraged by the program's direction and newfound momentum and are perhaps the most important drivers behind our current progress.
▶ 0:56:25As for the system itself, VA and Oracle Health have made significant strides in assuring the federal EHR is performing reliably and meeting our expectations. As an example, as of November 19th, Oracle Health Systems within the federal EHR maintained an incident free time of 95.93% exceeding our agreement um of greater than 95% for 21 consecutive months.
▶ 0:56:47We're also delivering system enhancements, new features and system changes that are responsive to the feedback we're hearing from VA staff and are driving improved standardization across the enterprise. For example, I know we've often spoken about the systems pharmacy capabilities in this committee and we'll be delivering seven further pharmacy improvements before our go lives in Michigan in April.
▶ 0:57:10And as another example, we just released new system functionality called seamless exchange in September, reducing by more than 95% the volume of external data requiring manual review and reconciliation by VA clinicians. We are seeing evidence of the results of the change we have made.
▶ 0:57:29We continue to administer the federal EHR user experience survey twice yearly and I'm pleased that we have seen consistent improvement survey over Ultimately, our goal is to deliver an EHR system that earns the trust of veterans, clinicians and staff. And that means a system that works efficiently, enhances care coordination, reduces administrative burden, and improves health outcomes for veterans.
▶ 0:57:53With the partnership of this subcommittee, we look forward to continued and accelerated progress over the remainder of the 119th Congress and beyond.
▶ 0:58:06Thank you, Dr. Evans. The written statement of Dr. Evans will be entered into the hearing record. Miss Verma, you are now recognized for five minutes to read your opening statement on behalf.
▶ 0:58:14Thank you, Chairman Barry. Ranking
▶ 0:58:17can you please use your um
▶ 0:58:19Oh, I'm sorry. Yeah, I'll try again.
▶ 0:58:21Thank you. Good afternoon, Chairman Barrett, Ranking Member of Bzinski, and members of the subcommittee. Thank you for the opportunity to speak with you today about Oracle's work with the VA's EHR modernization program. Since the last hearing, VA announced an accelerated deployment schedule that will complete the full implementation for all sites by 2031. Next year, the federal EHR will go live at 13 sites and we are preparing to launch at 26 facilities in 2027.
▶ 0:58:50I am pleased to report significant progress on the accelerated deployment plan and that Oracle is confident that we're prepared and fully aligned with the VA to meet this goal. Most importantly, leadership, engagement, and ownership for the EHR implementation has never been stronger. There is clear direction from the highest levels and a deep sense of accountability across all partners. We also want to recognize and commend VA leadership for their clear commitment to standardization across the enterprise.
▶ 0:59:20Their decisive leadership has strengthened the program and demonstrated a shared determination to deliver a unified high-erforming EHR for veterans. Overall system performance is strong. The system is stable and there is notable decrease in interruptions to end users. We have met or exceeded the 95% incident free time requirement for 21 consecutive months and we have been free of any systemwide outages for eight consecutive months.
▶ 0:59:49These improvements are a direct result of the coordinated effort between Oracle and VA. Together we have formalized our incident review process and implemented proactive monitoring and targeted upgrades. We have optimized the EHR to improve veteran health outcomes, enhance provider productivity, and strengthen financial performance results.
▶ 1:00:11With these optimizations, productivity has increased at all facilities and cash collections exceeded FY25 goals, achieving 180% of target. Lastly, as Dr. Evans referenced, we have expanded seamless exchange to all federal EHR facilities. Seamless Exchange compiles and dduplicates patient data from multiple sources.
▶ 1:00:35This reduces the volume of external data that requires manual review and enables improved medical charting and decision-making Finally, we have strengthened every part of our deployment methodology with a focus on improving staff readiness. This includes enhanced training and change management both virtual and in person that allows endusers to not just learn about changes but to actually try the system out in advance of go lives.
▶ 1:01:04We are modernizing the underlying infrastructure through the migration of the federal EHR to Oracle's cloud. This move will not only provide better system performance and security but will also allow VA to adopt modern tools including our clinical AI agent. The clinical AI agent reduces clinical burden and supports safer, more efficient care, all while ensuring the provider remains at the center of decisionmaking. Our work does not end here.
▶ 1:01:32With VA's commitment to a commercial solution, they will continue to benefit from Oracle's ongoing innovation, including our new voice first ambulatory EHR recently certified by HHS. With this certification, ambulatory clinics across the United States, including the VA, can begin planning for the adoption of our transformative EHR. Unlike other EHRs, Oracles was built from the ground up on a secure, modern cloud.
▶ 1:01:59This allows for streamlined clinical workflows and automation of manual tasks so providers can spend more time with patients. Oracle continues to lead on data interoperability. We have taken the White House interoperability pledge and have recently been designated as a qualified health information network or QEN by HHS.
▶ 1:02:20This achievement will enable broader and more secure exchange of patient data records across disperate systems as veterans receive care from multiple sites and multiple providers. Our Qen will streamline connectivity, enhance data accessibility, and help ensure that every care provider has timely, comprehensive information to support better outcomes for veterans In closing, as we move into 2026, we are confident and prepared to deploy the federal EHR
▶ 1:02:51under the accelerated deployment schedule. This will bring a unified health record to veterans, which we can all agree brings incredible opportunity to improve the experience with the VA and the health of our veterans. Thank you, and I look forward to answering your
▶ 1:03:09Thank you, Miss Verma. The written statement of Miss Verma will be entered into the hearing record. Miss Harris, you're now recognized for five minutes to deliver your opening statement on behalf of the GAO. Thank you, Chairman Barrett, Ranking Member Bodzinski, um, Congressman Latrell, thank you for inviting us to discuss the readiness of VA's EHRM program. In June 2017, the department initiated this program to replace the legacy Vista system and has since deployed the new EHR to six of its medical centers at a cost of about 12.7 billion.
▶ 1:03:40The 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 concerns, VA paused deployments in April 2023 to improve the system and address those concerns. On December 2024, VA announced it would resume deployment starting with four Michigan sites in April. By the end of 2026, VA plans to complete another nine sites under an accelerated deployment schedule.
▶ 1:04:09and roughly 170 more throughout the nation by 2031. Over the past five years, we've issued five reports on VA's efforts to deploy its new EHR system. These reports describe actions taken by the department and identified challenges with key planning tools critical for program We also reported on challenges experienced with the initial deployments such as the ones I just noted.
▶ 1:04:35To address these challenges, we made 18 recommendations, 12 of which we have marked as priority because of the critical impact they have on strengthening successful future deployments. While VA has taken action to address our recommendation recommendations, it has not fully implemented 16 of them. I'll highlight the 12 priority recommendations here. The first two are that VA needs to produce an updated cost estimate and schedule.
▶ 1:05:01The latest independent cost estimate of roughly $50 billion does not reflect the many changes and delays to the program. And I know you've said that they have provided you with an updated estimate of 37 billion. We have not received that estimate. And so I would ask the department to provide that to us so we can review it. Um but the updated estimate is imperative to understanding the full magnitude of VA's investment. We have also yet to see an updated integr integrated master schedule.
▶ 1:05:29Consequently, as the department increases its momentum to complete 170 total site deployments by 2031, more information critical to controlling risks and informing congressional oversight is needed. Additionally, more work is needed to demonstrate results of VA's actions to address user concerns and system issues. In May 2023, we reported on gaps in VA's organizational change management activities for EHRM.
▶ 1:05:57We also reported that users expressed great dissatisfaction with the new system and that VA did not adequately identify and address those issues. We made 10 priority recommendations to address change management, user satisfaction, system trouble tickets, and independent operational assessment deficiencies.
▶ 1:06:17VA concurred with those recommendations and as of December 2025, VA has partially implemented one of the 10 priority recommendations and continues to work towards implementing the remaining nine. For example, VA partially implemented the recommendation to address users barriers to change. To do so, VA developed plans to address user concerns about the new system identified in a strategic review of the program.
▶ 1:06:42However, VA has not yet adequately demonstrated that corresponding improvement projects have fully addressed underlying barriers. VA has also not yet approved and implemented a VA specific change management strategy to formalize how it will improve the readiness of end users to adapt to working in the new EHR system.
▶ 1:07:02Further, VA has no plans to conduct an independent operational an assessment or an IV test to determine whether the system is operationally suitable. Without an IVNV, the department increases the risk of deploying the system prematurely, thereby posing unnecessary risk to patient health and safety. Moving forward, it will be critical for VA to address the 12 priority recommendations along with the other four open ones as soon as possible.
▶ 1:07:31Until these are fully implemented, future deployments are at risk of prolonging challenges like those experienced in the initial deployments. Doing so will position VA to more effectively deliver a modern health record system our our veterans deserve. And that concludes my statement. I look forward to addressing your questions.
▶ 1:07:49Thank you, Miss Harris. And the written statement of Miss Harris will also be entered into the hearing record. And we'll now proceed to questioning. I'll recognize myself for five minutes. Um Miss Harris, thank you. um mentioned some of the cost associated considerations and concerns that are out there, what the true price tag of this is going to be. Um Dr. Evans, is this something that you can furnish uh through the department over to the GAO for them to review that life cycle cost
▶ 1:08:17Yes, we provided that to this committee on September 30th and we certainly can provide it to the GAO.
▶ 1:08:22Okay, appreciate that. Um and then um anecdotally um so I go to the predominantly the Battle Creek VA hospital near my district um for most of my care. Occasionally go to the Lancing um outpatient clinic there and I'll usually ask the folks that I interact with kind of their thoughts on this coming up and they're all well familiar with it. I mean there are posters up.
▶ 1:08:48you can't pull into the driveway of the hospital without seeing this announcement of the, you know, unrolling of a new electronic health record management system. And um I don't advertise to them the the you know role that I have on this committee of oversight of this process, but I'll just kind of get their opinion as to how it's going. And I would say it's it's not great. Um there's a bit of a mixed opinion.
▶ 1:09:15Uh, some of them feel like they're not fully ready for the new system at this point. Um, Dr. Evans, can you walk me through I mean, I understand we're not going to train people on this but do you have confidence? Does the department have confidence that the enduser, the people that are actually interfacing with this program are going to be well equipped to deal with it at the time that we go live?
▶ 1:09:45In short, yes. But let me give you some
▶ 1:09:49comfort behind that answer. Um in for the four sites in Michigan, we just completed last month super user training. So super users are folks who are in every department of the medical centers in Michigan who will be the kind of experts in the federal EHR for their peers. Um I think we there was over 400 folks who went through super user training.
▶ 1:10:17Um I don't have the exact number here but it's a sizable number. They are the super users are going to basically help the end users when they start their training for the average users. So somebody who has not been selected as a super user they start their training February 1st. So the beginning of February uh with super user training when uh we have introduced a lot of changes to our train how we do training and how we support adoption for the Michigan go lives.
▶ 1:10:46Um we had uh 96% of those we expected to complete super user training completed super user training. On average they rated the classes four out of five. We had a lot of direct feedback that this was significantly better than the first time that for those who had gone through this before before we paused at the Michigan sites they said yes this has been much better and in addition for the super users we've added and for all end users something called learning labs
▶ 1:11:16this was a success at FHCC learning labs are when we finish classroom training or what's delivered virtually virtually instructor-led training after that we do a learning lab, which is where users can come together and practice using the system in the sandbox together with their colleagues and see exactly how it works. We had 13 scenarios at FHCC in North Chicago. We went live there, got a lot of great feedback about that.
▶ 1:11:44We've now built 98 scenarios um and went through those learning labs with the super user. Got a lot of great feedback about it. So I would say that the end users should expect their confidence to start to grow as they get into training in February and learning labs in March.
▶ 1:11:58Okay. Um thank you. And then the uh Miss Harris, the IVNV test that you pointed out, is that the one um I think you had mentioned to me separately that that the kind of four parallel testing going on instead of sequential testing. Is that part of the IVNV or is that a separate test that would be required?
▶ 1:12:22Well, given the change in the the strategy for testing with this market-based approach where they're going to be basically simultaneously testing at four sites, it will make it more difficult to do an IVMV, which is that end to end test.
▶ 1:12:36That's a separate than
▶ 1:12:37Yes. Okay. Yes. in both are in your opinion complicating could lead to significant risk?
▶ 1:12:47I do believe so. I think that the the simultaneous testing at the four sites um it it will take a tremendous amount of resources and to deal with the issues that come up inevitably with a go live to be able to handle it at all four sites simultaneously could be you know significantly risky for the department.
▶ 1:13:06Mr. Verma when I get back to my next order of questions I'll have a question for you about that but beforehand I want to you'll drink member Bazinski for five minutes for her questions.
▶ 1:13:14Thank you Mr. Chairman. Um Dr. Evans um VA's plan to accelerate EHRM deployments will rely on sufficient on having sufficient manpower. Um in the history of this program the program office has never really been fully staffed. So I have a couple quick questions. How many open positions do you currently have in the program office? It's just over a hundred, but that's also because we just had a new signed org chart which increased the number of positions that we are authorized to hire.
▶ 1:13:44So, we are now actively hiring to fill the additional uh positions that we've added to the program office
▶ 1:13:52So, your plan is to fill all of those
▶ 1:13:56Okay. Um, and how will your current staff levels be able to not only resume go lives, but support for the four go lives at one time, but but support up to four go lives at one time? I guess that would be taking into account the hundred that you would be adding.
▶ 1:14:13Yes, we'll be we are so we are actively hiring. Um, in addition at the sites that are going live, there's active hiring going on. There are 510 positions in recruitment. Um, actually I thinkund uh 63 of those uh folks are already on board um at the at the sites that are going live to support operations locally um plus we're hiring in the program office and then of course we have a significant amount of help from our contract partners Oracle
▶ 1:14:43Booze Allen and Accenture Federal Services as you just
▶ 1:14:46Okay. So you have significant hiring that needs to happen though there are a lot of vacancies in the program office. I there are vacancies in the program office in part because we are expanding the size of the program office.
▶ 1:14:59Um from the perspective of our ability to execute to the um go lives in April in Michigan, we are confident that our current staffing is sufficient to get us
▶ 1:15:11Okay, Miss um Verma, the scope of what Oracle and VA are planning to do is almost unprecedented. So the number of simultaneous go lives and the time between the waves will require a massive pool of contractors to support all of these facilities as Dr. Evans has mentioned. How is Oracle going to ensure that these people understand the system and the VA well enough to be helpful?
▶ 1:15:33Sure. So first I would say that Oracle does implementations all over the world for systems. So, you know, this amount and the number of sites is not unusual for Oracle as a as a worldwide company in terms of the deployments. Um, that being said, we also continue to add more staff to our teams to make sure that we can scale with the deployments as well.
▶ 1:15:56Um, but I think this is not an unusual thing for our company and so we feel very well prepared um to deal with the expansions and the challenges of of something of of this scale. But can I just drilling down just a little bit more beyond just the having the bodies, the VA itself is unique in its mission and and culture. So when someone were to hit the ground, how what is Oracle doing to make sure that that additional capacity understands the uniqueness of the VA and its challenges?
▶ 1:16:26Sure. Well, there are requirements around training and then there's also some federal certifications that are required as well. So it's not like we interview somebody and put them on the ground. There's some training that happens internally and then there's also like I said the federal certifications and some required training that the federal government requires as well around security as well as the specific needs around the VA.
▶ 1:16:47Okay. Um Dr. Evans, as I mentioned in my opening, I have serious concerns about the secretary's plan to eliminate 35,000 positions um at VH VHA in a department that has been chronically understaffed where veterans sometimes wait months for appointments. How can these cuts, how will these cuts impact your program?
▶ 1:17:09They won't. As I just mentioned, we are hiring additional staff at the sites where we are going live with the federal EHR over the course of calendar year 2026. 510 additional staff. Currently, recruitment is ongoing. I don't anticipate any issues.
▶ 1:17:25Okay. Um and then just to go to the life cycle cost estimate questions. Um, does the VA have a definition for life cycle cost estimate? Dr. Evans,
▶ 1:17:36what we provided to the committee was what what we called a program cost estimate. It is the estimated cost for us to complete deployment of the federal EHR across the enterprise by 2031 and to operate that federal EHR that is to support or what some might call sustainment to support that EHR at the existing sites that have gone live.
▶ 1:18:01And that cost estimate, that program cost estimate includes all money spent in the EHR appropriation to date and our estimate of what it will take to get to the finish line of finalizing
▶ 1:18:17Again, not just finalizing deployment, but finalizing deployment and supporting the operations across this. Can I just inter does that break down then program versus contract expenditures like the details or is it just a topline number?
▶ 1:18:33It does uh it does break down and we broke it down into four um categories. One is implementation costs. So that's you can think of that as the cost to actually deploy the system. The second category being site and system operations that in many ways is the cost of running the system the hosting of the system help desk support of the operational support.
▶ 1:18:56The third being infrastructure I think uh we've talked about this in this committee before that a significant part of the spend here has been an uplift of the IT infrastructure to support the new modernized EHR that has sort of had to occur in parallel with the EHR rollout. And then the fourth we call office operations but it is really the staff both government staff and contract staff necessary to deploy the EHR.
▶ 1:19:22Okay. Thanks.
▶ 1:19:24All right. Thank you. And um Mr. Latrell recognized for five minutes.
▶ 1:19:28Thank you, Mr. Chairman. Dr. Evans, what's the what's [clears throat] the dollar sign on sustainment for these for this these for this software once EHR is implemented in all 170 sites and Um I don't have a number for you that is specific to sustainable. What I can tell you is that our estimate in the final year when it comes to system operations which I mentioned
▶ 1:19:52after 2031 moving forward what are what are we going to have to pay for this?
▶ 1:19:57Yeah I would estimate it's our again our estimate for the operations in the final year that we estimated was 2.1 billion
▶ 1:20:05annually. Correct. Miss Verma, if we have four sites are going to be going to go live in April, I'm sure Oracle is hovering over the top of those four sites. If those four sites going off of what Miss Harris laid out for us, if those four sites fail, are are other sites will they will we continue to move forward and fire up those other sites or is it an alltop I can't can't speak
▶ 1:20:36to exactly um
▶ 1:20:38Oracle if Oracle is not
▶ 1:20:41doing contingency planning on if these sites fail
▶ 1:20:45117 days.
▶ 1:20:46Yeah. So first off I would say that we are focused on a successful deployment. We're doing everything we can
▶ 1:20:53to to make sure that that happens. Training and support testing and of the system making sure that the teams are adequately supported. You heard about
▶ 1:21:02Yes, ma'am. I I got you. I'm just Worst case scenario, we we I'm that's the kind of guy I am. Worst case scenario, these four sites don't don't go like they should. What is the contingency plan that day?
▶ 1:21:16Well, you know, when something goes live and there is a deployment, there are teams in place. There's elbow-to- elbow support. We have war rooms. So, if there's an issue that's going on, we are rapidly able to assess what the problem is and fix it. The other thing that over the last few years we've been doing a number of optimization projects, right? So you heard about our capability block
▶ 1:21:37I got it. Yes, ma'am. But if those four sites fail, is Oracle going to continue to move on the other sites that need to be activated or is this or
▶ 1:21:46Yeah, that's a decision I think that we would discuss with the VA and figure out the appropriate course. But
▶ 1:21:52we haven't had that discussion yet.
▶ 1:21:54We have not had that discussion. Our discussions are focused on successful implementations and because of the previous experiences right we've gone through a number of deployments there's been a lot of lessons learned if we look at the past deployment that we had at Chicago again that went very well um and we continue to learn we continue to do upgrades and so far in these last few upgrades as well as in Chicago those have gone successfully well so we have no reason to believe that there would be a total failure
▶ 1:22:24of the system because we haven't seen that in our you know the last few projects whether it's our optimization projects or the go live it
▶ 1:22:32I hope you know I hope that doesn't happen we've been waiting 10 years for this thing to work correctly just from my experiences in the past if you're not contingency planning on the worst case scenario when it shows up we're we're in a lot of we're in a lot of trouble fair enough how are the sites chosen we have these four in Michigan that are being activated. We had Chicago earlier. We have six sites online if if I'm reading this correctly. How are the specific sites?
▶ 1:23:01They is there connectivity currently between sites that that um that were we're going live on? So, it's an easier lift and then the sites that are kind of expanded out in like where I live, they're going to be the last ones to get a shot at it. Mr. Evans?
▶ 1:23:19Yes, I can answer that. And let me just uh I will answer that question about how the sites are selected. I want to quickly correct the record on the your sustainment cost question. I don't have a definitive estimate for the cost. What I was giving you there was the potential cost of operations. We don't have the the sort of nailed down number for what it's going to cost yearly. And
▶ 1:23:41well, I appreciate you saying that because eventually you the secretary is going to have to come back to the committee and ask for a substantial amount of money to sustain to sustain the EHR. Correct. And I mean we're almost 50 billion into it and it's not even working,
▶ 1:23:59That be that's going to be a very interesting conversation,
▶ 1:24:01right? and and there will be and part of that conversation is also what money comes off the books as we don't have to sustain ex you know legacy technology that we will be able to shut down at that point in time. So but coming back to how sites were selected uh we started uh uh we spent a lot of time looking together to say what sites are have the highest level of readiness to move forward and part of that was based on where we had already made investments.
▶ 1:24:28So the sites that are the earliest sites in our schedule that we provided to you through 2031 um were the sites where oftentimes we had started deployment activities and we had already made an investment and we could all we could save resources essentially by getting restarted there earlier. We had already done the infrastructure upgrades at those sites. We were ready to roll. Um we chose to move forward as I mentioned with a market-based approach.
▶ 1:24:54One of the things that we've learned, lessons learned, is that it is better for sites in a region to all be using the same electronic health record. That is, if you take a look in Michigan, there's a lot of interdependencies between the VA there. You look at Ann Arbor as an example. I think it's more than 20% of the patients they see in Ann Arbor have a primary care provider elsewhere in Michigan, for example, in Battle Creek or Sagenol and come there for specialty care.
▶ 1:25:24Having those sites on the same
▶ 1:25:26Keep going. Is this okay?
▶ 1:25:30Thank you.
▶ 1:25:30Same electronic health record allows us to have some efficiencies. And so we were looking by market going one vision at a time. We're going to complete by the end of 2026 vision 10 and then we will go to vision 12 and 23 and beyond from that based on the schedule.
▶ 1:25:48All right. Thank you. Um I am going to recognize myself for five minutes um for another round of questioning. Um Miss Harris I started to ask you about the uh kind of simultaneous testing uh that is going on that is you know the GAO has raised as a concern. Um, Miss Verma, what what do you feel is a counterpoint to that?
▶ 1:26:12And what can you do to convince me and and the GAO that doing this in a simultaneous fashion is the appropriate way to do it without just hitting a deadline for a date without thinking through the the risks associated with
▶ 1:26:26Sure. Well, well, first of all, we strongly support, you know, robust testing. That's an important part of an implementation. when you do testing that's when you may see things that you didn't anticipate. So agreed that it's a it's a very important part of an overall deployment. I think it's important to recognize in this situation is that the system is live in six sites today. And since we have implemented in those six sites, we've also done a number of optimization projects.
▶ 1:26:54And so in those when we do those optimization projects, we go through a big process of testing the system. um we do that with the VA. And then what we've also more recently implemented is that instead of waiting till the end to do testing, we kind of do it on an ongoing basis. We show them the optimization work. So I think we've had very strong robust testing and so we feel confident that the system that we have in place around testing is working.
▶ 1:27:23There have been improvements. I think an IVMV vendor at this point would just add to cost and not necessarily add anything new. We have had now successful implementations through our optimization work that shows that the testing is working. There are times when we've done testing, we've picked up things, we've delayed in some cases when we realized we needed to spend more time on it. But I think at this point the IV andV vendor
▶ 1:27:49laying aside the IV and V just doing all four sites simultaneously instead of one after another does increase the risk if something is discovered that needs action. Correct. And increases the risk of of potential problems would it not?
▶ 1:28:05Right. This is more of a scale issue. When we know we have four sites we make sure that there's adequate teams on the ground to do elbow elbow testing. We also have a war room so that our teams are actively monitoring.
▶ 1:28:17That's when it goes live. Correct. Not
▶ 1:28:19even before that. Even before that, right? That's when Dr. Evans and I spoke about hiring enough staff to make sure that we can scale so that we are testing, we're supporting those sites as that's going on. So, it's just a matter of scale. The process is the same around testing, around training, around supporting. It's just a matter of having enough staff to do it. But this is
▶ 1:28:39each of these are very unique in their application. these each of these VA hospitals that are not, you know, cookie cutter stamped out. These are very very
▶ 1:28:49to their unique situation and doing them all four together to me elevates the risk that there's going to be problems that arise or issues that are overlooked or we're batching these all together and then we're going to have them all go live nearly simultaneously without a lot of, you know, without a lot of of consideration for what happens if, as Mr. Latrell pointed out. And I think those are the things that we have to bear in mind.
▶ 1:29:14And you know, not to not to discredit what you're saying, but it feels like a lot of that is, you know, we have these things and, you know, we're a big company and we can do that, but I don't think that Oracle has had a project like the one that the VA is undertaking right now. Would you agree with that? I think we feel very confident that we can do this and we can do it at more at more than one site at a
▶ 1:29:41and I would I would expect and hope that you'd be confident in it for sure.
▶ 1:29:45We feel very confident in doing that and and I agree with you that that every VA is different which is why we've had teams on the ground.
▶ 1:29:52It's not like we're turning on the system quickly. We've been in these sites. We've been doing assessments of the sites so we can understand what they have on the ground. What are the differences between each site? So, we have a plan for each site and we have adequate staff and support for each of those sites.
▶ 1:30:10Miss Harris, do you feel like these um commitments by Oracle are satisfactory to the overall concerns that the GAO raised? I mean in taking a look at the previous history of the initial six sites particularly in the the five I mean when they went when they went live um Oracle Cerner did have a difficult time in addressing those ticket resolving those tickets in a timely manner.
▶ 1:30:35I know that they did a lot of streamlining in that process so that they would be able to meet their contractual marks for completing resolving those tickets you know against their contractual obligations. But I think again when you're doing it for simultaneous ones, I mean there's a tremendous amount of resource that are going to go towards um ensuring for example that that that ticket resolution is done, you know, under the contractual obligation. So that alone I think is very risky.
▶ 1:31:03It's going to take a tremendous amount of resources that I'm not quite sure is sustainable for for multiple sites at once.
▶ 1:31:09Last question. Is that something that was at the request of the VA or Oracle to do these for simultaneously? Uh if I may,
▶ 1:31:19either one of you go ahead.
▶ 1:31:20It was uh it was VA asked to do this and I would say I'd like to kind of take us back a step. One of the parts that we have talked about in this committee that is super important for us to succeed is to standardize our workflows. And one of the things we've done over the last year is establish very clearly what the federal EHR baseline is. As a reminder, this system is one instance, one system to support all of these medical centers.
▶ 1:31:47Part of being locking down a baseline will actually streamline our ability to do testing because some of that variation that you're mentioning from one site to the next becomes less and testing becomes much easier at scale when you're testing against a standardized set of workflows and a standard baseline. Um the other the second thing is that we are you know as
▶ 1:32:12sorry I got to I got to yield to the ranking member. Um but we will come back for for more questions time permitting. Uh ranking member Bazinski is recognized for five minutes.
▶ 1:32:20Thank you. I actually just want to pick up on some of your questions about readiness. I was curious Dr. Evans because I think you and and Miss Felma have talked a lot pointed to North Chicago as the example of how of readiness but I am curious of how well the readiness is going there and and the development since it's go live. That's a unique case as we know though because that was with DoD.
▶ 1:32:43Can you speak though to the other sites that have already gone live um as well and the and just you know um what's happening at at those sites as it relates to readiness?
▶ 1:32:57Sure. Um at the sites other than FHCC which are in Spokane, Walawala, uh White City, um and then also Columbus, Ohio. Um I would say overall we have we are tracking numerous metrics at those
▶ 1:33:15Um you heard uh Miss Verma mention uh about the revenue capture. We're doing very well with regard to um appropriate revenue capture. Productivity at all sites at Roseberg has returned to greater than the um 2019 preandemic baseline productivity.
▶ 1:33:35Uh we continue um to hold a problem management forum with live site recommend uh representatives every single day, every single workday where issues are surfaced. We address those.
▶ 1:33:50We've done a lot of work to work down the ticketing backlog for significant change requests, reduced that by well over 40% and are being quite responsive to the sites with their with their needs. Frankly, they can escalate anything any day at our 10 a.m. meeting. So, we're we're seeing um definite improved operations with the EHR at those original five sites. um at FHCC likewise it's pretty similar
▶ 1:34:20Can I just ask on those sites how are you measuring then productivity and and how it's changed at those sites?
▶ 1:34:27Um for the productivity um at those sites we are looking at something called
▶ 1:34:33um which is a mechanism it's it's an industry standard for measuring productivity. It's um captured through uh billing encounters or encounters that that sort of capture the documentation or the work that was done at the time of visit. We look at our views um per
▶ 1:34:52Okay. Um I'd like to shift to Miss Harris. Um so it was we talked about the testing. I also just wanted to circle back to your testimony about the GAO um more broadly that are still open. Um what do you think are some of the most concerning of those that are still open today? I think one of the most concerning ones is change management. Um VA still has yet to have a for an approved and formal policy in place there.
▶ 1:35:21Um as part of change management, there's training as well. Um when you take a look at the first five sites as well as FHCC uh those were vendor-led trainings and at all of those sites they had the feedback has been that those vendorled um trainings had failed to prepare them for their specific roles and workflows and so I think it is important for VA to take a more um leader to take the leadership role in that training. So again we have those open recommendations there that's that's vitally important.
▶ 1:35:51Okay. Um and Dr. Evans. Um, in addition to those recommendations that Miss Harris identified, um, I think there are 28 open from VA's Inspector General as well. What is the plan and timeline to close them?
▶ 1:36:09With regard to the GAO recommendations, we take, of course, all of the JO recommendations seriously. of the 17 open JO recommendations, um I do want to highlight that for eight of those um nearly half of those VA has made very significant progress and JO has asked to keep those recommendations open until after we get past some of these initial go lives in Michigan specifically.
▶ 1:36:39So, for example, um there is an open recommendation about making sure that that our contractor staff and the VA is using the right terminology. This was a recommendation from 2020. We've fully implemented that recommendation. Jo asked us to wait to see how things go in Michigan to close that recommendation.
▶ 1:36:59Can I just interrupt because I'm running out of time, but Miss Harris, would you agree with that? I did note that some of the recommendations do say partial. Um but still many of them just still say open. So is there more to the story from what Dr. Evans is saying?
▶ 1:37:13There has been action taken on on um many of the recommendations for sure. The one that that Dr. Evans noted is not one that we do consider to be priority. Um it is important of course but um but certainly all 12 of our priority uh those are are still the majority of them um is not in the situation that that he had he had mentioned.
▶ 1:37:37However, I will say they've done work but we do need to hold some of those open to ensure that the actions that they've taken are effective because we'll see those results in Michigan.
▶ 1:37:46Okay, I yield back.
▶ 1:37:48Thank you Mr. Latrell for five minutes.
▶ 1:37:51thank you Mr. Chairman. The six active systems say that um system itself has proven difficult to use and is not well suited for VA workforce workflow. Excuse me. Staff have reported slow performances, excessive clicks, data loss, and a cumbersome documentation All six facilities that implemented the new system have faced increased workloads due to workaround processes, burnout, staffing shortages.
▶ 1:38:14Uh the the report goes on about talking speaking on because of the weight of the implementation of this morale is down there have been system updates. There has been a standardization and readiness improvements and the user experience apparently went from 7% and 22 to 33% and 25. Now these are the six sites that are currently working under the system.
▶ 1:38:43the Oracle system and you're about to add four more. Mr. Evans, you you said in your previous statement that all the all you you're doing Michigan because Michigan's the same. We're going to do Washington because Washington's the same. You come down to Texas, Texas is Texas. And if you have these particular sites that are having these issues, you're going to add these other sites on board that are different and then you're going to try to complete the entire system. That's a extremely heavy weight.
▶ 1:39:12I'm curious, Miss Verma or Dr. Evans, what does that even look like? Because if the current system doesn't work effectively at 33% and we're about to add four this four next year or four in April and then what's the number in 27, please? 26 26 and 07 or 27.
▶ 1:39:39You see where I'm going with this? walk me through it.
▶ 1:39:42I do. Um first of all I think we [clears throat] have uh just to give you a sense um for the change over the course of [clears throat] the reset we were introducing we introduced over functional changes that is changes responsive to end users where end users said hey the system needs to work better in the following way
▶ 1:40:05just on these six sites the active sites
▶ 1:40:07at the six sites 1500 changes over the course of the reset that was more than 50 changes on average a week that we were introducing responsive to their feedback. That's not that beyond that. Um thousands of other changes that were introduced as part of block upgrades which are platform upgrades where Oracle's improvements to their base platform are being introduced to the VA.
▶ 1:40:31There has been uh a significant uh amount of improvements to the user experience and I think the data that you were quoting the 33% is from our enduser experience survey and I you know I believe that we are seeing direct line improvement that is as we pay attention to end users as we address the change requests in a standardized way at the national level that is responsive to our clinical communities and as we deliver those
▶ 1:41:01in a way that as um Miss Harris mentioned is rolled out in a way where users feel supported where they get adequate communication where they get training to the changes we are seeing confidence improve. Now, it's not where I want it to be, but we are seeing confidence improve at the at the six live sites.
▶ 1:41:20Are the four active sites in Michigan that is this implementation has this been handed off to them? So, you won't be surprised when something like this populates after they go active 117 days. They're not going hopefully not I shouldn't I'm not going to call it a mistake but they're not going to have the same issues that the current sites are having because everything that we've learned off the current six sites has been pushed over to the four sites are going to go active in April.
▶ 1:41:44That is correct. All of the improvements that the six sites that we have learned from the six sites and frankly from our lessons learned working with the DoD and and working with Oracle and commercial customers about what best practices are. All of that value will be delivered to
▶ 1:42:01Hopefully. Yes, it will. I yield, sir.
▶ 1:42:07Thank you, Mr. Latrell. I recognize myself for another five minutes. Um, so I know this issue of a change management and everything is is difficult and uh Dr. Dr. Evans, I think I shared with you that I I think uh as a classification physicians tend to be a little bit stubborn and I think you agreed with me and then I think physicians within the VA might be a particularly stubborn bunch.
▶ 1:42:33Um but with that being the case and laying that aside, who's ultimately responsible for that change management? Is it Oracle? Is it VA? Or is it Accenture? like who who's responsible for that part of this?
▶ 1:42:53I mean at the end of the day VA is responsible. This is our health care system. This is the VA healthcare system and this is our project to implement a new electronic health record. One of the things that we um as we during u you know as we sort of sat before we started to accelerate deployments we said we need a new change management strategy. We worked that out. One of the big pieces of that is is that it is VA leaders standing in front of their peers that kick off this process.
▶ 1:43:23We introduced a new event. It's the change leadership team, executive leadership team, onboarding event. We do it in every market. It is led by VA leaders who are speaking as peers to their staff to say this is what the change will feel like. This is what is going to be. I can own a little bit of stubbornness as a primary care provider in VA as you pointed out. But I will say this, my experience is that VA clinicians, they circle around the veteran.
▶ 1:43:49If you are delivering a better experience to the veteran, that is a worthwhile change to adopt. And part of this is is is building a real sense of the why. Why is there value in us coming together around a single electronic health record that supports veterans wherever they are where the care surrounds the veterans regardless of what physical geographical location they walk into in a VA?
▶ 1:44:15And I'm not seeing objections from our clinical staff or our administrative staff when they understand that why and when they're adequately supported. So, we own it. VA owns it, but I am very grateful as well for the contractors who are supporting us in executing that change
▶ 1:44:39And then um the the surveys that you're undertaking, you know, Mr. Law pointed out you guys went from 7% to 33%. So congratulations, you're more popular than Congress finally. Um but with that being the case, um do you feel the survey methodology is accurate or is it one of those things that tends to attract more negative response bias?
▶ 1:45:05Yeah, it's a good question. We get about 20% um participation in the surveys on average when we send them out twice a year. And that's actually a good response rate for a survey with when we're asking busy folks in the medical centers to take their time out to do the survey. Point number two, the survey methodology, the survey questions that we use are a standardized set of questions used by many health care systems both in the private sector as well as in the federal government and are comparable with the DoD.
▶ 1:45:35Um and so those questions I do believe that the that they are robust questions that we can learn from and by and from which we can look at other health systems that have engaged in a similar transition and and track our progress accordingly.
▶ 1:45:49Okay. Okay. And do you feel that VA end users as they're being trained on this have adequate um you know authority to to raise their concerns without feeling like they're being you know that that there's going to be not punishment but just um you
▶ 1:46:08absolutely I mean it is an anonymous survey. We expect um complete honesty on the survey.
▶ 1:46:13Okay. Um switching briefly because I've only got about one minute left. Um I know we talked Miss Verma a little bit about some of the pharmacy related implementation and things like that being a unique role that the VA has and some of the drug interaction pieces. Um what I guess where do you see Oracle integrating into this to make sure that we can resolve that going forward for the understandably unique way that the VA does the pharmacy role.
▶ 1:46:42Sure. And you're you're absolutely right. Right. we're taking an solution and bringing it to the VA and the VA has some very specific and unique needs. I think that there's been um some points that we've implemented or some projects that we've implemented that have really upscaled the level of safety um things like opioid prescribing.
▶ 1:47:02We've also improved communication between umarmacies and the providers if a drug's not available to have that conversation so that they make sure that what's being prescribed is available. Um and we are seeing some definite improvements. We are seeing some providers out there that have a level of productivity to pre-eployment. That being said, I think we would recognize that we that this is an area of continued focus where we want to make sure that we have adequate training.
▶ 1:47:31Um, we also sent, you know, our CEO went to go visit one of the centers and specifically looked at pharmacy because we do know that this is going to be something that we are going to continue to improve. So, I think we've made progress, but um, I would also acknowledge that this is an area that we continue to focus on at the highest levels of Oracle and we continue to make improvements. Um, and we have conversations about this on an ongoing basis. One of the things that I really appreciate, um, the leadership,
▶ 1:47:58I'm going to have to cut you off in just a second. I apologize. Um, ranking member Bazinski for five minutes.
▶ 1:48:04Thank you. Um, Miss Verma, um, Oracle has been touting its effort to build a new EHR. Um, I think you've gone as far as to say that Cerner's EHR is equivalent to crumbling infrastructure. Is this crumbling infrastructure the product that is being deployed at VA?
▶ 1:48:22We are making improvements to the the Cerner system that's being implemented in the VA. So, we took the Cerner system. You've heard about all the different optimization projects that we are doing. We are also introducing a lot of AI agents that will sit on top of the Cerner system to help it, you know, to help it provide, you know, the best experience for providers on the front
▶ 1:48:46And how much of this is informed by lessons learned at the VA?
▶ 1:48:50I think a lot of it is is informed by lessons learned. Um, one of the things that we appreciate is that the leadership today is very active in terms of visiting the sites um, seeking input from providers and understanding what are the pain points and then communicating it to us. We meet very frequently with the VA almost every two weeks. There's weekly meetings with the secretary and in those meetings we're identifying where where are there opportunities for optimization. We've executed on a lot of these projects.
▶ 1:49:20you've heard of the um capability block updates that we've been doing and those represent the optimization projects and I think that's why we are starting to see um better results in terms of the experience of providers and I think the sentiment overall is increasing as well in terms of the positivity. We've spent a lot of time today talking about cost and I'm just curious how you'd respond you know hearing this is this going to all lead us down the path of additional cost from Oracle's perspective.
▶ 1:49:48Yeah. So, I haven't reviewed um any of the new estimates that that have come out, but I think that's something that we're very cognizant of with with of cost. I think that some of the more recent changes that we've made, the first one I would say is the
▶ 1:50:02You know, having a system where you had six different sites re you requesting different types of changes. Those kinds of things contribute to increased cost. So, we're very excited about the changes that we've heard about in terms of moving to standardization that's going to make the cost more predictable and more sustainable. That being said, it's always, you know, foremost on our minds.
▶ 1:50:24This is why um Oracle agreed to move the um federal system to our cloud to make sure that we had, you know, greater security and performance and we're doing that at our cost as well. And we we advise the the VA. One of the things that we um really advocated for was the standardization because we also knew that not being standard would contribute to increased costs.
▶ 1:50:50I think the pause in it of itself hasn't helped in terms of cost because you're maintaining two systems. Um and so moving forward I think will also help make sure that we are using taxpayer dollars appropriately and efficiently. And is um we've tal you've talked a little bit about in your testimony obviously AI. Um is AI capability included in VA's contract with Oracle and is there additional cost to that?
▶ 1:51:16It depends on which AI agent. So there's not a one-sizefits-all approach. We are bringing the brand new EHR to the VA. We are not charging for that um you know new ambulatory system but there are there will be some AI agents that are included inside the EHR and there are some that are additional and the VA will have to assess those and decide which ones that they want to use.
▶ 1:51:38Okay. Miss Harris, can I just ask you in your testimony you'd flagged we were talking about the overall cost in the beginning of this hearing and I didn't I wanted to get to you but could you I think you had flagged some concerns around that number um the 37 billion. Could you speak to that?
▶ 1:51:54Yeah. Well, we haven't seen the 37 billion number. So, as soon as our office receives that, we will, you know, certainly uh do a deep scrub of that and then get back to you on that. But I will say the independent cost estimate that is out there is the total life cycle cost is roughly $49.8 billion. So, roughly $50 billion. And so, um you know, we're going to have to go through the differences. that number also is outdated because it doesn't reflect the changes and the delays including the pause.
▶ 1:52:24Um so that that's also something that we'll have to to take a look at. But we'll certainly do a um a comparison there of that. Okay.
▶ 1:52:33That thank you when you get that. Um, Miss Verma, if I could just ask again, um, going back to, um, Oracle health software, um, and specifically the veterans data, um, is it being used to train the AI that Oracle will use for its commercial clients?
▶ 1:52:51Absolutely not. We do not have access any data rights. So, we do not use that data to train our models. No.
▶ 1:52:57Okay. Will VA receive credits of some sort for the benefit or goals derived from the information? We don't use their information for any of our training for AI models.
▶ 1:53:07Okay. Okay. Um, Miss Harris, your testimony indicated that VA has not instituted plans to conduct an independent operations assessment to evaluate the suitability and effectiveness of Oracle's EHR. We've been contemplating the need for such an evaluation. Uh, what do you think this should entail and what do you think um should who should conduct it?
▶ 1:53:30Yeah. So I think that uh given this approach to go go live at four sites at Michigan um once that takes place I think that there should be an IV after that looking at all four sites to do that systematic cataloging of those defects. Um and it should be an independent third party that that goes in and does does that review. And again I can't stress enough the reason why MHS Genesis was so successful in their deployments. You know we've spent a lot of time with them.
▶ 1:53:59A large part of that was because of the IV and V test that they performed.
▶ 1:54:03Sorry. Thank you very much, Miss Trell for five minutes and then we'll go
▶ 1:54:07Thank you, Mr. Chairman. So, so the VA did not Dr. Evans, I don't know how long you've been in the VA, but I was just curious. So, we didn't negotiate into our contract with Oracle any kind of AI footprint because what I heard her say is we're just trying to get the baseline. It's like this is like when my 8-year-old comes up and buys wants to buy an a video game. It's like, hey, we can get the baseline model, then when you're inside, you got to buy everything else to get it where it needs to be. That kind of sounds like where we're at. You don't have to answer that question. I just wanted to say that out loud.
▶ 1:54:39We have six sites that are currently on Oracle, right, Miss Verma? So, the rest 160 plus are still on what? Vista A, Dr. Evans? We spend roughly about a billion dollars on software across the board. Some some of the VA facilities use software that other VA facilities don't use. Some have the highest level of software um advancements inside their facilities and some don't.
▶ 1:55:05But we have to pay for it all whether or not that we even use it or not. Like my little facility in Conro, Texas still uses some some software that helps Vista A but Dakei does not. But we still have to fund the whole thing and it's almost a billion dollars if I'm correct. I may be off on that, but I think it's almost a billion dollars. Miss Verma, when when Oracle activates on every single site, do we have the ability to tell everybody else, "Hey, we don't need you anymore.
▶ 1:55:39I think your button's off."
▶ 1:55:40Yeah. Okay. So, I think it's going to depend on every site. My My
▶ 1:55:44No, it can't depend on every site because the whole purpose of us doing this with you guys is that every site's the same.
▶ 1:55:49It says that multiple times.
▶ 1:55:50Yeah. So my expectation would be that with a new Oracle EHR that they should be able to use our system and that that should address the needs that they have. I I don't know whether you know every single site and what they have, but I would anticipate that this EHR with the standardization that we're bringing that it should be able to meet the needs of of any hospital or clinic across the country.
▶ 1:56:13I hope so for $50 billion because we're going to have to have the conversation with everybody saying, "Hey, look, we implemented this at $50 billion plus the dollar sign, Dr. Evans, of what sustainment looks like." And then hopefully at the end of the day, we don't have to say we have to continue to pay for everything that's in Vista because we already have it in the system and then we're going to pay for Oracle on top of it. Are we going to have to have that conversation? Miss Harris, what do you think about that?
▶ 1:56:44That sound reasonable? This is kind of the math problem I'm drawing out in my head, but it's where we are. The the slide deck that they brought to my office when it shows every single software that we pay for, we have one software program that only one VA uses and we still pay for it because they have to have it for some reason. What do you think about that, Dr. Evans?
▶ 1:57:07I think that um you're this is a very important point as we move forward the federal EHR think of that as the operating system for the hospital will be the same at all hospitals. Not all hospitals offer the same clinical services. For example, we're going live uh in Michigan for the first time. We'll be implementing radiation oncology.
▶ 1:57:29There is some unique software that is necessary to support a radiation uh clinic and operation uh that won't be needed at every site. But one of the real advantages uh and one of the reasons why when you hear me and us and VA talk about what we call the federal EHR baseline, we think that is so important is because we are going we are publishing it's published right now on our website.
▶ 1:57:54These are the software systems that we will support and can support connected to the federal EHR and by definition that also means there are those that we won't support.
▶ 1:58:04So every system that we have in place currently once Oracle activates in all sites are going to come running to you guys and say you have to use this. Well,
▶ 1:58:13because we're already here.
▶ 1:58:15No, no, that we are making the decisions now as we go from sight to sight around what the standard is going to be.
▶ 1:58:21Every I'm sorry. I I'm still I'm still under the impression that every site's going to be the same.
▶ 1:58:28Not every site has the same clinical
▶ 1:58:31I understand that. But when we go to a
▶ 1:58:33but every site can have what Oracle is populating and the six sites that have are active and four sites that are coming up and the 27 next year will be the exact same. Correct?
▶ 1:58:43So I have that in my my little satellite campus in Conroe.
▶ 1:58:47So I'll give you an example. Bedside monitors when you walk into an intensive care unit, the thing that's hanging up above the bed with the EKG on it, um that is not a core part of the electronic health record. that is a biomedical device that is a it has software that runs it that we'll need to plug into the electronic health record.
▶ 1:59:05One of the ways we will be able to manage cost is by by standardizing which of those devices we can support and it should be a limited number in order to be able to manage the EHR in a more coste effective way across the
▶ 1:59:23All right, thank you. I apologize. We're up against a bit of a uh hard stop uh for the uh committee. Um we're going to move on to closing statements. Um do I go to you first? Okay. Uh I will go to ranking member Bazinski for her closing statement.
▶ 1:59:41Thank you, Mr. Chairman. Thank you. Um I agree that we need to give veterans and VA employees the modern tools that a new EHR can offer, but those tools have to work for the VA. And I just don't believe that we're there yet. I don't want to be a pessimist, but I don't feel like I'm leaving this hearing having my mind changed on this point. Dr.
▶ 2:00:04Evans and Miss Verma are quick to point out that the new administration is driving increased momentum and leadership involvement in the project. I'm concerned that the administration's involvement is only moving the program forward faster, not better. There are so many recommendations from the GAO and the inspector general as well as Congress that will continue to sit unheated.
▶ 2:00:29I have no confidence that the next round of go lives is going to be any better than the last. I would implore Secretary Collins and the Trump administration to pay attention to their own words and put the veterans at the center of everything. Anything else puts the health and safety of our veterans at risk. Thank you. And I yield back, Mr.
▶ 2:00:50Thank you, Ranking Member Bazinski. I was actually voted most optimistic of my high school graduating class, mostly because I thought it was the Lions year every year. And again, we find ourselves on the edge of not even making the playoffs perhaps. But I uh I in my old age, I've moved from an optimist to more of a realist. And I think the issue before our committee is what is the real assessment of where we're at and what we need to do to prepare going forward.
▶ 2:01:18And I think a healthy amount of question, concern, and even a little bit of skepticism is appropriate for our committee to feel given the past performance of how this has gone and what we need to be prepared for. And I can tell you with cander what I what I will not accept if we fast forward the tape 117 days from today is if things don't go well and do not go as necessary to protect the health and benefit and welfare of the veterans that we serve is fingerpointing and blame between
▶ 2:01:49you know various different vendors the department and who had what and musical chairs as to where things land. So this committee, our work here is not going to tolerate that. If there are differences between opinions as to what needs to take place, I encourage you to resolve those. Um, if you need help from this committee to to to do that, I am very willing to be the person to step in into that role and with the ranking member to assist in doing that.
▶ 2:02:17But we need to absolutely make sure that we have a no fail mindset going into this go live 117 days from today. When I was at my last uh appointment in Battle Creek uh for a physical, they set a follow-up that was a few months into the future and it happened to land on the week that this go live is. And um you know, I'm comparing my session calendar with when I can be back home. And I'm like, "Well, I'm available on this day." And they're like, "Oh no, we are getting a new electronic health record system.
▶ 2:02:46We are not scheduling appointments on that day." And so I know that they are taking it seriously. I just want to make sure that the tools are going to be there for the enduser, the the practitioners, the doctors, the medical assistants, the nurses, and all the other various people involved in this from front to back are going to be ready for this as it comes up.
▶ 2:03:09I'm hopeful and encouraged that you pointed out the super users have begun getting their training now, but then the the more, you know, rudimentary kind of day-to-day users are going to be getting that at an point that is appropriate for them. I have concerns about the the, you know, simultaneous testing going on as we pointed out in the questioning and I want to make sure that that is done appropriately. Um, and I think there are questions that the committee has that are still unresolved and a few more that Mr. Latrell raised as well.
▶ 2:03:38So, uh, we want to be partners in this, not antagonists, and we don't want to slow you down, but we do want to maintain the appropriate level of accountability to make sure that this goes, um, as well as we need it to. So, um, with that, I think I have some disclaimers I got to say here at the end. I ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extraneous material. Without objection, so ordered. And with that, this hearing is