    [House Hearing, 119 Congress]
    [From the U.S. Government Publishing Office]

                    READY, SET, GO-LIVE: ASSESSING VA'S EHR
                       MODERNIZATION DEPLOYMENT READINESS

    =======================================================================

                                    HEARING

                                   before the

                    SUBCOMMITTEE ON TECHNOLOGY MODERNIZATION

                                     of the

                         COMMITTEE ON VETERANS' AFFAIRS

                         U.S. HOUSE OF REPRESENTATIVES

                        ONE HUNDRED NINETEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                           MONDAY, DECEMBER 15, 2025

                                   __________

                               Serial No. 119-40

                                   __________

           Printed for the use of the Committee on Veterans' Affairs

                   [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                        Available via http://govinfo.gov
                                  ______

                     U.S. GOVERNMENT PUBLISHING OFFICE

    62-607                    WASHINGTON : 2026

                         COMMITTEE ON VETERANS' AFFAIRS

                         MIKE BOST, Illinois, Chairman

    AUMUA AMATA COLEMAN RADEWAGEN,       MARK TAKANO, California, Ranking
        American Samoa, Vice-Chairwoman      Member
    JACK BERGMAN, Michigan               JULIA BROWNLEY, California
    NANCY MACE, South Carolina           CHRIS PAPPAS, New Hampshire
    MARIANNETTE MILLER-MEEKS, Iowa       SHEILA CHERFILUS-MCCORMICK,
    GREGORY F. MURPHY, North Carolina        Florida
    DERRICK VAN ORDEN, Wisconsin         MORGAN MCGARVEY, Kentucky
    MORGAN LUTTRELL, Texas               DELIA RAMIREZ, Illinois
    JUAN CISCOMANI, Arizona              NIKKI BUDZINSKI, Illinois
    KEITH SELF, Texas                    TIMOTHY M. KENNEDY, New York
    JEN KIGGANS, Virginia                MAXINE DEXTER, Oregon
    ABE HAMADEH, Arizona                 HERB CONAWAY, New Jersey
    KIMBERLYN KING-HINDS, Northern       KELLY MORRISON, Minnesota
        Mariana Islands
    TOM BARRETT, Michigan

                           Jon Clark, Staff Director
                      Matt Reel, Democratic Staff Director

                    SUBCOMMITTEE ON TECHNOLOGY MODERNIZATION

                        TOM BARRETT, Michigan, Chairman

    NANCY MACE, South Carolina           NIKKI BUDZINSKI, Illinois, Ranking
    MORGAN LUTTRELL, Texas                   Member
                                         SHEILA CHERFILUS-MCCORMICK,
                                             Florida

    Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
    hearing records of the Committee on Veterans' Affairs are also
    published in electronic form. The printed hearing record remains the
    official version. Because electronic submissions are used to prepare
    both printed and electronic versions of the hearing record, the process
    of converting between various electronic formats may introduce
    unintentional errors or omissions. Such occurrences are inherent in the
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    further refined.

                             C  O  N  T  E  N  T  S

                                  ----------

                           MONDAY, DECEMBER 15, 2025

                                                                       Page

                               OPENING STATEMENTS

    The Honorable Tom Barrett, Chairman..............................     1
    The Honorable Nikki Budzinski, Ranking Member....................     3

                                   WITNESSES
                                    Panel I

    Dr. Neil Evans, M.D., Acting Program Executive Director,
      Electronic Health Record Modernization Integration Office, U.S.
      Department of Veterans Affairs.................................     5

    The Honorable Seema Verma, Executive Vice President, Oracle
      Health and Oracle Life Sciences, Oracle Corporation............     7

    Ms. Carol Harris, Director, Information Technology and
      Cybersecurity, U.S. Government Accountability Office...........     8

                                    APPENDIX
                        Prepared Statements Of Witnesses

    Dr. Neil Evans, M.D. Prepared Statement..........................    31
    The Honorable Seema Verma Prepared Statement.....................    33
    Ms. Carol Harris, Director Prepared Statement....................    45

                           Statements For The Record

    The American Legion Prepared Statement...........................    63

                    READY, SET, GO-LIVE: ASSESSING VA'S EHR
                       MODERNIZATION DEPLOYMENT READINESS

                                  ----------

                           MONDAY, DECEMBER 15, 2025

      Subcommittee on Technology Modernization,
                        Committee on Veterans' Affairs,
                                 U.S. House of Representatives,
                                                        Washington, DC.
        The subcommittee met, pursuant to notice, at 3:01 p.m., in
    room 360, Cannon House Office Building, Hon. Tom Barrett
    (chairman of the subcommittee) presiding.
        Present: Representatives Barrett, Luttrell, and Budzinski.

               OPENING STATEMENT OF TOM BARRETT, CHAIRMAN

        Mr. Barrett. All 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 U.S. Department of
    Veterans Affairs (VA) Electronic Health Record Modernization
    (EHRM) Program. I was actually joking with some friends back
    home recently. They were asking me what it is like my first
    year in Congress, and I was telling them a little bit about the
    work we are doing on this subcommittee. I said, before I came
    here, I did not even--I could not 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. But appreciate the work that
    we have done on this committee and for the witnesses that are
    here today.
        Right now, of course, we are at a pivotal moment. I think
    we are down to 117 days until the new system will be launched
    at 4 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. The question remains, 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?
        For millions of veterans relying on VA hospitals and staff
    supporting them, this is not something that is theoretical. It
    is real, it is happening, and we have to do it right. As I said
    before, the veterans that we serve and that the Department is
    going to serve have 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. They expect safe
    and timely care. 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. While progress has been made
    since then, we know that significant work remains before we go
    live. VA has standardized over 1,000 workflows into a national
    baseline, with 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. Thirty-four new complex
    clinical workflows will debut there for the first time. VA
    plans to test across four sites 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.
        The committee has heard from physicians that the critical
    function system remains unstable. We hear from VA pharmacists,
    I know that is 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
    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.
        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 am encouraged by the momentum we have seen. I am
    encouraged by the commitment of my friend 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 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 cannot accept failure.
        Thank you, again, for being here today. I do want to say it
    is never my intention to take gratuitous shots at anybody
    appearing before this committee, but we do have a role to play
    in oversight of what is taking place, and we intend to
    vigorously and robustly carry that forward.
        With that, I will yield to Ranking Member Budzinski for her
    opening statement.

          OPENING STATEMENT OF NIKKI BUDZINSKI, RANKING MEMBER

        Ms. Budzinski. Thank you, Mr. Chairman, and I agree with
    you. Thank you to our witnesses for being here today. It seems
    we are bookending this year with EHRM hearings, and I look
    forward to hearing how the program has improved and how the
    Department has prepared to resume Go-Live activities.
        To start, I do want to address an article that I read over
    the weekend about Secretary Collins' plans to eliminate 35,000
    positions from the Veterans Health Administration (VHA). I 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, but the word is ``most'' and they do not use
    ``all.'' The VA workforce is already stretched too thin.
    Eliminating 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 is irreplaceable. If Secretary Collins is
    serious about keeping veterans at the center of everything, VA
    healthcare 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.
        Their efforts to outsource veterans' care will also have
    dire impacts on the success of the EHRM program. Today we are
    117 days from VA's EHRM Go-Live at 4 VA medical centers in
    Michigan. After the program was reset for 3 years, the
    Department made the decision not only to restart, but to
    accelerate the Go-Lives in an effort to finish almost on
    schedule. I 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 sites.
        The veterans of Michigan's 7th District and Illinois' 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.
        At 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 U.S. Government
    Accountability Office (GAO). According to GAO's testimony, it
    has not changed. Our goal is to ensure that we are setting VA
    up for success. However, 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.
        I 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 the 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. There 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? Is it a true systems integrator or is it a
    continuation of the role currently held by Booz 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. In 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 costs. In 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. Now the Deputy Secretary is
    backtracking and saying that it is only going to cost $37.2
    billion.
        I am concerned that nobody actually knows what the bottom-
    line cost is. I need to hear today that VA has a grasp on this.
    The 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.
        I find it very troubling that the Department instead seems
    to be minimizing the concerns raised. Their framing of the
    story takes their usual tack: blame everything on the previous
    administration. I will be honest, I think there is plenty of
    blame to go around. 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. We 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 world-class healthcare.
        Thank you, Mr. Chairman, and I yield back.
        Mr. Barrett. Thank you, Ranking Member Budzinski.
        I will now introduce our 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 say that correctly,
    Doctor? All right, very good. From Oracle, we have Hon. Seema
    Verma, executive vice president and general manager of Oracle
    Health and Life Sciences. From the GAO, we have Ms. Carol
    Harris, a familiar face to this committee, the director of
    Information Technology (IT) and cybersecurity at GAO.
        I will ask the witnesses to please stand and raise your
    right hands. Well, your right hand.
        [Witnesses sworn.]
        Mr. Barrett. Thank you. Let the record reflect that all
    witnesses have answered in the affirmative.
        Dr. Evans, you are now recognized for 5 minutes to deliver
    your opening statement on behalf of VA.

                        STATEMENT OF NEIL EVANS

        Dr. Evans. Thank you. Good afternoon, Chairman Barrett,
    Ranking Member Budzinski, and distinguished members of the
    subcommittee, including Mr. Luttrell. I 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 (EHR) system , which we refer to as the Federal
    EHR, and we intend to implement that across the entire VA
    enterprise.
        As was mentioned, since our last hearing in February, VA
    has made significant progress toward 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.
    Those were in addition to the four previously announced medical
    centers in Michigan slated for deployment, bringing the total
    number of planned deployment sites 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 Veterans
    Health Information Systems and Technology Architecture (VistA)
    to the Federal EHR in this coming year.
        In addition, we have begun deployment work at 7 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 2031.
        Based on lessons learned, VA will now be using a market-
    based approach for deployments, with 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 markets.
        Now, I would like to bring our focus back to the near term.
    As was mentioned, we are only 117 days, less than 4 months,
    away from our planned Go-Lives in Michigan, and less than a
    year away from the remainder of our deployments across all of
    Veterans Integrated Service Network (VISN) 10 and 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.
        Contributing 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
    roles, 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. Lawrence has been talking to site and VISN 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 VISN level are encouraged by the
    program's direction and newfound momentum and are perhaps the
    most important drivers behind our current progress.
        As 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 percent, exceeding
    our agreement of greater than 95 percent for 21 consecutive
    months. We are also delivering system enhancements, new
    features and system changes that are responsive to the feedback
    we are hearing from VA staff and are driving improved
    standardization across the enterprise.
        For example, I know we have often spoken about the system's
    pharmacy capabilities in this committee and we will be
    delivering seven further pharmacy improvements before our Go-
    Lives in Michigan in April. As another example, we just
    released new system functionality called ``Seamless Exchange''
    in September, reducing by more than 95 percent 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. We continue to administer the Federal EHR User Experience
    Survey twice yearly and I am pleased that we have seen
    consistent improvement survey over survey. Ultimately, our goal
    is to deliver an EHR system that earns the trust of veterans,
    clinicians, and staff. That means a system that works
    efficiently, enhances care coordination, reduces administrative
    burden, and improves health outcomes for veterans.
        With the partnership of this Subcommittee, we look forward
    to continued and accelerated progress over the remainder of the
    119th Congress and beyond.

        [The Prepared Statement Of Neil Evans Appears In The
    Appendix]

        Mr. Barrett. Thank you, Dr. Evans. The written statement of
    Dr. Evans will be entered into the hearing record.
        Ms. Verma, you are now recognized for 5 minutes to deliver
    your opening statement on behalf of Oracle.

                        STATEMENT OF SEEMA VERMA

        Ms. Verma. Thank you. Chairman Barrett, Ranking Member----
        Mr. Barrett. Can you please use your----
        Ms. Verma. Oh, I am sorry.
        Mr. Barrett. Yes.
        Ms. Verma. Let us try again.
        Mr. Barrett. Thank you.
        Ms. Verma. Good afternoon, Chairman Barrett, Ranking Member
    Budzinski, 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. I am pleased to report significant progress on the
    accelerated deployment plan and that Oracle is confident that
    we are 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. Their decisive leadership has strengthened the
    program and demonstrated a shared determination to deliver a
    unified, high-performing 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 percent incident-free time
    requirement for 21 consecutive months and we have been free of
    any systemwide outages for 8 consecutive months. These
    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 strengthened
    financial performance results. With these optimizations,
    productivity has increased at all facilities and cash
    collections exceeded Fiscal Year 2025 goals, achieving 180
    percent of target.
        Last, as Dr. Evans referenced, we have expanded Seamless
    Exchange to all Federal EHR facilities. Seamless Exchange
    compiles and deduplicates patient data from multiple sources.
    This reduces the volume of external data that requires manual
    review and enables improved medical charting and decision-
    making efficiency.
        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 end users to not just learn about
    changes, but to actually try the system out in advance of Go-
    Lives.
        We 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 Artificial Intelligence (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 decision-making.
        Our work does not end here. With 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 U.S. Department of Health
    and Human Services (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, Oracle's was built from the ground up on a secure,
    modern cloud. This 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
    QHIN, by HHS. This achievement will enable broader and more
    secure exchange of patient data records across disparate
    systems as veterans receive care from multiple sites and
    multiple providers. Our QHIN will streamline connectivity,
    enhance data accessibility, and help ensure that every care
    provider has timely, comprehensive information to support
    better outcomes for veterans everywhere.
        In closing, as we move into 2026, we are confident and
    prepared to deploy the Federal EHR under the accelerated
    deployment schedule. This will bring a unified health record to
    veterans, which we can all agree brings incredible opportunity
    to improve their experience with the VA and the health of our
    veterans.
        Thank you and I look forward to answering your questions.

        [The Prepared Statement Of Seema Verma Appears In The
    Appendix]

        Mr. Barrett. Thank you, Ms. Verma. The written statement of
    Ms. Verma will be entered into the hearing record.
        Ms. Harris, you are now recognized for 5 minutes to deliver
    your opening statement on behalf of the GAO.

                       STATEMENT OF CAROL HARRIS

        Ms. Harris. Thank you, Chairman Barrett, Ranking Member
    Budzinski, Congressman Luttrell. 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. The rollout 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 and roughly 170 more throughout the Nation
    by 2031.
        Over the past 5 years, we have issued five reports on VA's
    efforts to deploy its new EHR system. These reports describe
    actions taken by the Department and identify challenges with
    key planning tools critical for program oversight. We also
    reported on challenges experienced with the initial
    deployments, such as the ones I just noted.
        To 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
    recommendations, it has not fully implemented 16 of them. I
    will highlight the 12 priority recommendations here.
        The first two are that VA needs to produce an updated cost
    estimate and schedule. The latest independent cost estimate of
    roughly $50 billion does not reflect the many changes and
    delays to the program. I know you have 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. The updated estimate
    is imperative to understanding the full magnitude of VA's
    investment.
        We have also yet to see an updated integrated master
    schedule. Consequently, 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. We 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. VA concurred
    with those recommendations, and, as of December 2025, VA has
    partially implemented 1 of the 10 priority recommendations and
    continues to work toward implementing the remaining 9.
        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. However, 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. Further, VA has no plans to conduct an independent
    operational assessment or an Independent Verification and
    Validation (IV&V) test to determine whether the system is
    operationally suitable. Without an IV&V, the Department
    increases the risk of deploying the system prematurely, thereby
    posing unnecessary risks to patient health and safety.
        Moving forward, it will be critical for VA to address the
    12 priority recommendations along with the other 4 open ones as
    soon as possible. Until 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 veterans deserve.
        That concludes my statement. I look forward to addressing
    your questions.

        [The Prepared Statement Of Carol Harris Appears In The
    Appendix]

        Mr. Barrett. Thank you, Ms. Harris. The written statement
    of Ms. Harris will also be entered into the hearing record.
        We will now proceed to questioning. I will recognize myself
    for 5 minutes.
        Ms. Harris, thank you. You mentioned some of the cost-
    associated considerations and concerns that are out there, what
    the true price tag of this is going to be. Dr. Evans, is this
    something that you can furnish through the Department over to
    the GAO for them to review that life cycle cost analysis?
        Dr. Evans. Yes, we provided that to this committee on
    September 30th and we certainly can provide it to the GAO.
        Mr. Barrett. Okay, appreciate that. Then, anecdotally, so I
    go to predominantly the Battle Creek VA Hospital near my
    district for most of my care, occasionally go to the Lansing
    Outpatient Clinic there. I will usually ask the folks that I
    interact with kind of their thoughts on this coming up. They
    are all well familiar with it. I mean, there are posters up,
    you cannot pull into the driveway of the hospital without
    seeing this announcement of the, you know, unrolling of a new
    electronic health record management system. I do not advertise
    to them the, you know, role that I have on this committee of
    oversight of this process. I will just kind of get their
    opinion as to how it is going.
        I would say it is not great. There is a bit of a mixed
    opinion. Some of them feel like they are not fully ready for
    the new system at this point. Dr. Evans, can you walk me
    through? I mean, I understand we are not going to train people
    on this prematurely, but do you have confidence, does the
    Department have confidence that the end user, 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?
        Dr. Evans. In short, yes, but let me give you some----
        Mr. Barrett. Yes.
        Dr. Evans [continuing]. comfort behind that answer. For the
    four sites in Michigan, we just completed last month super user
    training. 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. I think there was
    over 400 folks who went through super user training. I do not
    have the exact number here, but it is a sizable number. The
    super users are going to basically help the end users when they
    start their training. For the average user, so that is somebody
    who has not been selected as a super user, they start their
    training February 1st, so the beginning of February.
        With super user training, we have introduced a lot of
    changes to how we do training and how we support adoption for
    the Michigan Go-Lives. We had 96 percent 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. For those who had gone through this before,
    before we paused at the Michigan sites, they said, yes, this
    has been much better.
        In addition for the super users we have added, and for all
    end users, something called learning labs. This was a success
    at Captain James A. Lovell Federal Health Care Center (FHCC).
    Learning labs are when we finish classroom training or what
    is--well, it is delivered virtually, virtual 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 when we went
    live there, got a lot of great feedback about that. We have now
    built 98 scenarios and went through those learning labs with
    the super user, got a lot of great feedback about it. 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.
        Mr. Barrett. Okay. Thank you.
        Then the Ms. Harris, the IV&V test that you pointed out, is
    that the one I think you had mentioned to me separately, that
    the kind of four parallel testing going on instead of
    sequential testing, is that part of the IV&V or is that a
    separate test that would be required?
        Ms. Harris. Well, given the change in the strategy for
    testing with this market-based approach where they are going to
    be basically simultaneously testing at four sites, it will make
    it more difficult to do an IV&V, which is that end-to-end test.
        Mr. Barrett. That is a separate then----
        Ms. Harris. Yes.
        Mr. Barrett. Okay.
        Ms. Harris. Yes.
        Mr. Barrett. Both are, in your opinion, complicating--could
    lead to significant risk?
        Ms. Harris. I do believe so. I think that the simultaneous
    testing at the four sites, it will take a tremendous amount of
    resources. 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.
        Mr. Barrett. Ms. Verma, when I get back to my next order of
    questions, I will have a question for you about that.
    Beforehand, I want to yield to Ranking Member Budzinski for 5
    minutes for her questions.
        Ms. Budzinski. Thank you, Mr. Chairman.
        Dr. Evans, VA's plan to accelerate EHRM deployments will
    rely on sufficient--on having sufficient manpower. In the
    history of this program, the Program Office has never really
    been fully staffed. I have a couple quick questions. How many
    open positions do you currently have in the Program Office?
        Dr. Evans. Just over 100. That is also because we just had
    a new signed org chart which increased the number of positions
    that we are authorized to hire. We are now actively hiring to
    fill the additional positions that we have added to the Program
    Office docket.
        Ms. Budzinski. Your plan is to fill all of those positions
    then?
        Dr. Evans. Absolutely.
        Ms. Budzinski. Okay. 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 support up to four Go-Lives at one time?
    I guess that would be taking into account the hundred that you
    would be adding.
        Dr. Evans. Yes, we will be--we are--so we are actively
    hiring. In addition, at the sites that are going live, there is
    active hiring going on. There are 510 positions in recruitment.
    Actually, I think 163 of those folks are already on board at
    the sites that are going live to support operations locally.
    Plus, we are hiring in the Program Office. Then, of course, we
    have a significant amount of help from our contract partners,
    Oracle, Booz Allen, and Accenture Federal Services, as you just
    heard.
        Ms. Budzinski. Okay. You have significant hiring that needs
    to happen, though there are a lot of vacancies in the Program
    Office.
        Dr. Evans. There are vacancies in the Program Office in
    part because we are expanding the size of the Program Office.
    From the perspective of our ability to execute to the Go-Lives
    in April in Michigan, we are confident that our current
    staffing is sufficient to get us there.
        Ms. Budzinski. Okay. Ms. Verma, the scope of what Oracle
    and VA are planning to do is almost unprecedented. 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?
        Ms. Verma. Sure. First, I would say that Oracle does
    implementations all over the world for systems. You know, this
    amount and the number of sites is not unusual for Oracle as a
    worldwide company in terms of the deployments. 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. I think this is
    not an unusual thing for our company. We feel very well
    prepared to deal with the expansions and the challenges of
    something of this scale.
        Ms. Budzinski. Can I just--drilling down just a little bit
    more beyond just having the bodies, the VA itself is unique in
    its mission and culture. When someone were to hit the ground,
    what is Oracle doing to make sure that that additional capacity
    understands the uniqueness of the VA and its challenges?
        Ms. Verma. Sure. Well, there are requirements around
    training, and then there are also some Federal certifications
    that are required as well. It is not like we interview somebody
    and put them on the ground. There is some training that happens
    internally, and then there are, 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.
        Ms. Budzinski. Okay. Dr. Evans, as I mentioned in my
    opening, I have serious concerns about the Secretary's plan to
    eliminate 35,000 positions at 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?
        Dr. Evans. They will not. 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 do not
    anticipate any issues.
        Ms. Budzinski. Okay. Then just to go to the life cycle cost
    estimate questions, does the VA have a definition for life
    cycle cost estimate, Dr. Evans?
        Dr. Evans. What we provided to the committee was what we
    call 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. 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 deployment. Again, not
    just finalizing deployment, but finalizing deployment and
    supporting the operations across this timeline.
        Ms. Budzinski. Can I just interrupt? Does that break down
    then program versus contract expenditures, like the details, or
    is it just a top line number?
        Dr. Evans. It does. It does break down. We broke it down
    into four categories. One is implementation costs, so 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, the operational support. The third
    being infrastructure. I think we have 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. Then the fourth we call office operations, but
    it is really the staff, both government staff and contract
    staff, necessary to deploy the EHR.
        Ms. Budzinski. Okay, thanks.
        Mr. Barrett. All right. Thank you.
        Mr. Luttrell, recognized for 5 minutes.
        Mr. Luttrell. Thank you, Mr. Chairman.
        Dr. Evans, what is the dollar sign on sustainment for this
    software once EHR is implemented in all 170 sites and running?
        Dr. Evans. I do not have a number for you that is specific
    to sustainment, but what I can tell you is that our estimate in
    the final year when it comes to system operations, which I
    mentioned----
        Mr. Luttrell. After 2031, moving forward, what are we going
    to have to pay for this?
        Dr. Evans. Yes, I would estimate it is--our, again, our
    estimate for the operations in the final year that we estimated
    was 2.1 billion.
        Mr. Luttrell. Annually?
        Dr. Evans. Correct.
        Mr. Luttrell. Ms. Verma, if we have four sites that are
    going to go live in April, I am sure Oracle's hovering over the
    top of those four sites. If those four sites going off of what
    Ms. Harris laid out for us, if those four sites fail, are other
    sites, will we continue to move forward and fire up those other
    sites? Or is it an all-stop evolution?
        Ms. Verma. I cannot speak exactly, you know----
        Mr. Luttrell. Oracle is not doing contingency planning on
    if these sites fail----
        Ms. Verma. First----
        Mr. Luttrell [continuing]. in 117 days?
        Ms. Verma. Yes. First off, I would say that we are focused
    on a successful deployment. We are doing----
        Mr. Luttrell. Are not we all?
        Ms. Verma [continuing]. everything we can to make sure that
    that happens: training and support, testing of the system,
    making sure that the teams are adequately supported. You heard
    about super users----
        Mr. Luttrell. Yes, ma'am. I got you. I am just worst-case
    scenario, that is the kind of guy I am, worst-case scenario,
    these four sites do not go like they should. What is the
    contingency plan that day?
        Ms. Verma. Well, you know, when something goes live and
    there is a deployment, there are teams in place, there is
    elbow-to-elbow support. We have war rooms. If there is an issue
    that is 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 have been
    doing a number of optimization projects. Right? You heard about
    our capability block updates?
        Mr. Luttrell. No, I got it. Yes, ma'am. If those four sites
    fail, is Oracle going to continue to move on the other sites
    that need to be activated or is it----
        Ms. Verma. Yes, that is a decision I think that we would
    discuss with the VA and figure out the appropriate course. Like
    I said----
        Mr. Luttrell. We have not had that discussion yet?
        Ms. Verma. We have not had that discussion. Our discussions
    are focused on successful implementations. Because of the
    previous experiences, right, we have gone through a number of
    deployments, there has been a lot of lessons learned. If we
    look at the past deployment that we had at Chicago, again, that
    went very well and we continue to learn, we continue to do
    upgrades. In these last few upgrades as well as in Chicago,
    those have gone successfully well. We have no reason to believe
    that there would be a total failure of the system because we
    have not seen that in our--you know, the last few projects.
    Whether it is our optimization projects or the Go-Live at
    Chicago.
        Mr. Luttrell. Well, I hope, you know, I hope that does not
    happen. We have been waiting 10 years for this thing to work
    correctly. Just from my experiences in the past, if you are not
    contingency planning on the worst-case scenario when it shows
    up, we are 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 I am reading this correctly. How are the
    specific sites? Is there connectivity currently between sites
    that we are going live on so it is an easier lift? Then the
    sites that are kind of expanded out in like where I live, they
    are going to be the last ones to get a shot at it? Mr. Evans?
        Dr. Evans. Yes, I can answer that. Let me just--I will
    answer that question about how the sites are selected. I want
    to quickly correct the record on your sustainment cost
    question. I do not have a definitive estimate for the cost.
    What I was giving you there was the potential cost of
    operations. We do not have the sort of nailed down number for
    what it is going to cost yearly.
        Mr. Luttrell. Well, I appreciate you saying that because
    eventually the Secretary is going to have to come back to the
    committee and ask for a substantial amount of money to sustain
    the EHR.
        Dr. Evans. Correct.
        Mr. Luttrell. I mean, we are almost 50 billion into it and
    it is not even working.
        Dr. Evans. Right.
        Mr. Luttrell. That is going to be a very interesting
    conversation.
        Dr. Evans. Right. There will be--and part of that
    conversation is also what money comes off the books as we do
    not have to sustain, you know, legacy technology that we will
    be able to shut down at that point in time.
        Coming back to how sites were selected, we started, we
    spent a lot of time looking together to say what sites have the
    highest level of readiness to move forward? Part of that was
    based on where we had already made investments. The sites that
    are the earliest sites in our schedule that we provided to you
    through 2031 were the sites where oftentimes we had started
    deployment activities and we had already made an investment and
    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.
        We chose to move forward, as I mentioned, with a market-
    based approach. One of the things that we have 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 are a lot of interdependencies between
    the VAs there. You look at Ann Arbor as an example. I think it
    is more than 20 percent of the patients they see in Ann Arbor
    have a primary care provider elsewhere in Michigan, for
    example, in Battle Creek or Saginaw, and come there for
    specialty care. Having those sites on the same----
        Mr. Luttrell. Mr. Chairman, can he keep going? Is it Okay?
        Mr. Barrett. Yes, I will allow you to finish the question.
        Mr. Luttrell. Thank you.
        Dr. Evans. Same electronic health record allows us to have
    some efficiencies. We were looking by market, going one VISN at
    a time. We are going to complete by the end of 2026, VISN 10
    and then we will go to VISN 12 and 23 and beyond from that
    based on the schedule.
        Mr. Barrett. All right, thank you. I am going to recognize
    myself for 5 minutes for another round of questioning.
        Ms. Harris, I started to ask you about the kind of
    simultaneous testing that is going on, that is, you know, the
    GAO has raised as a concern. Ms. Verma, what do you feel is a
    counterpoint to that? What can you do to convince me 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 risks associated with it?
        Ms. Verma. Sure. Well, first of all, we strongly support,
    you know, robust testing. That is an important part of an
    implementation. When you do testing, that is when you may see
    things that you did not anticipate. Agreed that it is a very
    important part of an overall deployment.
        I think it is important to recognize in this situation is
    that the system is live in six sites today. Since we have
    implemented in those six sites, we have also done a number of
    optimization projects. In--when we do those optimization
    projects, we go through a big process of testing the system. We
    do that with the VA. Then what we have 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. I think we have had very strong robust
    testing. We feel confident that the system that we have in
    place around testing is working. There have been improvements.
        I think an IV&V vendor at this point would just add to
    costs 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 have
    done testing, we have picked up things, we have delayed in some
    cases when we realized we needed----
        Mr. Barrett. Right.
        Ms. Verma [continuing]. to spend more time on it. I think
    at this point, the IV&V vendor is----
        Mr. Barrett. Laying aside the IV&V, just doing all four
    sites simultaneously instead of one after another does increase
    the risk if something is discovered that needs action. Correct?
    Increases the risk of potential problems, would it not?
        Ms. Verma. Right. This is more of a scale issue. When we
    know we have four sites, we make sure that there are adequate
    teams on the ground to do elbow testing. We also have a war
    room so that our teams are actively monitoring what is going on
    on the ground.
        Mr. Barrett. Right. That is when it goes live, correct,
    not----
        Ms. Verma. Not even before that. Even before that. Right?
    That is when Dr. Evans and I spoke about hiring enough staff to
    make sure that we can scale so that we are testing, we are
    supporting those sites as that is going on. It is just a matter
    of scale. The process is the same around testing, around
    training, around supporting. It is just a matter of having
    enough staff to do it. This is a----
        Mr. Barrett. Each of these are very unique in their
    application. Each of these VA hospitals, they are not----
        Ms. Verma. Correct.
        Mr. Barrett [continuing]. you know, cookie-cutter stamped
    out. These are very, very customized to their unique situation.
    Doing them all four together, to me, elevates the risk that
    there is going to be problems that arise or issues that are
    overlooked, or we are batching these all together and then we
    are going to have them all go live nearly simultaneously
    without a lot of, you know, without a lot of consideration for
    what happens if, as Mr. Luttrell pointed out. I think those are
    the things that we have to bear in mind.
        You know, not to discredit what you are saying, but it
    feels like a lot of that is, you know, we have these things
    and, you know, we are a big company and we can do that. I do
    not think that Oracle has had a project like the one that the
    VA is undertaking right now. Would you agree with that?
        Ms. Verma. I think we feel very confident that we can do
    this and we can do it at more than one site at a time.
        Mr. Barrett. I would expect and hope that you would be
    confident in it, for sure, but.
        Ms. Verma. We are very confident. We feel very confident in
    doing that. I agree with you that every VA is different, which
    is why we have had teams on the ground. It is not like we are
    turning on the system quickly. We have been in these sites, we
    have been doing assessments of the site so we can understand
    what they have on the ground, what are the differences between
    each site. We have a plan for each site, and we have adequate
    staff and support for each of those sites.
        Mr. Barrett. Ms. Harris, do you feel like these commitments
    by Oracle are satisfactory to the overall concerns that the GAO
    raise?
        Ms. Harris. I mean, in taking a look at the previous
    history of the initial six sites, particularly in the five, I
    mean, when they went live, Oracle Cerner did have a difficult
    time in addressing those ticket--resolving those tickets in a
    timely manner. I know that they did a lot of streamlining in
    that process so that they would be able to meet their
    contractual marks for completing or resolving those tickets,
    you know, against their contractual obligations.
        I think, again, when you are doing it for simultaneous
    ones, I mean, there is a tremendous amount of resources that
    are going to go toward ensuring, for example, that ticket
    resolution is done, you know, under the contractual obligation.
    That alone, I think, is very risky. It is going to take a
    tremendous amount of resources that I am not quite sure is
    sustainable for multiple sites at once.
        Mr. Barrett. Okay. Last question. Is that something that
    was at the request of the VA or Oracle to do these four
    simultaneously?
        Dr. Evans. If I may.
        Mr. Barrett. Either one of you. Go ahead, Doctor.
        Dr. Evans. Yes. It was VA. VA asked to do this. I would say
    I would 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.
    One of the things we have 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. Part of being--locking
    down a baseline will actually streamline our ability to do
    testing because some of that variation that you are mentioning
    from one site to the next becomes less and testing becomes much
    easier at scale when you are testing against a standardized set
    of workflows and a standard baseline.
        The other--the second thing is that we are--you know, as
    our----
        Mr. Barrett. Sorry, I got to yield to the ranking member.
    We will come back for more questions, time permitting.
        Ranking Member Budzinski is recognized for 5 minutes.
        Ms. Budzinski. Thank 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 Ms. Verma have talked a lot,
    pointed to North Chicago as the example of how--of readiness. I
    am curious of how well the readiness is going there and the
    development since its Go-Live. That is a unique case, as we
    know, though, because that was with U.S. Department of Defense
    (DOD). Can you speak, though, to the other sites that have
    already gone live as well and just, you know, what is happening
    at those sites as it relates to readiness?
        Dr. Evans. Sure. At the sites other than FHCC, which are in
    Spokane, Walla Walla, Roseburg, White City, and then also
    Columbus, Ohio, I would say overall we have--we are tracking
    numerous metrics at those sites. You heard Ms. Verma mention
    about the revenue capture. We are doing very well with regard
    to appropriate revenue capture. Productivity at all sites at
    Roseburg has returned to greater than the 2019 pre-pandemic
    baseline productivity.
        We continue to hold a problem management forum with live
    site representatives every single day, every single workday
    where issues are surfaced, we address those. We have done a lot
    of work to work down the ticketing backlog for significant
    change requests, reduced that by well over 40 percent, and are
    being quite responsive to the sites with their needs. Frankly,
    they can escalate anything any day at our 10 a.m. meeting.
        We are seeing definite improved operations with the EHR at
    those original five sites. At FHCC, likewise, it is pretty
    similar performance.
        Ms. Budzinski. Can I just ask, on those sites, how are you
    measuring then productivity and how it has changed at those
    sites?
        Dr. Evans. For the productivity at those sites we are
    looking at something called Relative Value Units (RVU), which
    is a mechanism, it is an industry standard for measuring
    productivity. It is captured through billing encounters or
    encounters that sort of capture the documentation or the work
    that was done at the time of visit. We look at RVUs per
    provider.
        Ms. Budzinski. Okay. I would like to shift to Ms. Harris.
    We talked about the testing. I also just wanted to circle back
    to your testimony about the GAO recommendations more broadly
    that are still open. What do you think are some of the most
    concerning of those that are still open today?
        Ms. Harris. I think one of the most concerning ones is
    change management. VA still has yet to have an approved
    informal policy in place there. As part of change management,
    there is training as well. When you take a look at the first
    five sites as well as FHCC, those are vendor-led trainings. At
    all of those sites they have--the feedback has been that those
    vendor-led trainings had failed to prepare them for their
    specific roles and workflows. I think it is important for VA to
    take a more leader--to take the leadership role in that
    training. Again, we have those open recommendations there. That
    is vitally important.
        Ms. Budzinski. Okay. Dr. Evans, in addition to those
    recommendations that Ms. Harris identified, I think there are
    28 open from VA's inspector general as well. What is the plan
    and timeline to close them?
        Dr. Evans. With regard to the GAO recommendations, we take,
    of course, all of the GAO recommendations seriously. Of the 17
    open GAO recommendations, I do want to highlight that for 8 of
    those, nearly half of those, VA has made very significant
    progress. GAO has asked to keep those recommendations open
    until after we get past some of these initial Go-Lives in
    Michigan specifically.
        For example, there is an open recommendation about making
    sure that our contractor staff and the VA is using the right
    terminology. This was a recommendation from 2020. We fully
    implemented that recommendation. GAO asked us to wait to see
    how things go in Michigan to close that recommendation.
        Ms. Budzinski. Can I just interrupt? I am running out of
    time. Ms. Harris, would you agree with that? I did note that
    some of the recommendations do say partial, but many of them
    just still say open. Is there more to the story from what Dr.
    Evans is saying?
        Ms. Harris. There has been action taken on many of the
    recommendations, for sure. The one that Dr. Evans noted is not
    one that we do consider to be priority. It is important, of
    course, but certainly all 12 of our priority recommendations,
    those are still--the majority of them is not in the situation
    that he had mentioned. However, I will say they have done work,
    but we do need to hold some of those open to ensure that the
    actions that they have taken are effective, because we will see
    those results at Michigan.
        Ms. Budzinski. Okay. I yield back.
        Mr. Barrett. Thank you.
        Mr. Luttrell, for 5 minutes, sir.
        Mr. Luttrell. Thank you, Mr. Chairman.
        The six active systems say that the system itself has
    proven difficult to use and is not well-suited for VA
    workforce--workflow, excuse me. Staff have reported slow
    performance, excessive clicks, data loss, and a cumbersome
    documentation process. All six facilities that implemented the
    new system have faced increased workloads due to workaround
    processes, burnout, staffing shortages. 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 percent in 1922 to 33 percent
    in 1925. These are the six sites that are currently working
    under the system, Oracle system, and you are about to add four
    more.
        Mr. Evans, you said in your previous statement that all
    the--you are doing Michigan because Michigan is the same. We
    are going to do Washington because Washington is the same. You
    come down to Texas, Texas is Texas. Now, if you have these
    particular sites that are having these issues, you are going to
    add these other sites on board that are different, and then you
    are going to try to complete the entire system. That is an
    extremely heavy weight.
        I am curious, Ms. Verma or Dr. Evans, what does that even
    look like? If the current system does not work effectively at
    33 percent and we are about to add 4 next year or 4 in April,
    and then what is the number in 2027, please?
        Dr. Evans. Twenty-six sites.
        Mr. Luttrell. Twenty-six in 2027. You see where I am going
    with this? Walk me through it.
        Dr. Evans. I do. First of all, I think we have--just to
    give you a sense for the change, over the course of the reset
    we were introducing--we introduced over 1,500 functional
    changes, that is changes responsive to end users, where end
    users said, hey, the system needs to work better in the
    following way.
        Mr. Luttrell. Just on these six sites, the active sites.
        Dr. Evans. At the six sites, 1,500 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 is
    not--beyond that, 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, there has been a significant
    amount of improvements to the user experience.
        I think the data that you were quoting, the 33 percent, is
    from our end user experience survey. 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 in a way
    that, as Ms. 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 is not where I want it to be, but
    we are seeing confidence improve at the six live sites.
        Mr. Luttrell. Are the four active sites in Michigan, this
    implementation, has this been handed off to them, so you will
    not be surprised when something like this populates after they
    go active 117 days? They are not going to say, hopefully not, I
    should not--I am not going to call it a mistake, but they are
    not going to have the same issues that the current sites are
    having because everything that we have learned off the current
    six sites has been pushed over to the four sites are going to
    go active in April?
        Dr. Evans. That 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
    working with Oracle and commercial customers about what best
    practices are, all of that value will be delivered to Michigan.
        Mr. Luttrell. Hopefully.
        Dr. Evans. Yes, it will.
        Mr. Luttrell. I yield, sir.
        Mr. Barrett. Thank you, Mr. Luttrell. I will recognize
    myself for another 5 minutes.
        I know this issue of change management and everything is
    difficult. Dr. Evans, I think I shared with you that I think as
    a classification, physicians tend to be a little bit stubborn.
    I think you agreed with me. Then I think physicians within the
    VA might be a particularly stubborn bunch. With that being the
    case and laying that aside, who is ultimately responsible for
    that change management? Is it Oracle, is it VA, or is it
    Accenture? Like, who is responsible for that part of this?
        Dr. Evans. I mean, at the end of the day, VA is
    responsible. This is our healthcare system. This is the VA
    healthcare system. This is our project to implement a new
    electronic health record.
        One of the things that we--as we during--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 that it is VA leaders
    standing in front of their peers that kick off this process. We
    introduced a new event. It is 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 it 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. If you are delivering a better experience to the
    veteran, that is a worthwhile change to adopt. Part of this 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? I am not seeing objections from our
    clinical staff or our administrative staff when they understand
    that why and when they are adequately supported.
        We own it, VA owns it. I am very grateful as well for the
    contractors who are supporting us in executing that change
    management tasking.
        Mr. Barrett. Okay. Then the surveys that you are
    undertaking, you know, Mr. Luttrell pointed out you guys went
    from 7 percent to 33 percent. Congratulations, you are more
    popular than Congress finally. With that being the case, do you
    feel the survey methodology is accurate or is it one of those
    things that tends to attract more negative response bias?
        Dr. Evans. Yes, it is a good question. We get about 20
    percent participation in the surveys on average when we send
    them out twice a year. That is actually a good response rate
    for a survey with when we are 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 healthcare systems, both in the private sector as well
    as in the Federal Government and are comparable with the DOD.
    Those questions, I do believe that they are robust questions
    that we can learn from and from which we can look at other
    health systems that have engaged in a similar transition and
    track our progress accordingly.
        Mr. Barrett. Okay. Do you feel that VA end users, as they
    are being trained on this, have adequate, you know, authority
    to raise their concerns without feeling like they are being--
    you know, that there is going to be not punishment, but just,
    you know----
        Dr. Evans. Absolutely. I mean, it is an anonymous survey.
    We expect----
        Mr. Barrett. Yes.
        Dr. Evans [continuing]. complete honesty on the survey.
        Mr. Barrett. Okay. Switching briefly, because I have only
    got about 1 minute left. I know we talked, Ms. 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. 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?
        Ms. Verma. Sure, and you are absolutely right. Right? We
    are taking an off-the-shelf solution and bringing it to the VA,
    and the VA has some very specific and unique needs. I think
    that there has been some points that we have implemented or
    some projects that we have implemented that have really
    upscaled the level of safety, things like opioid prescribing.
    We have also improved communication between pharmacies and the
    providers if a drug's not available, to have that conversation
    so that they make sure that what is being prescribed is
    available. We are seeing some definite improvements. We are
    seeing some providers out there that have a level of
    productivity to pre-deployment.
        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. We also sent--you know, our
    Chief Executive Officer (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.
        I think we have made progress. 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
    and we have conversations about this on an ongoing basis.
        One of the things that I really appreciate the leadership
    doing----
        Mr. Barrett. I am going to have to cut you off in just a
    second. I apologize.
        Ranking Member Budzinski for 5 minutes.
        Ms. Budzinski. Thank you. Ms. Verma, Oracle has been
    touting its effort to build a new EHR. I think you have 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?
        Ms. Verma. We are making improvements to the Cerner system
    that is being implemented in the VA. We took the Cerner system.
    You have 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 lines.
        Ms. Budzinski. How much of this is informed by lessons
    learned at the VA?
        Ms. Verma. I think a lot of it is informed by lessons
    learned. One of the things that we appreciate is that the
    leadership today is very active in terms of visiting the sites,
    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 2 weeks, there are weekly
    meetings with the Secretary. In those meetings we are
    identifying where are there opportunities for optimization?
        We have executed on a lot of these projects. You have heard
    of the capability block updates that we have been doing. Those
    represent the optimization projects and I think that is why we
    are starting to see better results in terms of the experience
    of providers. I think the sentiment overall is increasing as
    well in terms of the positivity.
        Ms. Budzinski. We have spent a lot of time today talking
    about cost, and I am just curious how you would respond, you
    know, hearing this, is this going to all lead us down the path
    of additional cost from Oracle's perspective?
        Ms. Verma. Yes, so I have not reviewed any of the new
    estimates that have come out, but I think that is something
    that we are very cognizant of with--of cost. I think that some
    of the more recent changes that we have made, the first one I
    would say is the standardization. You know, having a system
    where you had six different sites requesting different types of
    changes, those kinds of things contribute to increased cost. We
    are very excited about the changes that we have heard about in
    terms of moving to standardization. That is going to make the
    cost more predictable and more sustainable.
        That being said, it is always, you know, foremost on our
    minds. This is why Oracle agreed to move the Federal system to
    our cloud to make sure that we had, you know, greater security
    and performance. We are doing that at our cost as well. We
    advise the VA. One of the things that we really advocated for
    was the standardization because we also knew that not being
    standard would contribute to increased costs.
        I think the pause in and of itself has not helped in terms
    of cost because you are maintaining two systems. Moving forward
    I think will also help make sure that we are using taxpayer
    dollars appropriately and efficiently.
        Ms. Budzinski. You have talked a little bit about in your
    testimony, obviously, AI. Is AI capability included in VA's
    contract with Oracle and is there additional cost to that?
        Ms. Verma. It depends on which AI agent. There is not a one
    size fits all approach. We are bringing the brand new EHR to
    the VA. We are not charging for that, 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.
        Ms. Budzinski. Okay. Ms. Harris, can I just ask you, in
    your testimony, you had flagged, we were talking about the
    overall cost in the beginning of this hearing, and I did not--I
    wanted to get to you, but could you--I think you had flagged
    some concerns around that number, the 37 billion. Could you
    speak to that?
        Ms. Harris. Yes. Well, we have not seen the 37 billion
    number. As soon as our office receives that, we will, you know,
    certainly do a deep scrub of that and then get back to you on
    that. 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. You know, we are going to have to go
    through the differences.
        That number also is outdated because it does not reflect
    the changes in the delays, including the pause. That is also
    something that we will have to take a look at, but we will
    certainly do a comparison there of that.
        Ms. Budzinski. Okay. Thank you, when you get that.
        Ms. Verma, if I could just ask again, going back to Oracle
    Health Software and specifically the veterans' data, is it
    being used to train the AI that Oracle will use for its
    commercial clients?
        Ms. Verma. Absolutely not. We do not have any data rights,
    so we do not use that data to train our models. No.
        Ms. Budzinski. Okay. Will VA receive credits of some sort
    for the benefit Oracle has derived from the information?
        Ms. Verma. We do not use their information for any of our
    training for AI models.
        Ms. Budzinski. Okay. Okay. Ms. Harris, your testimony
    indicated the VA has not instituted plans to conduct an
    independent operations assessment to evaluate the suitability
    and effectiveness of Oracle's EHR. We have been contemplating
    the need for such an evaluation. What do you think this should
    entail and what do you think should--who should conduct it?
        Ms. Harris. Yes. I think that given this approach to go
    live at four sites at Michigan, once that takes place, I think
    that there should be an IV&V after that looking at all four
    sites to do that systematic cataloging of those defects, and it
    should be an independent third party that goes in and does that
    review.
        Again, I cannot stress enough the reason why Military
    Health System (MHS) GENESIS was so successful in their
    deployments, you know, we have spent a lot of time with them. A
    large part of that was because of the IV&V test that they
    performed.
        Mr. Barrett. Sorry. Thank you very much.
        Mr. Luttrell, for 5 minutes. Then we will do closing.
        Mr. Luttrell. Thank you, Mr. Chairman.
        The VA did not--Dr. Evans, I do not know how long you have
    been in the VA, but I was curious, we did not negotiate into
    our contract with Oracle any kind of AI footprint? What I heard
    her say is we are just going to get to the baseline. This is
    like when my 8-year-old comes up and wants to buy a video game.
    Hey, we can get the baseline model. Then when you are inside,
    you got to buy everything else to get it where it needs to be.
    It kind of sounds like where we are at. You do not have to
    answer that question. I just wanted to say that out loud.
        We have six sites that are currently on Oracle. Right, Ms.
    Verma? The rest, 160-plus, are still on, what, VistA, Dr.
    Evans? We have spent roughly about a billion dollars on
    software across the board. Correct? Some of the VA facilities
    use software that other VA facilities do not use. Some have the
    highest level of software advancements inside their facilities
    and some do not. We have to pay for it all, whether or not we
    even use it or not. Like my little facility in Conroe, Texas,
    still uses some software that helps VistA, but DeBakey does
    not, but we still have to fund the whole thing and it is almost
    a billion dollars if I am correct. I may be off on that, but I
    think it is almost a billion dollars.
        Ms. Verma, when Oracle activates on every single site, do
    we have the ability to tell everybody else, hey, we do not need
    you anymore? I think your button is off.
        Ms. Verma. Yes, Okay. I think it is going to depend on
    every site. My----
        Mr. Luttrell. No, it cannot depend on every site----
        Ms. Verma. Well----
        Mr. Luttrell [continuing]. because the whole purpose of us
    doing this with you guys is that every site is the same.
        Ms. Verma. Yes. My----
        Mr. Luttrell. It says that multiple times.
        Ms. Verma. Yes. My expectation would be that with a new
    Oracle EHR that they should be able to use our system and that
    should address the needs that they have. I do not know
    whether--you know, every single site and what they have, but I
    would anticipate that this EHR with the standardization that we
    are bringing, that it should be able to meet the needs of any
    hospital or clinic across the country.
        Mr. Luttrell. I hope so for $50 billion. We are going to
    have to have a conversation with everybody saying, hey, look,
    we implemented this at $50 billion, plus the dollar sign, Dr.
    Evans, of what sustainment looks like. Then, hopefully, at the
    end of the day, we do not have to say we have to continue to
    pay for everything that is in VistA because we already have it
    in the system and then we are going to pay for Oracle on top of
    it. Are we going to have to have that conversation?
        Ms. Harris, what do you think about that? Does that sound
    reasonable? This is kind of the math problem I am drawing out
    in my head, but it is where we are. The slide deck that they
    brought to my office 1 day, 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?
        Dr. Evans. I think that you are--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 are going live in Michigan. For the first time
    we will be implementing Radiation Oncology. There is some
    unique software that is necessary to support a radiation
    oncology clinic and operation that will not be needed at every
    site.
        One of the real advantages, 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 is published right now on our
    website, these are the software systems that we will support
    and can support connected to the Federal EHR. By definition, it
    also means there are those that we will not support.
        Mr. Luttrell. Every system that we have in place currently,
    once Oracle activates in all sites, they are going to come
    running to you guys and say, you have to use this?
        Dr. Evans. Well, again----
        Mr. Luttrell. We are already here.
        Dr. Evans. No, no, we are making the decisions now as we go
    from site to site around what the standard is going to be.
        Mr. Luttrell. I am sorry, I am still under the impression
    that every site is going to be the same.
        Dr. Evans. Not every site has the same clinical services.
        Mr. Luttrell. I understand that.
        Dr. Evans. When we go to a site----
        Mr. Luttrell. Every site can have what Oracle is populating
    and the 6 sites that have are active and 4 sites are coming up
    and the 27 next year will be the exact same. Correct? I have
    that in my little satellite campus in Conroe.
        Dr. Evans. I will give you an example. Bedside monitors,
    when you walk into an intensive care unit, the thing that is
    hanging up above the bed with the Electrocardiogram (EKG) on
    it.
        Mr. Luttrell. Yes, sir.
        Dr. Evans. That is not a core part of the electronic health
    record. That is a biomedical device. It has software that runs
    it that we will need to plug into the electronic health record.
    One of the ways we will be able to manage cost is by
    standardizing which of those devices we can support. It should
    be a limited number in order to be able to manage the EHR in a
    more cost effective way across the enterprise.
        Mr. Barrett. Thank you. I apologize, we are up against a
    bit of a hard stop for the committee. We are going to move on
    to closing statements.
        Okay. I will go to Ranking Member Budzinski for her closing
    statement first.
        Ms. Budzinski. Thank you, Mr. Chair. Thank you.
        I agree that we need to give veterans and VA employees the
    modern tools that the new EHR can offer. Those tools have to
    work for the VA, and I just do not believe that we are there
    yet. I do not want to be a pessimist, but I do not feel like I
    am leaving this hearing having my mind changed on this point.
        Dr. Evans and Ms. Verma are quick to point out that the new
    administration is driving increased momentum and leadership
    involvement in the project. I am 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 unheeded. I 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. Barrett. Thank you, Ranking Member Budzinski.
        I was actually voted most optimistic of my high school
    graduating class. Mostly because I thought it was the Lions'
    year every year. Again, we find ourselves on the edge of not
    even making the playoffs perhaps.
        In my old age, I have moved from an optimist to more of a
    realist. I think the issue before our committee is what is the
    real assessment of where we are at and what we need to do to
    prepare going forward. 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.
        I can tell you with candor what I will not accept if we
    fast-forward the tape 117 days from today is if things do not
    go well and do not go as necessary to protect the health and
    benefit and welfare of the veterans that we serve, is finger-
    pointing and blame between, you know, various different
    vendors, the Department, and who had what, and musical chairs
    as to where things land.
        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. If you
    need help from this committee to do that, I am very willing to
    be the person to step into that role and, with the ranking
    member, to assist in doing that. 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 appointment in Battle Creek for a
    physical, they sent a follow up that was a few months into the
    future, and it happened to land on the week that this Go-Live
    is. You know, I am comparing my session calendar with when I
    can be back home. I am like, well, I am available on this date.
    They are like, oh, no, we are getting a new electronic health
    record system. We hare not scheduling appointments on that day.
        I know that they are taking it seriously. I just want to
    make sure that the tools are going to be there for the end
    user, 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. I am hopeful and encouraged that you pointed out the super
    users have begun getting their training now, but then the more,
    you know, rudimentary kind of day-to-day users are going to be
    getting that and at a point that is appropriate for them.
        I have concerns about 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. I think there are
    questions that the committee has that are still unresolved and
    a few more that Mr. Luttrell raised as well.
        We want to be partners in this, not antagonists. We do not
    want to slow you down. We do want to maintain the appropriate
    level of accountability to make sure that this goes as well as
    we need it to.
        With that, I think I have some disclaimers I got to say
    here at the end. I ask unanimous consent that all members have
    5 legislative days to revise and extend their remarks and
    include extraneous material. Without objection, so ordered.
        With that, this hearing is adjourned.
        [Whereupon, at 4:26 p.m., the subcommittee was adjourned.]

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                             A  P  P  E  N  D  I  X

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                        Prepared Statements of Witnesses

                                  ----------

                        Prepared Statement of Neil Evans

        Good afternoon, Chairman Barrett, Ranking Member Budzinski, and
    distinguished Members of the Subcommittee. Thank you for the
    opportunity to testify today about the initiative of the Department of
    Veterans Affairs (VA) to modernize its electronic health record (EHR)
    system.
        I want to begin by thanking Congress and this Committee for your
    shared commitment to Veterans and for your continued support of the VA
    Electronic Health Record Modernization (EHRM) efforts. VA is committed
    to successfully implementing a modernized, interoperable Federal EHR
    system across its enterprise. Implementation of the Federal EHR system
    will facilitate unprecedented ease of transition from Department of War
    (DoW) to VA and quality of care coordination between the agencies. VA's
    focus is keeping Veterans at the center of everything we do. Veterans
    deserve high-quality health care, which means health care that is
    timely, safe, Veteran-centric, evidence-based, and efficient. The EHR
    is, and will remain, a key enabler of VA's ability to deliver the
    comprehensive health care Veterans deserve.
        The Federal EHR will provide a framework for improved enterprise
    standardization of evidence-based health care delivery, positively
    impacting patient care quality and safety. The Federal EHR will support
    simpler integration of other modern health information technologies and
    infrastructure to provide a more coordinated experience for VA staff
    and clinicians as they care for Veterans. The modernized EHR will also
    support improved interoperability with the rest of the American health
    care system. In addition, the adoption of a single system used by VA
    and DoW will help simplify health care delivery for providers in both
    Departments, benefiting patients who receive care in both systems or
    who are transitioning from DoW to VA for care.
        Since our last hearing in February 2025, VA has continued to build
    on previous milestones to achieve the mission objectives set for the
    EHRM program. In March, VA announced its intention to deploy the
    Federal EHR to nine sites in Ohio, Indiana, Kentucky, and Alaska by the
    end of calendar year 2026, in addition to four previously announced
    sites in Michigan. This brings the total sites to go live in calendar
    year 2026 to 13, with all sites in Veterans Integrated Service Network
    (VISN) 10 going live by the end of calendar year 2026, supporting
    better coordinated care across the entire regional network. VA aims to
    complete deployment of the Federal EHR to all VA medical facilities as
    early as 2031.
        VA closed out Fiscal Year (FY) 2025 on target in meeting deployment
    activity milestones to ensure timely go-lives in 2026. Based on the
    lessons learned from our prior VISNs 20, 10, and 12 deployments, VA is
    using a market-based approach for future deployments to scale up the
    number of concurrent deployments, enable staff to work more
    efficiently, and increase the sharing of best practices by frontline
    staff and the Federal EHR community. Training schedules and course
    loads were adjusted to better support end-users and patient scheduling.
    VA also provided Congress with an updated long-term cost estimate for
    the EHRM program, along with a timeline for deployments through 2031.
    To demonstrate VA's commitment to successfully meeting that timeline
    within the expected cost, we have augmented our team by contracting a
    systems integrator to help coordinate deployment activities. We have
    always relied on the expertise of our government contractors. We need
    their functional and technical expertise and resources, working
    together with the government, to execute our programmatic goals and
    deliver on VA's promise to our Veterans.
        VA has made significant strides in stabilizing its systems, with
    improved performance metrics demonstrating system reliability. As of
    November 19, 2025, Oracle Health-owned systems maintained an incident-
    free time (IFT) of 95.93 percent, exceeding the Service Level Agreement
    (SLA) requirement of 95 percent consistently for 21 consecutive months.
    Ten of the 12 months in Fiscal Year 2025 were free of any system-wide
    outages. At the conclusion of Fiscal Year 2025, the system had
    experienced more than 200 consecutive days without any outages.
        The momentum demonstrated this year can be attributed to increased
    VA leadership involvement under this new Administration. Since assuming
    their roles, Secretary Collins and Deputy Secretary Lawrence have
    prioritized attention to this critical project and have taken
    significant steps to assure alignment across all stakeholders in
    support of the accelerated implementation of the system in support of
    Veterans. Dr. Lawrence has been talking to site and VISN leaders weekly
    and making multiple visits per month to sites set to go live with the
    system in 2026, making it a priority to listen to fellow Veterans talk
    about their experiences and expectations. During visits across
    Michigan, Ohio, and Indiana, he has met with executive leadership
    teams, change leadership teams, super users, and frontline clinicians
    to discuss preparations for the 2026 deployments and to review how
    recent improvements have helped frontline staff. While these visits are
    ongoing and will continue, the feedback has been positive. Leadership
    and staff at both the individual sites and the VISN level are
    encouraged by the program's direction and newfound momentum and are
    confident in this administration's path forward.
        VA has continued to listen to and engage with Veterans and
    clinicians about their experience with the Federal EHR, and is seeing
    meaningful success with deployments, according to results of the most
    recent Federal EHR User Experience survey completed in Spring 2025. For
    the first time since the survey's inception, at least half of survey
    respondents felt positive about some aspects of the Federal EHR system.
    On November 21, 2025, we completed our Fall 2025 survey and look
    forward to sharing those results when they are available.
        VA is continuing to move forward with a modern, commercial EHR
    solution in close coordination with our Federal partners, including DoW
    and the Federal Electronic Health Record Modernization office. This new
    Federal EHR system will empower Veterans to receive care that is more
    seamlessly coordinated across the enterprise. It will help providers
    more holistically understand injuries or illnesses that Veterans
    suffered years ago, so that they can provide those Veterans with the
    best possible care today. It has the potential to further streamline VA
    operations and most importantly, it will improve the Veteran
    experience.
        Ultimately, our goal is to deliver an EHR system that earns the
    trust of Veterans, clinicians, and staff. This means a system that
    works efficiently, enhances care coordination, reduces administrative
    burden, and will improve health outcomes for Veterans. We are not
    simply continuing business as usual; we are committed to getting this
    right. The responsibility we carry is immense, and we will not rest
    until this system delivers what our Veterans and providers truly need.
    With the activities and improvements that are now underway, VA leaders
    are optimistic about the success of our Federal EHR system optimization
    efforts and the eventual full implementation of the system throughout
    VA.
        With the partnership of this Subcommittee, we look forward to
    continued and accelerated progress implementing the Federal EHR across
    VA over the remainder of the 119th Congress and beyond. We are only 117
    days away from our planned go-lives in Ann Arbor, Battle Creek,
    Detroit, and Saginaw, Michigan, with many more sites following quickly
    thereafter.
        This concludes our testimony. We look forward to responding to any
    questions that you may have.

                       Prepared Statement of Seema Verma

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                       Prepared Statement of Carol Harris

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                           Statements for the Record

                                  ----------

                   Prepared Statement of The American Legion

        Chairman Barrett, Ranking Member Budzinski, and distinguished
    members of the subcommittee, on behalf of National Commander Dan K.
    Wiley and more than 1.5 million dues-paying members of The American
    Legion, we thank you for the opportunity to offer our statement for the
    record on the Department of Veterans' Affairs' modernization efforts.
        The American Legion is guided by active Legionnaires who dedicate
    their time and resources to serve veterans, service members, their
    families, and caregivers. As a resolution-based organization, our
    positions are directed by over 106 years of advocacy and resolutions
    that originate at the grassroots level of our organization. Every time
    The American Legion testifies, we offer a direct voice from the veteran
    community to Congress.
        As the United States Department of Veterans Affairs (VA) resumes
    rollout of the Electronic Health Record Modernization (EHRM) program it
    is important to note that the VA began the EHRM program to make
    critically needed updates to the VA's software systems. VA's current
    electronic health record (EHR), the Veterans Health Information Systems
    and Technology Architecture (VistA), is extremely outdated and simply
    cannot serve current or future veteran needs.
        Though the name VistA was adopted by VA in 1994, the system itself
    can date its origins back to 1977.\1\ While it was a triumph of its
    age, this decades-old system lacks many modern features available to
    civilian hospitals. The VA's new EHRM, Oracle Cerner Millennium, is
    intended to bring new, modern capabilities to the VA such as more
    accurate and faster tracking and identifying of potential health risks,
    scheduling features that would improve on wait times, and a seamless
    experience across different hospitals and departments.\2\ The EHRM
    program, as intended, will provide veterans with an easily updated
    health record that follows a veteran for life, from the time of their
    service in the Department of War (DOW) through their time in VA
    healthcare. The American Legion strongly supports these goals.\3\
    ---------------------------------------------------------------------------
        \1\ Allen, Arthur. n.d. ``A 40-Year `Conspiracy' at the VA.'' The
    Agenda. Politico.com. https://www.politico.com/agenda/story/2017/03/
    vista-computer-history-va-conspiracy-000367/.  Unless otherwise noted,
    all cited hyperlinks accessed March 28, 2023.
        \2\ Communication, IT Strategic. 2022. ``What Veterans Need to Know
    about How VA's Health Record System Is Changing--VA EHR
    Modernization.'' Digital.va.gov. July 21, 2022. https://digital.va.gov/
    ehr-modernization/resources/fact-sheets/what-veterans-need-to-know-
    about-how-vas-health-record-system-is-changing/.
        \3\ ``Resolution No. 83: Virtual Lifetime Electronic Record.''
    2016. https://archive.legion.org/node/329.; ``Resolution No. 12:
    Implementation of the MISSION Act.'' 2022. https://archive.legion.org/
    node/14050.
    ---------------------------------------------------------------------------
        However, the rollout has not gone as intended. The deployment of
    this new system began in 2020 at Mann-Grandstaff VA Medical Center in
    Spokane, WA, and was almost immediately inundated with issues.\4\
    Several of these issues were severe, such as veteran data being
    migrated to the new system with outdated prescriptions and emergency
    contact information, or dropping prescriptions altogether. Problems
    with further rollout sites led to the program being put on pause in
    April 2023, with one exception allowing for a rollout to the Captain
    James A. Lovell Federal Health Care Center (FHCC) in Chicago, Illinois.
    ---------------------------------------------------------------------------
        \4\ VA OIG Details Continued Deficiencies with VA's EHRM.'' n.d.
    www.meritalk.com. https://www.meritalk.com/articles/va-oig-details-
    continued-deficiencies-with-vas-ehrm/.
    ---------------------------------------------------------------------------
        The American Legion visited the Lovell FHCC in August 2025 to
    review how the facility has adopted and implemented the new electronic
    health record system. The results we saw reflected a marked improvement
    from prior rollout experiences at other locations. Facility staff
    reported zero instances of critical harm, and no veterans' health
    seriously affected due to problems resulting from the rollout. Staff
    further reported that VA had provided ample staff to assist with the
    rollout, complemented by Oracle employees who spent significant time at
    the facility assisting with the process. All the departments with which
    we spoke to reported being generally pleased with the new software, and
    the facility has since been able to return to near-normal staffing
    levels. TAL is hopeful that Lovell FHCC's successes can be duplicated
    in future rollouts.
        Staff at the Lovell FHCC reported that the software itself has
    significantly improved operations at the facility. Medication ordering
    systems are tied together so, for example, once a pharmacist scans out
    a medicine, the logistics team is immediately informed so that they can
    order more. Tasks take fewer clicks than with the previous system,
    reducing the amount of time to perform routine functions. Total patient
    records from every medical center department are immediately available
    at a single click. These and many more updates to the system help
    Lovell FHCC provide the world-class, modern healthcare that veterans
    have earned.
        For these successes to be duplicated, it is critical that
    facilities with upcoming rollouts are provided with the same level of
    support, training, and oversight. Specifically, VA and Oracle must
    commit increased facility staffing during rollouts similar to the
    levels provided to Lovell FHCC during the transition. Software changes
    led to planned and unforeseen complications, and the increased staffing
    helped ensure that veteran health and safety was not lost in the
    change-management process. A lack of adequate vendor support from
    Oracle would undermine the VA staff's ability to properly do their
    jobs, potentially risk lives, and any system downtimes could force
    staff to rely on time-consuming paper records, slowing processes to a
    crawl and impacting health and safety. When this happened during
    previous rollouts veterans were directly harmed, including six veteran
    deaths in Spokane, WA.\5\ Lovell FHCC's successful roll-out shows that
    adequate staffing and preparation by the vendor and by VA are necessary
    and will lead to success. The American Legion National Staff routinely
    attends briefings from Oracle to track progress, and we have been
    assured the Millennium EHR deployment at new sites will not face the
    same difficulties and setbacks as at the first six sites. Oracle has
    committed to the necessary investments needed to ensure the deployment
    of the EHR at new sites will be more stable. Also, the system has
    extensive updates, enhancements, and simplifications to improve
    usability. Oracle report targeted EHR optimizations, designed to
    address VA's unique needs in the areas most critical for a successful
    expansion. TAL urges Congress, VA, and Oracle to ensure adequate
    staffing augmentation and robust technical support for all future
    deployments in order to duplicate the successes seen at Lovell FHCC.
    ---------------------------------------------------------------------------
        \5\ Donovan Smith and Desmond Butler, Orion. ``VA Staff Flag
    Dangerous Errors Ahead of New Health Records Expansion.''
    Spokesman.com, December 3, 2025. https://www.spokesman.com/stories/
    2025/dec/03/va-staff-flag-dangerous-errors-ahead-of-new-health/.
    ---------------------------------------------------------------------------
        The American Legion's position and outlook on the upcoming EHRM
    rollouts remains positive. The rollout at Lovell FHCC was an overall
    success, but VA and Oracle must heed the important lessons learned
    there and put them to future use. Absent the same level of preparation
    given to Lovell FHCC, future EHR rollouts should not be expected to
    achieve comparable results. Oracle must strengthen all aspects of their
    deployment methodology, with a deliberate emphasis on improving staff
    readiness. Significant improvements must be made in testing and
    aligning Change Management (CM) through increased training and
    communications.
        Similarly, VAMC leadership must take ownership of the EHR
    deployment at their sites, while continued oversight from Congress and
    stakeholders remains essential, particularly as EHRM rollouts
    accelerate. TAL urges Congress to conduct regular oversight hearings
    with Oracle and VA stakeholders to ensure transparent, ongoing updates
    throughout the deployment process.
        Chairman Barrett, Ranking Member Budzinski, and distinguished
    members of the subcommittee, The American Legion thanks you for your
    leadership on this matter and for allowing us the opportunity to
    explain the position of our more than 1.5 million members. The American
    Legion stands ready to work with the subcommittee on changes as they
    develop, and we look forward to sharing the feedback we receive from
    our membership. For 106 years, The American Legion has never shied away
    from the responsibility of being a voice for veterans, and we will not
    start now. For additional information regarding this testimony, please
    contact Ms. Bailey Bishop at The American Legion's Legislative Division
    at b.bishop@legion.org.

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