VA Electronic Health Record Modernization Faces Persistent Challenges Despite Incremental Progress

The Department of Veterans Affairs (VA) continues to struggle with its Electronic Health Record Modernization (EHRM) program, despite making incremental improvements. The Government Accountability Office (GAO) reported that while VA has made over 1,500 system configuration changes and addressed some user concerns, significant issues remain. A backlog of approximately 1,800 complex configuration change requests persists, and VA has yet to update its total life cycle cost estimate or integrated master schedule. The program, originally launched in 2017, faced multiple delays, with VA pausing deployments in April 2023 due to poor user feedback. Although planning for future deployments is set to resume in 2026 at four Michigan facilities, the vast majority of VA medical centers—about 94%—still rely on the legacy system.

GAO has previously made 15 recommendations to address EHRM challenges, but only one has been fully implemented. These recommendations include improving change management, addressing user satisfaction issues, and resolving system trouble tickets. VA’s user surveys continue to reflect dissatisfaction, with many clinicians reporting that the new system negatively impacts productivity. While VA has closed nine of 14 highest-priority patient safety enhancement requests, critical concerns remain, particularly in referral management and system interoperability. Additionally, financial estimates for the program vary significantly, with VA’s original $16.1 billion estimate now considered outdated, and an independent estimate suggesting costs could reach nearly $50 billion.

Another major issue is the lack of a comprehensive deployment schedule. Although VA initially planned a full system rollout by 2028, delays and the recent program reset have made this timeline uncertain. The system’s instability has also been a concern, with incident-free time and outage-free time falling short of targets in multiple months throughout 2023 and 2024. In a draft report currently under review, GAO has proposed three additional recommendations: updating the life cycle cost estimate, revising the integrated master schedule, and defining baselines and performance targets for key program metrics. Without these updates, VA leadership and stakeholders lack crucial information needed to manage costs and timelines effectively.

GAO’s findings highlight the urgency of addressing these ongoing challenges to ensure that VA’s modernization efforts result in a functional, efficient electronic health record system for veterans and healthcare providers. The department’s commitment to resuming deployments is a step forward, but significant work remains to deliver a system that meets user expectations and operates within budget and schedule constraints.

Article by multiple RFHC contributors.

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