VA, Oracle Cerner EHR system in the crosshairs

Jul 24, 2023

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By Ben Leonard and Daniel Payne

Presented by

With Megan R. Wilson

Driving the Day

Rep. Mike Bost is pictured.

Rep. Mike Bost, chair of the House Veterans' Affairs Committee, says trying to modernize the VA's electronic health records system has been "a nightmare." | AP Photo

CONGRESS AT A BREAKING POINT — The Department of Veterans Affairs and Oracle Cerner’s woes in replacing the agency’s digital health records system has left Congress seething.

The project — tied to at least four veterans’ deaths and estimated to cost more than $50 billion after initial estimates put it at $10 billion — is on pause, and lawmakers are threatening action.

Some are browbeating to end the program, while others want to boost oversight. And last week, the problems led Sen. Chuck Grassley (R-Iowa) to put a hold on a confirmation vote for President Joe Biden’s nomination to fill the VA’s No. 2 position.

One last shot? Key lawmakers, including Senate Veterans’ Affairs Chair Jon Tester (D-Mont.), are trying to give the VA another attempt to get it right after the department halted the system rollout this spring and renegotiated its contract with Oracle Cerner.

“Modernization of the electronic health record is not optional,” Tester told POLITICO.

“It has been a nightmare,” House Veterans’ Affairs Chair Mike Bost (R-Ill.) told POLITICO. Bost is among those threatening to pull the plug, saying the old system could be improved. “I carry the carrot and the stick. … The stick got their attention. That is good because we need to wake them up.”

The backstory: More than a dozen officials who’ve been involved or intimately familiar with the project told POLITICO that the problems stem from myriad issues.

They bemoaned a lack of leaders with relevant experience, a failure to prepare for deployments, a rushed initial rollout and a lack of buy-in from VA clinicians wedded to its homegrown system, VistA, which dates back at least 40 years.

“The program was never designed to be successful,” said Peter Levin, a former VA chief technology officer. “Not making difficult choices and not making good choices is costing, at the very least, taxpayers billions of dollars.”

The response: Oracle Cerner declined to comment on the record but previously told POLITICO it backed the pause.

The VA says it will continue to press forward and use the pause to fix technical problems and optimize the system to meet clinicians’ needs. Neil Evans, the VA’s program director, said that organizational change is more difficult than implementing the new technology.

WELCOME TO MONDAY PULSE. Are you involved in the VA’s EHR modernization, whether as a government official, contractor, clinician or patient who has experienced the system? I want to hear from you and can keep you anonymous if needed. Reach me at bleonard@politico.com. And contact me or our regular host, Daniel, at dpayne@politico.com with any other tips and feedback.

TODAY ON OUR PULSE CHECK PODCAST, Kelly Hooper talks with Robert King, who moderated POLITICO's Next Generation of Health Care Therapies event, about what the event's panelists think the future will hold for rare disease treatments, including how gene therapy might hold the key to effectively treat rare genetic diseases and alleviate future chronic diseases.

Listen to today’s Pulse Check podcast

A message from PhRMA:

Research and development of cancer medicines after their initial FDA approval can help expand treatment populations, find new ways of treating a cancer or help patients earlier in their cancer battle. Unfortunately, provisions in the Inflation Reduction Act put this progress in jeopardy by selecting medicines for price setting before many of these critical advancements can be fully realized. Read the new report.

In Congress

Sen. Patty Murray (D-Wash.).

Senate Appropriations Chair Patty Murray says House GOP attempts to insert riders into spending bills “will not fly” in her committee. | Francis Chung/POLITICO

ABORTION HOLDING UP APPROPRIATIONS — The perennial battle over abortion policy is no longer limited to Congress’ yearly health care spending package, POLITICO’s Alice Miranda Ollstein reports.

This year, Republicans have tucked anti-abortion language into nearly every corner of the appropriations process, complicating the delicate negotiations as House leaders race to bring the first of a dozen bills to the floor before the August recess.

Some GOP proposals include:

— Banning mail delivery of abortion pills

— Barring access to gender-affirming care

— Eliminating funding for the Teen Pregnancy Prevention Program

Dems eye Senate ‘firewall’: Democrats plan to force amendment votes but are largely counting on the Senate to push back against the House health proposals, setting up a clash in the coming months when the two chambers must reconcile their differences. But some in the party fear they might be forced to compromise to keep the government open because of the sheer number of riders Republicans are attaching to the spending bills.

Senate Appropriations Chair Patty Murray of Washington told POLITICO that House attempts won’t “fly,” and committee member Brian Schatz of Hawaii said they’ll ignore House Republicans’ efforts.

Still, some Democrats are nervous. Rep. Norma Torres (D-Calif.) fears the more budget riders House Republicans push through, the more leverage they’ll have.

“Our caucus is having a very difficult time,” she said — torn between a desire to avoid a shutdown and stopping what they consider an “extreme agenda” from becoming law.

E&C GOP DEMANDS ANSWERS FROM HHS — House Energy and Commerce Committee chair Cathy McMorris Rodgers (R-Wash.), Health Subcommittee Chair Brett Guthrie (R-Ky.) and Oversight Subcommittee Chair Morgan Griffith (R-Va.) wrote to HHS Secretary Xavier Becerra to give a “final warning” in an investigation into allegations of “risky” mpox research.

The background: The GOP lawmakers first raised concerns in November 2022 about a purported experiment after Bernard Moss, a leading NIH researcher, was quoted in a Science magazine article discussing an experiment he was “planning” that apparently made mpox, formerly known as monkeypox, 1,000 percent more deadly in mice than other variants.

The Republicans have deemed HHS’ responses inadequate and said there were inconsistencies. They're calling for Moss to appear for a videotaped interview.

HHS responses: The June 30 letter signed by Moss says he never conducted the experiment and hasn’t proposed doing so.

“Should it appear in the future that such an experiment would greatly contribute to understanding the basis for mpox virus virulence, then I may make such a proposal,” Moss said, adding he’d abide by what the Institutional Biosafety Committee deems appropriate.

JOIN 7/26 FOR A TALK ON THE NEW ENERGY ECONOMY: Join POLITICO's lively discussion, "Powering a Clean Energy Economy," on July 26 to explore the effectiveness of consumer-targeted policies to boost sustainability and create clean energy jobs. How are the Inflation Reduction Act's provisions faring? Which strategies truly sway consumer behavior? Hear from featured speaker, Rep. Debbie Dingell (D-Mich.), among other experts. Don't miss this insightful event — register today and be part of the conversation driving America's clean energy future! REGISTER NOW.

PRICE TRANSPARENCY

PRICE TRANSPARENCY COMPLIANCE LAGS — Patient Rights Advocate, a nonprofit group that’s pushed for price transparency policy across Congress, released a new report finding that just 36 percent of hospitals comply with hospital price transparency requirements.

That’s up from 24.5 percent as of February, the group said. The organization’s findings have diverged from CMS officials’ findings — they said in February that “at least” 30 percent weren’t fully compliant.

It comes after lawmakers advanced price transparency legislation for hospitals earlier this month and CMS proposed major changes to how hospitals post prices for certain services in a bid to make them easier for consumers to understand.

A message from PhRMA:

Names in the News

FIRST IN PULSE: INSURERS SNAG CMS OFFICIAL — AHIP, the nation's largest insurance advocacy group, hired LaShawn McIver to serve as chief health equity officer — a new role at the organization meant to push equitable access to health coverage for those in underrepresented and medically underserved communities, Megan reports.

McIver most recently served as the director of the Office of Minority Health at CMS but previously spent nearly a decade leading advocacy efforts for the American Diabetes Association and worked as an HIV/AIDS fellow for the Congressional Black Caucus’ Center for Policy Analysis and Research.

"Too many Americans have faced persistent and detrimental health inequity for too long, and we must work to accelerate our efforts and close health equity gaps faster," said AHIP CEO Matt Eyles in a statement about her hire.

JOIN 7/27 FOR A TALK ON WOMEN LEADERS IN THE NEW WORKPLACE: In the wake of the pandemic, U.S. lawmakers saw a unique opportunity to address the current childcare system, which has become increasingly unaffordable for millions of Americans, but the initial proposals went nowhere. With the launch of the Congressional Bipartisan Affordable Childcare Caucus in May, there may be a path to make childcare more affordable. Join Women Rule on July 27 to dive into this timely topic and more with featured speakers Rep. Nancy Mace (R-S.C.), Rep. Ro Khanna (D-Calif.) and Reshma Saujani, Founder & CEO of Moms First and Founder of Girls Who Code. REGISTER HERE.

What We're Reading

Healthcare Dive reports that the FTC and DOJ’s new merger guidelines could hold up health care deals.

HealthcareInfoSecurity details a three-week cyber attack at Tampa General Hospital that led to the breach of 1.2 million patients’ data.

CNN reports on a new study finding that errors in diagnosis lead to nearly 800,000 deaths or instances of permanent disability each year nationwide.

A message from PhRMA:

A new report showcases the vital role of post-approval R&D in nine critical oncology treatments. This research can help expand treatment populations, find new ways of treating a cancer or help patients earlier in their cancer battle. Unfortunately, provisions in the Inflation Reduction Act put this progress in jeopardy by selecting medicines for price setting before many of these critical advancements can be fully realized. See how post-approval R&D in cancer is at risk.