The U.S. Department of Veterans Affairs has arrived at a new electronic health record deal with Oracle, following five years marked by rollout challenges and performance problems that have impacted veterans' care – resulting in reported harm to at least 149 patients – and recently led to the temporary halt of the VA EHR modernization program.

WHY IT MATTERS

The VA's modified contract with Oracle Cerner aims "to deliver the high-functioning, high-reliability, world-class electronic health record that Veterans deserve," the agency said in an EHR modernization contract update obtained by Bloomberg Government.

"This renegotiated contract dramatically increases VA’s ability to hold Oracle Cerner accountable across a variety of key areas."

Under the new terms, past system outages would have yielded "a 30-fold increase" in monetary credits, according to the agency.

Outage-free is one of 28 performance metrics that would result in monetary credits built into the renegotiated contract. Incidents where one component is not working or the system is experiencing interruptions and operating slowly would also result in cost reductions for the VA. 

In addition to reliability, Oracle Cerner is incentivized to be responsive to VA clinicians and support requests and is required to meet interoperability goals. The EHR vendor needs to ensure access to patient health records at private hospitals and interface with the VA's website, mobile applications and other patient-facing applications the agency has rolled out.

"All in all, this is a much stronger contract, and I’m hopeful it will help VA ensure that Oracle Cerner gets this EHR program to work for Washington state providers and veterans," U.S. Sen. Patty Murray, D-Washington, chair of the Senate Appropriations Committee and the VA Subcommittee and a senior member of the Senate Committee on Veterans Affairs, said in a statement Tuesday. 

THE LARGER TREND

Murray has been a vocal critic of many aspects of the EHR program. This past March, she and other Senate Democrats introduced the EHR Program RESET Act, which would require the VA to implement a series of EHR reforms. Republicans in the House of Representatives and Senate, meanwhile, offered their own measures to reset or terminate the VA's EHRM program. 

In April, the VA halted all planned deployments of the Oracle Cerner EHR to focus on fixing issues identified at five sites currently using it – Spokane VA Health Care System, VA Walla Walla Health Care, Roseburg VA Health Care System, VA Southern Oregon Health Care and VA Central Ohio Health Care System.

"For the past few years, we've tried to fix this plane while flying it – and that hasn't delivered the results that veterans or our staff deserve," said Dr. Neil Evans, acting program executive director of the VA's EHRM Integration Office, in the agency's announcement. 

Clear improvements in the clinician and veteran experiences, sustained high performance and high reliability must be evident before the EHR is rolled out at any other VA medical center, the VA had said.

ON THE RECORD

"This new agreement reflects Oracle's commitment to veterans’ healthcare as well as complete confidence in our technology and our partnership with the VA to deliver an EHR that far exceeds the expectations of users," Mike Sicilia, executive vice president of Oracle Global Industries, in an email to Healthcare IT News.

"Ultimately, we believe that this new contract gives VA the tools we need to hold Oracle Cerner accountable to deliver an EHR that will meaningfully improve veterans' health outcomes and benefits," said VA officials in the contract update. "The system has not delivered for veterans or VA clinicians to date, but we are stopping at nothing to get this right."

Article updated May 18 to reflect statement from Oracle.

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.