VA is accelerating a health-record overhaul it hasn't fixed
Summary
The Department of Veterans Affairs is on its fourth attempt since 2001 to replace the 30-year-old system that runs its hospitals' medical records, and it's now preparing to accelerate deployment to roughly 170 sites by 2031. Two GAO testimonies, about 10 months apart, show what that acceleration is starting from: as of February 2025, user-satisfaction surveys still showed three-quarters of staff disagreeing that the new system helped them work efficiently, and by December 2025, GAO reported VA had fully implemented only 2 of the 18 recommendations made across five audits since 2020 -- including 9 of 10 priority recommendations from a 2023 report on user dissatisfaction still not implemented at all.
A program built on two cost estimates, both now stale
's own January 2019 estimate put the program's total life-cycle cost at about $16.1 billion over 10 years. In October 2022, an independent estimate by the Institute for Defense Analyses put the true figure at $49.8 billion -- $32.7 billion to implement over 13 years, plus $17.1 billion for 15 years of sustainment -- more than three times 's own number. Neither estimate has been updated since to reflect the deployment pause and other program changes. 's March 2025 report made two priority recommendations: get an updated, independent cost estimate, and update the integrated master schedule, both using 's own best-practice guides. concurred. Congress separately told to deliver a detailed cost estimate and schedule by September 30, 2025. As of December 2025, still hadn't provided an updated cost estimate, and had delivered only a 'notional schedule' that lacked the documentation needs to check it against best practices.
View data as table
| VA's own estimate (January 2019) | 16.1 |
|---|---|
| Independent estimate (October 2022) | 49.8 |
Meanwhile the meter keeps running. had obligated about $12.71 billion on the program through the third quarter of fiscal year 2024; by the second quarter of fiscal year 2025, that had grown to about $13.84 billion. Spending is already closing in on 's own original total estimate for the entire program, with a large share of deployments still ahead.
Recommendations pile up faster than they close
Across five reports since June 2020, has made 18 recommendations on the EHRM program, 12 of them designated priority recommendations because of how critical they are to successful future deployments. As of December 2025, had fully implemented just 2 of the 18, partially implemented a third, and left 15 not fully addressed. The one bright spot: in September 2025, finally established baselines and performance targets for all nine metrics wanted tracked for the reset, closing that recommendation. But a May 2023 report's 10 priority recommendations on change management, user satisfaction, trouble tickets, and independent testing fared worse -- as of December 2025, had only partially implemented one of them, including still not having instituted an independent operational assessment of whether the system actually works for users in practice.
View data as table
| Fully implemented | 2 |
|---|---|
| Partially implemented | 1 |
| Not implemented | 15 |
Users are still unconvinced
's own user surveys show slow movement. Asked whether the new system made them as efficient as possible, 5% of respondents agreed or strongly agreed in September 2022; by September 2024 that had risen to 13% -- but 75% still disagreed or strongly disagreed. In interviews conducted with 71 staff about the system's effect on their productivity, 54 said it decreased or greatly decreased productivity, versus just one who said it increased productivity.
View data as table
| Agreed or strongly agreed, Sept. 2022 | 5.3% |
|---|---|
| Agreed or strongly agreed, Sept. 2024 | 13.2% |
| Disagreed or strongly disagreed, Sept. 2024 | 74.7% |
Some operational metrics have improved. implemented more than 1,500 enterprise-level configuration changes by June 2024, and its backlog of unresolved complex configuration-change requests fell from about 2,200 in September 2024 to about 1,800 by February 2025. closed 9 of 14 highest-priority patient-safety enhancements by July 2024 and delivered 6 of 7 pharmacy enhancements identified by clinicians. Under its service-level agreement with Oracle Health, the system met its outage-free-time requirement in 14 of 16 months from June 2023 to September 2024, missing only March and April 2024 due to database bugs, and met its incident-free-time requirement in 12 of those 16 months.
That improvement is happening at a small number of sites. Eight years after the 2018 contract award, and with two years remaining on the original contract term, 's plan to deploy to four Michigan facilities by mid-2026 will bring the total to just 10 locations live -- leaving about 160 of 's roughly 170 medical centers, or 94%, still running the legacy system it's trying to replace. plans to deploy to nine more sites in 2026 and to accelerate deployment to reach all approximately 170 sites by 2031 -- an acceleration says depends on recommendations that, as of December 2025, remain mostly unimplemented.
The takeaway
- Spending has nearly caught up to 's own original total estimate for the whole program. $13.84 billion obligated through Q2 FY2025 is about 86% of 's 2019 estimate of $16.1 billion for the entire effort -- while an independent 2022 estimate puts the true total cost at $49.8 billion, over three times as much, and neither figure has been updated since.
- Most of 's oversight recommendations remain open even as moves to accelerate. 16 of 18 recommendations made since 2020 were not yet fully implemented as of December 2025, including 9 of 10 priority recommendations from a 2023 report on user dissatisfaction that 's December 2025 update found still not implemented at all.
- The vast majority of 's hospitals are still waiting. Eight years after the 2018 contract award, only 10 of roughly 170 targeted medical centers will have the new system by mid-2026 -- leaving 94% still on the legacy system, even as user surveys show three-quarters of staff still disagree the new system helps them work efficiently.
Findings on program status as of February 2025 -- financial obligations through Q3 FY2024, the cost-estimate gap, configuration-change backlog, patient-safety and pharmacy enhancements, uptime metrics, and user-satisfaction survey results -- are from -25-108091, 'Electronic Health Record Modernization: Is Making Incremental Improvements, but Much More Remains to Be Done' (February 24, 2025), read directly in full. Findings on the December 2025 recommendation-implementation tally and updated financial figures through Q2 FY2025 are from -26-108812, ' Electronic Health Record Modernization: Critical Actions Needed to Support Accelerated System Deployments' (December 15, 2025), also read directly in full. Both are testimonies by the same official (Carol C. Harris) before the same House Veterans' Affairs Subcommittee on Technology Modernization, part of a recurring oversight series that has tracked this program since June 2020.
Sources(2) ▾
- U.S. Government Accountability Office, Electronic Health Record Modernization: VA Is Making Incremental Improvements, but Much More Remains to Be Done (2025-02-24) — -25-108091, testimony of Carol C. Harris before the House Veterans' Affairs Subcommittee on Technology Modernization, summarizing 's prior EHRM reports plus preliminary results of a then-draft report (later issued as -25-106874). Rich empirical detail: financial data through Q3 FY2024, configuration-change backlog, patient-safety/pharmacy enhancement status, system uptime, and user-satisfaction survey results. Distinct from doc-gao26-108812 (the same recurring congressional testimony series, about 10 months later, with updated financial/recommendation-status figures). Fetched directly from files.gao.gov (HTTP 200); direct gao.gov PDF asset returns HTTP 403. gao.gov · original document
- U.S. Government Accountability Office, VA Electronic Health Record Modernization: Critical Actions Needed to Support Accelerated System Deployments (2025-12-15) — -26-108812, testimony of Carol C. Harris before the same House subcommittee about 10 months after doc-gao25-108091, updating the recommendation-implementation tally across all five prior EHRM reports and the program's financial and deployment-schedule status as prepares an accelerated push to roughly 170 sites by 2031. Fetched directly from files.gao.gov (HTTP 200); direct gao.gov PDF asset returns HTTP 403. gao.gov · original document
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depends on its electronic health record system to manage care for more than 9 million veterans. Since 2017, it has been trying to replace its 30-plus-year-old legacy system, VistA, with a commercial Oracle Health system shared with the Department of Defense -- the department's fourth attempt at modernization since 2001, after three earlier approaches were abandoned over cost and planning concerns. In February 2025⧉, testified that was making incremental improvements at its first five deployment sites but that dissatisfaction persisted and major planning tools remained outdated. In December 2025⧉ -- about 10 months later, as prepares to accelerate deployment to roughly 170 sites by 2031 -- testified that most of its recommendations were still unaddressed.