The Department of Veterans Affairs has "not yet fully implemented 16 of the 18 recommendations" for its new Oracle Health electronic health record that the Government Accountability Office has made since 2017, according to the GAO’s new status report released Monday.

However, testimony provided to lawmakers this week by the VA and its current EHR vendor, based on system operating metrics over nearly two years and successes implementing the new EHR at the Captain James A. Lovell Federal Health Care Center in North Chicago last year during a long pause on wider rollout across VA medical centers, points to readiness to deploy at 13 more facilities in 2026.

First up for the scheduled second-quarter transition to the new EHR are four VA medical facilities in Michigan – Ann Arbor, Battle Creek, Detroit and Saginaw.

But lawmakers concerned about cost estimates, persistent system flaws and open recommendations in the federal watchdog agency’s new report invited the GAO, VA and Oracle to answer questions about the EHR modernization program’s preparedness and costs before the scheduled 2026 deployments.

Change management discussion

The GAO releases periodic VA EHR modernization program status reports because the office previously designated it a high-risk area for the federal government, "in part due to its challenges" in implementing and controlling system costs over the past nearly 10 years.

In the report, Critical Actions Needed to Support Accelerated System Deployments, the GAO highlighted user dissatisfaction with the new system in May 2023, which resulted in "10 priority recommendations to address change management, user satisfaction, system trouble ticket and independent operational assessment deficiencies."

During a pause on deployments that began that year after the report was released, the VA was permitted to deploy the Oracle EHR system at the Captain James A. Lovell Federal Health Care Center in North Chicago, Illinois, last year.

It was the first joint government EHR implementation with the U.S. Department of War (formerly Defense). The federal EHR, called MHS Genesis, is fully operational across all the Defense Department’s locations worldwide. A unified federal EHR is intended to provide a seamless care experience for patients, regardless of whether they receive care from the DoD, VA, Department of Homeland Security’s U.S. Coast Guard or another participating health system.

The VA has partially addressed users’ barriers to change, the GAO said.

However, "As of December 2025, VA has partially implemented one of 10 priority recommendations and continues to work toward implementing the remaining nine," according to the latest report. "The department has not yet adequately demonstrated that corresponding improvement projects have fully addressed underlying barriers."

The GAO said that from FY 2018 through Q2 2025, the VA reported spending a total of $13.84 billion on the program. The office also cited the 2022 Institute for Defense Analyses, which estimated EHR modernization life cycle costs of $49.8 billion for a 13-year implementation period and $17.1 billion to sustain it for 15 years.

Asked about the GAO’s concerns, the VA said it is working with the office on its recommendations for program improvement.

"VA continues to work proactively with the Government Accountability Office to resolve its recommendations for program improvements related to electronic health record modernization," VA Press Secretary Peter Kasperowicz told *Healthcare IT News *by email on Monday evening.

"Following Federal Electronic Health Record deployment at four sites in Michigan in April 2026, we believe GAO will be able to close an additional eight recommendations," Kasperowicz said.

VA closed two GAO recommendations

At a live-streamed hearing of the House Subcommittee on Technology Modernization Oversight on Monday, Michelle Harris from the GAO; Dr. Neil Evans, acting program executive director for the VA’s EHR Modernization Integration Office; and Seema Verma, Oracle Health and Oracle Life Sciences executive vice president, testified on the VA’s readiness for EHR deployment.

Harris reiterated the GAO’s lingering concerns addressed in its status report about incomplete open recommendations in her statement.

She noted there are tasks related to making needed improvements in cost estimating, scheduling, program management, user adoption and satisfaction, and operational testing, which were highlighted in the GAO’s new status update report.

Meanwhile, two GAO recommendations have been closed.

The VA’s EHR modernization team and the Veterans Health Administration responded to a previous recommendation to together identify baselines and performance targets for nine identified metrics intended to measure system performance, and that recommendation has been completed, the GAO said.

Also completed is a stakeholder registry that the GAO previously said is necessary to improve the identification and engagement of all relevant EHR modernization programs and their reporting.

Some lawmakers discussed what the continuing operating cost would be, and Evans provided a rough estimate for potential EHR operational costs in the final year of implementation at $2.1 billion per year.

He later said that once the new EHR is running across all VHA facilities, there would be cost savings in decommissioning legacy systems, including its legacy EHR, VistA, which would also factor into ongoing EHR operational costs.

Of note, lawmakers said they had received an updated lifecycle cost estimate of $37 billion from VA, but Harris said the GAO had not received that and then requested it during the hearing.

"Yes, we provided that to this committee on Sept. 30, and we certainly can provide it to the GAO," Evans told lawmakers.

Positive operational metrics

Evans presented lawmakers with positive metrics and testified that the VA is ready to begin deployments.

"Leadership and staff at both the individual sites and the vision level are encouraged by the program’s direction and newfound momentum and are perhaps the most important drivers behind our current progress," he said.

"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 of Nov. 19, the EHR has maintained an incident-free time of 95.93% for 21 consecutive months and is delivering on "system enhancements, new features and system changes that are responsive to the feedback we’re hearing from VA staff."

He noted that there is also momentum at VA medical centers awaiting deployment of the new EHR.

The Chillicothe VA Medical Center in Ohio launched a campaign with a mascot, EHRnie the Eagle, which the department said in a news release is addressing "lessons learned from previous deployments" and is providing updates to staff and patients on next steps as the medical center moves closer to its go-live date.

VA Deputy Secretary Paul Lawrence visited Chillicothe last week, and in a video post on social media, he and VHA officials talked about being ready to go for their scheduled EHR deployment next year.

Harris told lawmakers that from the GAO’s perspective, simultaneous go-live across the four Michigan facilities could be risky.

"It will take a tremendous amount of [VA] resources to deal with the issues that come up inevitably with a go-live," she said.

When asked, Verma said deploying across a number of sites is not unusual for Oracle.

"We feel very well-prepared to deal with the expansions and the challenges of something of this scale," she said.

"One of the things that we’ve learned, lessons learned, is that it is better for sites in a region to all be using the same electronic health record," Evans added. "That is, if you take a look in Michigan, there’s a lot of interdependencies between the VA there."

Using Ann Arbor as an example, Evans said more than 20% of the patients have a primary care provider elsewhere in Michigan, such as in Battle Creek, and come there for specialty care.

Ongoing testing, but no roadmap

Earlier this year, the GAO acknowledged improvement at the five initial sites using the system, but said, "VA had not refined its corrective action plan to provide a clearer roadmap for addressing root causes of IT concerns related to deploying the new system."

Verma said Monday at the House hearing that Oracle "strongly" supports "robust testing" to address problems.

"That’s an important part of an implementation," she explained. "When you do testing, that’s when you may see things that you didn’t anticipate."

She also encouraged lawmakers to recognize that the system is live in six sites today.

"Since we have implemented in those six sites, we’ve also done a number of optimization projects," Verma said. "When we do those optimization projects, we go through a big process of testing the system; we do that with the VA."

More recently, Oracle has implemented EHR system testing "on an ongoing basis."

"We show them the optimization work," she said. "So, I think we’ve had very strong, robust testing, and so we feel confident that the system that we have in place around testing is working."

Risk planning is still TBD

In the latest report, the GAO also noted that the VA has not planned an independent operational assessment to evaluate the new EHR system’s efficacy for VA care providers and other users, and thus poses risks to veterans.

"An operational assessment, particularly if it were conducted by an independent entity, would help VA catalog findings with greater rigor, transparency and accountability," the GAO said. "In addition, without having conducted an independent operational assessment, VA had not validated that the system satisfies user needs in an operational environment. This elevates the risk of deploying the system prematurely, thereby posing unnecessary risks to patient health and safety."

During the House hearing, Rep. Morgan Luttrell, R-Texas, expressed concern about not having any formal analyses on contingencies considered.

He asked about deployments in the event of operational failures at the initial four Michigan sites planned for next year, and Verma answered that conversations with VA are largely focused on successful deployments.

"That’s a decision I think that we would discuss with the VA and figure out the appropriate course," she said. "But we haven’t had that discussion yet."

Based on the experience at the VA’s Lovell facility last year, Verma said there have been many "lessons learned" and that she expects the 2026 deployment to succeed.

"That went very well, and we continue to learn, we continue to do upgrades," she said. "We have no reason to believe that there would be a total failure of the system because we haven’t seen that in … the last few projects, whether it’s our optimization projects or the go-live."