What GAO Found
From June 2020 to May 2023, GAO issued four reports on the Department of Veterans Affairs’ (VA) efforts to implement its electronic health record modernization (EHRM) and made a total of 15 recommendations aimed at improving implementation. Among other things, these recommendations addressed poor user satisfaction, the need for better change management, the pace of system trouble ticket resolution, and the importance of addressing independent operational assessment deficiencies.
Most recently, in its draft report currently at VA for comment, GAO’s preliminary results show that VA is making incremental improvements. This includes implementing over 1,500 system configuration changes and initiating projects to address user challenges. However, much more remains to be done:
• As of February 2025, VA had not addressed approximately 1,800 complex configuration change requests.
• The program lacks an updated total life cycle cost estimate that reflects the many EHRM changes and delays. Existing EHRM life cycle cost estimates range from VA’s $16.1 billion to an independent estimate of $49.8 billion. Updating the independent life cycle cost estimate is imperative to understanding the full magnitude of VA’s investment.
• Similarly, it is critically important that VA update its integrated schedule to inform decision-making. Planned system deployment at four additional locations results in about 160 medical centers (94 percent of VA’s total number of medical centers) without the new system as of mid-2026.
• The EHRM program did not identify baselines and targets for one of its nine metrics to measure the impact of the new system at the live sites.
• VA’s 2024 user surveys continue to reflect general dissatisfaction with the new system.
An updated cost estimate and integrated schedule are essential management tools to inform VA of the challenges it faces in moving forward.
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