VA Electronic Health Record Modernization: Critical Actions Needed to Support Accelerated System Deployments

What GAO Found

After three unsuccessful attempts over two decades, the Department of Veterans Affairs (VA) undertook a fourth effort in 2017—the Electronic Health Record Modernization (EHRM) program—to modernize its legacy health information system. GAO has previously reported on the challenges VA has experienced with this effort. In these reports, GAO made 18 recommendations to improve cost estimating, schedule, program management, user adoption and satisfaction, and operational testing. GAO deemed 12 of these as priority recommendations because of their criticality to successful future deployments. VA has not yet fully implemented 16 of the 18 recommendations.

Implementation Status of GAO Electronic Health Record System-Related Recommendations to the Department of Veterans Affairs as of December 2025

Source: GAO reports. I GAO-26-108812

In March 2025, GAO reported that VA had made improvements at five initial sites but noted that the department’s actions to address challenges had impacted the program’s total cost estimate and schedule. Accordingly, GAO made two priority recommendations to update the cost estimate and schedule. Senate and House Authorizing and Appropriations Committees subsequently sent a letter to VA requesting a detailed cost estimate and schedule before September 30, 2025. While VA has delivered a notional schedule to congressional committees, it has not provided a cost estimate or detailed documentation of its schedule necessary to determine the extent to which it is consistent with leading practices.

In May 2023, GAO reported that users expressed dissatisfaction with the new system and VA did not adequately identify and address system issues. GAO made 10 priority recommendations to address change management, user satisfaction, system trouble ticket, and independent operational assessment deficiencies. VA has not yet fully implemented the 10 recommendations.

Until VA fully implements the priority recommendations, future deployments risk prolonging management challenges like those experienced in the initial deployments and users will likely not be positioned to achieve optimal usage of the new electronic health record (EHR) system.

Why GAO Did This Study

VA depends on its EHR system to manage health care for its patients. Since 2017, the department’s EHRM program has undertaken efforts to replace its legacy EHR system with a modernized, commercial system.

VA first deployed its new EHR system in October 2020 and followed up with further deployments to four additional sites in 2022. However, in 2023, it halted future system deployments due to feedback from veterans and clinicians that the new system was not meeting expectations. In December 2024, VA announced plans to restart deployments beginning with four facilities in Michigan. The department plans for nine additional site deployments in 2026. VA plans to accelerate deployments to complete approximately 170 sites by 2031.

GAO has previously designated VA health care as a high-risk area for the federal government, in part due to its challenges implementing EHRM initiatives.

GAO was asked to testify on its key prior reports and related recommendations to improve VA’s EHRM program. GAO summarized the results of five prior reports and followed up with VA on actions to implement recommendations.