Unreliable Information Technology Infrastructure Cost Estimates for the Electronic Health Record Modernization Program

The Electronic Health Record Modernization program manages VA’s transition to a new electronic health record system interoperable with the Department of Defense’s system, allowing care providers to access more comprehensive medical histories for the nine million-plus veterans enrolled in VA health care. The VA Office of Inspector General (OIG) conducted this audit because of the importance of the modernization program and its extensive costs. The audit assesses whether the Office of Electronic Health Record Modernization (OEHRM) estimated information technology (IT) infrastructure upgrade costs in accordance with VA standards and Government Accountability Office guidance. The OIG also examined whether OEHRM reported to Congress all costs needed to support the program, including future technology refreshment. This is the second OIG report this year examining VA’s development and reporting of cost estimates for infrastructure upgrades needed to support the program (See VA OIG, Deficiencies in Reporting Reliable Physical Infrastructure Cost Estimates for the Electronic Health Record Modernization Program, Report No. 20-03178-116, May 25, 2021). In this report, the OIG found weaknesses in how OEHRM developed and reported cost estimates. The two $4.3 billion infrastructure upgrade estimates reported to Congress were not reliable and, because of incomplete documentation, determining the accuracy of the estimates was not possible. The OIG also found VA did not report to Congress other IT upgrade costs of about $2.5 billion because OEHRM did not include costs other VA agencies would bear. OEHRM also did not update the cost estimates it provided to Congress. The OIG made six recommendations to help VA ensure an independent cost estimate is performed, reassess and refine the estimate to comply with standards, develop procedures consistent with guidance, disclose to Congress all costs for all IT infrastructure upgrades and updates, and formalize agreements with OIT and VHA to identify expected funding contributions from each entity.