Why it Matters
For more than six million veterans who depend on the Department of Veterans Affairs (VA) for their health care, getting a timely appointment can mean the difference between managed care and a medical crisis. Yet a new congressional testimony from the Government Accountability Office, delivered June 12 before the House Subcommittee on Technology Modernization, paints a picture of a scheduling infrastructure so fragmented and outdated that even VA staff must navigate dozens of overlapping systems just to book a single appointment.
The testimony, which synthesizes findings from five prior Government Accountability Office (GAO) reports, arrives as VA's flagship effort to modernize its technology, a contract with Oracle Health worth billions, remains stalled years behind schedule.
The Big Picture
In fiscal year 2023, the Veterans Health Administration (VHA) handled approximately 42 million in-person appointments and more than 29 million telehealth and telephone visits with VA providers. An additional 47 million appointments took place with non-VA providers through the community care program. VHA serves veterans across roughly 1,300 sites, including about 170 medical centers and more than 1100 outpatient facilities.
Behind that volume sits a technology stack that GAO describes as deeply fragmented. VA's primary health information system, VistA, is more than 30 years old and comprises roughly 170 clinical, financial, and administrative applications. Approximately 130 versions of VistA are deployed across the department. To schedule a single appointment, facility staff are required to open multiple applications simultaneously.
The full scope of the problem becomes clearer when the systems are counted: seven VistA applications used for scheduling and related activities, nine additional systems supporting scheduling at VistA facilities, five systems for managing referrals, eight veteran-facing appointment engagement tools, and 14 systems used at facilities running Oracle Health. That is 43 systems touching the scheduling process in some form.
VA Appointment Scheduling Modernization
In 2018, VA contracted with what was then Cerner Government Services, now Oracle Health, to replace VistA with a modern electronic health record system. The rollout began in October 2020. By June 2022, six locations had deployed the new system.
Then, in April 2023, VA halted further deployments to address technical and performance problems, including scheduling concerns. Except for one joint VA and Department of Defense facility that went live in March 2024, the program sat largely frozen. As of May 2025, very few facilities were using Oracle Health.
In December 2024, VA announced a plan to restart deployments, targeting 13 sites in 2026. GAO has flagged two open recommendations from its May 2025 report on the modernization effort: that VA develop a comprehensive and credible project schedule and a requirements management plan consistent with best practices. VA has agreed with both recommendations, but GAO is still monitoring for implementation.
Scheduling Failures
The community care program, which allows veterans to receive care from non-VA providers when VA cannot meet their needs, has its own scheduling crisis embedded within the larger one.
Under VA standards, community care appointments are expected to be scheduled within seven calendar days of a request. In fiscal year 2022, fewer than 40% of VA facilities scheduled more than half of their community care appointments within that window. Fewer than 10% of facilities scheduled more than 75% of appointments within the standard.
A GAO recommendation from September 2020, that VA assess community care staffing and resource needs and develop a plan to address scheduling risks, remained not fully implemented as of February 2026, more than five years after it was issued.
The community care program was significantly expanded by the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018, which broadened veteran eligibility to receive care outside the VA health care system. That expansion increased the volume and complexity of referrals without a corresponding improvement in the infrastructure to manage them.
What's At Stake
Among the more troubling findings in the underlying reports is a documentation gap in behavioral health referrals. GAO analyzed all 357,299 behavioral health referrals in VA's Corporate Data Warehouse from fiscal years 2021 through 2023. Of those, 33%, or 118,373 referrals, were missing records for initial visits.
GAO noted that no data were available for final visits, meaning the full extent of missing documentation is unknown. Three open recommendations from a May 2025 GAO report call on VA to improve its monitoring of medical record exchanges across all VA facilities. VA has concurred in principle, and GAO is monitoring progress.
For veterans seeking mental health care through community providers, incomplete records can disrupt continuity of care and leave both patients and providers without critical clinical history.
The Bottom Line
GAO has been reporting on VA scheduling challenges for nearly 25 years. VA health care was added to GAO's High Risk List in 2015, a designation reserved for federal programs with significant vulnerabilities to waste, fraud, abuse, or mismanagement, and it remains there today.
VA has a network of approximately 1.3 million community care providers across all 50 states and U.S. territories. The scheduling failures documented by GAO are systemic, embedded in the architecture of a department that has struggled for decades to translate its size and mission into a functional patient experience.
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