Oracle may be losing ground to Epic across several major health systems, but it has just secured something far larger than an individual hospital deployment. The US Department of Veterans Affairs has raised the ceiling of its electronic health record modernisation contract with Oracle Health from approximately £7.3 billion to nearly £19.8 billion. It represents a remarkable £12.5 billion increase, reinforcing the scale of Oracle’s biggest healthcare priority and giving the company a powerful answer to its recent losses.

The Largest Prize in Healthcare Technology

The original 10 year contract was awarded to Cerner in 2018, four years before Oracle acquired the company for approximately £20.7 billion at today’s exchange rate. It was intended to replace the VA’s ageing VistA platform and create a common electronic health record across the Department of Veterans Affairs and Department of Defense. The latest proposed modification would add three optional one year ordering periods, potentially extending the relationship from May 2028 to May 2031.

However, this should not be read as an immediate £19.8 billion payment to Oracle. It is an increase in the contract ceiling, allowing the VA to order additional deployment, testing, training, infrastructure, support and system sustainment services. Actual expenditure will depend on future orders, government appropriations and delivery. Nevertheless, few healthcare technology companies have ever been given access to an opportunity of this size, duration or strategic importance.

Why the Cost Has Exploded

The VA says the increase reflects the ‘unanticipated complexities’ of deploying a single electronic health record across one of America’s largest and most operationally complex healthcare systems. Site specific configuration, infrastructure readiness, training requirements and the accelerated national deployment schedule have consumed the original contract capacity more quickly than expected. The department anticipates reaching the existing ceiling during the first quarter of its 2027 financial year.

The programme has hardly followed a smooth path. Early deployments generated concerns from veterans, clinicians and congressional oversight bodies. Technical failures, workflow problems, user dissatisfaction and reported patient safety incidents led the VA to pause most new deployments in 2023. Although more than 1,500 configuration changes had been completed by mid 2024, the Government Accountability Office reported in 2025 that approximately 1,800 further change requests remained unresolved.

The financial picture is also bigger than the Oracle contract alone. Previous estimates placed the VA’s total programme cost at approximately £11.8 billion, while an independent assessment suggested that implementation and long term sustainment could ultimately approach £36.5 billion. That estimate included around £24 billion for implementation and £12.5 billion for 15 years of sustainment. The contract ceiling therefore represents Oracle’s potential share of the programme, not its complete cost to the US government.

Epic Is Winning Sites, Oracle Is Playing for Scale

This announcement follows our previous analysis of Epic’s accelerating advance. Oracle has lost several important sites as health systems increasingly select Epic for its integrated clinical workflows, user experience and established network. If those individual migrations are valued at around £200 million each, as estimated in our earlier analysis, the cumulative competitive impact is substantial.

Yet Oracle’s strategy is operating on a different scale. While Epic accumulates major hospital and regional wins, Oracle is concentrating enormous resources on the VA, a programme intended to reach approximately 170 locations and serve more than nine million veterans. The contrast is sharp: Epic is winning more visible site battles, while Oracle is defending one of the largest healthcare technology contracts ever awarded.

Indiana Becomes the Next Test

The next test arrives immediately. Fort Wayne, Marion and the Richard L. Roudebush VA Medical Center in Indianapolis are scheduled to activate the Federal EHR on 22 August. They form part of the VA’s restarted and accelerated deployment programme, following a lengthy period devoted to correcting problems at earlier sites.

The VA’s published schedule says 14 medical centres are already live, leaving the overwhelming majority of the national rollout still to be completed. Each successful activation will strengthen the case that Oracle and the VA have moved beyond the programme’s troubled opening phase. Every serious disruption will revive questions about whether more money and a longer timetable are solving the underlying delivery problems or simply enlarging them.

A Victory, But Not Yet a Vindication

For Oracle, the £19.8 billion ceiling is unquestionably a commercial victory. It protects a defining government relationship, creates another potential three years of work and gives Oracle Health a flagship deployment of unmatched scale.

But the real judgement will not be made through an award notice. It will be made in hospitals, where clinicians need a dependable system and veterans need safer, faster and more coordinated care.

Oracle has secured the runway. It must now prove that it can land the aircraft.

_{Currency note: Conversions use the indicative GBP/USD rate on 21 August 2026 of approximately £1 = $1.3642. Figures are rounded and will move with exchange rates.}