[House Hearing, 114 Congress]
[From the U.S. Government Publishing Office]
VA AND DOD IT: ELECTRONIC HEALTH RECORDS INTEROPERABILITY
=======================================================================
JOINT HEARING
BEFORE THE
SUBCOMMITTEE ON
INFORMATION TECHNOLOGY
OF THE
COMMITTEE ON OVERSIGHT
AND GOVERNMENT REFORM
AND THE
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
OF THE
COMMITTEE ON VETERANS' AFFAIRS
HOUSE OF REPRESENTATIVES
ONE HUNDRED FOURTEENTH CONGRESS
FIRST SESSION
__________
OCTOBER 27, 2015
__________
Serial No. 114-147
__________
Printed for the use of the Committee on Oversight and Government Reform
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COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM
JASON CHAFFETZ, Utah, Chairman
JOHN L. MICA, Florida ELIJAH E. CUMMINGS, Maryland,
MICHAEL R. TURNER, Ohio Ranking Minority Member
JOHN J. DUNCAN, Jr., Tennessee CAROLYN B. MALONEY, New York
JIM JORDAN, Ohio ELEANOR HOLMES NORTON, District of
TIM WALBERG, Michigan Columbia
JUSTIN AMASH, Michigan WM. LACY CLAY, Missouri
PAUL A. GOSAR, Arizona STEPHEN F. LYNCH, Massachusetts
SCOTT DesJARLAIS, Tennessee JIM COOPER, Tennessee
TREY GOWDY, South Carolina GERALD E. CONNOLLY, Virginia
BLAKE FARENTHOLD, Texas MATT CARTWRIGHT, Pennsylvania
CYNTHIA M. LUMMIS, Wyoming TAMMY DUCKWORTH, Illinois
THOMAS MASSIE, Kentucky ROBIN L. KELLY, Illinois
MARK MEADOWS, North Carolina BRENDA L. LAWRENCE, Michigan
RON DeSANTIS, Florida TED LIEU, California
MICK, MULVANEY, South Carolina BONNIE WATSON COLEMAN, New Jersey
KEN BUCK, Colorado STACEY E. PLASKETT, Virgin Islands
MARK WALKER, North Carolina MARK DeSAULNIER, California
ROD BLUM, Iowa BRENDAN F. BOYLE, Pennsylvania
JODY B. HICE, Georgia PETER WELCH, Vermont
STEVE RUSSELL, Oklahoma MICHELLE LUJAN GRISHAM, New Mexico
EARL L. ``BUDDY'' CARTER, Georgia
GLENN GROTHMAN, Wisconsin
WILL HURD, Texas
GARY J. PALMER, Alabama
Sean McLaughlin, Staff Director
Troy Stock, Subcommittee on Information Technology Staff Director
David Rapallo, Minority Staff Director
Sarah Vance, Clerk
------
SUBCOMMITTEE ON INFORMATION TECHNOLOGY
WILL HURD, Texas, Chairman
BLAKE FARENTHOLD, Texas, Vice Chair ROBIN L. KELLY, Illinois, Ranking
MARK WALKER, North Carolina Member
ROD BLUM, Iowa GERALD E. CONNOLLY, Virginia
PAUL A. GOSAR, Arizona TAMMY DUCKWORTH, Illinois
TED LIEU, California
COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
DOUG LAMBORN, Colorado CORRINE BROWN, Florida, Ranking
GUS M. BILIRAKIS, Florida, Vice- Minority Member
Chairman MARK TAKANO, California
DAVID P. ROE, Tennessee JULIA BROWNLEY, California
DAN BENISHEK, Michigan DINA TITUS, Nevada
TIM HUELSKAMP, Kansas RAUL RUIZ, California
MIKE COFFMAN, Colorado ANN M. KUSTER, New Hampshire
BRAD R. WENSTRUP, Ohio BETO O'ROURKE, Texas
JACKIE WALORSKI, Indiana KATHLEEN RICE, New York
RALPH ABRAHAM, Louisiana TIMOTHY J. WALZ, Minnesota
LEE ZELDIN, New York JERRY McKNERNEY, California
RYAN COSTELLO, Pennsylvania
AMATA COLEMAN RADEWAGEN, American
Samoa
MIKE BOST, Illinois
Jon Towers, Majority Staff Director
Eric Hannel, Subcommittee on Oversight and Investigtions Staff Director
Jessica Eggimann, Chief Clerk
Don Phillips, Minority Staff Director
------
SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS
MIKE COFFMAN, Colorado, Chairman
DOUG LAMBORN, Colorado ANN M. KUSTER, New Hampshire,
DAVID P. ROE, Tennessee Ranking Member
DAN BENISHEK, Michigan BETO O'ROURKE, Texas
TIM HUELSKAMP, Kansas KATHLEEN RICE, New York
JACKIE WALORSKI, Indiana TIMOTHY J. WALZ, Minnesota
C O N T E N T S
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Page
Hearing held on October 27, 2015................................. 1
WITNESSES
The Hon. Laverne Council, Assistant Secretary for Information
Technology, Chief Information Officer, U.S. Department of
Veterans Affairs
Oral Statement............................................... 7
Written Statement............................................ 9
Mr. Brian P. Burns, Deputy Director, Warfighter Systems
Integration, Office of Information Dominance, U.S. Department
of Veterans Affairs
Mr. Christopher A. Miller, Program Executive Officer, Defense
Healthcare Management Systems, U.S. Department of Defense
Oral Statement............................................... 20
Written Statement............................................ 22
Mr. David Devries, Principal Deputy Chief Information Officer,
U.S. Department of Defense
Oral Statement............................................... 30
Written Statement............................................ 32
Ms. Valerie C. Melvin, Director of Information Management and
Technology Resources Issues, U.S. Government Accountability
Office
Oral Statement............................................... 40
Written Statement............................................ 42
APPENDIX
Congressman Gerald E. Connolly Opening Statement................. 96
Questions for the Record for the Hon. LaVerne Council, submitted
by Chairman Hurd............................................... 99
Questions for the Record for Mr. Christopher Miller, Submitted by
Chairman Hurd.................................................. 103
VA AND DOD IT: ELECTRONIC HEALTH RECORDS INTEROPERABILITY
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Tuesday, October 27, 2015
House of Representatives,
Subcommittee on Information Technology,
Committee on Oversight and Government Reform,
joint with the Subcommittee on Oversight and
Investigations, Committee on Veterans' Affairs
Washington, D.C.
The subcommittees met, pursuant to call, at 2:50 p.m., in
Room 2154, Rayburn House Office Building, Hon. Will Hurd
[chairman of the Subcommittee on Information Technology,
Committee on Oversight and Government Reform] presiding.
Present from the Committee on Oversight and Government
Reform: Representatives Hurd, Farenthold, Walker, Blum, Kelly,
Connolly, Duckworth, Lieu, and Moulton.
Present from the Committee on Veterans' Affairs:
Representatives Coffman, Lamborn, Roe, Benishek, Huelskamp,
Walorski, Kuster, O'Rourke, and Walz.
Mr. Hurd. The Subcommittee on Information Technology of the
Committee on Oversight and Government Reform and the
Subcommittee on Oversight and Investigations of the Committee
on Veterans' Affairs will come to order.
Without objection, the chair is authorized to declare a
recess at any time.
Let me start today's hearing by trying to simply state my
frustration. It's the year 2015. We live in a complex
interconnected society with self-driving cars, wearable
technology, and complex algorithms that can predict when a
critical mechanical component is going to break, but our
soldiers, sailors, airmen, and marines who are making the
transition from DOD to VA healthcare are literally told to
print out hard copies of their medical records and then walk
them to the VA.
We have sent men to the moon and robots to Mars. I feel
like we should be able to move one electronic file no matter
how big, no matter how old, from one computer system to
another. I don't mean to understate the enormity of the
challenge of integrating the two largest Federal bureaucracies,
but it's clear to me that our inability to integrate these two
systems is a problem of leadership rather than technical
feasibility.
The story of the interoperable electronic health record
starts in 1998 with the government computer-based patient
record initiative. Since then, I've counted six programs or
other initiatives from 2002 to 2013 designed to increase the
exchange of healthcare data between the VA and the DOD.
In that time, we've had three Presidents and two wars, and
the members of our Armed Forces are still coming home to find
that two decades was not long enough for these two Departments
to get together and develop a workable and fully interoperable
electronic health record.
While today's hearing could include a conversation laced
with technical terminology, interoperability, mapping national
data standards, graphical user interfaces, and health data
domains, at its core, this is not a problem of technology. This
is an issue of management.
Why do these two departments abandon the integrated health
record program? Cost-effectiveness was the answer given after
spending, according to the Interagency Program Office, $564
million on the integrated health record. But continual failures
to make deadlines and deliver on capabilities led to these two
Departments doing what they so often have done in the past: go
their separate ways.
The current plan for DOD and the VA to modernize their
healthcare IT infrastructure in order to achieve full
interoperability lacks metrics and goals. These are not issues
of data standardization. This is management 101. In fiscal year
2014, the Department of Veterans Affairs spent 3.2 billion on
outdated legacy technology while Department of Defense spent
24.3 billion.
Over the summer, DOD awarded a $4.3 billion contract award
to upgrade DOD's DHMSM program, which is DOD's program to
modernize its health IT systems. But what concerns me are the
statements by Mr. Frank Kendall, the Under Secretary of Defense
for Acquisition, Technology, and Logistics, who downplayed the
role of DHMSM in interoperability. Mr. Kendall made these two
comments about DHMSM, ``It's a big misconception out there that
this software system we're buying is about interoperability,
period. There is not a big interoperability problem with the VA
and DOD today.''
This is the problem I keep coming back to. Does management
understand the depth of the problem when it comes to
interoperability? Let me say this right now, just to get it out
of the way. The Joint Legacy Viewer, the JLV, is not real
interoperability, and I hope that is not any one of you all's
answers today to any of our questions about interoperability.
The ability to view patient data and the ability to access and
use in realtime patient data are two profoundly different
things. Missed deadlines, cost overruns, and failures to
deliver on expectations leave me with a series of doubts about
these two Departments' ability to work towards this common
goal.
When can DOD and the VA actually implement their planned IT
improvements? When can DOD and the VA modernize their systems?
When can DOD and the VA achieve full interoperability? I am
looking forward to exploring these topics today.
My colleagues and I recognize these are big challenges.
Interoperability of health records is something the private
sector is still struggling with, but if DOD and the VA get it
right, they can be a model for the rest of the world. At the
end of the day, when we cut through all the technical jargon,
the myriad of acronyms and the countless PowerPoints on this
topic, we have two very simple questions that must be answered:
When will our men and women in uniform be able to walk across
the street the day they are discharged from service to a VA
medical facility and have their health record waiting for them,
and who is in charge of making this happen?
It's now my pleasure to recognize the ranking member of the
Subcommittee on Information Technology, Ms. Kelly from
Illinois, for her opening statement.
Ms. Kelly. Thank you, Mr. Chairman.
According to the American Hospital Association, only 23
percent of all hospitals are equipped with the technology that
would allow them to find, send, receive, and use electronic
health records. The ability of different healthcare providers
to share and use electronic health information with one
another, regardless of their location, is often referred to as
interoperability. The American Hospital Association's findings
made clear that achieving the full interoperability of
electronic health records among different healthcare providers
is a challenge the entire healthcare industry is struggling to
meet.
Nowhere is this challenge more prevalent, as my chairperson
said, than with the Department of Defense and the Department of
Veterans Affairs, operators of two of the Nation's largest
healthcare systems. For our military personnel and veterans,
the interoperability of electronic health records is crucial
for ensuring they receive the best medical care.
While on Active Duty and later on as veterans, many DOD and
VA personnel tend to be highly mobile and are more likely to
have health records residing at multiple medical facilities
within and outside of the United States. For several years now,
the VA and the DOD have been working to achieve
interoperability. Both report that so far, as interoperability
concerns, the exchange and use of electronic health records
between their two systems, this goal has been achieved.
However, as GAO's August report on the status of
interoperability at both the VA and the DOD makes clear, both
Departments are still years away from achieving full
interoperability so that the electronic health records can be
exchanged and used not just between their two systems but with
any private medical provider in the country.
GAO recommended that VA and DOD promptly develop outcome-
oriented metrics and goals for defining and measuring their
progress on achieving full interoperability. As GAO noted in
its report, and I quote, ``using an effective outcome-based
metric approach could provide DOD and VA a more accurate
ongoing picture of their progress toward achieving
interoperability and the value and benefits generated.''
I look forward to hearing in more detail from today's
witnesses on their plans for ensuring that the VA and DOD have
in place a fully modernized interoperable electronic health
records system.
Today's hearing also raises valid cybersecurity concerns
with respect to what each Department is doing to ensure that
medical records stored on their networks are adequately
protected from hackers. As we've learned from this year's cyber
attacks against leading health insurers, like Anthem and
Premera or Blue Cross, hackers are now targeting medical
records in an effort to obtain highly sensitive information
about individuals.
As the operators of two of the Nation's largest healthcare
systems, it is critical that DOD and the VA invest in and
deploy the most advanced cybersecurity tools to safeguard the
sensitive medical information that is stored on their networks.
Thank you, Mr. Chair, for the hearing, and I yield the
balance of my time.
Mr. Hurd. Thank you, Ms. Kelly. I now welcome and recognize
the chairman of the Subcommittee on Oversight and
Investigations, the Committee on Veterans' Affairs, Mr. Coffman
from Colorado, who has been showing leadership on supporting
our veterans for many years.
I welcome you for your opening statement, sir.
Mr. Coffman. Thank you, Chairman Hurd.
I would like to welcome everyone to today's joint hearing
to address ongoing issues with the electronic health records or
EHR's of the Department of Defense and Veterans Affairs. VA and
DOD have been attempting to harmonize their EHRs for decades,
leading to an erratic history where billions of dollars have
been expended to reach that goal.
Initially, they sought to make their systems interoperable,
the plan being that they could keep their separate systems but
make them able to seamlessly transmit critical data. Later, the
agencies abandoned that idea and decided that it would be
better to create a new, integrated system that would be shared
by both agencies.
In a February 2014 report, GAO found that the VA and DOD
Interagency Program Office charged with overseeing these
efforts estimated the cost of this integrated system would be
$29 billion from fiscal year 2013 through fiscal year 2029.
Notably, this figure does not include the pre-2013 attempts by
the agency to join their health records dating back to at least
1998.
Yet, again, the decision was made to switch course, this
time abandoning the efforts to create an integrated system
after spending at least $564 million on it and resuming pursuit
of separate systems that would ideally achieve full
interoperability.
There have been numerous subcommittee investigations,
hearings, and GAO reports highlighting the extreme dysfunction
occurring in this process. The National Defense Authorization
Acts for fiscal year 2008 and 2014 were explicit in their
requirements for VA and DOD to jointly develop fully
interoperable EHR systems as well as to ensure that all
healthcare data contained in both agencies' systems complied
with national standards and were computable in realtime.
Both agencies have failed to meet this legal requirement by
missing the October 1, 2014 deadline. To do so, and GAO has
found that full interoperability will not occur before 2018.
Additionally, the Centers for Medicare and Medicaid Services
developed criteria to incentivize meaningful use of certified
EHRs in order to help promote health data interoperability. In
the private sector, the path toward compliance and
certification with those criteria is generally done using
commercial off-the-shelf software.
Use of successfully deployed off-the-shelf software lowers
risk of project failure, reduces time to get to the desired
capability, and, generally speaking, costs less at
implementation and sustainment, none of which appeared to
matter to VA. Instead, VA opted to create a proprietary system
which many of its healthcare facilities across the country have
further customized, leading to 130 different electronic
healthcare systems.
Unfortunately, this sort of disarray and failure to produce
positive results has become the hallmark of VA's Office of
Information and Technology. There has been a substantial
personnel change in that office, which is encouraging, but
there is a tremendous amount of damage that must be undone
before these agencies' EHRs can meaningfully interact.
The National Defense Authorization Act--I look forward to
hearing from the witnesses today about the rationale for the
decisions that have been made as well as the plans to correct
decades of information security weaknesses within both
Departments.
With that, I yield back to Chairman Hurd.
Mr. Hurd. Thank you, Chairman Coffman.
I now recognize the ranking member of the Subcommittee on
Oversight and Investigations, Ms. Kuster, for an opening
statement.
Ms. Kuster. Thank you, Chairman Hurd, Chairman Coffman, and
Ranking Member Kelly for holding this hearing on issues with
DOD and VA electronic health records. Both agencies have been
working for almost 20 years to achieve true interoperability
for their health records, and one of my very first hearings at
the VA committee was on this topic. The goal of real
interoperability and the seamless sharing of health information
has seemed in reach, but unfortunately, never quite achieved.
In an August 2015 GAO report, GAO noted that both agencies
had failed the October 2014 deadline imposed by the 2014
National Defense Authorization Act, as referenced by my chair,
to certify that all healthcare data complies with national data
standards and is computable in realtime. DOD and VA now report
that they may be, quote, ``weeks away'' from meeting this
deadline a full year later, but it is still unclear whether VA
and DOD will achieve interoperability between their electronic
health records by the end of 2016.
This raises what I believe to be the heart of this decade-
long effort and why the achievement of this goal always seems
to be just out of reach. What, in practical terms, does
interoperability mean to DOD, VA, and private providers? GAO
refers to this as, quote, ``the criticality of these
Departments needing to define what they aim to accomplish
through these efforts and identify meaningful outcome-oriented
goals and metrics that indicate not only the extent to which
progress is being made toward achieving full interoperability
but also the measures to which they will be held accountable.''
If we are not clear as to what we all mean by
interoperability and what we're hoping to achieve in the case
of an individual veteran or servicemember in the healthcare
they receive, then we will never achieve what we need to and
interoperability will only be in the eye of the beholder. The
search for real interoperability goes beyond DOD and VA and
raises questions as to our expectations regarding how
healthcare data flows between agencies, and now with the VA
Choice Card, between those agencies and private healthcare
providers.
In addition, we must always ensure to the fullest extent
practicable that this healthcare data is secure and safe. Until
VA is able to demonstrate that its providers are able to
readily access the relevant information from DOD records to
make the most informed decisions on treatment options, neither
agency can declare mission accomplished.
As DOD pursues an overall of its EHR through the latest
partnership for defense health and VA continues with its
incremental plan to modernize the VistA EHR under the new VistA
Evolution Program, I remain concerned that interoperability
will no longer be a DOD and VA focus. I'm concerned that these
separate efforts, at the end of the day, might not fully match
the capabilities we envision while coming with a higher price
tag for the American taxpayer.
The recent VA independent assessment found that VistA is in
danger of become obsolete and that VA lacks standard clinical
documentation, making it difficult to exchange EHR information
among all VA medical centers. We need to take a realistic look
at whether the VistA evolution program is the best means for VA
to modernize its EHR system and achieve all the benefits and
capabilities of interoperability with DOD and private
providers.
As more servicemembers leave the military and as more
veterans and servicemembers receive their healthcare from a
combination of VA, DOD, and private providers, it is vitally
important that DOD and VA work to achieve interoperability not
only between the two agencies but with other healthcare
providers treating veterans.
And, with that, I yield back, and thank you, Mr. Chairman,
for scheduling this hearing.
Mr. Hurd. Thank you, Ms. Kuster.
I will hold the record open for 5 legislative days for any
members who would like to submit a written statement. And I
want to thank the staffs of all the committees for helping us
to be prepared for such an important hearing that we have going
on today.
I'd like to also note the presence of our fellow colleague
from the full Committee on Oversight and Government Reform, Mr.
Hice and also Seth Moulton, Mr. Seth Moulton.
Without objection, Mr. Hice and Mr. Moulton are welcome to
fully participate in today's hearing.
We will now recognize our witnesses. I am pleased to
welcome Ms. LaVerne Council, Assistant Secretary for
Information Technology and Chief Information Officer at the
U.S. Department of Veterans Affairs.
Thank you for being here, Ms. Council.
Mr. Brian Burns, Deputy Director of Warfighter Systems
Integration at the Office of Information Dominance at the U.S.
Department of Veterans Affairs; Mr. Christopher Miller, program
executive officer of Defense Healthcare Management Systems at
the U.S. Department of Defense; Mr. David DeVries, Principal
Deputy Chief Information Officer at the U.S. Department of
Defense; and Ms. Valerie Melvin, Director of Information
Management and Technology Resources Issues at the U.S.
Government Accountability Office.
Welcome to you all, and thank you for being here.
Pursuant to Oversight and Government Reform Committee
rules, all witnesses will be sworn in before they testify.
Please rise and raise your right hand.
Do you solemnly swear or affirm that the testimony you are
about to give will be the truth, the whole truth, and nothing
but the truth?
Thank you. Please be seated, and let the record reflect
that all witnesses answered in the affirmative.
In order to allow time for discussion, we would appreciate
if you would limit your oral testimony to 5 minutes. Your
entire written statement will be part of the record.
Assistant Secretary Council, you are recognized for 5
minutes. Thank you for being here.
WITNESS STATEMENTS
STATEMENT OF LAVERNE COUNCIL
Ms. Council. Thank you.
Chairman Hurd and Coffman, Ranking Members Kelly and
Kuster, and members of the House Oversight and Government
Reform Subcommittee and Information Technology and the House
Veteran Affairs Subcommittee. Thank you for the opportunity to
appear before you today to discuss interoperability, electronic
health records, cybersecurity, and the state of the Office of
Information and Technology, or OI&T, at the Department of
Veterans Affairs.
I'm accompanied today by OI&T's lead for the Interagency
Program Office, Deputy Director Brian Burns. Over the last 3-1/
2 months, I've had the privilege to be a part of VA, where we
have the greatest mission in government: to care for the
Nation's veterans.
VA's Office of Information and Technology is at a critical
inflection point. Persistent internal challenges exist in
delivering IT services, and external pressures are compelling
OI&T to change and adapt. OI&T supports each of VA's diverse
lines of business, including the largest integrated healthcare
system in the United States, a benefits processing organization
equivalent to a medium-sized insurance company, one of the
largest integrated memorial and cemetery organizations in the
country, a court system, and many other components.
I believe we can and must do better to deliver excellent
health care and benefits to our veterans through world class
technology, and I'm delighted to discuss our new OI&T strategy
with you today.
Our vision is to become a world class organization that
provides a seamless unified veteran experience through the
delivery of state-of-art technology. Our guiding principles are
transparency, accountability, innovation, and teamwork. We will
measure success, ensure accountability, invest in the
capabilities of the OI&T employees and collaborate across VA to
build trust.
One of our key organizational changes is the establishment
of an Enterprise Program Management Office or EPMO. The EPMO
will ensure visibility and governance of all programs and
projects. As we establish EPMO, we will be integrate our four
largest programs first VistA Evolution, health data
interoperability; the Veterans Benefit Management System, or
VBMS; and Medical Appointment Scheduling System, or MASS. For
VistA Evolution, I have tasked the program leads, David Waltman
from VHA and Alan Constantian from OI&T to deliver a business
case that explains measurable outcomes for the program. After
reviewing the business case, Under Secretary for Health, Dr.
David Shulkin and I will determine the next steps. The
development of a business case will be the standard from all
programs from their inception.
Chairman Hurd, I agree, interoperability isn't just
technology. It is clear to me that we need to establish a
strong technical foundation through data visibility,
accessibility, and interoperability. This is a precursor to the
work happening in the IPO as well as improving the veteran
experience. As you know, VA and DOD systems already share
millions of health records. Having a veteran's complete health
history from DOD and VA, as well as community providers, is
critical to providing seamless, high-quality access to care and
benefits.
We will continue to work closely with the IPO and Office of
the National Coordinator to ensure national standard codes are
used when describing our health information. I think that VA
and DOD together should be leaders in this area.
When you think of data, you must also consider
cybersecurity. As part of our overall strategy, our first area
of focus is cybersecurity. We delivered an actionable far-
reaching cybersecurity strategy and implementation plan to
Congress on September 28 of this year. OI&T is committed to
protecting all veterans' information and VA data and limiting
access only to those with proper authority. The strategy
establishes an ambitious yet carefully crafted approach to
cybersecurity and privacy protections. Our strategy includes
taking immediate steps to address the material weakness and
includes many efforts already underway and scheduled to
complete within the next quarter.
Chairman and ranking members, thank you again for the
opportunity to discuss our new VA IT strategy with you.
Throughout this transformation, our number one priority is
always the veteran, by ensuring a safe and secure environment
for their information as well as an overall improved experience
with VA. I'm committed to seeing this strategy through and
leaving behind a transformed OI&T when my term is over.
I'm happy to take your questions at this time. Thank you.
[Prepared statement of Ms. Council follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Hurd. Ms. Council, thank you for being here. I know
you're pretty fresh to the job. You're stepping into a big
role. I'm looking forward to working with you on this topic.
Mr. Miller you are now recognized for 5 minutes.
STATEMENT OF CHRISTOPHER A. MILLER
Mr. Miller. Chairman Hurd, Ranking Member Kelly, Chairman
Coffman, and Ranking Member Kuster, distinguished members of
the committee, thank you for the opportunity to address you
today on the state of information technology within the
Department of Defense and our efforts to achieve
interoperability with the Department of Veterans Affairs.
I am honored to represent DOD as the secretary's program
executive officer responsible for the Department's efforts to
improve interoperability and modernize our electronic health
record. Our servicemembers, veterans, retirees, and their
families deserve innovating less than the best possible health
care and services that DOD and VA can provide. DOD is committed
to ensuring servicemembers and their families are ready to
support operational mission requirements and ensuring
continuity of care as members transition to veteran status.
Our DOD healthcare providers have requested and need a
modern system that can support increasing demands, including
data sharing. To this end, DOD is committed to two equally
important objectives, improving data interoperability with both
VA and our private sector healthcare partners and successfully
transitioning to a state of the market electronic health
records that is interoperable with VA and the commercial
healthcare systems used by TRICARE partners.
Since October 2013, we have made significant progress in
achieving both of these objectives. Our actions speak louder
than our words and demonstrate our steadfast commitment. Today,
DOD and VA share a significant amount of health data, more than
any other two major health systems. Over the past 24 months, we
have deployed four major interoperability software releases,
conducted numerous test events, mapped more than a million
terms to national standards, and deployed the system to over
200 DOD and VA sites.
Clinicians are currently able to use our existing software
applications to view records of more than 7.4 million shared
patients who have received care from both Departments. Both
Departments' healthcare providers and VA claim adjudicators
successfully accessed the system nearly a quarter million times
per week. This data is available in realtime, and the number of
records viewable by both Departments continues to increase.
As a result of this progress, DOD will certify to Congress
that it has complied with the Fiscal Year 2014 National Defense
Authorization Act requirements for interoperability with the VA
by the end of this month. Most importantly, we are getting a
tremendous amount of feedback from our users in both
Departments.
On a parallel path, DOD's modernization effort is well
under way. Our goal is a system for the future which is open
and flexible so that it can easily adapt to meet changing
requirements.
After a rigorous and comprehensive evaluation of industry
proposals, DOD awarded a contract without protest in July 2015
to a team led by Leidos that includes 34 other partners. The
contractor team will provide an off-the-shelf suite of products
that is ONC certified, secure, interoperable, and meets our
operational requirement. The system must support the full range
of military operations to include health readiness, casualty
care, humanitarian assistance, disaster response, and
population health.
As a result of this competitive acquisition strategy, DOD's
lifecycle costs have been reduced from $16 billion the previous
iEHR strategy to less than $9 billion today. We are on track to
begin testing the system this coming winter to support our
initial fielding in the Pacific Northwest.
Through our close collaboration with the Office of National
Coordinator for Health IT, we are aligning our modernization
interoperability efforts with nationally recognized data
standards and industry best practices. The adoption of these
will ensure that the health data of our servicemembers and
veterans is interoperable with the health systems of our
private sector healthcare providers, which account for over 60
percent of the care provided within the military health system.
We have the opportunity to save time, save money, and most
importantly, save lives. Our progress the past 24 months has
been a matter of getting back to acquisition basics, getting
the requirement right, thinking like a taxpayer, delivering on
our promises, and developing our technical work force. We
clearly understand that our mission is not complete. To remain
successful, we must continue to stay focused, innovate, and
hold ourselves to the highest standards of excellence.
Chairman Hurd, Ranking Member Kelly, Chairman Coffman, and
Ranking Member Kuster, thank you again for the opportunity to
testify today. The Department greatly appreciates the Congress'
continued interest and efforts to help us deliver the
healthcare that our Nation's veterans, servicemembers, and
their dependants deserve. The Department of Defense and our
colleagues at the Department of Veterans Affairs will continue
to work closely together in partnership with Congress to
deliver the benefits and services to those who sacrifice so
willingly for our Nation, whether it's on the battlefield, at
home with their families, or after they have faithfully
concluded their military service. Again, thank you for this
opportunity, and I look forward to your questions.
[Prepared statement of Mr. Miller follows:]
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Mr. Hurd. Mr. Miller, I appreciate you being here today.
And now I'd like to recognize Mr. DeVries for 5 minutes for
your opening statement.
STATEMENT OF DAVID DEVRIES
Mr. DeVries. Good afternoon, Chairman Hurd, ranking
members, distinguished members of both subcommittees. Thank you
for the opportunity to testify here today on the Department's
cybersecurity posture and our information technology in this
very important topic called, ``electronic health record.'' I am
a veteran. I still serve in today's Nation here because I care
about the servicemember and our families and the commitment to
the quality there for the care.
I am Dave DeVries, the Department of Defense Principal
Deputy Chief Information Officer. Simply put, the deputy DOD
CIO. I share one imperative with the CIO, Mr. Terry Halvorsen,
to ensure the Department has access to the information, the
communication networks, the decision support tools needed to
successfully execute while warfighting and business support
missions of today.
Today I'm going to talk to you briefly about some of our
efforts underway to ensure that DOD can execute its missions in
the face of increasingly cyber-aggressive threats and also how
we're working with the government, industry, and international
partners to accomplish our secure information sharing
capabilities, our cybersecurity missions while improving our
ability to share securely with both industry and the public.
We are in the business of defense. That requires us to be
integrated in almost every discipline you can think of,
acquisitions, health, logistics, real estate, food,
distribution, industry control systems, and many, many more.
Every sector out there in the public side, we represent inside
DOD and need to protect that information as well as share it
securely.
While our top goal is to deliver capabilities more
effectively and efficiently, we also need to maximize security
in a budget-constrained environment worldwide. Our cyber
adversaries are agile, diverse, and sophisticated, and we must
be able to maneuver in several worlds at unprecedented speeds
to protect our Nation's assets.
The Department's fiscal year 2016 IT budget request is 36.9
billion. This request included funding for a broad variety of
IT, ranging from DOD warfighting command-and-control
communication system, our computing services; cybersecurity;
enterprise services, like collaboration and electronic mail;
and intelligence support systems; and business systems. These
investments support mission critical operations. They must be
delivered both on the battlefield and in an office environment.
We will continue to focus attention on cybersecurity and
take aggressive action to counter cyber threats to our networks
and weapons systems. In today's networked world, this requires
collaboration and cooperation of many partners, other
government agencies, industry partners and allies to ensure we
are mitigating these threats and vulnerabilities to our
national security interests. You have my written comments as we
prepared them before coming in here. I welcome the questions in
our upcoming discussions. Thank you.
[Prepared statement of Mr. DeVries follows:]
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Mr. Hurd. Thank you, sir.
Director Melvin, you are now recognized for 5 minutes.
STATEMENT OF VALERIE C. MELVIN
Ms. Melvin. Chairman Hurd and Coffman, Ranking Members
Kelly and Kuster, and members of subcommittees, thank you for
inviting me to this important discussion of VA's and DOD's
progress toward developing interoperable electronic health
records. We have been reviewing the Department's initiatives
for many years, and this past August, as you mentioned, issued
a report on their efforts to plan for and measure progress
toward achieving interoperability. My remarks this afternoon
summarize our findings from that report.
As you've stressed, VA and DOD have been undertaking
initiatives to exchange health information and increase
interoperability for almost two decades. Among others, these
have included initiatives to share viewable health data in
their existing systems and link and share computable data
between their repositories.
As you've stated, the Department also took steps toward
developing a single joint system and approach aimed at
sidestepping challenges to achieving interoperability between
their separate systems. However, while increased data sharing
has occurred in various ways, the Departments did not follow
through with developing a single system, and persistent
management challenges over the years have hindered progress and
elevated the uncertainty about when and how fully interoperable
capabilities will be achieved.
With this uncertainty, the National Defense Authorization
Act for fiscal year 2014 established the two deadlines for VA
and DOD to first ensure that all their health data complied
with national standards and with computable and realtime by
October 1, 2014, and second, to deploy, modernize, and fully
interoperable electronic health records by December 2016. In
response, the Departments mapped selected health data in their
existing systems to national standards and began planning and
working toward their implementation of separate modernization
system--modernized systems.
However, of significant concern is that the Departments
have not identified outcome-oriented goals and metrics to
clearly define what they aim to achieve from their
interoperability efforts and the results and benefits
anticipated.
Such metrics can help in assessing the progress of the
Department's efforts, identifying areas that need attention,
and ensuring accountability for end results such as improved
quality of care for veterans and servicemembers.
Further, the Department's most recent decision to pursue
separate interoperable systems rather than a single joint
system adds to our concern. Taking separate paths to modernize
their systems increases the risk that there will not be the
effective collaboration and coordination needed to establish
and convey a joint position on what fully interoperable
capabilities will look like and how and when they will be
achieved.
Over the long history of the Department's efforts, reaching
such a state of clarity has been elusive and is further
evidence of the need for outcome-oriented goals and metrics to
help gauge and encourage progress on this latest effort.
DOD and VA agreed with our recommendation that they develop
such measures, and we look forward to following their actions
to do so. Nevertheless, the Department's longstanding attempts
to achieve interoperable electronic health records is an
example of the larger problem with ineffective management of IT
projects across the Federal Government as we have highlighted
in our 2015 high-risk update.
The history of these Departments' efforts also highlights
the importance of continued congressional oversight as you are
providing by holding this hearing today. VA and DOD must now do
their part to more efficiently and effectively bring this
challenging endeavor to a successful outcome. Recommendations
that we and others have made, along with the important IT
acquisition reform provisions outlined in FITARA, should give
the Departments a more clear basis for demonstrating further
success. This concludes my oral statement, and I would be
pleased to respond to your questions.
[Prepared statement of Ms. Melvin follows:]
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Mr. Coffman. [presiding.] All right. Thank you, Ms. Melvin.
I'll begin with questions.
Ms. Council, as required by the NDAA of 2014, all VistA
data was to be in a compliant format established by the Office
of the National Coordinator for Health Information Technology,
or the ONC, but VA stated it would not certify until later in
2015. Has VA certified its compliance to the standard?
Ms. Council. You want to take that, Brian?
Mr. Burns. Yeah.
Mr. Coffman. Mr. Burns
Ms. Council. Yes, I'll have Mr. Brian respond because I
want to make sure we're precise on this answer.
Mr. Coffman. Okay.
Mr. Burns. At this point, we have not certified to the 2014
requirement, the October 1, 2014, requirement. The approach we
took is we identified 25 domains. From those 25 domains, we
prioritized those. The first seven we looked at were the most
frequently used, the most high volume, and what we consider the
most relevant terms. Those we did do data mapping to, and then
we continued to map from there, and we're still continuing to
do that process
As we go forward, we also do updates to each one of those
respective domains to make sure that any additional terms that
come in are also mapped. Those then are used in data maps that
go into the capability of sharing the information with JLV. So,
at this point, we have data maps for most of the sets. We have
partial mapping for most of the sets at this point
Mr. Coffman. Okay. Mr. Miller, nearly 6 years after a 2010
GAO report discussed the need for VA and DOD to address
unstructured data, what has the IPO done to accomplish the
interoperability of unstructured data or the development of a
national standard?
Mr. Miller. Sir, I would offer a couple of things, sir. We
do have a dedicated IPO, Dr. Lauren Thompson. She reported in
on the board in May. For sometime I was wearing two hats. I'm
no longer wearing two hats. I think that's reflective of our
commitment to the IPO and the work that they do.
With regards to national standards, you heard in my opening
comments, our strategy has been to partner with the Office of
National Coordinator for Health IT in identifying those areas
and what standards we need to have and to leverage things like
ONC certification and then to bring those forward between the
two Departments and let's determine jointly what those
standards needs to be and then promulgate those back out to
both Departments.
I think you will see on both the DOD and the VA, those
standards are incorporated. If you were to go look inside the
DOD's acquisition program, you would see where those were
required as part of our modernization. They are part of our
technical package. Those things are currently flowing back to
both Departments.
The IPO is basically responsible for working between the
two Departments, providing technical leadership to make sure
that those standards apply, and then--and bringing things back
to the Office of National Coordinator where we need refined
standards and improvements in standard.
Just recently, the IPO took a very strong leadership role
in looking at things like the CCVA document, which is a
consolidated document that provides the transition of care
within the commercial side that DOD and VA are both using as
part of our exchange with our commercial providers, and so
those are the kinds of activities where the IPO is taking
strong technical leadership and helping us understand what the
appropriate national standards are.
I think, as everybody's highlighted today, the national
standards piece is much bigger than its DOD and VA, and we need
to have a strong collaboration with the leadership of HHS.
Mr. Coffman. Ms. Melvin, in February 2014, GAO reported
that VA and DOD failed to correctly implement the IPO and
further noted the diminished role the IPO plays between VA and
DOD. Considering this finding, what purpose does the IPO serve
in its current state, and similarly, is there a need for the
IPO at all?
Ms. Melvin. I would like to start by saying that the IPO
was established by the National Defense Authorization Act for
2008, so it has a specific function in statute to be the single
point of accountability for VA and DOD achieving the electronic
health record.
Several of our reports, in fact, have noted that the
position of the office has not been specific to or as connected
to the overall function for which it was assigned. We have seen
it having a limited role in the Department's current efforts
over time. It's been what I would describe as more of an
evolving role, and it's one that it is reasonable that one
would question its current responsibilities and whether it
should exist.
Having said that, the IPO is currently responsible for
developing the national standards or at least identifying the
national standards that VA and DOD ought to adhere to, so they
do have an important function. I think the important thing
about it is it must be clear what the role of that office is
going to be. If it's not going to be at the level of a role of
authority, a single accountability office for authority, then
it is important for the agencies and for Congress to determine
what their role should be.
Mr. Coffman. Thank you. Ms. Kelly, you are now recognized
for 5 minutes.
Ms. Kelly. Thank you, Mr. Chair.
Mr. Miller, why is it important that your Department first
ensure that all healthcare data comply with national standards?
Mr. Miller. Because, ma'am, as we've highlighted today, our
care is provided in a number of different settings. In the case
of DOD, more than 60 percent of our care is provided out in the
market through our TRICARE contracts, and the way that we get
the ability to really share and use information is by adopting
these national standards.
And I think it's important that we all recognize that both
DOD and VA were well ahead of where the larger national effort
was that started really in the HITECH Act in 2008, 2009, and so
part of our struggle has been taking a lot of legacy data that
we were leaders in and then working towards and getting on
board with these national standards that have fairly rapidly
evolved over the past few years as part of our EHR adoption.
But simply put, ma'am, DOD generates veterans. Those
veterans need to have seamless care no matter where they go,
and the way that we make sure that there is a common meaning
and common understanding of that information is by all of us
agreeing at the national level to what those standards are. The
challenge is there's a lot of them, and the other challenge is
that we all have to agree at a little bit lower level than just
adopting a top level standard. There have to be some lower
level agreement about what we mean with certain standards, and
so again, that reinforces where the IPO fits, because the IPO
provides a critical linkage between our 2 Departments and the
Office of National Coordinator because we provide a lot of
feedback.
We do believe we can be on the leading edge in many of
these efforts, and it's that IPO function that really provides
the strong leadership role to make sure that we implement the
national standards correctly, ma'am.
Ms. Kelly. Well, Mr. Miller and Ms. Council, can you tell
me when your respective Departments will be able to certified
that the data complies with national standards? When's your
goal? What are you looking at?
Mr. Miller. So ma'am, I'll state from DOD, I just reviewed
our letter for certification. I do want to highlight one of the
reasons why DOD is a little bit late here is that the NDAA,
which I have a copy of, if you really want to look at it, it
refers only to DOD's AHLTA data. AHLTA data is our outpatient
data, and the reason why I want to make a second and explain
this is, when we met with our functionals--and I'm here to tell
you, I don't measure success for DOD. I measure success by what
our users say, and so when we started down this journey to do
this data mapping and understand what they wanted to be able to
access in an integrated view, as the NDAA required, they came
back and said it's much more than your outpatient data. It's
your inpatient data. It's your data from the private sector.
It's the data from in theater and our theater systems, and so
because of that, DOD took the last year to integrate much more
than what the NDAA required because I felt like that was the
right thing to do.
And so I will defend, you know, the time we took because it
is what our functional users really asked for, and so along
with making that data available, we also had to work through a
series of data maps, and over the last year, we went through
four iterative builds. Those builds were reviewed by subject
matter experts in the DOD as well as the IPO before we put them
in production, and so those things took a little time.
I am here to say that some of this stuff is incredibly
complicated. We are dealing with a large number of terms, and
it was important that we did this right. The last thing I want
to do, as an acquisition person, is put a bad tool in my users
hands because they will not like it. They will get turned off
from it. And we have been very careful about how we've deployed
the things and how we have increased access. And I'm here to
tell you today, our results are pretty staggering when you look
at the demands and the feedback we're getting for the use of
this information.
It is not about JLV. What really JLV provides is a view
into the data that's flowing between the two Departments. In
the reality what will happen is, is that the VA--any of their
systems will use that data, whether it's eHMP, their VistA
follow-ons, and they will use it however it best makes sense
within their healthcare setting. The same in DOD.
We are working right now to make you sure that data coming
back from VA is provided to our new system as part of our
integration and testing over the next year, so thank you,
ma'am.
Ms. Kelly. Ms. Council.
Ms. Council. Yes. As far as our data is concerned and
spending some team with the team, certainly we receive the data
from DOD, and then we have to map it to the standards to our
system. The team says that we should be well on time to certify
in 2016, but the veteran--the VA issue around data is much
broader than that. A veteran has more than just health data
that we're concerned about. It's general, Active Duty, other
sets of data that we'll be bringing together.
One of the key factors of our new strategy is starting and
establishing a strong data management capability to give us a
wholistic look at the veteran and be able to interchange and
engage with that veteran in a very different way than we do
today. So for the VA, our look is not just the health--we will
certify that in 2016--but broader so that we can change the
veteran's experience by having a holistic look at their
information that's important and germane to the benefits, the
healthcare, as well as the end care that they receive.
Ms. Kelly. So can you two currently exchange patient health
data between one another?
Ms. Council. We currently do today exchange health
information between each other.
Ms. Kelly. You can do that, and do all users have access to
interoperable electronic health records system?
Mr. Burns. At this point, we have, depending on the system,
we have users that use the existing system, CPRS. We also,
through the viewers, we are adding users on a regular basis.
This time last year we had--with JLV, we had 600 users. We now
have up to 19,000 users, and we continue to add more users
every single week in doing that. That's just one tool.
That said, there's other tools that are accessed to in our
Web-based solutions as we move forward and even our follow-on
modernization, so we continue to add users on a regular basis.
This year also we added VBA, Veterans Benefits Administration,
users, which was a significant help to help in getting them to
be able to look at the records in addition just from the health
standpoint.
Ms. Kelly. Thank you. I'm out of time.
I yield back.
Mr. Coffman. Thank you, Ms. Kelly.
Mr. Farenthold of Texas, you are now recognized for 5
minutes.
Mr. Farenthold. Thank you very much, and I'd like to follow
up on that a little bit, Mr. Burns, if you will. You say you've
added 19,000 users in a viewer. I mean, is that--that really
isn't interoperability where everybody can access the data that
needs to access the data and doctors can and nurses can input
the data. I mean, that's just, okay, I'm able to look at it,
right?
Mr. Burns. With the current--with JLV, it is a viewer, so
you're able to look at the data. The one thing that we did add
through that is that we have where data is mapped. We can then
demonstrate and show the mapping of the data in addition to the
original data, so----
Mr. Farenthold. That isn't where I wanted to go, but I
wanted----
Mr. Burns. Okay.
Mr. Farenthold. --to follow up on that question.
Ms. Council, the Secretary of the VA, Mr. McDonald was
recently in south Texas and said, you know, one of reasons it
was such a slow-paced system is some of legacy systems are
still operating in the COBOL programming language, I mean,
1960s technology. You know, it just seems like there's not a
focus there.
You spoke a little bit about, you know, making the business
case for what products in IT that you work on. You know, can
you tell me a little bit what the business case is? To me, the
number one focus should not be the business case but should be
providing quality service to veterans. I mean, I could make a
business case for making veterans wait months for service so we
don't have to make more doctors. I mean, what constitutes
business case?
Ms. Council. It really gets to the point that was raised
earlier. How do we measure success? How do we know we're
actually accomplishing what we said we would accomplish, and
how do we know we are spending our time and monies on the right
things to enable help for the veteran? So that's what we mean
by business case.
Mr. Farenthold. All right. So let's look at what's
happening now. There was just a report out today that in San
Antonio, just north of the district I represent, that we have
the highest wait times since May. We are up to 12,000 veterans
waiting over 30 days to get care. That's the worst in the
entire VA.
I mean, I thought we were trying to address these wait
times. Shouldn't that be--the wait times be one of the top
priorities of getting veterans the care that they need in a
timely fashion?
Ms. Council. It certainly should, sir. And at the end of
the day, that's what the MASS project is scheduled--set
scheduled so we can really handle the capacity that we have. It
is our responsibility to ensure that we change the veteran's
experience at the VA, and my intent as leading the IT
organization is to modernize this organization and gets us to
make the decisions that we need to make to focus on the right
things.
Mr. Farenthold. We've looked at--we started talking about
this in Congress in 2008, 2009. I just--you know, you look at
2008, 2009, Uber didn't exist. They've come up with a complete
data infrastructure of the world's largest taxi service without
a single driver that can be wherever you--you know, in most
cities, can pick you up in a matter of minutes.
Square technologies has come online where you can plug
something into your iPad and do credit card. Pinterest wasn't
in existence in 2007. I mean, the technology can be done in a
timely fashion. Is there a culture problem? What is the problem
within the VA that makes IT such a struggle?
Ms. Council. I think part of the issue is many of the
examples you gave are independents, and they're not trying to
enable an enterprise. They're not trying to enable H.R. And
finance and all the other things that come with it. But I also
say part of it has been, frankly, making some hard decisions
and holding people accountable to achieve things we said we
will do and making sure we have focus.
We cannot do everything. We've got to do the right things.
So when we start a program, we have to complete a program. We
need to be relentless in our execution, and we have to focus.
And the bottom line is, the team has not done that. We will do
that, and that's part of our current new strategy.
Mr. Farenthold. And you know, one of the things Mr. Miller
said, he doesn't want to deploy a bad app to turn people off,
but part of any IT system--and I remember this back in the
1980s and 1990s when I was a computer consultant. You had to
get buy-in from your folks that this was going to make their
jobs easier and that it was going to be good for them.
It sounds like that's one of the struggles you're talking
about. I mean, this is the 21st century. In almost every case,
especially in the private sector, you see the implementation of
IT really greatly improve efficiency. Now, some people may
argue they have to work harder with fewer people with it, but
the level of customer service that people have come to expect
as a result of the technology revolution is higher. How can the
folks within the VA not get that?
Ms. Council. You are 100 percent correct. At the end of the
day, our opportunity is to bring the system forward and do it
in a way that's going to change the environment for the
veteran, and up to this point, we have not had core portfolios
for our various business groups. We will be putting in, as part
of this strategy, new account managers that actually work
within the business, with customer relationship people within
the business to create portfolio and a ranked stack against the
things that need to get done to change this perspective.
If you don't have the business perspective working in
conjunction with IT, you don't end up with that kind of system.
It's going to make a difference, and so that's where we're
focussing.
Mr. Farenthold. Well, I see my time has expired. I would
like to take 1 second and urge you to maybe take some lessons
from the private sector and develop a entrepreneurial spirit
within the VA and the IT department to get her done. Thank you.
Mr. Coffman. Ms. Kuster of New Hampshire.
Ms. Kuster. Thank you very much. My comments and questions
are focused on the VA.
Ms. Council and Mr. Burns, Ms. Council just talked about
hard decisions and focus. Some have said, and in fact, the
recent independent assessment found, that the VistA program was
in danger of becoming obsolete.
My question is: Are we at the point where we just can't
keep trying to re-jigger the technology, but that we would have
better outcomes. And you're focused on the different business
activities. And one that I am very focused on is the scheduling
to bring down the wait times. You've got the health records.
We've now got outside providers.
Could you just give me, if you have an opinion on this,
since you've arrived. Or, Mr. Burns, if you've been around
longer. Do you feel that maybe we're at the point where we
should be considering more an approach from the bottom up
rather than trying to change what we're currently working with?
Ms. Council. I come from the private industry. I've spent
30 years in private industry. So this is my first foray into
any kind of government appointment. And what I look for and
what I really want to understand with any large business
investment or any system investment, like a VistA Evolution, is
what do we expect to be the outcome? What are we really trying
to play for, and what do we think that it's going to do for us,
not just now, but also in the future.
So to answer your question, that is the reason why Dr.
Shulkin and I requested the business case. We wanted to have a
fact-based conversation about what the right next steps should
be with VistA. We didn't want to take it from the cuff. We
didn't want to take it from pulling various data. We really
wanted to go into understanding where we are today, where we're
hoping to go, and will that take us where we need to go for the
veteran in the future? He and I will be looking at that case
and spending a concerted amount of time--the timing just didn't
work out, but it's this week--to really decide on those core
next steps. It's the right thing to do. It's the coherent thing
to do. But we want to do it based on having real facts behind
us and making sure that we're making the right decision for the
veterans long term.
At the end of the day, VistA is a clinical, focused system.
It is focused on the patient. And it has enabled that
capability to really drive many breakthroughs. What we've got
to figure out is what opportunities do we have to continue with
it as a backbone, and should we be moving with different levels
of technology that we haven't used before, and thinking about
it differently architecturally, and thinking about it
differently, how the veterans should engage with it, and how it
should engage with the clinician?
We are leveraging the program managers' Mr. Waltman's and
Mr. Costantian's business report with Dr. Shulkin and myself,
and we will make a decision.
Ms. Kuster. Great. Well, I hope you will keep us apprised.
But I think we will be well served by that analysis.
Sometimes we talk about this interoperability, and I wonder
whether we are agreeing on what it is that we are trying to
describe. It seems to me that there are three different levels:
The foundational is just the very basic, where you're looking
at the page on the screen and it doesn't allow for the
interpretation of the data, or the sharing of the data;
structural, the intermediate level, defining the structure or
format of the exchange; and then semantic, the highest level,
the ability to exchange and use the exchange information. And I
know going forward--and certainly the practitioners that I've
spoken to--the providers in the VA want to be able to use the
data for research, for trends. We have a terrible opioid
addiction problem going on. Can we look at the population,
learn from the best practices?
Could you just comment on where you feel the VA is right
now--what level we are at, and where we might expect to be a
year from now?
Ms. Council. Sure. Actually, Brian and I have been talking
about this a lot. So I'm going to give him an opportunity to
answer your question.
Mr. Burns. In the terms that you laid out, first of all,
the first level is foundational, or another way of saying it is
technical; we do technical exchange
day-to-day. And that's is the fundamental basic level. So
we're pretty good there.
Ms. Kuster. And that's happening right now throughout the
VA?
Mr. Burns. That is happening throughout the VA. It's been
happening actually for over a decade of transferring data.
Speaking of transmission of data, it is showing the data as is,
or, to some degree, with the standards.
The next level, the intermediate level, gets more into how
do you begin to use the data. And that's where we're focusing,
at least from the IPO perspective of what are the use cases;
how do we actually want to use that data, and what is
pertinent? What are the key components? What are the key
elements? And then how much of that needs to be beyond the
technical level?
So we're focusing on that and bringing in the subject
matter experts from DOD and VA to have those conversations.
That's a continuing, evolving process.
The highest level, as you mentioned, semantic--or another
way of saying it is process--that is really looking at the work
flows. And that's going across the organizations. That's a much
more future issue. And candidly, that's an issue that even ONC
is working with, with a strategic plan of how do we get from
the current sharing data at the rudimentary levels moving
forward.
So to answer your question, I think from a technical
standpoint, or foundational standpoint, we are really close. We
are there. If we get into the intermediate level, we have
pieces of it that we actually can do today. And ultimately, we
are trying to go with the modernization beyond just the NDAA,
is really to have to monitor our system where we get the work
flows and the semantics down that it's
machine-to-machine, and you can do the trend analysis and
you do the look-at-the-patient data far better to make
decisions real quick, much quicker, and actually seeing more
patients as we go.
And that's fundamentally, too, with the VistA Evolution
solution, where we are really transforming to look at patient-
centric and team-centric and data-centric approaches to the
information far beyond what we have traditionally done in our
existing systems.
Ms. Kuster. Thank you very much. And I apologize for going
over. Thank you.
Mr. Coffman. Mr. Lamborn of Colorado, you're now recognized
for 5 minutes.
Mr. Lamborn. Thank you, Mr. Chairman. I want to thank both
the chairmen for having this meeting today. This is a huge,
monumental, massive project. And I have to ask a preliminary--I
want to back up a step--a preliminary question. So for someone
from the VA and someone from DOD, as you work on this
interoperability, and I agree with the GAO conclusion, there
has to be goals and metrics as you do this. But let me back up
and ask about cybersecurity.
Can you assure us that, as you build this forward, that
hackers can't come in like they did at OPM, and access medical
records of our veterans or of our active duty military?
Ms. Council. What I will tell you is that our--everything
that we're doing around our new cyber strategy is what we also
currently do with our defense in-depth, is to protect that data
at all cost. Our data is not only in the system, but our data
is also on paper. And so ensuring that we're educating the
workforce, that we're being diligent about our information and
where we leave it, how we mail it, what we do with it, are all
a part of what OI&T has to do with ensuring that we keep the
veterans safe.
When you look at where we went with our cybersecurity
strategy, it's the most holistic strategy that we have ever had
in our history. It is focused on eight key domains, including
medical cyber. And the whole focus is no one on a team ever
wants to happen to a veteran what happened to them through OPM.
So that is our focus, that's our key, and that's our mission.
Mr. Lamborn. Thank you. Mr. Miller, or DeVries?
Mr. DeVries. I would just like to add on to that. The
cybersecurity is one very important aspect of it, but just as
we talked about the standards for the health record that's
based on the ONC model, all of us in the government are
conforming to the same security standards set up by NIST that
we all participate in.
It's important that we have those common standards and that
we all conform to them and rigorously enforce the adoption of
those. So that's the biggest push. VA has been doing the same
thing. DOD is doing it. We have been pushing now the
cybersecurity aspect and the need to conform to the standards
that have been put out and then measure it by leadership.
Just recently, DOD has put out its cybersecurity. We have
published that. We have not come up with a common
scorecard. With that whole aspect is, no matter what the
mission area is--and medical, it's just one of those mission
areas for us--it must be about protecting the identity of the
person, protecting the data, where it is in storage, but also
in transport, and then how it's being consumed.
Mr. Lamborn. Okay. Well, thank you both.
Ms. Council or Mr. Burns, VA interoperability, just among
yourselves, is a concern of mine. Leaving aside DOD. There are
1,700 points of healthcare providers among the VA nationwide.
What is the interoperability, just among VA health care
providers?
Ms. Council. That is the core part of why we are putting a
data management process in place.
Today, when you look at the OI&T organization, we actually
have the best opportunity to bring the information together on
the veteran's behalf. So you have the health side. And, of
course, we have to be able to work with our community
providers. But, again, remember, there is a whole benefit level
side, and many veterans that don't use the health side, that
also creates a level of data and information for the veteran
and to their end.
And so our issue, and our opportunity, is really to bring
together the entirety of that set of information and start to
leverage it on behalf of the veteran and sharing with the
veteran what the opportunities are, where the benefit
opportunities are, as well as what they should be thinking of
in relationship to their health. That is core to this strategy.
We've got to do it. And today, health data sort of sits
separately from the benefits data. And that's not appropriate
for the veteran.
Mr. Lamborn. So, if someone moves from Portland, Maine, to
San Diego, a veteran, their records go with them electronically
today?
Ms. Council. They do not go with them electronically today.
That is what we are working on.
Mr. Lamborn. Okay. Because, obviously, that has to happen
before you can interact with the DOD, and vice versa.
Ms. Council. Well, interacting with the DOD, information is
from active duty to becoming a veteran on active duty. The
issue with topography and moving from one location to another
is making sure that another location can take that information
and use it.
So unless the veteran ports that information, or we send
that information on their behalf, it won't be there. We can
send the information, but the key is we want to be in a
situation where the information is everywhere the veteran is,
regardless of their location. And that's what we're working
toward.
Mr. Lamborn. Okay. Thank you.
Mr. Coffman. Mr. Lieu of California, you are now recognized
for 5 minutes.
Mr. Lieu. Thank you.
Over 45 years ago, the United States of America sent a
human being to the Moon and brought that person back. The DOD
and VA can certainly have interoperable health records. The
fact that you haven't been able to do it for nearly two decades
is not excusable. There's a failure of prior leadership at the
VA and the DOD. And I believe what compounds this is a decision
made in 2013 for both agencies to now pursue separate
modernizations. I think that's a ridiculous decision.
And the GAO, in fact, has noted that the 2013 decision to
pursue separate modernization rather than a single joint system
indicates that achieving interoperability will be an ongoing
concern for years to come.
So what I want to know is, why can't you all just pick one
system, whether it's a DOD system, or the VA system, and
implement it? Why do you have to pursue two separate
modernizations? I don't understand that.
Mr. Miller. So my first reaction is I think it's important
we understand that the two departments have different
healthcare missions. I think----
Mr. Lieu. But you're not customer-focused, you're not
focused on taking care of the active-duty person?
Mr. Miller. But I'm worried about making sure it works on a
submarine at beyond periscope depth; I'm worried about it
working in Afghanistan on SATCOM; I'm worried about it taking
care of children. I think it's important that we do share a
common veterans population, but I think we also need to
recognize that the two departments do have two different
organizational missions when it comes to healthcare delivery.
Mr. Lieu. Are your systems lesser systems? Are they more
basic because they've got to work on a submarine? Are they not
as robust?
Mr. Miller. I wouldn't say they're more basic. I think we
have different operating environments. And so, when you're
taking care of veterans in the United States CONUS, and you
have the ability to do certain things, that environment does
not exist in theater for our people that are taking care of our
soldiers, sailors, airmen, and marines that go in harm's way.
So I think we have to recognize they're a different
operating environment. Additionally----
Mr. Lieu. Okay. So if your system can work in a submarine--
let me ask the VA: Why don't you just take their system? If it
works on a submarine, it's going to work in your VA hospital.
Why don't you just use that system?
Ms. Council. I can't speak for what decisions were made in
2013, but I certainly can say that our clinical capabilities
and what we have to do for the veteran from the time they
become a veteran to the time that they leave this Earth is a
much more holistic calling. And for us, it is about the total
health and capability of that veteran, and for us managing that
care of that veteran during that time.
It is a different transaction, I think, is what Mr. Miller
is getting to. The timing of that transaction, our situation,
our alignment, is a lifelong alignment. And so our decision
base probably would not work with the level of transactional
focus that they would have.
Mr. Lieu. So you're saying that when the two Secretaries in
2011 said you all could have a single joint system, that they
were just wrong?
Ms. Council. I have no idea what the requirements were.
Mr. Lieu. Now, let me ask you, do any private sector
hospitals use VistA?
Ms. Council. Not that I'm aware of, sir, inside the United
States. Outside the United States, yes.
Mr. Lieu. Okay. And do any private sector hospitals use
your DOD system that also works on submarines?
Mr. Miller. Yes, sir. It's one of the largest used in the
United States today.
Mr. Lieu. Okay. A question about the viewer that you all
are talking about. Can you search on this viewer for terms, or
anything else, or is it just a viewer? Interoperable viewer?
Mr. Miller. I wish we could give you a demo. I think it
would explain a lot here. I think--when you think about health
care, a lot of the information that your providers or our
providers are accessing is just information they're
referencing. Right. The decision's going to get documented in
their primary care system. But when you think about this viewer
that we've been working together on--oh, by the way, it's been
jointly done between the two departments--you can configure
your displays, you can search for VA patients, you can search
for DOD patients.
Mr. Lieu. Can you search for, I don't know, blood test
results, or for----
Mr. Miller. So if you're talking about getting down to a
lower level of search capability, that is one of the things
that we're working on. Right now, we've been asked to be able
to show all those different domains. And now we're taking a
look at the next level, which would be lower level search
capabilities within those domains.
Mr. Lieu. What can you currently search for?
Mr. Miller. When you bring up--it would be easier to
display it. When you bring up the patient, it actually shows
you all their information, so----
Mr. Lieu. And can you search for something in that
document?
Mr. Miller. Right. So it's not like you're doing business--
deep business analytics through the tool. The tool basically
presents an integrated record.
Mr. Lieu. Is there any difference between that and someone
handing you a Xerox of the file?
Mr. Miller. Absolutely.
Mr. Lieu. Because you can search for things.
Mr. Miller. Right. You can search for things. You can
configure only what you want to see. So if there's a module you
care about, or that you don't want to see, depending on your
role, whether you're an ED doctor or you're an outpatient
doctor, you can configure that view.
Mr. Lieu. My time is up, so let me just conclude. I believe
that two separate modernizations are a mistake. I think that
DOD should just take the VistA system and make it applicable on
submarines. It shouldn't be that hard.
I yield back.
Mr. Coffman. Thank you, Mr. Lieu.
Mr. Walker from North Carolina, you're now recognized for 5
minutes.
Mr. Walker. Thank you, Mr. Chairman, and thank you to the
witness panel. I appreciate your time in being here today and
sharing your thoughts and the information that's so crucial to
this hearing.
As part of the Cloud Computing Caucus, I have got a few
questions from that particular perspective in the world of
cyber arena that we are entering in. And let me start with Mr.
DeVries, and then maybe we'll come back to Mr. Miller.
How are the VA and the Department of Defense taking
advantage of these commercial cloud services to streamline the
EHR, the electronic health record, interoperability, and then
reduce cost? It's a two-part question there. First, how are we
doing that? And how do you perceive it to reduce the cost?
Mr. DeVries. I think it's important to lay out where we are
today. Today, the Department of Defense health records system,
the medical records themselves, sit in a centralized data
repository that allows us to have access to it globally down to
the submarine, as Chris talked about there.
We are moving aggressively now into the commercial
environment. The DHMSM contract that we talked about here in
the opening statements, that's on the street. We're
aggressively now looking at where are we going to put the
medical records, and I will let Mr. Miller talk more about
that. But we have laid open, through the Federal standards as
well as inside DOD, to grossly pursue, if you meet the security
requirements and standards, then let's go ahead with the most
economic and feasible way of doing it. It may not be a cloud,
but it may be a commercially-provided data storage.
Mr. Walker. Mr. Miller?
Mr. Miller. So as part of our modernization strategy, I
would tell everyone that we're trying to take advantage of
those emerging technologies because we know it'll simplify
things and allow us to accelerate our deployment.
So if I were to go back to our previous systems, we would
be installing software and things inside of our hospitals.
Well, today--and I think you will see this if you go to any
commercial health care provider--really, you don't provide
anything to the hospital anymore. That system is basically
hosted centrally somewhere, whether in a data center, a cloud,
or part of a managed service, and basically, you just have to
have a network connection and a device that can support it,
just like your smartphone or something else. And that's the
same strategy we're pursuing.
Mr. Walker. I'm aware of how it works. But my question is--
I hear you say future tense, we are pursuing. Are there action
steps that we're taking?
Mr. Miller. Absolutely, sir. The proposals that we
evaluated all banked on that technology being a key enabler.
And so as part of our testing here in a couple of months, we
will be testing how well that works. And as part of our
deployment, that's our hosting strategy that we're currently
under the process of finalizing. But our hosting strategy will
be centrally done so that we can take advantage of those
technologies.
Mr. Walker. I appreciate the timeline there. Let me ask
this question as well: If agencies that have sensitive
information, such as the Health and Human Services Department,
can leverage commercial cloud services, can I ask, then, why
isn't the VA?
Ms. Council, then I will come back to Mr. Miller.
Ms. Council. Yes. Fundamentally, that is where we're moving
to. Part of our new strategy is a buy first and looking at the
platform.
Initially, when I first arrived, I met with the inspector
general to understand what their concerns were around us using
the cloud. I also looked at our FISMA posture around our data.
We had ranked all of our data FISMA-high. And a cloud
environment, that is incredibly difficult to be in a FISMA-high
platform, and use the cloud. We have reassessed that and re-
looked at our policy so that we can move to the cloud.
In addition, our electronic health management platform,
which is the platform that is being placed on top of VistA,
basically prepares us to move to the cloud. It moves the data
into a new platform. So it'll be much more fungible and move us
at a location. And we are currently now looking at key
applications and virtualization with cloud technology.
Mr. Walker. Mr. Miller, if I have time, I will come back.
But Ms. Melvin, I do have a question for you, making sure that
I am crystal clear on this. What is the statutory deadline for
deploying modernized electronic health records software with
interoperability?
Ms. Melvin. The deadline that we spoke to in our report was
December 31, 2016. That was based on what the 2014 National
Defense Authorization Act is currently calling for.
Mr. Walker. And that's a self-imposed deadline?
Ms. Melvin. That's the deadline that is called for in the
Act.
Mr. Walker. All right. And you feel good that you are on
track?
Ms. Melvin. Well, from my--from GAO's perspective, our
review looked at that and we found that through the plans that
both VA and DOD provided to us, no, they are not on track to
meet the 2016 deadline. They are in the process of implementing
capabilities. They do have initial capabilities I know within
the departments.
Mr. Walker. I'm going to cut you off. That's my concern. We
have a deadline, and we are here and we're working towards
that. But my time has expired. I will throw it at Mr. Miller,
if you want to respond to that, and then I'll yield back to the
chairman.
Mr. Miller. Yes, I would just highlight that the NDAA was
silent about what deployment actually meant. And I think, based
on any industry best practice, there is no way physically
possible for us to take a 2014 NDAA and fully deploy it within
the Department of Defense at over 1,200 locations in that
timeline. I have to go to ships. I have to go in theater. I
have to go around the world.
And so we have provided numerous feedback to the Armed
Services Committee. They understand our plan. We met all their
NDAA requirements. We got our funding restrictions lifted. They
understand that. I think it's important that--I understand the
desire to go faster, but there is reality in some of these. We
are talking laws of physics about how fast we can modernize
this system within the Department of Defense. Because it is
much more than just documentation. It drives our scheduling, it
drives our registration, it drives our people engagement. It is
a fundamental business transformation about how we do business.
It not simply a small app that you will have on your smartphone
that has to go to a lot of places.
So we need to be incredibly smart here. This is not
something we should rush to. And so I understand the GAO
report, but I think that the language, as written, was not
clear about what deployment actually meant, sir.
Mr. Coffman. Mr. O'Rourke of Texas, you're now recognized
for 5 minutes.
Mr. O'Rourke. Thank you, Mr. Chairman.
I have yet to hear a compelling answer to Mr. Lieu's
questions about why we can't unify within a single system. I
understand the system has to run on submarines, I understand
that within the VA we are taking care of veterans from the
point at which they transition out of active duty service
until, as you said, Secretary Council, they leave this Earth.
But I think the fundamentals of the system seem to be basic
enough. And given the leverage that you two departments have as
the two largest departments within the Federal bureaucracy,
there's got to be a way that you can figure this out.
Ms. Melvin, has the GAO arrived at an assessment of the
conclusions that these two departments have that they simply
not work together? Is that conclusion shared by the GAO, or
have you asked yourselves that question?
Ms. Melvin. Our concern is with the departments going down
separate paths. We do think that it has inherent duplication in
that approach.
What I would say over time is that as we've looked at both
departments' initiatives, I think back in 2013, we issued a
report that looked at some of the fundamental reasons, or
barriers, if you will, for why these departments weren't able
to do that. I mean, inherently, each department has its own
culture. And we understand that. What we found, though, that
there was a lack of joint strategic planning on the part of the
two departments to really look at what it is that they can do
collectively to achieve this end state in terms of a joint
system. We also saw that--and reported on the fact that there
was a lack of a joint architecture, or an overall investment
management plan for getting them there.
Mr. O'Rourke. Let me ask you this--and I'm sorry to
interrupt you--but is part of the problem that there are no
consequences? Congress mandates a requirement and an
outcome back in 2008, 2009, and Mr. Miller and Secretary
Council have given us lots of great excuses for why they can't
get it done. You've suggested some of the roadblocks that were
in the way. But was there a consequence? Was anybody held
accountable? Could these two departments just come to the
conclusion that this is just too hard to do; we don't want to
do it, for whatever reasons, and they don't do it. And now we
are marching down these two paths that may or may not be
parallel; may or may not be interoperable; may or may not work
together; may or may not waste billions of taxpayer dollars;
and there's no consequence.
I've reached the conclusion that the only person who can
referee this dispute between these two departments is the
President. And it must become a priority of his. And he must--
unless there's--and I'm all ears on a compelling reason why we
can't do this--unless he says to the Secretary of Defense and
the Secretary of the VA: You have to find a way to get to a
unified system that works for every active duty servicemember,
their family members, dependents, and the veterans. It is
certainly possible for all the reasons that everyone has given.
Do you agree with that assessment? Do you think it is possible?
Or do you agree with Mr. Miller and Secretary Council that this
is impossible?
Ms. Melvin. I won't say that it's impossible. I think our
concern is that over the years, the history of looking at this,
we've had a lot of concerns about the starts and stops with
this initiative. There have been mandates. The 2008 National
Defense Authorization Act, for example, directed them to have
fully interoperable capabilities.
It has been a history of the two departments going down
particular paths that they wanted to pursue for this, changing
at certain points. And there has not, in our view, been the
accountability for them doing it. They have changed gears along
the way; the most clear being moving from two systems to a
joint system, and back to two systems again.
So, it is a matter of the leadership taking the stand and
saying we're going to make this happen, and working to do that.
We have not seen the dedication on the part of the two
departments to take a stand on that and actually make it stick.
Mr. O'Rourke. I would just say to my colleagues that if we
are satisfied by the excuses given today, then we share in the
culpability for the consequences that I think we are going to
be hearing about at a hearing in 2, 4, 6, 8, 10 years about why
these systems can't work together, why we've spent billions of
dollars, and why we haven't been able to get the job done. I
think we have to insist on consequences and accountability and
performance. And we have not done that effectively to date. So
I look forward to joining my colleagues in working on that and
demanding that of the administration.
With that, I yield back.
Mr. Coffman. Dr. Benishek of Michigan, you're now
recognized for 5 minutes.
Mr. Benishek. Thank you, Mr. Chairman.
Frankly, I agree strongly with Mr. O'Rourke and Mr. Lieu.
Some of the answers I heard today, like from you, Ms. Council,
you talked about we can't work together with the DOD until we
actually get a system that works with the private sector as
well. Well, the private sector is not going to be interoperable
at any time in the near future that I can ever see. And to just
link that together, it gives you another excuse as to why this
is not happening.
Frankly, I agree that the President really needs to make
this a priority to make this happen. I think I was at that
hearing with the Secretary of Defense and the Secretary of the
VA a while back, maybe this is 2011, where $1 billion has been
spent and given up. And we just can't stand the fact that we
are spending $1 billion on integrating health care, and you
tell us it can't be done. I know that a lot of you are new. But
we get sick of this. Really, I want the President to be
involved.
I want to go into something else here now that I heard
about just today, and that is, the Orlando Sentinel described a
project of the VA as making a virtual hospital with 3-D
graphics in which veterans will create avatars and walk around
examining their healthcare records searching for medical
information, and walking to a virtual medical adviser doing e-
consults with physicians.
Is anybody aware of this program? Are you, Ms. Council?
Ms. Council. No, I am not.
Mr. Benishek. To me, this is something--do the DOD guys
know anything about this? Apparently, this was rejected by the
DOD?
Mr. Miller. No, sir.
Mr. Benishek. It's just that it's kind of funny to see the
VA doing some kind of a weird virtual hospital as a pilot
program when we don't even have--we can't be working the real
hospital. So you guys just aren't aware of that. And especially
since the fact that most of the veterans have no idea what an
avatar and all that stuff is.
Do you know how much--is anyone aware of how much money
that the VA has spent in trying to integrate this system? Ms.
Melvin, do you know? Or Ms. Council, you're new, so I don't
expect much from you. Ms. Melvin, do you know the amount of
money? They told me over $1 billion.
Ms. Melvin. We don't have a credible number. The most
credible number we had was actually in the millions, at $564
million for the couple of years of doing the integrated
electronic health record. We have asked for figures to try to
understand more specifically what that number is. I think I
would say just over the history of the initiatives that we are
looking at, to have it be above $1 billion would not be a
surprise to me.
Mr. Benishek. Let me ask another question. This is more
like a philosophical question. I had a subcommittee hearing in
the VA this morning, and one of the things about IT in the
public sector is that I see changes so fast, that there's a new
iPhone every 6 months. So the IT stuff changes really fast, but
it seems like the VA and the DOD, they take years and years and
years to develop a change in their IT system. And they have to,
like, consider every possibility before they implement it, and
that process takes like 8 years, by which time the thing is
obsolete.
Ms. Council, you have some kind of a software background.
Why can't we institute the kinds of changes incrementally all
the time, rather than have to build a system that takes 8 years
to build them, and then by the time it's implemented, it
doesn't work?
Ms. Council. I totally concur with you. I think that since
my arrival 3-1/2 months ago into government, it's been an eye-
opener of how long it takes to move technology.
There are a number of different governance processes in
place that don't hinder in private industry because our focus
is on productivity and moving things forward, and at a very
different aggressive manner.
What I will tell you we have done with our new strategy is
to put a framework forward to push us to much more of an
execution focus by having a now, near, and future timeframe. I
think we need to time-box our work, and think about what is
really going to give us the most bang for our effort and get
those things done, and done quickly.
Mr. Benishek. Well, that's what I'm talking about. We can't
expect to fix the comprehensive repair of the entire system.
Let's just move along incrementally and do some changes. You
have probably been on VistA, it's like a disaster. But it's
like the best thing out there, because nobody has any
interoperativity at all.
So I just encourage you and I encourage the President to
focus on making sure that you two guys get this all figured
out.
Thanks.
Mr. Coffman. Retired Sergeant Major Walz of Minnesota, you
are now recognized for 5 minutes.
Mr. Walz. I thank the chairman and my colleagues. I thank
each of you for being here. I just came from a roundtable with
the 40 largest veteran service organizations. They understand
how key this is. Any reform is going to hinge on this.
I also say I understand your expertise that many of you
have. I represent the Mayo Clinic. And so, I have at least a
working knowledge now over the years of how electronic medical
records are diagnostic tools, and all the importance and all
the challenges you're up against.
I also know my friend, Dr. Roe and I, years ago, traveled
to Afghanistan to watch five different databases be opened as
they were operating on someone. Watch MRI--or, in that case, I
guess it was an x-ray--not have the bandwidth to move it from
Afghanistan, to tape it on their chest on the way to Landstuhl.
So we get this. We were looking at it. We were trying to
piece it all together. And our goal is to follow that soldier
back from that injury on the battlefield from right at the aid
station all the way back to the VA hospital in Tennessee, or
wherever in Minnesota. So we've been on this. We were there and
celebrated on April 9, 2009, when the Virtual Lifetime Record
President Obama signed. And I say that to you not to
grandstand, not to highlight back-to-the-future week, or
something like that. I say it to you because you're hearing it
up here from members who have been down this road. And it's not
for lack of commitment, it's not for lack of expertise, but
something has got to break. And you're probably right, Mr.
Miller. And I look back at the NDAA on the issue of what
deployment means, the spirit and letter of the law. The spirit
is, obviously, we just want them to be able to access and make
it work. And I get that we've got to clarify and get at
specifics.
I guess I'm throwing it out there, and maybe it's more
rhetorical than anything, because, again, I do not question
your commitment. I think we've got very bright people here. In
all fairness, there were very bright people that sat there
before you in these very same jobs.
And I hear the deployment date we set. And you're telling
us, again, not because you're not working hard or you're not
trying, or don't want to get it, or we're saying we're not
going to get there. My question might be to all of you, is
this, again, like, my question: Can we do this? I mean, I know
it goes against the American spirit. I kind of feel like
Churchill was right on this. You can always count on America to
get it right after they try everything else first. Dang, we're
trying a lot of stuff here. When do we get it right?
Mr. Miller. Sir, I guess just let me make a couple of
comments. One is, I think we get it right when our users are
happy. And I would offer I really do think if you were to sit
down and talk to our users and they see what we've done, we've
delivered four releases in 22 months jointly between the DOD
and VA focused on improving interoperability, getting feedback
back, incorporating it in. So I can show you, just like Apple
does, just like Microsoft does, four releases, 22 months.
That's actually a little faster than Apple rolls out their
iPhone every year. So we have demonstrated that we can make
this move faster. I think the bigger thing is that we've all
got to remember, it's bigger than the IT, right? The IT is
actually the easy part of what we're talking about today. What
we don't seem to every want to tackle are the people stuff, the
process stuff. All the things that make business systems really
hard.
And so I hear what GAO says. I would like to believe a
single system between DOD and VA would be able to be there
tomorrow. But the reality is, we've got a lot of hard things
that make joint programs in DOD incredibly hard. Adding another
level with the VA makes it even more hard.
And so I would just offer to everybody, we have to view
this as an incremental progression. And I personally believe
that what DOD and the VA are doing right now are getting both
houses in order to position us, in the future, where we are
actually ready to have the discussion about moving to a single
system, there is actually a business case.
I think what we tried to do back in 2010 was way ahead of
the technology, it was way ahead of where our processes were,
it was way ahead of where we are on data, and we fundamentally
set ourselves up to fail. It's not because we didn't have
people that believed. It's not because I couldn't show you a
pretty technology slide that shows you all these cool wiz-bang
things are going to happen. We failed for nontechnical reasons.
And those things are things that we have to understand and we
have to deal with.
That is why I think you've seen more progress the last 2
years between the two departments, because we learned from
that. And now we're focused on getting our collective houses in
order and really addressing the interoperability thing.
And just let me say, a single system does not guarantee
interoperability. You can go talk to any major national
healthcare provider, and they will tell you that they struggle
when you're talking about regions or they're talking about
working across large geographic areas.
It's not, again, because of the technology; it's because at
the local level, they generate different processes, they do
business differently.
And so, for us to think that just adopting a single system
is going to solve all that, I think it's a little naive. I
actually believe we need have the discussion about how do we
actually get ourselves to a level of maturity and readiness so
that when we want to make the smart business decision, because
at the end of the day, this is all about the taxpayer, and it's
all about a beneficiary. And I think I can show you very
clearly where, using the power of competition and using
technology the right way, at least in the DOD, we have been
able to drive this cost down and really save on the Department
of Defense and make sure our users are getting what they need
without, in any way, shape, or form, jeopardizing
interoperability.
Mr. Walz. I appreciate that. My time is up, but I
appreciate your candidness. I think that is a question we're
going to have to do. We're going to have to dig deep on this.
Again, the taxpayers are going to ask for results. And I think
you're on the right place there.
I yield back. Thank you, Chairman.
Mr. Coffman. Thank you, Mr. Walz.
Mr. Huelskamp of Kansas, you're now recognized for 5
minutes.
Mr. Huelskamp. Thank you, Mr. Chairman. Excellent
questions. I appreciate the joint hearing on this.
I want to follow up with Mr. Miller, if I might. You've
indicated you thought there was no way possible to deploy and
meet the interoperability requirements of NDAA, is that the
case?
Mr. Miller. Sir, what I've said is we will have an initial
capability that is in line with the NDAA. What I said is not
possible, based on industry experience, based on on all
feedback from everybody we've engaged with, is to think that I
can deploy to more than 1,200 locations within that short of
time----
Mr. Huelskamp. But you've been in your position for 2
years. Is that what you told us 2 years ago?
Mr. Miller. Yes, sir.
Mr. Huelskamp. Is that what you told the VA 2 years ago?
This was not possible?
Mr. Miller. The deployment date for 2016, sir?
Mr. Huelskamp. You've have been in this position for 2
years. Now you're telling us that this was never, ever
possible, if I understood correctly, and $564 million later, we
are now saying, well, this is really not possible.
Mr. Miller. The $564 million dealt with IHR, which is a
prior strategy. The 2014 NDAA directed us to deploy a
modernized electronic healthcare software supporting clinicians
at the Department no later than 31 December 2016.
What I have routinely said, in my engagements on the Hill,
has been, we will provide that software capability at our IOC
sites in the Pacific northwest, but it is not physically
possible to touch over 1,200 locations around the globe to
deploy that software and have a remote chance of being
successful.
Mr. Huelskamp. So do you have interoperability within DOD
currently?
Mr. Miller. Yes, sir. As I mentioned earlier----
Mr. Huelskamp. Or in the NDAA definition?
Mr. Miller. Yes, sir, I do.
Mr. Huelskamp. Okay. I'll ask the VA. Do you have
interoperability currently within the VA?
Mr. Burns. As I said earlier, we have, at the fundamental
level, we have the capability of sharing the data, and with
data standards. We are doing the ``use'' case analysis to look
at more of the semantic level at this point. So we have pieces
of it at this point.
Mr. Huelskamp. I'm confused. Yes or no, do you have
interoperability within the VA?
Mr. Burns. We have interoperability within the VA in terms
of the data that we have. I don't want to get too technical on
this.
Mr. Huelskamp. I'm just asking for a yes or no, as defined
within the NDAA.
Mr. Burns. Within the VA, we are able to bring the data
together to share it across the areas.
Mr. Huelskamp. Yes or no, we have interoperability today in
the VA? I thought earlier you said we did not.
Mr. Burns. What I'm saying was the interoperability, we
were talking about DOD and VA. So, within VA----
Mr. Huelskamp. There's 1,700 locations in the VA. And we've
got thousands of non-VA care locations. I definitely know there
is not interoperability between the VA and the non-VA care. Is
that correct? My question is within the VA.
Mr. Burns. Within the VA, we have interoperability to share
the data, yes.
Mr. Huelskamp. I wonder about that.
A follow-up I have with the VA is, according to the VA,
less than 8 percent of medical records are marked as sensitive,
based on the aggregate of all VistA systems. In a briefing with
IOG, the subcommittee staff was informed that unless records
are classified as sensitive, VA does not have the capability to
track when those records have been accessed. So does this mean
the VA has no visibility on who accesses over 92 percent of
medical records at the VA?
Ms. Council. I think, if your question is related to who
actually--that's called segmentation, who actually looks in
logs. There is audit and logging into those systems. You know
who goes into the system and who's looking at which records. Is
it beyond that?
Mr. Huelskamp. This is different information. From what I
understood, you told our subcommittee staff, you said unless
the records are classified as sensitive, you do not know who
accesses those records. Is that inaccurate? Is that a change?
Or, are you tracking? This is pretty critical. I want to know
who's really getting into these systems.
Ms. Council. I wasn't part of the testimony, sir. I don't
know what you're referring to.
Mr. Huelskamp. Mr. Burns, do you know what percentage of
your records, or do you track the access of those records?
Mr. Burns. I'm not aware of that statistic, no.
Mr. Huelskamp. Would you be willing to provide that to the
committee?
Ms. Council. We can come back to you.
Mr. Huelskamp. Would you agree that if you do not know who
accesses those records, that we have a problem with privacy of
that particular data?
Ms. Council. I would say yes. And today, what happens with
our PII and PHI information, doctors log in, we follow who logs
in, as well as the nurses. They log into those records and out.
But we will be happy to furnish you with the further
information.
Mr. Huelskamp. Based on what we find out, if the 8 percent
matches, again, we are seeing 92 percent you don't track the
access to those records. A follow-up would be later, once we
figure out that number is, I want to know what the VA is doing
to improve audit details in VistA to ensure that the veteran's
PI is not inappropriately accessed.
With that, Mr. Chairman, I yield back.
Mr. Coffman. Thank you, Mr. Huelskamp.
Mr. Connolly of Virginia, you're now recognized for 5
minutes.
Mr. Connolly. Thank you, Mr. Chairman. Welcome, to the
panel.
This really is so much more important than
recordkeeping or how we deploy technology. This is about
how we treat our active duty and military veterans. Is that not
correct? Anyone disagree with that? Would you agree we haven't
done so good?
Mr. DeVries, you cited FITARA. We prefer to call it the
Issa-Connolly bill, but FITARA is fine. And I think you cited
it because it is a new tool, that had it been available, might
have helped us in looking at the investments we made in the
past. I don't want to put words in your mouth, but is that what
you cited it?
Mr. DeVries. So the FITARA ruling has come out----
Mr. Connolly. I'm sorry, what?
Mr. DeVries. The FITARA rule has come out, and I think it
has been a great leveling set for the other agencies across the
Federal side of the house, providing the tools for the CIO to
look at. It also reinforced a lot of the behaviors that we were
exercising already inside the DOD.
In the case of here, for the medical records, I don't think
we had enough authorities, we had enough oversight on it. I
would challenge to the committee here. As we were talking about
this discussion, we kept using the words system. FITARA, in
itself, kind of deals with a system. But it is not a single
system. It's about a capability. It's about understanding the
data. It's about understanding the individual, both the
patient, but also the provider for it, and I really don't care
how the provider accesses or what tools he used, as long as he
takes care of me, the customer.
Mr. Connolly. Right.
Mr. DeVries. I think that is where we are going.
Mr. Connolly. I would just note for the record, had FITARA
been in law at the time, it would have required a cost-risk
analysis to substantiate whether the current approach is, in
fact, less expensive and faster to implement, as the
Departments have asserted, before the 2013 change was made to
pull the plug. And GAO, of course, has repeatedly asked for
data to substantiate that decision. So it would have been an
analytic tool to help us through.
Ms. Council, you're familiar with FITARA?
Ms. Council. Yes, sir.
Mr. Connolly. And you're moving to implement in the VA?
Ms. Council. We're fully implementing it within the VA.
Mr. Connolly. Good. Do you think it could have been a
useful tool? I know you are only there 3-1/2 months, but that
gives you the one benefit of looking back and thinking, How
could we have avoided some of the problems?
Ms. Council. It's always great to have solid data and
understand how decisions were made, so you can decide and
people understand, at that point in time, this is what we knew,
and this is a decision that we made.
Mr. Connolly. Mr. Miller, I wish I had lots of time to talk
to you. You said we failed for nontechnical reasons. What did
you mean?
Mr. Miller. Sir, what I mean is, with business systems,
you're really changing how the work is done. Right? So you've
got to think about the training, you've got to think about
changed management. You've got to think about communications.
The reality is, is that these tools on the business side exist
to enable work flows and to make decisions. And my comment
really is, is that oftentimes where we fail, is that we haven't
done a very good job of making sure that we account for the
user adoption; we don't account for the over-the-shoulder
training; we don't account for all those things that have to
happen to really make sure that the system is successful.
Mr. Connolly. Yeah. And I think that's a fair point. It's
not just about technology. And technology is a tool, not an end
in and of itself. But it's important. I've gone to oncology
centers where doctors initially really resisted electronic
recordkeeping. And now they wouldn't live without it, because
they can now see instantly the protocols in place for dozens of
patients and make instant modifications. It may be more
efficacious. It's saving lives.
What we're about here today is saving lives. It is vital
that if I'm active duty and you've got my medical records, they
would be seamlessly transferred to VA when I become a veteran.
So we're not worried about whether I need to reinvent the wheel
on testing and data, but that we're getting to my medical
condition and treating it.
And that is what concerns me; that by pulling the plug on
an integrated system in 2013 and deciding to reinvest in our
two parallel systems that are not interoperable, how do we get
to the point where it's interoperable? Maybe you perfect the
two parallel systems. But when I cease being active duty, I
have to go into a brand new system and start all over again.
Mr. Miller. Sir, it's important to remember, that
requirement is not unique to DOD and VA. I'm a Marine. I took
my medical record home. But just as importantly, I'm a cancer
survivor. I had cancer as a civilian. When I moved from San
Diego to Charleston, my provider in Charleston told me to call
back to Kaiser Permanente, who had an electronic system, and
have them fax it to me.
I understand the importance of taking care of our veterans.
Mr. Connolly. And did that work?
Mr. Miller. No, sir, it did not. So I think it's important
we recognize this is a national issue. How we take care of
people, how we provide health care, how people move around
between our systems is something that the national community
has to figure out. And they are attacking this issue. It has
been very clear, if you watch during the procurement that we
went through this past year, how much the debate ensued on
interoperability and how much progress you got out of some of
our----
Mr. Connolly. Mr. Miller, it is a national issue. But we
are talking about two Federal agencies that deal with a
specific population in our care. And when we talk about
taxpayers, they want to know our military, our veterans are
getting the best we can possibly deliver. And we're not
delivering the best.
And one of the problems is, we've had bureaucratic inertia
between two agencies that can't get their acts together on
behalf of the men and women we are serving. That's the issue,
not that there is some national problem that is bigger than all
of this. This is conquerable. This is within our purview.
You're Federal agencies. And you owe more to the men and women
who've served this country than they're getting. And that's why
we're having this hearing.
I yield back.
Mr. Coffman. Thank you, Mr. Connolly.
Dr. Roe from Tennessee, you're now recognized for 5
minutes.
Mr. Roe. Thank you, Chairman. I'm going to probably go down
a little different road.
I was here, and probably other than Mr. Walz, I've been
here on the Veterans' Affairs Committee longer than anyone. I
served in the U.S. Army as a physician, as a doctor. I trained
in the VA. So I've been in both systems. I was in the system
when this was your health record. And you carried it back with
you. And it worked okay. And this electronic system we've got
in the VA now works so smoothly that the primary care doctors
can see about 10 or 12 people a day, and me using this
technology, I could see 25 people a day, easily.
Now, there are--we have transitioned to a more modern
system, there is no question. And Mr. Miller, you are 100
percent right. I went from paper to an electronic health
record. It is not easy. What you're trying to do is not easy.
But I agree with Mr. Connolly. Ditto, right on. What has got to
happen is we have got to have one system, or 20 years from now
we're going to be sitting here having exactly the same
conversation. And very smart people 5 years ago sat down and
told us, We can make these interoperable.
I went to Great Lakes, Illinois in January, that wasn't a
lot of fun, to see how interoperable the system was at the VA
and the Navy. And guess what? In about 5 minutes, they could
give me, the doctor, a CBC. Well, I haven't got 5 minutes to
wait. I can wait on a fax machine that quick, to be able to
pull it up.
Let me tell you what $1 billion is that was wasted. And to
do this day, I asked the Secretary, What happened to that $1
billion when you two were trying to work together--not you all,
but the previous DOD and VA--to make this work?
I served in a hospital system in Johnson City, Tennessee,
that is $1 billion system. It has 9,000 employees, 13
hospitals, 70,000 admissions, 250,000 ER visits, and they
service a $600 million debt. That is what a billion can do. And
that's what the VA and DOD managed to waste. And I have no idea
where it even is. It's hard for me, with a straight face, to go
home and say what we did with this money.
Now, I appreciate the fact that like the VA has a legacy,
you guys at DOD have a legacy system. I think you were smart to
get rid of it and go to something more modern. That does make
sense. But what should have happened in that time was your
partner, which are taking care of exactly the same patients--
one day I was an active duty military, the next day I was a
veteran. It happened to you. It happened to me. It's going to
happen eventually to everybody after their 30 is in.
So I think that the President should step up and say we're
going to put these two department heads together and they're
going to work on one system. It may take 5 or 6 years to
implement this system. But me personally, I'm not going to be
part of another system that 10 years from now, we have the same
thing, where you can't even pull up a CBC when you separate
from the military.
So, Ms. Council, you have a legacy system you're trying to
make work. And I'm not asking you to say it's up to you to
switch systems. That's above your pay grade. But wouldn't you
think it would be simple if both of you had the same system?
Ms. Council. Life is always easier when we're looking at
the same map, yes, sir.
Mr. Roe. That's what I thought. And the data--and I
understand being able to format data where you can see it. I've
got that. I know how that works. In our own ACO at home, we
have 40 different electronic health systems. I've got it. I
understand that. That's why if you can get to one, everybody
benefits. And I think if we're going to spend billions of
dollars, we ought to go deep in and convert both systems.
And the VA is comfortable, the DOD was comfortable with
what they had, but they couldn't work together. And look, smart
people tried. I don't think there was any fraud or anything. I
think a lot of smart people tried to make this work, and just
couldn't.
Ms. Melvin, you said that, no single system, no
identifiable goals. And I think that pretty much felt it out.
Ms. Melvin. I would agree with you. Our concern throughout
the history of this initiative is that there has never been a
really defined end state for what it was that the agencies were
trying to achieve, and how they could go about really
determining what interoperability is, and then establishing and
identifying how they were going to get there.
Mr. Roe. That's what we asked the Secretaries to do in
2013. I was at the hearing when both Secretaries came in and
gave us that information that it wouldn't work. So they just
stopped. And then that's when the DOD went a separate route.
And, again, I have no problem with that. I think it's probably
a good idea.
Mr. Miller, you said that this was hard. Well, hard isn't
an excuse not to do this. And it's something that I think we
have to do going forward for our veterans and for our active
duty people. And the fact that a private system will work, you
sort of made the system that it wouldn't work at the VA. Well,
if it works in a submarine, it works in the private sector. And
as Mr. Walz said, we have been to Afghanistan and looked at
that wounded warrior there. It will work at a VA, I would
think, with perhaps some modifications.
Mr. Miller. Sir, I'm not going to disagree with you. I
think what we also have to recognize is the two departments
have a culture of how they go about doing acquisition. In the
case of the Department of Defense, I think what we've
recognized over the past 5 years has really been we are not in
the health IT development business, really. We want to be
somebody that leverages the commercial market. We want to be
somebody that kind of rides that. When I was a Marine, we had
Banyan VINES. It no longer exists. We now use Microsoft
products.
I think what has to happen here is we have to attack the
problem the same way. The reason why I say it is, it's about
bigger than the technology is, when the two organizations
budget differently, they do acquisition differently, they view
their role in health IT differently, it sounds really----
Mr. Roe. But to interrupt you though, the whole purpose has
been stated a thousands times up here. The mission is to take
care of both the wounded warrior when they are on active duty,
and then the veteran. Nobody cares about all this stuff. What
they care about is do I get the care for me and my family?
That's what they care about.
Mr. Miller. Yes, sir, I completely agree. I just think as
an acquisition person, I can solve that problem more cost
effectively for the American taxpayer by solving
interoperability while letting the two departments go through
the necessary modernization that needs to happens. The reality,
sir, like you recognized, DOD stopped their last deployment of
the system in 2006. My niece's husband is an Air Force doctor
down in Biloxi, Mississippi. He calls me routinely to talk
about how bad his system is. Because he went through residency
using commercial systems. He cannot believe the impact on his
productivity by not having a system that is as modern and as
advanced as what he needs.
So the reason I say that is because we can solve the
interoperability challenge. What I can't afford to do is go
back to my clinical users who have demanded a new system and
tell them I've got 5 more years while we work through all these
other hard things. I just think we need to come back for the
record and show what the business case is.
Mr. Roe. I'm over my time, Mr. Chairman. One last thing is,
is that I've been hearing for 7 years we're going the make this
work and interoperable by smart people. It hadn't worked yet.
I yield back.
Mr. Coffman. Thank you, Dr. Roe.
Ms. Duckworth of Illinois, you're now recognized for 5
minutes.
Ms. Duckworth. Thank you, Mr. Chairman.
I'm thanking the witnesses for being here today. When I
left Walter Reed as a patient, I left with a CD-ROM with my
entire record, including the notes from the surgeons who
performed my amputation.
In order to get into the VA system, I had to wait 90 days
for an appointment, and that consisted of me going in to see a
physician's assistant for whom I had to disrobe to show him
that I was still an amputee, that in those 90 days my limbs had
not grown back.
Now, in that time period, that physician's assistant did
not want to see me. He had other patients to see. There was a
backlog of patients waiting to be seen. He was not able to just
accept DOD's records. And so it was a waste of time for him. It
was a waste of time for me. It was a waste of resources for
other veterans.
I say this because as a patient of the VA and as a former
patient of DOD, I am proud of both healthcare systems, and I am
proud of the people who work in both systems, but I am also
equally frustrated by both sides because I have been a member
of the leadership at VA. In fact, my frustration with this very
issue is one of the reasons that I quit VA in 2011 to go run
for Congress because of the posturing, the inability to work
with each other, and the continued strife, and the waste of
sheer taxpayer dollars.
It's literally one of the reasons why I ran for office
because I sat in those meetings every week at the Pentagon
where, let me tell you, from my personal opinion, Tammy
Duckworth's personal opinion, the VA got rolled by the DOD on a
weekly basis.
Mr. Miller, what you can tell your folks about--your
clinicians about what you can do to get them a good system and
not wait 5 years, you can tell them we're going to adopt VistA,
and then together, while we're using VistA, we can work toward
something else. That's how you get them a better system
immediately. But let me tell you that I was there week after
week, and then when it went onto months, it would be a new one-
star or a new two-star who would rotate in, the old one would
leave, and the new one would come in, and goes: Oh, I need a
new study, you know, because I wasn't here for all of those
weekly meetings, I need a new study, we need to figure out
what's going on.
And, Ms. Counsel, I know that you testified earlier, I was
watching from my office that the--you have to actually send the
data from one VA hospital to another in order to be able see
that. I have to tell you that you've undersold VA a little bit
because I've gone to different VA facilities and actually have
had my doctors know how to log out of the system for that
hospital and then log into the correct system and been able to
see my records, which has been very helpful.
And following Hurricane Katrina, veterans who were affected
by Hurricane Katrina could actually go to other VA facilities
and get the prescriptions they needed wherever they were.
Whether that was in Texas or Missouri or Mississippi, wherever
they ended up, they were able to get, so there is a way for
that to happen.
But, look, this is about a longstanding deeply embedded
culture that prioritizes in both agencies turf battles over the
well-being of our service members. It's about a VA system that
struggles with the growing demand for the Department's medical
services that is burdened by policies and written rules that
says you have to go in to see a physician's assistant before he
can confirm that your legs didn't grow back. I'm not a gecko.
They don't grow back on their own.
It's also about, you know, the fact that we're wasting
hours and resources to conduct medical examinations. We should
be treating veterans. It's really been disheartening for me
personally to watch the massive DOD bureaucracy repeatedly, and
I say this again, repeatedly, roll VA over and over and over
again, which despite its serious problems at VA, VA has real
problems, it was actually one of the earliest organizations to
implement EHRs, and let me--I just finished my Ph.D. In
October, and the topic of my Ph.D. Was actually electronic
health records, and it was partially inspired because of my
work on this issue.
It was even more shocking to watch DOD not only roll VA but
roll the Office of Management and Budget, which pushed in vain
earlier in the administration to convince DOD that it needed to
work with VA to develop a single integrated electronic health
record system, and to this day, I harbor serious concerns about
the decision to abandon the goal of a unified single integrated
system for DOD and VA. If we're going to spend $11 billion of
taxpayer money, I don't understand why we wouldn't have
invested this astronomical amount of money in a fully
functional interoperable system.
Now, having served on the committee--on this committee and
Armed Services Committee--I have my suspicions about the
motivations and incentives that explain DOD's longstanding
unwillingness to work with VA to modernize and enhance VistA to
meet 21st century healthcare needs. And I'm not going to get
into an argument with you. My personal opinion is everybody's
got bureaucratic turf battles. Everybody's got a budget that
you would like to hang on to and to supervise. That stuff has
got to end because veterans are suffering.
So my question is actually to Ms. Melvin. In your
testimony, you noted that neither DOD nor VA could substantiate
their claims that maintaining two separate EHR systems would be
less expensive than developing a single integrated system and
would be developed faster than creating a new unified DOD/VA
system. Is that correct?
Ms. Melvin. That's correct.
Ms. Duckworth. So they're not able to substantiate it?
Ms. Melvin. They were not able to provide us the
information. We asked--I suggest--recommended, I should say,
that they provide or develop cost analyses for--cost estimates
for the alternatives, the alternative to develop a single
system as well as the new--two separate systems and to compare
them and to provide information to us relative to--which was
the more viable solution.
We'd like to see the justification for why going back to
two systems is better than one system. That's very important to
really--the bottom line of whether this is a more reliable
approach that they're taking over what they had been going with
before.
Ms. Duckworth. Are you expecting that information anytime
soon?
Ms. Melvin. I don't believe we are. I don't think that we
have any date yet to get that information. We are still working
with them. We do still have our recommendations on record
related to that, so we are still coordinating with the agencies
about that.
Ms. Duckworth. Mr. Chairman, I am well over time. I
apologize. But may I request that the two agencies provide that
information to this committee?
Mr. Miller. Ma'am, we have provided that information.
Mr. Coffman. If there are no objections, with unanimous
consent, please submit the information that Ms. Duckworth has
requested for the record.
Ms. Duckworth. Thank you, Mr. Chairman. I yield back.
Mr. Coffman. Mr. Hurd of Texas.
Mr. Hurd. Dr. Duckworth, I like the sound of that. We may
have to have you as a witness on the followup hearing.
I like going at the end of the first round of questioning
because you get to hear all the conversations, and this is an
interesting topic to me. My dear old father is still upset with
me for not taking a job with IBM to help them build databases,
so this is something that's a topic that's near and dear to my
heart. And I talked about my opening frustration, and that
frustration is still here, despite all the testimony.
And my first question, Ms. Melvin, you've alluded to this,
and you've answered it, but I'm going to ask this question
again. Who is in charge of interoperability of electronic
health records between DOD and the VA?
Ms. Melvin. At this time, the interagency program office is
designated as the single point of accountability. However, what
we do know at this point and what we've reported is that VA has
its own governing body, I think as Ms. Council has alluded to,
and also DOD has its own governing body, so there actually are
at least three different entities that are involved with this.
Mr. Hurd. Thank you. That's helpful.
Mr. Miller, you represent the IPO. Is that correct?
Mr. Miller. Sir, I represent the Department of Defense as a
senior executive responsible for both our interoperability and
our modernization efforts. Director of the IPO is Dr. Lauren
Thompson, who reported back in May, and she actually runs that
office.
Mr. Hurd. So is that Dr. Thompson?
Mr. Miller. Yes, sir. So she reports to----
Mr. Hurd. Do you report to her?
Mr. Miller. No, sir. She works for me and Under Secretary
Kendall.
Mr. Hurd. So you're her boss?
Mr. Miller. Yes, sir.
Mr. Hurd. So--but you're a DOD employee?
Mr. Miller. That's correct, sir.
Mr. Hurd. So who is this governing body within DOD that is
looking about the interoperable medical health record?
Mr. Miller. So within both Departments, they have their own
IT acquisition organization. So within the Department of
Defense, that's Under Secretary Kendall. He's responsible for
all of our acquisition, and so as on the acquisition and
technology side, he is who we report to on our efforts within
operability. The same goes on the VA with Ms. Council. What we
do is we routinely meet between Ms. Council and Secretary
Kendall to review----
Mr. Hurd. I get that. I get that. Thank you.
So my question, Mr. DeVries, a clinic, a VA clinic, and
let's just say San Antonio, can they have one computer that has
access to the VA health system and the DOD health system?
Mr. DeVries. They could, sir.
Mr. Hurd. Do many people have access to that?
Mr. DeVries. Not today.
Mr. Hurd. It's a good question.
Mr. DeVries. Not today.
Mr. Hurd. Why is that?
Mr. DeVries. I think it's based upon technology, where we
are today, and where the data is. Identity is a critical part,
as I talked about before, from both the patient as well as the
provider.
Mr. Hurd. And you're responsible for that, correct,
providing the accesses and the protections around that data,
you specifically?
Mr. DeVries. Correct. Overall policy is, yes.
Mr. Hurd. So if Mr. Miller--can Mr. Miller tell you what to
do? Is he in your chain of command?
Mr. DeVries. He is not in our chain of command.
Mr. Hurd. So the person that's responsible for protecting
the data, all right, of our health data, all right, which is a
key part of interoperability, the person who's charged with
interoperability does not have control over those people making
those decisions, is that correct, or am I confused?
Mr. Miller. Sir, I would offer just checks and balances. So
my job within the Department of Defense is to lead the
acquisition, the testing, and deployment, but I have to get
approval from our CIO organization to make sure it meets the
security requirement, we're protecting data, so it's a
partnership. You know, there's no single, if you want to, go up
to the very senior level, but day-to-day, I don't do anything
without him, and obviously, they have to have something that we
provide in order to assess our security and how we're doing at
protecting people's information, sir.
Mr. Hurd. So, Mr. Miller, you said this is a national issue
about interoperability of health care records. I agree with
you, and I also agree with Mr. Connolly as well. This is about
two Federal agencies sharing information amongst each other,
and to me, it's shocking that a doctor in San Antonio, Texas,
can't have one computer on their desk that accesses both the
DOD records and the VA records.
Mr. Miller. Sir, he can, and I would love to----
Mr. Hurd. But they're not. Look, so how many doctors--how
many--how many DOD doctors and how many VA doctors have you all
talked to on the implementation of this system and what they
need in a interoperable electronic health record?
Mr. Miller. So let me talk about the requirements when
you're in interoperability. It is jointly led by easily, you
know, 20 or more clinical leaders from both Departments, and so
today, in San Antonio, on the DOD side, we provide access to--
through what we call JLV, but it's actually integrated her.
Mr. Hurd. Yeah. And let's get to JLV.
Mr. Miller. So, sir, let me just explain. It's in our her.
It's inside of AHLTA. There is access to be able to see the VA
data and the data from the private sector. That is available to
any DOD physician, PA, nurse----
Mr. Hurd. How do they gain access to it? Who do they ask?
How would--if I'm a doctor, how do I gain access to be able to
see those both records?
Mr. Miller. So to be able to see both records, all they
have to do is go--just like any other IT system, they go to the
local administrator, they grant them the keys to access the
system. We've gone in the DOD from about less than 500, now
over 8,000 in about 6 months, and we are continuing to rely. In
fact----
Mr. Hurd. And this is for JLV?
Mr. Miller. Yes, sir. In fact, at Brooke Army Medical, it
is one of our largest users and actually where we've been doing
the operational tests. So besides getting input back on the
requirement side, we've actually gone and done operational
testing at Brooke Army Medical in Alaska and at Walter Reed to
get feedback from, no kidding, users, which has been rolled
into the future enhancements of the system. So we have an
incredible engagements with our clinical functional users to
make sure we're meeting their requirements.
Mr. Hurd. But a soldier, sailor, airmen, and marine, when
they show up to a VA clinic for the first time, they still have
to print out----
Mr. Miller. No, sir. And I talk to people routinely.
Mr. Hurd. Okay. So let me ask you this. So you're saying
nobody has to do that?
Mr. Miller. So, sir, they print that record out because
oftentimes our Active Duty, especially when they have been in
the service a long time, predate our IT system, so I think it's
important to recognize that. We have not been fully electronic
within the entire Department.
Mr. Hurd. Absolutely. So here's the problem. You have--so
quick question, and Mr. DeVries, you may be able to answer this
question for me. If I'm in the Air Force and I go see a DOD
doctor, is my record different than someone in the Army that
goes and sees a DOD doctor?
Mr. DeVries. It is not.
Mr. Hurd. It is not?
Mr. DeVries. It is not.
Mr. Miller. Same system.
Mr. DeVries. Same system.
Mr. Hurd. So all branches--okay. Air Force, Army. Is it the
same for all branches of the military?
Mr. DeVries. Yes.
Mr. Miller. Same system.
Mr. DeVries. You have rights to the same data repository.
Ms. Duckworth. Will the gentleman yield?
Mr. Hurd. Please.
Ms. Duckworth. Very briefly. I just have a little
something.
Mr. Hurd. Please.
Ms. Duckworth. So I don't know if the gentleman is aware of
how frustrating this is when there's even a hospital in Chicago
that is a joint Federal VA/DOD facility. And in that hospital,
they actually have two computers sitting next to each other,
one with a VA system and one with a DOD system. And that
hospital is supposed to be a joint facility treating
simultaneously veterans and Navy personnel. And even there in
the hallmark hospital that is the flagship of this effort, it's
two computers sitting next to each other. Shameful.
Mr. Hurd. It really is. You know, who is actually, so I
look at this problem multiple ways. You have the various health
facilities that a soldier, sailer, airman, marine may see in
their time when they're in DOD. Then you have all the
facilities within the VA. Then you have if a veteran has to go
to a private, a private healthcare provider. It's a whole other
set of issues with interoperability, which I recognize the
complication of that. Then you have people that starting today,
brand new, starting basic training in this new system in their
lifetime. Then you have the people that have already been
serving, that have served for 30, 40 years. And they have a
number of old records in a legacy system that are super old and
outdated. I get that. But what we haven't heard from any of
this is what is the plan to solve those different problem sets?
We talk about mapping data. Do we not know what the format the
various pieces of data are in? Do we not know? They're all
basically databases. And we know how many fields there are.
There may be thousands of different fields. And each field may
hold, it could hold text; it could hold imagery. I get the
difficulty of that. But we should already know what that
mapping theme is. And in order to do the map from DOD to the
map at the VA system, why has it taken 4 years and $536 million
to do that and then everybody throws up their hands and says:
Our bad, this is really hard to do, and we're going to have to
go through separate systems.
Now, I recognize, I don't think anybody on this panel was
around in 2008.
Mr. DeVries, maybe you were. No? Okay. Not around, but you
weren't involved in this.
So the first step is have we gone back and looked at the
problems that this would solve, right? And, Ms. Council, I know
you're new. And I'm excited about you bringing some expertise,
some experience from the private sector. I don't know if you
knew what you were stepping into when you took this job, but
we're glad you stood up and are willing to take on this
challenge. But we have to look at the failures of the past.
And, I'm sorry, 2 years is not acceptable. And saying that, you
know, I wasn't around, when we are talking about the fiscal
year 2014 NDAA and that we're going to comply with that
requirement but at the end of this month, our soldiers are not
going to be able to walk into a VA system and get access to
their DOD record. They may be able to see it in JLV. But JLV is
the equivalent of using microfiche. And you may be able to
search for an individual patient, but you can't search, what
was their blood pressure? And sometimes you have to have VA
clinics do the same tests over because they can't see the
imagery that was included in their DOD system. That's a huge
waste of time. And what is shocking in all this, the men and
women, these doctors, the healthcare providers in the VA and
the DOD, they're doing a damn good job, right, when they're
actually providing that service. And they're the ones that are
having to get these workarounds for their system to make sure
that they're providing the kind of health care that our
soldiers, sailors, airmen, and marines have.
Now, my last question, I'm way over time, and I apologize,
Ms. Council, do you have all the tools, authorities in order to
do this job?
Ms. Council. I had this conversation with my team. I think
it's the first time in my career I can say yes.
Mr. Hurd. Excellent. If you need more, let us know.
Ms. Council. Will do.
Mr. Hurd. And, with that, I yield back.
Mr. Coffman. Ms. Kelly, you're now recognized for 5
minutes.
Ms. Kelly. Thank you, Mr. Chair.
The GAO's written testimony concludes that your decisions
to pursue separate her EHR highlights, and I quote, ``the
criticality of these Departments needing to define what they
aim to accomplish in these efforts and identify meaningful
outcome-oriented goals and metrics.'' DOD and VA, do you agree
with GAO's assessment that outcome-oriented goals would help
measure progress toward interoperability and hold your
Departments accountable for their progress?
Ms. Council. Yes, I do.
Mr. Miller. Yes, we do.
Ms. Kelly. So what do your respective agencies aim to
achieve from your interoperability efforts. What do you want
for your outcome?
Ms. Council. From our point of view, we want to be able to
have a medical, an electronic health record that is accurate
for that veteran that can be used in any way, shape, or form
that that veteran needs to have it used and be fully portable
to be where the veteran needs to be.
Mr. Miller. Ma'am, I would say it kind of goes around what
we use in the DOD, a quadruple aim, if you will. And those four
vectors really are, the first is readiness. At the end of the
day, the Department of Defense has to be operationally ready to
execute the mission. That includes our servicemembers as well
as our families who take care of them while they are on
deployment. Secondly, we got to address quality. We got to look
at our costs. And we got to look at improving decisions that
actually impact the lives of our servicemembers, beneficiaries,
and veterans.
Ms. Kelly. And what value in benefits would all users gain
from the deployment of modernized electronic health record
systems with interoperability?
Ms. Council. At the end of the day, it's a seamless,
unified point of view. And I think that's what every patient
wants. They want not to have to answer the question 10 times,
not to have to fill out another form, not to have a missed
record or a missed report or a missed test. They really want
the doctor to have the best information at their hands, at the
time that they need to make the decisions about their health.
Mr. Miller. Can I take it a couple ways? One is I think our
users really want a modern system that helps with
decisionmaking, gives them productivity time back, looks at
engaging modern technologies, like smartphones and some of the
natural language processing, because at the end of the day,
they're busy. And we ought to be doing everything we can to
provide them tools that are open and secure to enable them. The
second thing I would highlight is we want to go after a modern
system that is really about the patient, and it's really about
engaging the patient more. We have the ability today to provide
our health record information to our beneficiaries. But I think
when you see what's going on in the commercial market, you
really see where the more the patient is engaged in their
healthcare decisions, the better the outcome. So one of the
things we are really after here is making sure that we have a
system that engages them and so we really can help drive. And,
lastly I would say from our perspective on the IT side, it's
also about security and it's about driving down sustainment
costs. The system we have today, we, actually it's multiple
systems, we cannot sustain them forever. We have to adopt an
enterprise system that handles a lot of that integration and
continues to provide us new technologies so that we can drive
our sustainment costs down so we can be affordable.
Ms. Kelly. Both of you had great answers. My last question,
what is the status in defining these outcome-oriented goals?
You had the right answers. But what's the status?
Ms. Council. As far as we're concerned, our goals and our
new dashboard will be up in January for full visibility. We're
looking to make sure we're measuring the right things and we're
measuring metrics that matter, not just a bunch of stuff that
nobody really cares about.
Mr. Miller. Ma'am, the IT is actually taking the lead here.
They actually had a series of summits and meetings, pulling
together subject matter experts and people to kind of working
our way through this. In fact, tomorrow is one of those
meetings. In the case of the larger DOD side, just like the VA,
we have a larger performance metrics and things that we
monitor. What we're working through right now is trying to
understand is that the right map or are there things we're
missing. What we're really trying to do is generate a first
step that utilizes those. And, in parallel, what I've also
asked that we look at is bringing in some really smart people
who understand operations research. We have some great FFRDCs
and activities that really understand how to look at some of
these things, as well as some of the national health systems.
So while we're kind of doing this first effort, we're also
going to be doing a very strategic look in engaging some people
and having them help us work our way through this. We aren't
the first people that have tried to figure some of this out.
But we recognize that it's important. And we recognize we got
to get something in place that's better than just measuring
transactions between our two Departments.
Ms. Kelly. Mr. Chairman and both of you, I look forward to
having another hearing so we can hold these Departments
accountable and see what the progress is. Thank you.
Mr. Coffman. Thank you, Ms. Kelly. Dr. Benishek, you're now
recognized for 5 minutes.
Mr. Benishek. Thank you, Mr. Chairman. Ms. Council, I know
that you're new there. And I have a couple of specific
questions. Has anyone reported to you that the Choice Card
program participants, the database that's maintained in the
Health Eligibility Center is running out of space, and at some
point, this issue will cause it to crash? Have you heard
anything about that?
Ms. Council. I have not.
Dr. Benishek. Has anyone revealed to you that the Choice
Card database apparently didn't go through the normal security
review process?
Ms. Council. I'm not aware of that.
Dr. Benishek. This Health Eligibility Center is in Atlanta.
Do you think you could kind of look into these issues that have
come up to the committee, see if you can go there and see if
it's a reality or what exactly the story is with that?
Ms. Council. As far as the HEC is concerned, related to the
other issues, but I'm not sure of the Choice issues that you
mentioned but we----
Dr. Benishek. I'm just bringing this up because the
committee has had these issues, and as long as you're before me
here, it sort of relates to the security question, because I'm
on the O&I Subcommittee in the VA. We've been reported to that
the VA health system has been hacked completely. And, you know,
I would like to be sure that this does not continue to be the
case. What's your, what's your, I saw Mr. Miller was worried
about that with the DOD. And, certainly, we don't want a system
that gets hacked.
Ms. Council. No one wants a system that gets hacked. I'm
not aware of our systems being hacked, sir. I would love to
look at that information to certainly understand it better. And
we move with best diligence and quickly on this issue. And if
you, as you're aware, with the cyber strategy we put in place,
we've tighten up our processes aggressively, reduced elevated
privileges that people have had in our environments, and
changed it aggressively. And in particular, with the HEC, as it
related to the systems and the applications that were engaged
with the veterans, we have remediated that system, which was
not an OI&T system, but it is now. But the Choice program, I
will certainly look into that.
Dr. Benishek. I appreciate that. Thank you.
That's all I have, Mr. Chairman. Thank you.
Mr. Coffman. Thank you, Dr. Benishek.
Ms. Duckworth, you're now recognized for 5 minutes.
Ms. Duckworth. Thank you, Mr. Chairman.
There was earlier, Mr. Miller, I think you mentioned that
VA and DOD have very different acquisition systems. But I
believe that under the previous CIO at VA, he instituted a
program called PMAS, Project Management Acquisition System,
that, as I recall, was very well received and has saved
significant amounts of money for the taxpayers in terms of how
the VA acquires IT systems and programs.
Ms. Council, is VA sill using PMAS or something similar, a
legacy from that?
Ms. Council. PMAS is not our acquisition system as much as
it's a management system for how programs and product, how
programming is done to create code. We are in the process of
re-looking and reestablishing PMAS to reduce the overhead that
it has started to create in order to make sure we can get code
done faster with higher quality and security and different
techniques we need built in. So it will be a more wholistic
look at everything we do from end to end. It's a solid process.
But just like every other process, you need to look at it and
constantly keep it up to date.
Ms. Duckworth. So is it something that would be used as
you're working toward improving the electronic medical record
system, something that would be used with--perhaps work toward
interoperability?
Ms. Council. Our PMAS system is primarily used to develop
software and to follow the gates and processes to ensure we
have all the processes in place to develop software or to
purchase software and to deploy it. So it is our management
process for how we get things done.
Ms. Duckworth. Thank you.
Ms. Melvin, can you explain to me in more detail the GAO's
concerns with the decision by DOD and VA to keep operating two
separate EHR systems rather than establish a single, integrated
system?
Ms. Melvin. Our concern is just the inherent duplication
that comes with having two paths to developing systems that are
serving a large body of population that's very similar. Also
there are a large number of functions that are for inpatient
requirements that are the same. A prior report showed 97
percent of those requirements being the same for inpatient I
should say. And our concern is from the standpoint of not
having a common, whether the agencies will have a common goal
that they work toward; whether, in fact, when they ultimately
have this system and they've gone to these two separate paths,
whether they, in fact, do end up with systems that have the
interoperable capability between them that will allow them to
serve patients in the way that we've talked about today and
ultimately to improve the healthcare mission. So it's about the
cost of having duplicative systems. It's about the overall
management relative to your ability to deliver on those
capabilities and serve a common mission for the servicemembers.
Ms. Duckworth. So 97 percent----
Ms. Melvin. This was a study that was previously done that
showed 97 percent or over 97 percent of their inpatient
functional requirements were common across the two Departments.
So that is a factor that goes into our concern that the
agencies do need to look more closely at what their capability
is to put in place a system that's common for both Departments.
Ms. Duckworth. Is it a true statement that VA operates the
largest hospital network in the Nation?
Ms. Melvin. The VA and DOD have two of the largest
healthcare networks in the Nation, yes.
Ms. Duckworth. How big are they in relative size, the size
of VA's network compared to the DOD's size?
Ms. Melvin. I believe that DOD's system is slightly larger.
I don't want to misspeak on that. But I believe their
healthcare system is larger than VA's.
Ms. Duckworth. Is it larger in terms of number of patients
served? Or is it larger in terms of more facilities?
Ms. Melvin. I will defer----
Ms. Duckworth. Ms. Council, you look like you have an
answer.
Ms. Council. The DOD is larger in terms of different
outlets and facilities. We are larger in terms of the number of
patients we see.
Ms. Duckworth. Do you know how many patients you serve?
Ms. Council. The last time I saw the number, it was 10
million approximately in DOD; 24 million in the VA.
Ms. Duckworth. All right. So you have more than twice as
many patients accessing your healthcare system than DOD does.
Ms. Council. That information, if I'm recalling it
properly, yes.
Ms. Duckworth. Okay. Ms. Melvin, can you explain how this
decision for them to keep two different systems instead of a
single, integrated system is going to affect interoperability
well into the future?
Ms. Melvin. I don't know the answer to that. I mean, one of
our concerns is that the Departments haven't provided a clear
justification for why two systems is better than one. That's
the critical information that is needed to really justify
moving toward the two systems.
Again, the history of this has been that they've been down
the path of two systems for many, many years. The single joint
system, as we understood it, was intended to take care of some
of the challenges that the two departments had had in their
prior efforts to develop interoperable capabilities between two
systems. So having a justification for why moving back to that,
besides the obvious factors of cost and schedule that they have
mentioned, are important to know.
Ms. Duckworth. Maybe you'll get an answer to that question
since you've not been able to get that information as the GAO.
But maybe with the Congress asking for it, they will finally
provide it. I'm out of time.
I yield back.
Mr. Coffman. I thank you, Ms. Duckworth.
Mr. Hurd, you're now recognized for 5 minutes.
Mr. Hurd. Ms. Melvin, would you be able to get us a list of
the individuals by name at DOD and VA, including
subcontractors, contractors, that worked on the
interoperability project between 2008 and 2013?
Ms. Melvin. We will look into the information that we have
and provide you----
Mr. Hurd. And I'm curious as to the number of people that
worked on that project, the interoperability project, from 2008
to 2013, who are still employed at both organizations, and
which contractors we're still using from that period when we
spent over $500 million and decided that instead of joining
everything, we're going to split it up.
Ms. Melvin. Chairman Hurd, that is not information that I
know that we have in our records specifically at this point.
But we would be glad to work with your staff to get that
information.
Mr. Hurd. Great. Thank you very much.
Mr. Miller, what are your next two milestones for achieving
interoperability?
Mr. Miller. Sir, on the interoperability front, I actually,
just last night, we provided an update on our data maps. And so
our next milestones are basically to continue to evolve those.
Our next delivery on the maps because we are now entering a
maintenance phase and getting feedback, will be in the December
timeframe. And then we're also in the process of doing our next
software delivery which will be early next calendar year. And
that software delivery is, basically, again, taking feedback.
There's areas that our functional users have requested. And
we're going to be working that software release in the January
timeframe.
Mr. Hurd. Great. Thank you.
Ms. Council or Mr. Burns?
Mr. Burns. A couple different fronts. One is, on the data
mapping, we have a quarterly update that we do. The next one is
coming up in November to give us the next set, as I mentioned
earlier, the 25 domains. And then we update each one of the
respective domains going forward. That's just on data mapping.
And that's part of interoperability. In addition to that, we
are testing and rolling out EHMP, otherwise known as the
Electronic Health Management Platform. That is, in its current
form, is we call version 1.2. And that is a read-only version
right now. It's been--it's in delivery at two cites. And we're
going to continue to roll that out.
Mr. Hurd. It's in delivery, so they're the beta testers?
Mr. Burns. Yes.
Mr. Hurd. What are those cites?
Mr. Burns. Hampton and the other one, off the top of my
head, I don't recall. But I will get you the name of the other
one.
Mr. Hurd. Great.
Mr. Burns. And then we are then going to the next phase,
which is EHMP 1.3, in the January time frame to start what we
call IOC, Initial Operation Testing, of that. That will give us
the first capability of doing order and report write capability
beyond the read capability we have. By the way, that also has a
very good search engine built into it, the 1.2 version, that
will allow you to do a lot more search capability and look up
information, contextual and content capabilities. So those are
two key things moving us in the interoperability direction to
move out. And our goal is to have 1.3 out by the end of the
year so that we can meet the December 31st----
Mr. Hurd. Thank you, Mr. Burns and Ms. Council and Mr.
DeVries. I'm looking forward to having further conversations
with you all about the implementation of FITARA and ensuring
that you all have all the tools you need in order to bring our
IT infrastructure into the 21st century. Thank you all for
being here.
I yield back, Chairman.
Mr. Coffman. Thanks to the panel.
You're now excused.
Today, we have had a chance to hear about problems that
exist with multiple efforts between the Department of Defense
and Veterans Affairs to make their health records either
integrated or interoperable. This hearing was necessary to
identify the continued failures that have allowed these efforts
to remain ongoing after decades of attempts to join these two
health--to join these two health records that cover patients of
the largest healthcare systems in this Nation.
As I mentioned in my opening statement, VA has expended
billions of dollars in an attempt to improve its electronic
health record system and make it interoperable with that of the
DOD. Yet GAO has found that these agencies' health records
would not be fully interoperable until at least 2018.
Unfortunately, based on VA's track record regarding its
information security failures and the numerous attempts made to
join these two agencies' records, I am not even convinced that
it is a feasible completion date. I am encouraged, however, by
the recent personnel changes that have occurred within VA's
Office of Information and Technology. But there is still much
work to be done.
I believe LaVerne Council has a sound plan and strives to
fix VA's OI&T. But the question is, how long will it take? I am
angered by the fact that VA and DOD poorly structured and
continued to misuse the IPO. It is no longer a, quote/unquote,
``single'' focal point mandated by Congress. It has become as
divergent as the VA and DOD. And through it, both Departments
have grossly misused money appropriated by Congress.
As such, I am exploring ways to correct these problems once
and for all, since VA and DOD have continued to disregard
Congress on this matter.
I ask unanimous consent that all members have 5 legislative
days to revise and extend their remarks and include extraneous
material.
With that, without objection, so ordered.
I would like to, once again, thank all of our witnesses and
audience members for joining us in today's conversation. And I
would like to thank Chairman Hurd for holding this joint
hearing on these very important issues.
With that, this hearing is adjourned.
[Whereupon, at 5:27 p.m., the subcommittees were
adjourned.]
APPENDIX
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Material Submitted for the Hearing Record
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