[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
OVERSIGHT OF IT AND CYBERSECURITY AT THE DEPARTMENT OF VETERANS AFFAIRS
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HEARING
BEFORE THE
SUBCOMMITTEE ON
INFORMATION TECHNOLOGY
OF THE
COMMITTEE ON OVERSIGHT
AND GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
FIRST SESSION
__________
DECEMBER 7, 2017
__________
Serial No. 115-59
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Printed for the use of the Committee on Oversight and Government Reform
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Committee on Oversight and Government Reform
Trey Gowdy, South Carolina, Chairman
John J. Duncan, Jr., Tennessee Elijah E. Cummings, Maryland,
Darrell E. Issa, California Ranking Minority Member
Jim Jordan, Ohio Carolyn B. Maloney, New York
Mark Sanford, South Carolina Eleanor Holmes Norton, District of
Justin Amash, Michigan Columbia
Paul A. Gosar, Arizona Wm. Lacy Clay, Missouri
Scott DesJarlais, Tennessee Stephen F. Lynch, Massachusetts
Blake Farenthold, Texas Jim Cooper, Tennessee
Virginia Foxx, North Carolina Gerald E. Connolly, Virginia
Thomas Massie, Kentucky Robin L. Kelly, Illinois
Mark Meadows, North Carolina Brenda L. Lawrence, Michigan
Ron DeSantis, Florida Bonnie Watson Coleman, New Jersey
Dennis A. Ross, Florida Stacey E. Plaskett, Virgin Islands
Mark Walker, North Carolina Val Butler Demings, Florida
Rod Blum, Iowa Raja Krishnamoorthi, Illinois
Jody B. Hice, Georgia Jamie Raskin, Maryland
Steve Russell, Oklahoma Peter Welch, Vermont
Glenn Grothman, Wisconsin Matt Cartwright, Pennsylvania
Will Hurd, Texas Mark DeSaulnier, California
Gary J. Palmer, Alabama Jimmy Gomez,California
James Comer, Kentucky
Paul Mitchell, Michigan
Greg Gianforte, Montana
Sheria Clarke, Staff Director
Robert Borden, Deputy Staff Director
William McKenna General Counsel
Sean Brebbia, Senior Counsel
Kiley Bidelman, Clerk
David Rapallo, Minority Staff Director
------
Subcommittee on Information Technology
Will Hurd, Texas, Chairman
Paul Mitchell, Michigan, Vice Chair Robin L. Kelly, Illinois, Ranking
Darrell E. Issa, California Minority Member
Justin Amash, Michigan Jamie Raskin, Maryland
Blake Farenthold, Texas Stephen F. Lynch, Massachusetts
Steve Russell, Oklahoma Gerald E. Connolly, Virginia
Raja Krishnamoorthi, Illinois
C O N T E N T S
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Page
Hearing held on December 7, 2017................................. 1
WITNESSES
Mr. David A. Powner, Director, IT Management Issues, U.S.
Government Accountability Office
Oral Statement............................................... 4
Written Statement............................................ 6
Mr. Scott Blackburn, Acting Chief Information Officer, Department
of Veterans Affairs
Oral Statement............................................... 39
Written Statement............................................ 41
Mr. Bill James, Deputy Assistant Secretary for the Enterprise
Program Management Office, U.S. Department of Veterans Affairs
Oral Statement............................................... 58
Mr. John Windom, Program Executive for Electronic Health Records
Modernization, U.S. Department of Veterans Affairs
Oral Statement............................................... 58
Mr. Dominic Cussatt, Chief Information Security Officer,
Department of Veterans Affairs
Oral Statement............................................... 74
APPENDIX
Ranking Member Kelly Opening Statement........................... 78
Mr. Connolly Opening Statement................................... 80
GAO Chart submitted by Chairman Hurd............................. 82
OVERSIGHT OF IT AND CYBERSECURITY AT THE DEPARTMENT OF VETERANS AFFAIRS
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Thursday, December 7, 2017
House of Representatives,
Subcommittee on Information Technology,
Committee on Oversight and Government Reform,
Washington, D.C.
The subcommittee met, pursuant to call, at 2:38 p.m., in
Room 2154, Rayburn House Office Building, Hon. Will Hurd
[chairman of the subcommittee] presiding.
Present: Representatives Hurd, Amash, Gianforte, Kelly,
Lynch, Connolly, and Krishnamoorthi.
Mr. Hurd. The Subcommittee on Information Technology will
come to order. And without objection, the chair is authorized
to declare a recess at any time.
Good afternoon. Thank you for being here today.
Seventy-six years ago to the day, Japan launched a sneak
attack on the U.S. naval base at Pearl Harbor. By the time the
sun had set on that infamous day, 2,335 U.S. servicemen had
been killed and 1,143 had been wounded. The next day, the
United States of America declared war on Japan. Three days
later, the world was at war. Over 16 million Americans
eventually served in that war, the so-called war to end all
wars. There are only around 624,000 World War II veterans left.
Most are in their 90s. I want to take this opportunity today to
thank all of them for their service and their courage.
Sadly, that war did not end all wars. In 2016, Gulf War
veterans became the largest group of veterans at over 7
million. The total number of veterans enrolled in VA's
healthcare system rose from 7.9 million to almost 9 million for
fiscal year 2006 through fiscal year 2016. The total veteran
population currently stands at 20 million people, 20 million of
our fellow citizens who are willing to put their lives on the
line for this country and for the rest of us. And for that
sacrifice, we should honor our promise to provide them with
world-class health care.
But the modernization of the VA's legacy technology has
been a persistent concern that is affecting millions of
veterans. A veteran should be able to go from active duty on
base to the VA to a private-sector provider seamlessly. The
health records should be available and up-to-date no matter
where the veteran chooses to get health care. A fully
functional modernized healthcare information system is the
goal, and today, we are going to talk about some of the
specifics on how the VA will modernize and upgrade its
information systems and how we can learn from past mistakes so
that this time it is going to be a success.
But let's be honest. There is not a track record of
successes here. As a result of a GAO review requested by this
committee back in May of 2016, we have learned that during
fiscal years 2011 to 2016, VA obligated about $1 billion for
previous VistA modernization contracts. Seven hundred and forty
million went to 15 key contractors. Without objection, I would
like to enter into the record a chart from GAO that lists the
15 contractors and the amount they received to work on VistA
modernization and interoperable electronic health records. So
moved.
Mr. Hurd. On that list of 15 contractors is the Cerner
Corporation, which was recently chosen by the VA to provide an
electronic health record that will be interoperable with the
Department of Defense and then ultimately be interoperable with
the private sector. Also on the list are the Mitre Corporation
and Booz Allen Hamilton. According to the GAO, these companies
have been awarded program management contracts to develop
planning and support for the electronic health record
modernization effort.
Given the amount of money spent on VistA modernization, the
lack of return on that investment, we have concerns about this
rollout. It needs to succeed. The whole country is rooting for
the VA to succeed. Previous initiatives to modernize VistA and
to develop and interoperable electronic health record with the
Department of Defense have been full of missed deadlines, cost
overruns, and failures to produce. According to the GAO, from
2011 to 2016, the VA spent about $1 billion for contractors'
activities on their health information technology systems.
Additionally, veterans have had difficulties with
scheduling appointments for far too long. The VA has been
trying and failing to develop a scheduling system that is
compatible with VistA since 2000. That is 17 years spent
working on developing a scheduling system. It is a whole lot of
money, a whole lot of time, and very little to show for it.
VA Secretary Shulkin has said that the VA, and I quote,
``should focus on the things veterans need us to focus on and
work with companies who know how to do this better than we
do,'' end of quote. The Secretary is absolutely right. The
technology and tools to improve the VA's technology and
cybersecurity exist. What is required is strong leadership at
the VA to make the tough decisions about pursuing that
technology. Our veterans deserve a state-of-the-art scheduling
system, they deserve an interoperable and longitudinal
electronic health record, and they deserve good quality
information technology at the agency that exists to serve the
ones who served.
I am looking forward to our hearing today. I am looking
forward to hearing from our witnesses about the future of
modernization, improvement, and technology at the VA.
Mr. Hurd. And now, as always, it is my pleasure to
recognize my friend Robin Kelly for her opening statement.
Ms. Kelly. Thank you, Mr. Chairman.
Information technology is critical to improving the service
and performance of the Federal Government. This is especially
true at the Department of Veterans Affairs, which is one of the
largest integrated healthcare systems in the United States,
serving millions of veterans and their families. The VA's goal
for modernizing its healthcare IT is full of interoperability,
which would allow seamless sharing of health information
between the VA and the Department of Defense, as well as
private healthcare providers.
The VA is now in its fourth attempt since 2001 to modernize
its healthcare IT system. The record has not been good. The VA
abandoned two earlier attempts at spending billions of dollars.
This summer, the VA announced that it would scrap its third
attempt in favor of acquiring the same healthcare IT system as
the DOD. I do not know what we should make of that since the VA
previously abandoned the same approach four years ago.
Chairman Hurd and I requested that GAO examine the VA's
modernization efforts because of these red flags. We discovered
that, right now, the VA is relying on 138 contractors to help
it modernize. Some of them are the very same contractors VA had
hired and fired after their previous attempts had failed. In
fact, 34 through 38 repeat contractors make up about $793
million of the $1.1 billion of the contractual obligations
related to modernization between fiscal years 2011 through
2016. This raises serious concerns. Every change in strategy
delays actually modernizing and makes it harder on veterans who
rely on the agency for health care. We need to understand
whether these changes are justified.
I want to hear today what the agency is doing to hold this
army of contractors accountable. I also want to hear about the
progress made toward its interoperability and improving the
ability to track patient outcomes. Getting these efforts right
and improving VA operations and information security are
essential to regaining the trust and confidence of the American
public that the VA is taking care of our nation's veterans.
Thank you so much. Thank you for being here, and thank you,
Mr. Chair.
Mr. Hurd. The gentlelady yields back.
And I now am pleased to introduce our witnesses: Mr. Scott
Blackburn, acting chief information officer at the VA; Mr.
Dominic Cussatt, is that correct, sir? He is the CISO at the
Department of Veterans Affairs, the chief information security
officer; Mr. Bill James, the deputy assistant secretary for the
Enterprise Program Management Office at the Department of
Veterans Affairs; and Mr. John Windom, program executive for
Electronic Health Records Modernization at the Department of
Veterans Affairs; and the person that wins the award for most
times testifying in front of OGR, Mr. David Powner, director of
IT Management Issues at the U.S. Government Accountability
Office.
Welcome to you all. And pursuant to committee rules, all
witnesses will be sworn in before you testify, so please rise
and raise your right hand.
[Witnesses sworn.]
Mr. Hurd. Thank you. Please let the record reflect that all
witnesses answered in the affirmative.
And in order to allow time for discussion, please limit
your testimony to five minutes. I recognize there are only can
be two statements. And your entire written statement is going
to be made part of the record. As a reminder, the clock in
front of you shows your remaining time. The light will turn
yellow when you have 30 seconds left, and the red when your
time is up. Please also remember to press the button to turn
your microphone on before speaking.
We are going to actually start with Mr. Powner. Mr. Powner,
it is always a pleasure to have you here, sir. No-shave
November is over, just for the record. And you are now
recognized for five minutes, sir.
WITNESS STATEMENTS
STATEMENT OF DAVID A. POWNER
Mr. Powner. Chairman Hurd, Ranking Member Kelly, and
members of the subcommittee, thank you for inviting GAO to
testify on VA's FITARA progress and their efforts to modernize
their aging electronic health records system.
Technology can help make improvements so that ultimately
our veterans will face shorter wait times to schedule care,
receive higher-quality care, and have claims processed quicker
and more accurately. The Department will spend over $4 billion
on IT this year. That makes them the fifth-highest IT spender
in the government. Of the $4 billion, only about $360 million
goes towards developing or acquiring new systems. The remaining
goes towards operational systems and payroll. Many of these
operational systems are old, inefficient, and difficult to
maintain. In addition to its 30-plus-year-old medical
information system known as VistA, VA has an accounting system
and a claims processing system that are both more than 50 years
old.
In 2015, GAO added two new areas to our high-risk list:
managing VA health care and managing IT acquisitions and
operations, which both highlight concerns with VA's IT
management, including past failures where hundreds of millions
of dollars were wasted.
Turning to VA's FITARA progress, VA has historically done a
good job planning for incremental development and continues to
do so. Also to their credit they are only one of seven agencies
to have a complete software license inventory. The area that
needs the most work is data center optimization. VA has closed
about 40 of its 415 centers, saved just over $20 million, and
reports meeting one of OMB's five optimization metrics. Their
closure savings and optimization metrics all fall short of
OMB's goals. VA needs to consider more comprehensive data
center optimization strategy that coincides with their new
approach of reducing the 130 instances of VistA.
Now turning to the EHR modernization initiative, I will
briefly summarize the work we did for you looking at
contractors involved in previous VA EHR efforts, current plans
for the new approach, and suggestions for success moving
forward. My written statement provides details on specific
contractors and the amounts obligated to VA's EHR efforts over
the previous six years.
Here are the highlights: VA obligated approximately $1.1
billion to 138 contractors between 2011 and 2016. About $740
million or almost 70 percent of this went to 15 contractors.
Clearly, we did not get the return needed to modernize
electronic health records with these previous efforts, but
that's water over the dam. What's important now is how can we
improve contractor oversight, performance, and delivery with
the new effort. The decision by Secretary Shulkin in June to go
with the same commercial electronic health records system as
DOD is a good one. Contract award is expected this month. Plans
are to follow within 90 days, and we understand that initial
deployment is expected within 18 months with subsequent
deployments to occur over the next 10 years.
This is a massive undertaking, and I'd like to mention five
keys to success. One, continuity of leadership and Executive
Office of the President involvement. This continuity includes
the Secretary, CIO, and others. Of particular concern is VA's
CIO tenure, which is less than two years. They have had nine
CIOs since 2004. Since leadership change is inevitable, having
White House involvement could help mitigate setbacks associated
with this. The current administration has several EOP offices
whose involvement can help with this important acquisition.
This includes the Office of Innovation and the American Tech
Council. We also think that the Federal CIO's involvement is
important.
Number two, governance in building a robust Program
Management Office. We understand that both interagency
governance is planned, as is governance run by VA's Deputy
Secretary. In addition, it is important that the PMO ensure
better collaboration between the Veterans Health Administration
and the CIO shop than has occurred historically. Also, this PMO
needs to have a strong focus on contract management to ensure
that contractors have high levels of productivity, quality, and
delivery.
Number three, business change management. A major issue
with Federal agencies adopting commercial products is their
unwillingness to change their business processes. This is
definitely a high-risk area for VA.
Number four, leveraging lessons from DOD. Since DOD is
ahead of VA, learning from their experience is essential.
And lastly, number five, building in appropriate cyber
security measures. VA's FISMA audit shows several cyber areas
that need strengthening. Many of these are extremely important
to the new EHR acquisition, including controls associated with
network security and controls for monitoring systems hosted by
contractors.
Mr. Chairman, this concludes my statement. I look forward
to your questions.
[Prepared statement of Mr. Powner follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Hurd. Thank you, sir.
Mr. Blackburn, I have been advised you are going to speak
for the entire VA team. You are now recognized for five
minutes. Welcome.
STATEMENT OF SCOTT BLACKBURN
Mr. Blackburn. Will do. Chairman Hurd, Ranking Member
Kelly, members of the subcommittee, thank you very much for the
opportunity to discuss OIT transformation with an emphasis on
IT modernization, cybersecurity, FISMA and FITARA compliance,
and the electronic health record management initiative.
I'm accompanied by Mr. James, Mr. Cussatt, and Mr. Windom,
and then also available to answer questions behind me as Mr.
John Short, executive director of Information Technology
Systems Modernization.
Also, thank you all for the opportunity to meet with you
one-on-one. The feedback we received was very positive, very
constructive, and we really appreciate that. We especially
appreciate your interest to help ensure we get the electronic
health record modernization effort off on the right foot, along
with other pressing VA matters.
VA is in the midst of a turnaround. Trust was broken in
2014, and helping re-earn that trust is why I left the private
sector to join the VA in November of 2014. This is personal to
me as a disabled veteran and as one of five siblings who are
all either veterans or still serving today in uniform.
Our first quarterly survey to measure veteran trust two
years ago revealed that only 47 percent of veterans said that
they trusted the VA to fulfill our country's commitment to
veterans. Today, that number is 69 percent with an uptick in
each of the last seven quarters. OIT has played a major role in
that improvement. And while 69 percent is great compared to
where we started, that still means that 31 percent of veterans
do not trust VA, which means we still have a long way to go,
and OIT will play an even more important role closing that gap.
We have a comprehensive IT modernization plan, which is the
foundation for reducing reliance on the VA legacy systems. We
will leverage modern technology such as telehealth, cloud,
robotics, machine learning, mobile, digital services, and
blockchain. We will stop or migrate 240 of our 299 current
projects and leverage a buy-first strategy, getting us out of
the software development business and ensuring we are
positioned to manage the influx of new technologies and
innovations.
I'd like to highlight four areas which align with the
Secretary's priorities. Number one, the selection of the new
electronic health record is a major step for VA. A veteran will
have one single longitudinal lifetime medical record. That
means a single common system from the time of enlistment or
commission throughout their service and the remainder of their
life as a veteran. We realize implementing Cerner Millennium
across the country's largest integrated healthcare system will
not be easy, but we strongly believe it is the right thing to
do. Our new electronic health records system will enable VA to
keep pace with the improvements in health IT and cybersecurity,
which the current system VistA is unable to do. Continuing to
maintain VistA is costly. Transition solutions for nearly all
VistA modules have been identified with the majority to be
replaced by the Cerner solution.
Number two, modernizing our scheduling systems is something
I am extremely passionate about as a veteran who's received
treatment at the Washington, D.C., VA Medical Center. This is
an area where we have made improvements, but much more must be
done.
Number three, another OIT commitment is modernizing the
legacy COBOL-based financial management system to standardize
and improve accounting and acquisition services.
And number four involves our benefits delivery network,
BDN, and modernizing BDN will ensure that VBA-wide--that's our
benefits administration--wide monthly payment and processing of
4 million checks remains feasible and that veterans receive
benefits quickly.
Additionally, VA cybersecurity program enables data
protection in the face of threats and is committed to
safeguarding veteran information. We have recently achieved
various program capability and policy milestones to advance
cybersecurity to include just a few hours ago receiving from
the Federal CIO this memo closing 11 open cyber stat activities
with OMB.
VA received a B-plus grade from your FITARA scorecard, and
while we are proud of that score, we acknowledge that our data
center consolidation, as Mr. Powner noted, is nowhere near
where it needs to be, and we are working to fix it. The
establishment of an OIT-based strategic sourcing division will
ensure FITARA compliance for all IT acquisitions.
Thank you again, Chairman and Ranking Member, for the
opportunity to discuss OIT's transformation efforts. As a note,
if there are any questions that are acquisitions-sensitive to
our EHR efforts, we will not be able to discuss those in a
public session, but we can provide those--that information to
you in a closed session at a later date.
Ensuring a safe and secure environment for veteran
information and improving their experiences our goal. I look
forward to your questions.
[Prepared statement of Mr. Blackburn follows:]
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Mr. Hurd. Thank you, Mr. Blackburn.
And before we turn to Mr. Gianforte for the first round of
questions, Mr. Cussatt, we know what a CISO does. Mr. James and
Mr. Windom, can I get you all to explain to the committee what
your exact role is, who you report to directly? Just take 30
seconds.
Mr. James. Yes, Chairman, thank you. The Enterprise Program
Management Office inside the CIO's organization at the VA,
we're the control tower for all of the projects, the ongoing
projects with the exception of the EHR project, which has its
own BEO. So we track all the project's costs, schedule
performance that are ongoing today in the IT organization.
Mr. Hurd. And who is your direct supervisor?
Mr. James. Scott Blackburn, sir.
Mr. Hurd. Got you. Mr. Windom?
Mr. Windom. Sir, recently retired, Captain John Windom, 33
years United States Navy. I was a program manager that oversaw
the DOD successful acquisition of the Cerner Millennium
product. I was brought over in uniform about six months ago at
the request of Secretary Shulkin from Secretary Mattis to kick
off if you will the DNF activities and negotiations with
Cerner. I've been leading that and now in a retired capacity as
a--as the executive overseeing the entire electronic health
record modernization, direct report to the Deputy Secretary,
and so he is who I consider my boss.
Mr. Hurd. Well, welcome. It is good to have you here.
Mr. Windom. Thank you.
Mr. Hurd. It is a mess, and we are glad we have you on
board to work on this project.
Mr. Windom. Great to be here, sir.
Mr. Hurd. The distinguished gentleman from Montana is now
recognized for five minutes.
Mr. Gianforte. Okay. Thank you, Mr. Chairman. I want to
thank each of you for being here. This is a critically
important topic for us to be discussing. In Montana, we are the
second-largest per capita of citizens that have served in the
military. And as I travel the State, the number-one issue I
hear is health care from the VA in every single meeting, so I
appreciate you being here.
And in a rural State like Montana, it can take hours to
drive to a VA hospital or clinic, so scheduling becomes
extremely important, particularly advanced notice. It could
take three days to go to an appointment and come back again.
So, as we have heard, clearly we can do better, and I
appreciate your efforts in that regard.
I come from a software background. I have done literally
thousands of enterprise-class deployments. One particular one
was for the Air Force Personnel Center. It was their entire
records systems for processing all the stuff, so have some
experience. And that handled all active-duty and all retired
Air Force personnel, so it was of some scale.
You have shared that this new Cerner system, Mr. Blackburn,
will be $10 billion and 10 years to complete. Is that correct?
Mr. Blackburn. That's correct, sir.
Mr. Gianforte. Okay. I haven't been through a lot of sales
cycles on the software side. If I had walked into a boardroom
and asked for $10 billion and 10 years before we could get a
system deployed, honestly, I would have gotten laughed out of
the boardroom. It is difficult to fathom it could take that
long. And comparing my own experience with the Air Force system
that we deployed, granted, the entire VA is larger, but what
you are proposing is not 10 times more expensive, it is not 100
times more expensive, it is 1,000 times more expensive, three
orders of magnitude, which provides some level of sticker
shock.
Where I want to focus my questioning, Mr. Blackburn, is
just on what steps you are taking to minimize the cost and get
functionality in the field so that we can retire this VistA
system and move on. So the first area I want to speak about is
just customization of applications. When large enterprise-class
applications are customized, they tend to become brittle.
Integrations don't work as well. What percentage--and one
measure of that is how much of the total fee is going into
customization versus licenses versus operation and maintenance.
Can you share with me a little bit of how that $10 billion
breaks out between license and customization?
Mr. Blackburn. Well, first of all, thank you for the one-
on-one time. That was very productive, and I really appreciate
it.
This is going to be the largest implementation of a
healthcare system, EHR, ever, and it's going to be a really big
undertaking. The key difference between previous efforts is
we're going to be buying the commercial off-the-shelf solution
and absolutely minimizing the customization.
I'll ask Mr. Windom to kind of get into some of the
specifics there.
Mr. Windom. Sir, I appreciate your question, appreciate the
opportunity.
The--I need to make sure there are some facts brought to
the table. Number one is the VA is three times larger than DOD.
We awarded the contract for DOD at $4.33 billion, and so the
complexity is deemed about four times larger in that we have
well over 100 interfaces. DOD had approximately 25 to 27
interfaces.
The $10 billion is not what's needed at contract award. The
$10 billion is for the duration of the contract. And I'm really
not at liberty to talk about specifics of the price
negotiation. We'll gladly come brief you in whatever detail
you'd like personally and give you a complete breakdown of the
pricing structure.
Mr. Gianforte. So just in the initial acquisition, what
percentage is professional services versus license?
Mr. Windom. The--sir, that would be crossing me over to
Procurement Integrity Act because I would be giving you
contract values. Again, sir, prepared to give you that
granularity in a private session outside ----
Mr. Gianforte. Okay.
Mr. Windom.--the public forum, so I apologize. I guess ----
Mr. Gianforte. I think with a number that large we are just
asking to understand.
Mr. Windom. Well ----
Mr. Gianforte. And, Mr. Blackburn then, if we--one of the
recommendations from the GAO here was item 3 to redesign
business process to conform with commercial off-the-shelf
software as a way to bring costs down and reliability. What
business process redesign efforts are you undertaking inside VA
to conform with best practices and maybe leave behind some of
those 30-year-old processes and pick up new ones that are
available to us?
Mr. Blackburn. Well, one of the big issues that we have is
we have different processes at each one of our 168 medical
centers, and so we're not standardized right now across our own
medical system. What this will force us to do is standardize
across our medical system and then also in line with the
workflows of DOD in order to implement this off-the-shelf
solution.
Mr. Gianforte. And, Mr. James, is that a primary focus of
the PMO in doing business process redesign to bring conformity
across the ----
Mr. James. Congressman, that would be better addressed by
the PEO Mr. Windom.
Mr. Windom. Sir, my primary responsibility is program
management oversight, as you alluded to. You get what you
inspect, not expect. I have led to a number of multibillion-
dollar programs and understanding that though we have selected
a phenomenal partner in Cerner or will award a contract, we've
got to have the mechanisms in place to oversee their efforts to
protect the taxpayers' interest and obviously the interest of
our veterans. So our Program Management Office is going to
consist of what I believe is you need physics, physicists to
grade physics homework. So we're going to have the full breadth
of clinical capabilities and technological capabilities at our
disposal to oversee the implementation, sir.
Mr. Gianforte. Okay. Well, I would encourage you that as
much standardization would be ----
Mr. Windom. Yes, sir.
Mr. Gianforte.--helpful in keeping the cost down.
The last point I just want to ask Mr. Blackburn is we have
heard before this committee a number of other agencies testify
about the cost savings increase in reliability and speed to
deployment when solutions are in the cloud. What percentage of
the Cerner system will be native in-the-cloud technology?
Mr. Blackburn. The--Mr. Windom will probably have the best
information for that, but it's the majority.
Mr. Windom. Sir, so we're involving with technology. As you
know, there are a number of inhibitors associated with the
movement of PII data into the cloud. I can assure you we're
working ----
Mr. Gianforte. So is there a percentage?
Mr. Windom. Sir, I don't have a percentage, but we're going
to be on premise and in the cloud simultaneously in delivering
that support. What the ----
Mr. Gianforte. We have had other agencies testify that
there are 100 percent in the cloud now.
Mr. Windom. That's not the case, sir.
Mr. Gianforte. Okay. Well ----
Mr. Windom. That would not be the case for us.
Mr. Gianforte.--I just want to--I will just finish up. I
have run past my time. Thank you, Mr. Chairman. It is just the
work you are doing is critically important for our veterans.
They are not--we all know they are not being served well today.
Let's work together to make this happen.
Mr. Blackburn. Absolutely. Absolutely, sir.
Mr. Gianforte. I yield back.
Mr. Hurd. The gentleman yields back. Now, I recognize the
ranking member for her first five minutes of questions.
Ms. Kelly. Thank you, Mr. Chair.
The number-one mission of the VA is to care for our
veterans, and a central part of that mission in delivering
quality healthcare generally is tracking outcomes. The ability
to track outcomes help both prevention and treatment. Mr.
Blackburn, the VA cannot properly care for our veterans and
track outcomes without the ability to communicate with DOD and
share information. Can DOD and the VA currently exchange
patient health data between one another?
Mr. Blackburn. Thank you, Ranking Member Kelly, and thank
you also for our one-on-one session.
The--yes. The answer is yes, that we currently can. My
doctor in the Orange Clinic of the Washington VAMC, we have
something called Joint Legacy Viewer in--which allows
clinicians within DOD and VA to be able to see each other's
medical records. It's not perfect. It's read-only. It's as good
as it could possibly get it. I think we have roughly almost 8
million or so medical records that have been viewed on Joint
Legacy Viewer.
Ms. Kelly. Thank you. Do all users have access to
interoperable electronic health records, the system?
Mr. Blackburn. The--I think most. John Short, is that all?
All.
Ms. Kelly. All? Okay, great.
Mr. Blackburn. Yes.
Ms. Kelly. VistA evolution showed progress in achieving the
ability to share data between DOD and VA. In June of this year,
however, the Secretary announced that the VA would now acquire
the same health system as the DOD. This is a rather remarkable
shift since it was previously planned that DOD and VA would
have the same healthcare system and that efforts were
abandoned. Why is the VA going back to this plan that it
previously abandoned, and why does it believe this is the best
course of action at this time?
Mr. Blackburn. The--maintaining our current VistA system is
not an option. It will be incredibly costly. Matter of fact, we
had a third-party estimate that took a look at it and estimated
it would be roughly up to $19 billion to maintain and to
upgrade our current VistA system. And that would not get us the
seamless interoperability of--that we're looking for with
veterans. With--by moving to the same exact product, the same
exact instance that DOD has, it will all be one record. It will
be DOD doctors and VA doctors going into the exact same record,
which will make that seamless.
Currently, as a veteran, most of my records as a soldier
were on paper. Those were lost when my parents' basement was
flooded, so my VA doctor does not have that information. That
will not be the case for my kids when they go to serve.
Ms. Kelly. Okay. And, Mr. Blackburn, will the transition
away from the health management platform that was the key part
of the VistA evolution affect the interoperability with the
Department of Defense?
Mr. Blackburn. Please repeat the question.
Ms. Kelly. Will the transition away from the health
management platform that was a key part of VistA ----
Mr. Blackburn. Yes.
Ms. Kelly.--evolution, will that affect the
interoperability with the Department of Defense?
Mr. Blackburn. We will maintain that ability on Cerner to
be able to view those records within the Joint Legacy Viewer,
so we will not lose that data. That will be a key part of our
implementation.
Ms. Kelly. And what is your timeline?
Mr. Blackburn. The timeline overall for implementation of
Cerner is roughly 10 years ----
Ms. Kelly. And ----
Mr. Blackburn.--for the entire thing.
Ms. Kelly. And what are you doing to achieve
interoperability with healthcare providers outside of the VA
and DOD?
Mr. Blackburn. That's a great question, and that's actually
something that we're working with the Office of American
Innovation and the White House on. The Cerner solution, that
will give us interoperability within the VA, first of all.
Second, it will give us interoperability with the DOD because
it's the same record. And then thirdly, the--Cerner has a
CommonWell solution in which they have their network of private
hospitals that that will--but it won't give us 100 percent. No
solution right now will give us 100 percent with the private
sector. That solution does not exist right now, but I think
that would be a longer-term goal for our country so that it
would be completely seamless. And that's actually a problem
that we're working with the White House on.
Ms. Kelly. Okay. Thank you. In previous testimony before
this committee GAO has stated that agencies need, and I quote,
``To define what they aim to accomplish through 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?
Mr. Blackburn. Absolutely. Absolutely agree.
Ms. Kelly. And what do--well, what does your respective
agency aim to achieve regarding improved health outcomes and
delivery from your interoperability efforts?
Mr. Blackburn. Ask Mr. Windom for specifics there.
Mr. Windom. The metrics--the right metrics, ma'am, I would
offer are our primary concerns, so KPPs, SLRs, SLAs, things
that we can use to clearly identify that we are achieving our
quality goals on behalf of our beneficiaries.
We've got what's called a quality assurance surveillance
plan as part of the contract. Those contracting officer
representatives, quality assurance representatives will be
overseeing the delivery of those metrics as the product is
being rolled out to ensure that we're in fact getting what we
paid for. So there's a myriad of metrics that add value that
are not only aligned with the commercial standards that kind of
reduce that customized problem that we often have when
implemented business systems but also to leverage what's
important within the VA with regards to value metrics. So a
combination of the two, ma'am, and we use the quality assurance
surveillance plan as that tool to oversee those metrics.
Ms. Kelly. Can I just ask one more question?
When I asked about how you are working with outside ----
Mr. Blackburn. Yes.
Ms. Kelly.--entities, now in the State of Illinois I
believe they passed legislation where a veteran could go to
another hospital or at least they were working on it.
Mr. Blackburn. Yes.
Ms. Kelly. How many States is it, do you know, that ----
Mr. Blackburn. The whole ----
Ms. Kelly.--can do that? The whole ----
Mr. Blackburn. The whole country. That's the Veterans
Choice Program, which has not been perfect. I know in Montana
it has not been good. It's been terrible. But that's something
that we're working on, and actually, there's draft proposals of
bills in place to improve that program right now.
Ms. Kelly. Okay. Is this--like where I live in the suburbs
or the south suburbs of Chicago and where the VA hospitals are
----
Mr. Blackburn. Yes.
Ms. Kelly.--downtown and west, so it is an effort to get
there, not like Montana but ----
Mr. Blackburn. Yes. So, ma'am, I'm actually a good example.
I get my primary care at the Washington VAMC, but I get
physical therapy through the Veterans Choice Program in
Bethesda closer to where I live. The--and it makes a big
difference.
Ms. Kelly. Okay. Thank you.
Mr. Blackburn. Yes.
Mr. Hurd. All right. I recognize myself ----
Mr. Connolly. I am sorry, Mr. Chairman. Did I just hear
Maryland, not Virginia?
Mr. Blackburn. That is correct, Mr. Connolly.
Mr. Connolly. Oh, my Lord. All right.
Mr. Hurd. Bad move, Mr. Blackburn.
I recognize myself for five minutes, and I yield to the
gentleman from Montana.
Mr. Gianforte. Okay. Thank you, Mr. Chairman.
I just want to continue the conversation a little bit. And,
Mr. Blackburn, you testified again this Cerner implementation,
$10 billion, 10 years, and I understand the VistA system then
has to stay in place for that entire period of time. And as I
understand the cost to--annual cost currently for the system is
between 800 and $900 million a year. Is that correct?
Mr. Blackburn. Roughly. Roughly. It's multiple hundreds of
millions of dollars, way too expensive.
Mr. Gianforte. And aspects of that system are pretty long
in the tooth, is that correct? It has been around a long time?
Mr. Blackburn. Oh, it's been around for about 40 years.
Mr. Gianforte. And it is not working that well?
Mr. Blackburn. It has worked for 40 years, but it's not
sustainable. It can't go forward into the future.
Mr. Gianforte. It has lost its luster at a minimum ----
Mr. Blackburn. It has.
Mr. Gianforte.--the 40 years. So here is my--one strategy I
have seen used in the private sector when you have these
massive boil-the-ocean kind of projects like the one we are
undertaking that is 10 years and $10 billion is to use on an
interim basis best-of-breed technologies to pick off high-value
components that may be excessively costly or of high value in
terms of functionality. You mentioned scheduling.
Mr. Blackburn. Yes.
Mr. Gianforte. It happens that I had served on a board of
directors of a medical scheduling company. I am not here to
advocate for them, but we did scheduling for tens of thousands
of doctors across the United States completely in the cloud. If
you were able to spend a small amount of money to do something
and then throw it away when utopia arrives in 10 years, have
you considered strategies like this to use best-of-breed
technology on an interim basis to deliver more value to our
vets in the short term and save operation and maintenance costs
out of this $8-900 million a year you are spending on VistA?
Mr. Blackburn. We have. And scheduling's been a massive
issue for us. As a matter of fact, we have a board, a visual
that shows what our previous scheduling system looked like,
right? This is what doctors had to go and use. What we're
currently doing right now in 151 out of our 158 facilities is
we've moved under Mr. James, who has lead this program, to what
we're calling VSE, VistA--it's an upgraded VistA GUI system on
top of that. That is a shorter-term bridge as one of the
efforts we've done on there. There are also a couple of other
efforts that we have. One is an online scheduling application,
again, a homegrown system, so ----
Mr. Gianforte. Okay.
Mr. Blackburn.--the VSE system is homegrown.
Mr. Gianforte. To what extent have you looked at commercial
off-the-shelf ----
Mr. Blackburn. Yes.
Mr. Gianforte.--best-of-breed applications to pick off
either high-cost or high-value components of VistA just on an
interim--I mean, because 10 years is a long time. I am not sure
any of us are going to be sitting here in 10 years, but we are
going to have veterans looking for services. To what extent
have you implemented that sort of strategy?
Mr. Blackburn. Yes. Mr. James, do you want to talk a little
bit about that?
Mr. James. Sure. We've looked at that over and over again,
and we can apply, for example, with the VSE, VistA scheduling
enhancement outlook like GUIDANCE, that type of best-of-breed
at the top layer, but the problem comes when you have to
interface it to the 130 different versions of VistA across the
country, each one of which has 140 to 150 old ----
Mr. Gianforte. Does that ----
Mr. James.--applications.
Mr. Gianforte. That VistA GUI, does that work on mobile
devices?
Mr. Blackburn. Yes. Yes, sir.
Mr. Gianforte. And it works on a web browser?
Mr. James. Yes, sir.
Mr. Gianforte. So a veteran can access it from anywhere?
Mr. James. Yes, sir.
Mr. Gianforte. And is that deployed in Montana?
Mr. James. I believe it is. I'd have to confirm ----
Mr. Blackburn. It's currently deployed in 110 of our sites.
We'll have to check and make sure Fort Harris ----
Mr. Gianforte. I am more interested--I ask more from the
perspective of a rural State ----
Mr. Blackburn. Yes.
Mr. Gianforte.--that has a lot of veterans. So I would just
encourage you to do that. And just in our conversation, to
summarize, I think--and you have mentioned these things. I
would just encourage you, minimize customization.
Mr. Blackburn. Yes.
Mr. Gianforte. Change business practices to standardize
them so you are not doing the customization. Get to the cloud.
That is where the puck is going to be.
Mr. Blackburn. Yes.
Mr. Gianforte. We need to skate there. And then I would
highly encourage you to look at best-of-breed commercial off-
the-shelf apps as gap-fillers between now and utopia that is
going to show up in 10 years from now.
Mr. Blackburn. Absolutely. I appreciate that feedback.
Mr. Gianforte. And, Mr. Chairman, I yield back.
Mr. Hurd. Reclaiming my time. Mr. Powner, there is a lot of
conversations going on, a lot of topics hit. Do you have any
opinion on the comments so far?
Mr. Powner. Yes. I think clearly the word minimize is--
that's a scary word, okay, because we've heard minimize
customization with a lot of commercial products in the Federal
Government, and that's--minimize means a range of activities. I
think you want to really try to almost eliminate customization.
You're going to change your business processes anyway
significantly, so go full bore and eliminate.
Mr. Hurd. Thank you, Mr. Powner.
Now, it is a pleasure to recognize my friend from the
Commonwealth of Virginia, Mr. Connolly, for your round of
questions.
Mr. Connolly. I thank my friend from Texas, Mr. Chairman.
Thank you.
And welcome. And Mr. Blackburn was also--you made the
rounds, and good for you.
Mr. Blackburn. Thank you.
Mr. Connolly. Mr. Powner, let's begin by--can you summarize
what kind of performance did we see in the FITARA scorecard for
VA this time?
Mr. Powner. Well, on the FITARA scorecard overall B-plus.
They've consistently scored well on incremental development to
their credit. Software licensing, they were one of seven
agencies to have that inventory and do something with it, so
those areas are very strong. The one area that everyone
acknowledges that they have a lot of work to do is on data
center optimization. They fall far short of OMB's goals on
closures, savings, and also with the optimization metrics.
Mr. Connolly. And, by the way, just putting that in
context, if I am correct, GAO reported that, as of August 2017,
we have identified a total of 12,062 data centers. That is
2,000 more than a year ago.
Mr. Powner. Yes, we've been back and forth on the total
number here. A lot of that's attributed to Treasury where
you've ----
Mr. Connolly. Those people ----
Mr. Powner. They had a number in the inventory, off the
inventory. They're back in the inventory, so now we are up to
about 12,000. The good news government-wide is we've closed
almost half of those, close to 6,000, so that's the good news.
Mr. Connolly. Right. Okay. And let me see. And, Mr.
Blackburn, if I understand your inventory, you have got 415
data centers, correct?
Mr. Blackburn. Roughly. I think we started with 386, but
it's an awful lot, way too many.
Mr. Connolly. And you have closed only 39 as of August?
Mr. Blackburn. I had 24 but the--roughly correct.
Mr. Connolly. Mr. Powner, do you want to comment on that?
Mr. Powner. My numbers are close to about 40 of the 415 --
--
Mr. Connolly. Right.
Mr. Powner.--as of August.
Mr. Connolly. I mean, I am kind of following his numbers,
but ----
Mr. Powner. Sure.
Mr. Connolly.--if your performance is even less stellar --
--
Mr. Powner. I have even less closures.
Mr. Connolly. All right. Now, in our conversation you set a
metric for yourself, and do you want to share that with us? So
let's call the number somewhere around 400 data centers.
Mr. Blackburn. Yes.
Mr. Connolly. What do you want to get it down to and in
what time frame?
Mr. Blackburn. We would like to get down to 14 core data
centers by the end of 2020. In addition to that, we would have
42 special-purpose data centers. These are things like for our
mail-order pharmacy and things of that nature, but even that to
me feels it might be a little high, so I would like to go and
kind of scrub those with my team. But that would be our goal by
the end of 2020.
Mr. Connolly. That is a pretty strong stretch goal to go
from 400-plus to 20. Mr. Powner, realistic goal?
Mr. Powner. I believe--here's what's--that makes it
realistic. When you look at the 130 instances of VistA and a
lot of the data centers are co-located at these facilities, I
think the data center consolidation really needs to go hand-in-
hand with this migration to the commercial Cerner product.
That's where there's a real opportunity to save a lot of money
in the data center area. We're spending a lot of money, but we
can get a huge return from a data center point of view.
Mr. Connolly. What is the estimated savings if Mr.
Blackburn achieves this goal in three years for the data center
consolidation? Any estimate?
Mr. Powner. I don't have a good estimate on that.
Mr. Connolly. Are you operating on any kind of assumption
it will save us X?
Mr. Blackburn. I haven't been able to get an estimate yet.
I think that's one of the reasons why we have such a low grade
on FITARA.
Mr. Connolly. Yes, I think that is really important both
for ----
Mr. Blackburn. Yes.
Mr. Connolly.--incentivization and maybe more important now
that MGT, the bill we have been working on collectively here,
hopefully will be law soon.
Mr. Blackburn. By Tuesday.
Mr. Connolly. By Tuesday. And that obviously allows you to
be reinvesting in yourself with the savings effectuated
pursuant to FITARA. So we--among other things, but I mean I
would hope that is an incentive for people.
Mr. Blackburn. Absolutely. We're very excited about that,
and I think the more positive incentives like MGT that can put
in place where we can reinvest those savings, we're extremely
excited, and that will really help us.
Mr. Connolly. Mr. James, I see you affirming that. You are
welcome to comment.
Mr. James. Yes, Congressman. I'm from your district so I
can dig Scott out of ----
Mr. Connolly. Excuse me.
Mr. James.--his Maryland hole.
Mr. Connolly. This man is only deputy assistant. He needs a
promotion.
Mr. James. Congressman, the reason I share the excitement
in that act is that our Secretary has challenged us to go
find--ask industry for some innovative ideas, share-in-savings
types of ideas where we put in some seed money, they find
savings, and then we share the benefits. We win, they win. And
the seed money could come from that particular act, and so
we're--we have a runway in front of us that, with that act, I
think we can make some headway.
Mr. Connolly. And you have raised the Secretary, and that
is good to hear, too. Can you talk a little bit, both you and
Mr. Blackburn, anyone else who wants to as well, but one of the
things Mr. Hurd, Ms. Kelly, and Mr. Meadows and I are concerned
about frankly is the organization chart. Who reports to whom?
How high up in the hierarchy is the CIO? Because we feel that
if you don't have the ear of the boss, it is all fascinating
but no guarantee anyone is going to pay the kind of qualitative
attention we demand, we want. We think that the CIO has just
got to be an empowered person and everyone needs to know it. So
comment a little bit about what is the relationship with the
Secretary?
Mr. Blackburn. Yes.
Mr. Connolly. Let's stipulate the Secretary is wonderful
and walks on water. We will stipulate that, but what is the
working relationship and what does it look like on the
organization chart so the somebody like us, it would leap out
right away or it wouldn't?
Mr. Blackburn. So on the organizational chart the CIO
reports directly to the Deputy Secretary at the VA. The ----
Mr. Connolly. Which is Mr. James?
Mr. Blackburn. Which is Mr. Tom Bowman is the Deputy
Secretary.
Mr. Connolly. Okay.
Mr. Blackburn. The ----
Mr. Connolly. Oh, I'm sorry, you said Deputy Secretary.
Mr. Blackburn. Yes.
Mr. Connolly. Right.
Mr. Blackburn. Yes. Yes. So CIO reports to--I report to Tom
Bowman. The--Secretary Shulkin is incredibly hands-on involved.
He and I have a great relationship. I was the interim deputy
secretary until Mr. Bowman came on board. He has been very,
very hands-on and active. He is the one that personally made
the decision to go to the commercial off-the-shelf solution
with Cerner. He is very comfortable with technology and a big
proponent of what we're doing.
Mr. Connolly. Sure. And you concur, Mr. James?
Mr. James. Yes. Yes, Congressman.
Mr. Connolly. All right. Anyone else want to comment?
So, Mr. Powner, we are going to be back here in a year or
so hopefully with a different grade that is an improved grade
because of data center consolidation. Do you agree?
Mr. Powner. Let's hope so.
Mr. Connolly. All righty. Thank you all so much for being
here. I do hope--I want to underscore Mr. Hurd, my presence
here, and Ms. Kelly and Mr. Meadows--who couldn't join us
today--I don't mean to leave you out. I am just talking about
the ranking member and the chair. We are committed on a
bipartisan basis to make this happen, so we have got your back,
but we will also--we are more than willing to create pressure
and stress where it is needed to improve performance because we
are very serious about FITARA and the other related bills. So
thank you for being here and thanks for your commitment, which
I think is robust, and I like that in government, so thank you.
Mr. Blackburn. Thank you, sir.
Mr. Hurd. I now recognize myself again for five minutes of
questions. And to follow up on what my friend from Virginia was
talking about, about the question on coordinating data centers
with the Cerner rollout, and everybody was shaking their head
as if this is a good idea. And my question is are we
coordinating the closure of data centers with the Cerner
rollout? Mr. Blackburn, maybe that goes to you.
Mr. Blackburn. We are, and I'll yield to Mr. Windom to talk
about the Cerner rollout.
Mr. Windom. Yes, sir. Mr. Chairman, the Cerner solution has
a platform called Healthy Intent. That's its primary data
management hosting element that we intend to move our data into
obviously in a controlled and properly risk-mitigated fashion
such that we don't compromise that care being delivered. We are
going to make sure that we--that data is where we want it to be
and usable before we shut anything down. That's why I believe
that our data consolidation plan is feasible because we are
moving that data very similar to the DOD solution into the
Healthy Intent platform that gives us again that seamless
movement of data across DOD and VA environments.
Mr. Hurd. So how long will VistA and the new electronic
health records system coexist?
Mr. Windom. Sir, let me--so you have a relative--the DOD--
when we awarded the DOD contract, it's a seven-year rollout for
about a third of the size of the VA population, 1,600
facilities on VA side, about 600-plus including ships and
expeditionary platforms on the DOD side. In addition, we have
318,000 users relative to about 112,000 users on the DOD side.
So the answer to your question is is that the plan is going to
be to roll this out, VistA has to run simultaneously with the
new solution. That's part of the acquisition curve and that we
have to keep that solution delivering today.
Mr. Hurd. Mr. Windom ----
Mr. Windom. Yes, sir.
Mr. Hurd.--I understand, and your job is hard.
Mr. Windom. Yes, sir.
Mr. Hurd. Nobody questions that. Nobody questions that. But
the difficulty you are going to have is what I would call the
incompetence of previous activity, right? And so you are the
new man, and you have the right credentials to do this, but
this is the frustration when you see this has been going on for
a long time because we are solving the problem. So the first--
if the veteran leaves DOD in, let's say, 2019 and they
transition to the VA, he or she will be moving to the VistA
system, is that correct?
Mr. Windom. Potentially. And I say that because one of the
reasons for our deployment schedule is we're--we intended to
align as much as possible to the deployment schedule of DOD --
--
Mr. Hurd. Yes.
Mr. Windom.--because we want to demonstrate
interoperability to you immediately.
Mr. Hurd. So ----
Mr. Windom. So it depends would be the answer.
Mr. Hurd. And let's get to interoperability. We are going
to be here for a while. The JLV is not interoperability. Has
anybody at this panel set with doctors in a facility and had
them walk you through the JLV? Mr. Windom?
Mr. Windom. Yes, sir. I was DOD when we only were moving 50
records.
Mr. Hurd. Yes.
Mr. Windom. Now, we're moving tens of thousands if not
hundreds of thousands ----
Mr. Hurd. So ----
Mr. Windom.--so yes, sir, the answer is yes, sir.
Mr. Hurd. So you understand the problem. And so we talk
about JLV like we have already achieved interoperability. We
haven't. It is the equivalent of using microfiche, and so the
fact that, yes, it is the right decision to go to one system,
but that one--so the people that are going to benefit are
potentially--we are seven years away from that. And yes,
Healthy Intent is the data platform that you're going to be
using on Cerner, but what VA and DOD have not proven they can
do is to integrate that data in one view.
And so my concern is this is still a problem of data
interoperability because we have to take all the data that has
been gathered from VistA and make sure it is viewable through
Cerner. And there is nothing to date that makes me feel
comfortable that we know we can do that. And we are sitting
here saying, yes, it is a big--the largest software sale ever
in the history of the planet, right? Like I get how big of a
deal it is, but, number one, why the hell are there 130
versions of VistA? Now, Mr. Windom, I know that is not your
problem. That is not your problem. But, Mr. Blackburn, can you
give me some--like how has that been allowed to continue? I
don't even know what that means. How would you have 130
versions of the same program operating in one organization?
Mr. Blackburn. So my understanding of that--and VistA
started around the time I was born, so this decision dates back
to me being a toddler--was--the idea at the time was local
innovation. VistA was built by doctors, for doctors. Still to
this day it actually rates as a--doctors rate it as the most
user-friendly electronic health record.
Mr. Hurd. It was groundbreaking ----
Mr. Blackburn. Yes.
Mr. Hurd.--when it started.
Mr. Blackburn. Yes.
Mr. Hurd. Yes. I would agree with that.
Mr. Blackburn. And they ----
Mr. Hurd. But 130 versions later is pretty crummy.
Mr. Blackburn. You're exactly correct, and that means, you
know, if I go--if I'm getting seen in--right now in Washington,
they can't--it's difficult if I go to another instance for that
data to flow seamlessly.
Mr. Hurd. So what processes were in place or not in place
that allowed that behavior to continue? Because if we don't
first identify why that behavior was allowed to happen, we are
not going to be able to prevent it in the future.
Mr. Blackburn. The philosophy at the time was we're going
to push the power of how to run the hospital to the electronic
health record and their workflow to the local hospitals.
Mr. Hurd. Sure.
Mr. Blackburn. So there's the joke if you've seen one VA,
you've seen one VA. They run completely differently, and then
they map their health record to how they were run. What we
are--what we are going to do is standardize workflows and not
allow that to happen. And matter of fact, DOD and VA will have
the exact same workflows.
Mr. Hurd. Now, it is pretty clear from the limited time we
have in with Mr. Windom that he is high speed, low drag, and my
question, Mr. Windom, when will we be able to demonstrate for
one record that we can get the data from a VistA EHR and view
it through a Cerner application? When will we be able to
demonstrate the ability to do that for one?
Mr. Windom. Sir, the timeline for what we call initial
operating capability, which we anticipate for Pacific Northwest
is less than 18 months. So we expect to be able to demonstrate
interoperability. Obviously, we will be doing it in a
laboratory environment where will be able to demonstrate a
record, but we want to show you in a real-time environment. And
so prior to full deployment, we will have achieved IOC at these
various sites, sir.
Mr. Hurd. The last time we had this conversation with your
predecessors, my question was, at its core, this is not a hard
challenge. You map one data element to another data element. L
name maps to last name, full name maps to F name. Have we done
that mapping?
Mr. Windom. Sir, that alignment--we've got a comprehensive
data management strategy. You know, your points are right on
point if you will in that we are not going to put JLV data into
the Healthy Intent platform. That data is being reconciled such
that we have transactional capability to move data ----
Mr. Hurd. Sure.
Mr. Windom.--to process data between DOD and VA, so it's
not just--we know--JLV was a--was an interim fix. JLV access
will exist as we transition because we don't want to destroy
that existing continuity of data. But the Healthy Intent, it's
just not going to be load JLV into Healthy Intent. It's going
to have manipulatable data, transactional data that supports
the movement of information across the DOD and the VA
enterprise, sir.
Mr. Hurd. So is the data architecture of VistA version 1
different from VistA version 130? So are you working with 130
different data sets?
Mr. Windom. Yes, sir. That would be accurate.
Mr. Hurd. That is crazy.
I would like to now recognize Mr. Connolly.
Mr. Connolly. Thank you, Mr. Chairman. Just to humanize
what you are talking about, Mr. Chairman, Mr. Blackburn, I
think you shared with me your own personal experience in terms
of health records. Could you remind me, so you come from
Massachusetts, God's country, right ----
Mr. Blackburn. Right.
Mr. Connolly.--except for Virginia.
Mr. Blackburn. Yes.
Mr. Connolly. And your files were in ----
Mr. Blackburn. Partners Health Care, so Mass General
Hospital ----
Mr. Connolly. Right. Okay.
Mr. Blackburn.--Beth Israel.
Mr. Connolly. And you need to have someone here look at
them, right?
Mr. Blackburn. Yes, so I--and I lived in Cleveland for 10
years, so I have medical information in the Cleveland Clinic.
Obviously, I was a soldier in the Army. I get my care at the
VA. I get some of my care at NovaCare. The--last summer, I
broke my arm and got rushed to the hospital at a Johns Hopkins
Hospital, so all my data, my healthcare data is spread out over
all these different healthcare systems that do not necessarily
talk to each other.
Mr. Connolly. So how did that affect in any material way
the quality of care you were given?
Mr. Blackburn. Oh, it affects it drastically. The--you
know, when I came here and enrolled in the Washington VAMC, I
actually brought a large paper file from the Cleveland Clinic
that I printed out to my doctor, and he was very appreciative
of that. The--it's very difficult for them to tell me--to be
able to see things like x-rays from when I broke my arm, what
shots I've had. You have to fill out paperwork over and over
again.
Mr. Connolly. Which an electronic record-keeping system
ought to obviate?
Mr. Blackburn. As long as they talk to each other.
Mr. Connolly. But they have got to be compatible, which it
goes to interoperability, right, Mr. Windom?
Mr. Windom. Yes, sir.
Mr. Connolly. Well, as we heard, it is not just a nice
thing to do, and it is not even just that it saves money. It
also affects quality of care of the veterans we serve ----
Mr. Blackburn. Yes.
Mr. Connolly.--so there is a real imperative here. I thank
you. Thank you, Mr. Chairman.
Mr. Hurd. The distinguished gentleman from Montana is
recognized.
Mr. Gianforte. Thank you, Mr. Chairman.
Mr. Blackburn, you had said that scheduling is a particular
area of focus ----
Mr. Blackburn. Yes.
Mr. Gianforte.--for you, so a very simple question. Does
the VA currently have a commercial off-the-shelf scheduling
pilot in production?
Mr. Blackburn. We have two. So we have one as mandated by
the Faster Care for Veterans Act. We actually--it's in test
mode right now. I believe it just went live just a few days ago
in three VA hospitals: Minneapolis; Salt Lake City; and
Bedford, Massachusetts. We also have a pilot going on in
Columbus, Ohio, with a solution called MASS, which is an Epic-
based, resource-based scheduling system.
Mr. Gianforte. Okay. So Epic is really a competitor with
Cerner?
Mr. Blackburn. They are.
Mr. Gianforte. Yes, so you are deploying Epic as well as
Cerner?
Mr. Blackburn. The Epic is in pilot mode in Columbus. We--
that was actually--that was put in place before the Secretary
made the Cerner decision.
Mr. Gianforte. Okay. So that will be phased out and
converted to Cerner?
Mr. Blackburn. Depending on how the pilot--we haven't made
that final decision yet, but we will be making that in the
spring.
Mr. Gianforte. Okay. So we have VistA that is 30 years old.
We are rolling out a $10 billion Cerner project. We are also
rolling out a competitor in the Epic system. I thought I was
going to ask about scheduling, but this gives me more concern.
Why wouldn't you just shut that project down now that you have
made the decision to go with Cerner?
Mr. Blackburn. That was one of the options.
Mr. Gianforte. Is this ----
Mr. Blackburn. We just haven't made the final decision.
Mr. Gianforte. Is this taxpayer dollars being well spent on
a project that is going to get--I, honestly--frankly, I just
don't understand that decision.
On the scheduling, you say you have just been live a short
period of time. Do you have any initial analysis of the
functionality of this OPSS system that is piloted versus the
lipstick that was put on the pig on VistA?
Mr. Blackburn. Mr. James?
Mr. James. Yes, Congressman. The Faster Care for Veterans
Act specifies seven capabilities that must be provided by the
OPSS system, and today, our PM tells me that the OPSS system
meets those seven requirements. The other part of the Faster
Care for Veterans Act requires a Mitre in the IVNV mode to
assess other similar types of scheduling, homebrewed systems if
you will into VA, and that one is far. And that also has those
seven capabilities.
Mr. Gianforte. Okay. So you're just getting started with
that pilot. What is your first review period of the pilot? Is
it in 90 days or so?
Mr. James. Sir, the Secretary must certify according to the
law that it provides those seven capabilities by December 31 at
those three sites, and we believe that it is operating today,
but that's just today. We have some time. Then, subsequent to
that certification, we have to have an independent validation
verification of those seven capabilities. That's also in the
law by an FFRDC. In this case, that's Mitre. So that'll happen
after the Secretary certifies on--by December 31.
Mr. Gianforte. Okay. Well, Mr. Chairman, I would just
suggest that maybe we ask for some feedback on this pilot. We
have been advocating--earlier, I advocated for commercial off-
the-shelf scheduling applications. This OPSS didn't come up in
that earlier discussion. It sounds like we are live in a number
of cities. We ought to know in 90 days if it is working or not
and is it better than the lipstick we are putting on VistA that
is costing us so much money. So I thank you for sharing that
additional information. I yield back.
Mr. Hurd. I recognize myself for five minutes.
Mr. James, MGT, what do you need to do in order to ensure
that you have a working capital fund, an MGT working capital
fund to take advantage of the savings that Mr. Blackburn and
Mr. Windom are going to realize through their efforts?
Mr. James. Thank you. Thank you, Mr. Chairman. I'm not the
finance guy in OINT. I believe we do have today some working
capital fund mechanisms in place that we already use. My
expectation is that MGT would either complement those or
augment those or be part of those. I can come back with
additional information.
Mr. Hurd. Who would be the person that would set that up so
Mr. Blackburn has his MGT working capital fund?
Mr. James. Chairman, they're--inside our CIO organization
we have a finance organization that's dedicated to managing our
appropriation every year, so that is our--internally, we call
that ITRM. That's our CFO if you will for our CIO organization.
He would have that responsibility.
Mr. Hurd. Well, will you please deliver a message to him
that this committee is interested in ensuring that Mr.
Blackburn has a--or Mr. Blackburn's replacement has a working
capital fund from MGT because there is going to be a whole lot
of modernization going on in the VA. There is going to be
savings that are being realized, and because it is such a
massive enterprise, that will be able to help Mr. Windom
hopefully beat that 10-year clock ----
Mr. James. Sure.
Mr. Hurd.--of getting this implemented.
Mr. Cussatt, we haven't even gotten to you because there
are so many questions about the actual deployment. How are you
ensuring when this deployment is being done, that all the
appropriate cybersecurity tools and functions are activated and
live to ultimately protect the health data of our veterans?
Mr. Cussatt. Thank you, Chairman. So it's--I see it as my
job as the CISO for the VA to ensure that cybersecurity is not
a barrier to interoperability and information-sharing but
instead it's an enabler of it.
So I came from DOD. I was there for 12 years in the CIO's
office, and we rewrote all the DOD policy to better employ the
NIST standards. And in the year-and-a-half I've been at VA,
we've done the same at VA. So we are ----
Mr. Hurd. So, Mr. Cussatt, are we going to have a written
policy on application security for the Cerner implementation?
Mr. Cussatt. I believe the Cerner application will benefit
from the policy we have writ large for VA that applies to all
the systems. We're trying not to build a one--a single instant
solution for it. We want to build something that's going to
benefit us across the Department and be interoperable with DOD.
Mr. Hurd. So, gentlemen, there are so many questions here.
Mr. Powner, before I close, do you have any further insights on
the rest of the conversations that have been going on today?
Mr. Powner. Just a comment about the scheduling situation.
I mean, you have VSE, we have pilots going on, we clearly have
a module with Cerner. What needs to occur in the scheduling
area is direction forward. What's the plan? There needs to be a
clear plan because right now, it's duplicative. There's no
other way--it's duplicative. And it's okay to pilot and do
things and test all this, but we ultimately need a plan going
forward that's a solid plan with the right solution.
Mr. Hurd. Good copy, Mr. Powner. One of the things that I
feel good about is that I love that many of the folks
intimately involved in this are veterans. You understand the
type of sacrifices your compatriots have made. You understand
the interest that this service is to many of our veterans.
But I would say you all are actually doing something that
can be life-altering for a lot of folks. A $10 billion project
to integrate 130 different data sets and achieving true
interoperability, this will be the model. If we are able to
integrate DOD in VA, the two largest healthcare providers in
the world, then we are going to be able to integrate to every
other system.
And so the VA is going to be back in setting the curve and
being on the cutting edge because you all have achieved the
ability to do a true longitudinal record so everybody is going
to be able to have better health outcomes because every doctor
they go to, they are going to be able to see every other time
they went to the doctor. We are going to be able to do
virtualized research cohorts based on this information because
it is in the cloud and we are going to be able to access it.
Mr. Cussatt is going to make sure it is protected and
anonymized, and then we are going to be able to bring drugs,
lifesaving drugs to market faster. And so this is the
opportunity that we have here, and if we can't do it in 10
years with $10 billion, then it is never going to get done.
And so I think you all recognize and understand this issue.
This committee is going to continue to provide oversight and
continue to get into the weeds. It is great having the talent
of folks like my friend from Montana and the gentleman from the
Commonwealth of Virginia. We are not going to stop.
So thank you all for being here. Mr. Powner, it is always
great having you here. This is an important issue, and I know
many of my friends around the country are hoping you all
succeed. And we are going to continue to make sure we are doing
our part to make sure you have the tools to be successful. So I
thank you all for appearing before us today.
The hearing record will remain open for two weeks for any
member to submit a written opening statement or questions for
the record. And if there is no further business, without
objection, the subcommittee stands adjourned.
[Whereupon, at 3:50 p.m., the subcommittee was adjourned.]
APPENDIX
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