    [House Hearing, 118 Congress]
    [From the U.S. Government Publishing Office]

                             LEGISLATIVE HEARING ON
            H.R. 592; H.R. 608; H.R. 1658; H.R. 1659; AND H.R. 2499

    =======================================================================

                                    HEARING

                                   BEFORE THE

                  SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

                                     OF THE

                         COMMITTEE ON VETERANS' AFFAIRS

                         U.S. HOUSE OF REPRESENTATIVES

                        ONE HUNDRED EIGHTEENTH CONGRESS

                                 FIRST SESSION
                                   __________

                           WEDNESDAY, APRIL 19, 2023
                                   __________

                               Serial No. 118-10
                                   __________

           Printed for the use of the Committee on Veterans' Affairs

                     [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

                        Available via http://govinfo.gov

                                   __________

                        U.S. GOVERNMENT PUBLISHING OFFICE

    52-207                     WASHINGTON : 2023

                         COMMITTEE ON VETERANS' AFFAIRS

                         MIKE BOST, Illinois, Chairman

    AUMUA AMATA COLEMAN RADEWAGEN,       MARK TAKANO, California, Ranking
        American Samoa, Vice-Chairwoman      Member
    JACK BERGMAN, Michigan               JULIA BROWNLEY, California
    NANCY MACE, South Carolina           MIKE LEVIN, California
    MATTHEW M. ROSENDALE, SR., Montana   CHRIS PAPPAS, New Hampshire
    MARIANNETTE MILLER-MEEKS, Iowa       FRANK J. MRVAN, Indiana
    GREGORY F. MURPHY, North Carolina    SHEILA CHERFILUS-MCCORMICK,
    C. SCOTT FRANKLIN, Florida               Florida
    DERRICK VAN ORDEN, Wisconsin         CHRISTOPHER R. DELUZIO,
    MORGAN LUTTRELL, Texas                   Pennsylvania
    JUAN CISCOMANI, Arizona              MORGAN MCGARVEY, Kentucky
    ELIJAH CRANE, Arizona                DELIA C. RAMIREZ, Illinois
    KEITH SELF, Texas                    GREG LANDSMAN, Ohio
    JENNIFER A. KIGGANS, Virginia        NIKKI BUDZINSKI, Illinois

                           Jon Clark, Staff Director
                      Matt Reel, Democratic Staff Director

                  SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

                   JENNIFER A. KIGGANS, Virginia, Chairwoman

    AUMUA AMATA COLEMAN RADEWAGEN,       FRANK J. MRVAN, Indiana, Ranking
        American Samoa                       Member
    JACK BERGMAN, Michigan               CHRIS PAPPAS, New Hampshire
    MATTHEW M. ROSENDALE, SR., Montana   SHEILA CHERFILUS-MCCORMICK,
                                             Florida

    Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
    hearing records of the Committee on Veterans' Affairs are also
    published in electronic form. The printed hearing record remains the
    official version. Because electronic submissions are used to prepare
    both printed and electronic versions of the hearing record, the process
    of converting between various electronic formats may introduce
    unintentional errors or omissions. Such occurrences are inherent in the
    current publication process and should diminish as the process is
    further refined.
                             C  O  N  T  E  N  T  S

                                  ----------

                           WEDNESDAY, APRIL 19, 2023

                                                                       Page

                               OPENING STATEMENTS

    The Honorable Jennifer A. Kiggans, Chairwoman....................     1
    The Honorable Frank J. Mrvan, Ranking Member.....................     2
    The Honorable Mark Takano, Ranking Member, Full Committee........     3
    The Honorable Matthew M. Rosendale, U.S. House of
      Representatives, (MT-2)........................................     8

                                   WITNESSES

    Mr. Phillip Christy, Deputy Executive Director, Office of
      Acquisition, Logistics, and Construction, Department of
      Veterans Affairs...............................................     4

            Accompanied by:

        Ms. Catherine Cravens, Chief of Staff, Office of Information
            Technology, Department of Veterans Affairs

        Dr. Leslie Sofocleous, Executive Director, Program Management
            Office, Electronic Health Record Modernization
            Integration Office, Department of Veterans Affairs

        Ms. Shana Love-Holmon, Acting Assistant Secretary, Office of
            Enterprise Integration, Department of Veterans Affairs

    Ms. Shelby Oakley, Director, Contracting and National Security
      Acquisitions, Government Accountability Office.................     6

                                    APPENDIX
                        Prepared Statements Of Witnesses

    Mr. Phillip Christy Prepared Statement...........................    23
    Ms. Shelby Oakley Prepared Statement.............................    30

                           Statements For The Record

    The American Legion..............................................    49
    Fleet Reserve Association........................................    51

                             LEGISLATIVE HEARING ON
            H.R. 592; H.R. 608; H.R. 1658; H.R. 1659; AND H.R. 2499

                                  ----------

                           WEDNESDAY, APRIL 19, 2023

                 U.S. House of Representatives,
          Subcommittee on Oversight and Investigations,
                                Committee on Veterans' Affairs,
                                                       Washington, D.C.
        The subcommittee met, pursuant to notice, at 9:30 a.m., in
    room 390, Cannon House Office Building, Hon. Jen Kiggans
    [chairwoman of the subcommittee] presiding.
        Present: Representatives Kiggans, Rosendale, Mrvan, Pappas,
    and Cherfilus-McCormick.
        Also present: Representative Takano.

          OPENING STATEMENT OF JENNIFER A. KIGGANS, CHAIRWOMAN

        Ms. Kiggans. Good morning. Thank you to our witnesses for
    being here today. In today's hearing, we will examine
    legislative options to check the struggling Electronic Health
    Record (EHR) modernization effort to address VA management
    concerns, and to authorize VA's newest effort to modernize its
    supply chain. I will begin with my bill, which is H.R. 2499,
    the Supply Chain Management System Authorization Act.
        Though I have been in Congress a short time, I have learned
    that the VA's major modern modernization efforts over the past
    decade have been plagued by some challenges. Government
    Accountability Office's (GAO's) written testimony highlights
    one of the roots of this problem, and to quote them, ``the VA
    often puts actions ahead of planning.''
        This reality at the Department is precisely why Congress
    must be involved in VA's major programs and why I believe we
    need to specifically authorize VA's supply chain effort.
        My bill would give Congress the ability to have more
    control over the scope, planning, and spending of this major
    project by authorizing the VA to purchase and implement a
    system for Veterans Health Administration (VHA) focused
    specifically on inventory management, requiring the system to
    be implemented in 3 years, and directing VA to begin with a
    pilot of the system at one location to make sure it really
    works for the VA before implementing it across the country.
        I appreciate that the Department still has some concerns
    with the bill but considering the VA's struggle with a number
    of major projects like the EHR Modernization Program, which is
    the subject of the next two bills, I am convinced that H.R.
    2499 is vitally important.
        Now, I will turn to H.R. 592, the Department of Veteran
    Affairs Electronic Health Record Modernization Improvement Act
    introduced by Chairman Bost. Congress never authorized the EHR
    Modernization Program, and it has struggled from the very
    beginning. The program is live at only five medical centers
    after 5 years, and over $5 billion have been spent. It has
    faced issue after issue, and providers and veterans at these
    five sites are not getting the support and care they need. That
    is why H.R. 592 would require medical center and Veterans
    Integrated Services Network (VISN) leadership to certify the
    EHRs ready for their hospital before it can be installed. It
    would also require the Secretary to certify the EHRs running
    without issue 99.9 percent of the time, which is a requirement
    in the contract before the EHR can be installed anywhere else.
    VA must take these steps to make sure it does not repeat
    mistakes made at the first five sites. I look forward to
    hearing from our witnesses about this bill.
        Also on the agenda today is H.R. 608, to terminate the
    Electronic Health Record Modernization Program of the
    Department of Veteran Affairs. This bill was introduced by Mr.
    Rosendale, the Chairman of the Subcommittee on Technology
    Modernization. I will let him speak to the details of this
    bill.
        Another bill on today's agenda that would impact the EHR
    Modernization Program is H.R. 1659, the Department of Veteran
    Affairs IT Modernization Improvement Act. This bill was
    introduced by Ranking Member Takano and would require VA to
    contract for an independent verification and validation
    assessment of five major IT modernization efforts to include
    the EHR Modernization Program and the Supply Chain Program.
        Last, we have H.R. 1658, the Manage VA Act. Also introduced
    by Ranking Member Takano, this bill would create an
    undersecretary for management. The position would be
    responsible for VA's budget, accounting, procurement, human
    resources, information technology, and other VA central office
    functions. I will recognize Ranking Member Takano in a few
    minutes to speak to his bills.
        Again, thank you all for being here today and I look
    forward to our discussion. I now recognize Ranking Member Mrvan
    for his opening remarks.

          OPENING STATEMENT OF FRANK J. MRVAN, RANKING MEMBER

        Mr. Mrvan. Thank you, Chair Kiggans. I am looking forward
    to discussing two bills that I have co-sponsored with Ranking
    Member Takano at our hearing today. As the Chair of Technology
    Modernization Subcommittee last Congress, I have seen firsthand
    the impacts of failures to improve VA's large IT systems. The
    Department of Veterans Affairs IT Modernization Improvement Act
    is a strong first step to introducing a higher level of support
    and accountability for the VA and for Congress.
        Independent verification and validation is not a new
    concept and has been successfully utilized at the Department of
    Defense to ensure that the Department and the taxpayers get
    what they pay for. I am very pleased to see that VA supports
    this effort and I look forward to hearing their testimony on
    this bill today.
        A second broader and more aspirational bill we will discuss
    today is the Manage VA Act, which would create an
    undersecretary of management at the VA and consolidate
    acquisition and business functions at the Department. Creating
    one management position is not going to fix every issue that VA
    has had with managing acquisitions, budget, and IT across the
    Department, but it is a start. I feel it is time to provide a
    position that has the authority and weight to ensure that we do
    not keep making the same mistakes over and over and over again.
        We found out last Congress that it took a decision from the
    Secretary to end the failed supply chain modernization attempt
    with Defense Medical Logistics Standard Support (DMLSS). As we
    move toward yet another attempt at modernizing supply chain
    management, I want to ensure we are providing VA with every
    resource possible to get a successful program at this time.
        I would also like to acknowledge my colleagues' bills
    concerning the Electronic Health Record Modernization (EHRM)
    program. I was happy to lead the EHRM Transparency law with
    Chairman Bost and Ranking Member Takano on a bipartisan basis
    last Congress. I look forward to continuing to work on a
    bipartisan basis on this program and get a system and result
    that will benefit veterans and employees.
        I am happy to say that we will be introducing and I will
    cosponsor the EHRM Reset Act introduced by Senator Tester. This
    bill is an ideal platform for negotiating a long-term
    bipartisan fix to the program. This bill will address a number
    of issues, including in Chairman Bost's legislation today. I
    look forward to collaborating across the aisle, as we
    successfully accomplished last Congress. I look forward to
    hearing from our witnesses today, and I yield back my time.
        Ms. Kiggans. Thank you, Ranking Member Mrvan. I now
    recognize the ranking member for the full committee, Mr.
    Takano, to speak on his bills H.R. 1658 and H.R. 1659.

        STATEMENT OF MARK TAKANO, RANKING MEMBER, FULL COMMITTEE

        Mr. Takano. Well, thank you, Chair Kiggans. I am happy to
    discuss two bills today that I have introduced in this
    Congress. I am also happy to say that Chairman Bost and I will
    be working together on a bipartisan basis on a long-term
    solution to the EHRM program with our planned introduction of
    Senator Tester's EHRM Reset Act this week. We have had a lot of
    success working together on a bipartisan basis, and I look
    forward to continuing to work across the aisle to fix this
    problem.
        The Department of Veterans Affairs IT Modernization
    Improvement Act will require VA to contract for independent
    verification and validation of the EHRM, Financial Management
    Business Transformation (FMBT), supply chain, and Veterans
    Benefits Management System (VBMS) modernization programs. The
    key word there being independent. For too long, Congress has
    not had the visibility into these large IT modernization
    programs that we need to provide necessary oversight. This will
    also be an invaluable tool for VA to ensure that the
    government, veterans, and taxpayers are getting what they pay
    for. This is a long-standing best practice of Department of
    Defense (DoD). Given the ever-increasing size of the VA, the
    time is now to create this capacity.
        My second bill, the Manage VA Act, will create an
    undersecretary for management at the VA and consolidate
    acquisition and business functions at the Department. With the
    continued appearances of acquisition management and management
    IT acquisitions and operations on the GAO high risk list, it is
    past time that we designated an undersecretary whose expertise
    will be the business of government.
        The failures to modernize VA's financial systems, supply
    chain management, health records, et cetera, has had a direct
    impact on the care and benefits we provide to veterans. VA has
    not been provided with the management and acquisition resources
    commensurate with their responsibilities. Leadership is needed
    on these business functions so that our VA employees can do
    what they do best, which is provide exceptional care and
    benefits to our veterans.
        I hope both bills can get bipartisan support. It is in
    everyone's best interest to ensure that we are managing the
    business of VA wisely. I encourage all my colleagues to support
    these bills and I yield back.
        Ms. Kiggans. Thank you, Ranking Member Takano. We will now
    turn to witness testimony. Testifying before us today we have
    Mr. Phillip Christy, who is the Deputy Executive Director for
    the Office of Acquisition, Logistics, and Construction at the
    Department of Veteran Affairs. He is accompanied by Ms.
    Catherine Cravens, who is the Chief of Staff for the Office of
    Information Technology at the Department of Veteran Affairs. We
    have Dr. Leslie Sofocleous, who is Executive Director of the
    Program Management Office for the Electronic Health Record
    Modernization Integration Office at the Department of Veteran
    Affairs. We have Ms. Shannon Love-Holmon, who is Acting
    Assistant Secretary for the Office of Enterprise Integration at
    the Department of Veteran Affairs. Last but not least, we have
    Ms. Shelby Oakley, who is Director for Contracting and National
    Security Acquisition at the Government Accountability Office.
    Ms. Oakley, you appear outnumbered by Veteran Affairs members,
    but I trust you are not outgunned.
        Now I would like to swear in our witnesses. I will ask all
    witnesses to please stand and raise your right hand.
        [Witnesses sworn]
        Ms. Kiggans. Thank you so much. Let the record reflect that
    all witnesses answered in the affirmative. Mr. Christy, we will
    start with you. You are recognized for 5 minutes to provide
    your testimony.

                      STATEMENT OF PHILLIP CHRISTY

        Mr. Christy. Good morning, Chairman Kiggans, Ranking Member
    Mrvan, and other members of the subcommittee. Thank you for the
    opportunity to appear before you to discuss the pending
    legislation that would affect VA programs and services. Today,
    I am blessed and flanked by some incredible talent. Joining me
    are Dr. Leslie Sofocleous, Executive Director of Electronic
    Health Record and Modernization and Program Management Office,
    Ms. Shana Love-Holmon, the Acting Assistant Secretary, Office
    of Enterprise Integration, and Catherine Cravens, the Chief of
    Staff for the Office of Information and Technology.
        Madam Chairwoman, in my oral testimony, I will highlight
    the Department's views concerning the five bills on the agenda.
    Regarding the five bills we are here to discuss, the VA
    supports certain provisions of the proposed bills and would
    like to highlight areas of concern and certain provisions we
    oppose. VA appreciates the intent behind the bills and looks
    forward to discussing the opportunities to continue to improve
    program management, accountability, and jointness within the
    Department. The rationale for our VA's position is outlined in
    our written statement.
        First, the VA Electronic Health Record Modernization
    Improvement Act, H.R. 592, which VA supports, in part. VA
    supports the bill's requirement that VA continue to partner
    with the Department of Defense and the Federal Electronic
    Health Record Modernization Office to improve overall
    performance within the EHR and the systems connected to it.
    However, VA does not fully support some of the specific
    prohibitions and certification requirements. As currently
    written, the proposed limitations would pause program
    activities and cause significant cost impacts. We suggest
    modifications to the bill text to ameliorate these concerns,
    and we believe the modifications would work toward facilitating
    the intent of the bill.
        The second bill focused on EHR, H.R. 608, would require the
    Secretary to terminate the program, abolish the EHR Integration
    Office, and revert facilities where the new EHR is deployed
    back to Veterans Health Information Systems and Technology
    Architecture (VistA). VA opposes this bill, as it would
    frustrate VA's ability to have an interoperable and
    longitudinal record with the Department of Defense. Modernizing
    VA's EHR is critical for providing the best care for our
    veterans and facilitates advancements in the delivery of that
    care. We believe terminating the program would work against
    those goals.
        As for H.R. 1659, the IT Modernization Improvement Act, the
    VA supports the bill if amended and with appropriations. This
    bill would direct VA to contract for independent verification
    and validation of certain modernization efforts of the
    Department. Ideally, VA would have in-house team with the
    expertise to conduct Independent Verification and Validation
    (IV&V) of its major modernization efforts. Contracting IV&V
    support while VA builds internal capacity, makes practical
    sense, and will help expedite the resulting delivery of
    benefits and services to veterans, their caregivers and family
    members. VA anticipates an IV&V contract of this size would be
    extremely expensive. Appropriate and timely funding of this
    bill is critical.
        Regarding H.R. 1658, the Manage VA Act, the VA does not
    support. This bill would create a new undersecretary for
    management as the chief management officer of the Department.
    Integrating the Department's efforts in creating operational
    jointness in our support of veterans, their families,
    caregivers, and survivors is essential to veterans choosing VA
    for care, benefits, and services. VA has implemented robust
    governance to drive jointness and integration in support of the
    Secretary and the Deputy Secretary who serves as VA's Chief
    Operating Officer. This framework enables evidence-based risk
    informed decisionmaking that advances the mission of the VA.
        Currently, the Assistant Secretary for Enterprise
    Integration serves as the VA accountable executive for
    enterprise management and governance in support of the Office
    of the Secretary. In addition, VA has one of the most
    outstanding customer experience offices in the Federal
    Government, which serves as a key partner within our enterprise
    governance framework to ensure we continue to put veterans
    first in all of our decisions and all of our program execution.
    The VA already has in place many of the functions this bill
    prescribes.
        Finally, VA cites concerns with a draft bill that would
    authorize the Secretary to carry out an IT system and
    prioritize certain requirements to manage supply chains for
    medical facilities. As written, the bill may impede ongoing
    efforts toward an enterprise supply chain solution. We are
    concerned about the timeline for implementation does not
    accurately reflect the complexities involved in successful
    procurement and execution. VA welcomes the opportunity to
    continue working with the committee to provide additional
    technical assistance that will create the flexibility and the
    scope and timing needed to ensure the success of the supply
    chain mission.
        Madam Chairwoman, before I close, I wanted to share our
    deepest appreciation to the committee and all of the staff that
    have worked with us regarding these bills. This concludes my
    statement, and we would be happy to answer any questions you or
    other members of the subcommittee may have.

        [The Prepared Statement Of Phillip Christy Appears In The
    Appendix]

        Ms. Kiggans. Thank you so much, Mr. Christy. Ms. Oakley,
    you are now recognized for 5 minutes to provide your testimony.

                       STATEMENT OF SHELBY OAKLEY

        Ms. Oakley. Chairwoman Kiggans, Ranking Member Mrvan, and
    members of the subcommittee, I am pleased to be here today to
    assist you with your consideration of the legislative proposals
    to improve VA management and key modernization programs. While
    Congress provides VA with hundreds of billions of dollars each
    year, we are all aware of the opportunities VA has wasted
    because it has not followed disciplined management approaches
    when planning and executing its programs. EHRM is just one
    example, but a critical one.
        We added VA acquisition, management, and healthcare to our
    high-risk list because VA lacks a disciplined management
    approach, among other challenges. Our updated assessment of
    these high-risk areas will be issued tomorrow.
        The five bills the committee is considering reflect the
    underlying theme that change is needed. As I laid out in my
    written statement, we have issued an expansive body of work on
    effective management practices and made prior recommendations
    in line with aspects of the proposed legislation. Today, I will
    discuss ways in which this work could help Congress and VA as
    you seek lasting and transformative change.
        For example, we identified key strategies for implementing
    chief management officer positions, like the proposed VA
    undersecretary for management. These include ensuring that the
    Chief Marketing Officer (CMO) responsibilities are clearly
    defined and documented, and that the CMO have a high and
    sustained level of authority. We have also recommended CMO
    positions be established by other departments, such as DoD and
    Department of Homeland Security (DHS). Each department followed
    or identified key strategies to different degrees, and, as a
    result, have experienced varied success in integrating this
    position.
        Leadership is essential, but so is good information for
    decisionmaking. We have long recognized independent
    verification and validation as a best practice. When agencies
    are developing or acquiring a system IV&V can help reduce risk
    by having a knowledgeable independent party determine that the
    system meets users' needs and fulfills its intended purpose.
        We have identified key elements of effective IV&V plans
    that may be helpful to Congress as it considers this proposed
    legislation. These include risk-based criteria for determining
    which programs or aspects of programs require IV&V and
    establishing standards for independence. We recently
    recommended that VA reinstitute plans to conduct an EHRM
    independent operational assessment, which could be an element
    of an overall IV&V review. IV&V is a specific solution to one
    of the challenges the EHRM program faces.
        As the draft legislation indicates, the subcommittee is
    greatly concerned with broader program challenges. Our reported
    findings and those of the Inspector General (IG) over many
    years validate your concerns. For instance, we recently
    reported to Congress that the overwhelming majority of users
    are not satisfied with the system. Whichever approach Congress
    chooses for this program, heeding the numerous GAO and IG
    recommendations and lessons learned from the current effort
    could help ensure that VA uses a more disciplined management
    approach in pursuit of programmatic success.
        Finally, as VA pursues a new supply chain management
    system, our recommendations and our leading practices for
    effective pilot programs could come in handy. For instance, 2
    years ago, we recommended that VA develop a comprehensive
    supply chain management strategy to guide its multiple
    interrelated efforts. This strategy should drive the
    development of whatever system VA requires, not vice versa. VA
    is moving forward with its system acquisition despite still
    developing this strategy.
        Additionally, our prior work, consistent with the draft
    legislation, indicates that effective pilots can inform and
    facilitate program and policy decisions, especially for
    significant modernization programs. These practices for pilot
    programs call for having clear, well-defined, appropriate, and
    measurable objectives, among other things.
        In conclusion, the challenges these bills are trying to fix
    are complex, and there are really no easy solutions. However,
    consistently applying leading practices and strategies
    summarized in my testimony will better position VA to fulfill
    its mission in the years ahead. Your continued oversight will
    be essential to holding VA accountable for delivering what it
    has promised to our veterans. Thank you again for having me
    here this morning. This concludes my statement, and I look
    forward to any questions you have.

        [The Prepared Statement Of Shelby Oakley Appears In The
    Appendix]

        Ms. Kiggans. Thank you so much, Ms. Oakley. Now I would
    like to recognize Mr. Rosendale to speak on his bill H.R. 608.

                   STATEMENT OF MATTHEW M. ROSENDALE

        Mr. Rosendale. Thank you, Chairwoman Kiggans, for holding
    this hearing and to Chairman Bost for making oversight of
    electronic health record modernization project a major priority
    for this committee. We owe it to our Nation's veterans to have
    a safe, fully functioning electronic records system. Quite
    frankly, I feel sorry for the witnesses that are here trying to
    defend a demonstrably failed system.
        The Oracle Cerner electronic health record system operates
    at five of the 171 VA medical centers. The VA acknowledges the
    system has created unacceptable levels of productivity losses,
    patient safety risks, and stay at burnout at these five small
    to medium-sized facilities. Veterans at these five facility
    centers have complained about lost medication in the mail,
    receiving other veterans' medication, delayed specialist
    appointments and diagnostic tests, confusion with the patient
    portal, and generally increased wait times, widespread errors
    in their personal information.
        We are also seeing experienced employees at these five
    medical centers leaving their jobs because of frustrations with
    the system. In a survey, 60 percent of the staff at one of the
    centers said the system has made them question whether to
    continue working there. I was pleased with Secretary
    McDonough's recent decision to continue the pause on
    implementing the disastrous system at other VA sites. While
    Secretary McDonough deserves credit for this decision, I think
    it is unwise to delay the inevitable. This system and this
    project have simply not worked out and are bleeding critical
    resources from the VA at astronomical rates, and there is no
    reason to believe that that is going to change.
        It is not just bad execution. It is flawed concept. The VA
    is not ready to accomplish a massive EHR replacement. The VA's
    cost estimate was initially $16.1 billion over 10 years. Now,
    the Institute for Defense Analysis is estimating up to $38.9
    billion for implementation over 13 years. Our Nation is over
    $31 trillion in debt, yet we are throwing billions of dollars
    at a failed EHR system that is compromising veterans' safety.
    This is unacceptable.
        I introduced the EHR Termination Act to put a stop to this
    madness before the VA spends billions of dollars more of
    taxpayers' money. My legislation would abolish the Electronic
    Health Record Modernization Integration Office and transfer any
    functions to the Veterans Health Administration or the Office
    of Information and Technology at the VA. It would also revert
    all five medical centers using the Oracle Cerner EHR system
    back to VistA and Computerized Patient Record System (CPRS).
    Moreover, it would prevent the VA from exercising any options
    on Oracle Cerner's contract, causing it to expire within 1
    year.
        The Congressional Budget Office estimated my legislation
    would reduce discretionary costs by about $8 billion over 5
    years. The taxpayer has already shelled out over $5 billion for
    this project, and the only thing we have to show for it is
    worse care for our veterans. Money that the taxpayer expended
    should be returned because of this poor performance. The job of
    the VA should be providing veterans the world class benefits
    and services that they have earned, not doling out billions of
    dollars to Silicon Valley companies. It is time to put our
    Nation's veterans first by terminating the Oracle Cerner
    electronic health record system. Thank you, Madam Chair, and I
    yield back.
        Ms. Kiggans. Thank you, Mr. Rosendale. Now we will turn to
    questions, and I would like to yield myself 5 minutes. Starting
    with Mr. Christy, H.R. 2499 would authorize a VA supply chain
    management system. I know the VA is pursuing a massive
    enterprise-wide VA supply chain management system under its own
    authority, but what is the VA's independent lifecycle cost
    estimate for that effort?
        Mr. Christy. Ma'am, as we are working through the concepts
    of the supply chain and the overarching strategy, we still do
    not have a finalized cost estimate for what that will be in its
    total. It is something that is under development. Understand
    that when that number is arrived at that we could share it with
    you and the committee.
        Ms. Kiggans. Do you think you could get it to us by the end
    of the week? Could you commit to that or?
        Mr. Christy. I cannot commit to the end of the week that we
    will have that number. It is still under development.
        Ms. Kiggans. Do you know approximately how long it will
    take?
        Mr. Christy. Two components here. There is the internal
    estimate that the program office will be working up. As part of
    the acquisition strategy, we are using a statement of
    objectives for the actual procurement. What that means is we
    are going to lay out the objectives and industry will come back
    to us with their solutions and their cost to deliver on those
    solutions. Depending who wins through that procurement
    competition, that would be the cost of the procurement itself.
        Now, obviously, a program is just more than the contract
    with all the ancillary and overhead costs with that. That will
    be a key component into what is the cost of this program. Yes,
    the program is taking its stab at what will this cost through a
    lifecycle. A big, really important step to this, though, is
    what will be the procurement cost? That is where a lot of the
    money will go, frankly. Until we have those numbers, we are not
    able to provide that to you. We still do not have the
    procurement out on the street, right? That is still under
    development along with the strategy.
        Ms. Kiggans. Are we talking weeks or months or is this
    going to take another year? I am just wondering what the
    timeline looks like for that cost estimate.
        Mr. Christy. Just for as a working concept, I would say
    about 6 months before we could have that number ratcheted down.
        Ms. Kiggans. Okay. We would like that number as soon as you
    have that available, please.
        Mr. Christy. We will try to.
        Ms. Kiggans. We just need that before going forward, I will
    say that. Ms. Oakley, you testified that just to quote your
    statement, ``a recurring theme from our findings has been that
    the VA often puts action ahead of planning.'' Would you please
    explain why this finding is so important when we are talking
    about starting major projects like the supply chain management
    system?
        Ms. Oakley. Absolutely. Thank you for your question. Yes,
    it has been a recurring theme that we have seen, especially
    with regard to the supply chain management approaches that VA
    has attempted over the years in terms of putting action ahead
    of strategy. I think, you know, a perfect example of this is
    the fact that 2 years ago we made a recommendation about
    instituting or developing a comprehensive supply chain
    management strategy that would guide acquisition of the
    individual technical solutions that VA is seeking for the
    system itself. Unfortunately, that strategy is not finished,
    but the acquisition is proceeding.
        To comment on the lifecycle cost estimate issue, having a
    lifecycle cost estimate before committing to a program is super
    important. Our work in other agencies has validated having that
    as a key piece of the business case information for committing
    to a program is essential to understanding if you are going to
    get what you are saying for the cost and within the timeframes
    that you are anticipating.
        Ms. Kiggans. I agree, and it is hard to do much without
    having that before we can go forward. Mr. Christy, do you agree
    with the GAO's testimony that the VA has often or has in the
    past acted before it is sufficiently planned?
        Mr. Christy. Yes, I do concur with that. There are numerous
    GAO findings and IG findings. This is what we are trying to
    correct through the----
        Ms. Kiggans. Yes.
        Mr. Christy [continuing]. supply chain and I know it is
    probably frustrating to say, hey, when are you going to give me
    the number? It is----
        Ms. Kiggans. Yes.
        Mr. Christy [continuing]. wanting to make sure that we do
    not repeat the sins that GAO, and IG, and others have
    identified. We want to get this right and not go out the door
    and repeat the same things that we have been doing for years.
        Ms. Kiggans. Agree very much. Ms. Oakley, my bill would
    esquire the VA to pilot the new supply chain platforms function
    prior to wider deployment. Can you explain why it is important
    to pilot a program like this before rolling it out VA-wide?
        Ms. Oakley. Absolutely. Piloting a program can provide you
    with valuable information on whether it is going to meet its
    intended purpose and whether it is even scalable across the
    enterprise. When you consider an organization like VA as big
    and complex with medical centers with different needs and
    different, you know, configurations and whatnot, a pilot would
    allow you to understand those pain points, get feedback from
    users, people who are actually going to be implementing the
    system, and incorporate that feedback to make changes to the
    program, to be able to then scale it and distribute it across
    the organization.
        You know, it is not, you know, as my testimony stated, and
    as my written testimony stated, it is not just as simple as
    putting in place a pilot. It has to be structured effectively
    such that you can collect data from that pilot to be able to
    use going forward. Our leading practices would indicate ways in
    which that can happen for VA.
        Ms. Kiggans. Out of curiosity, did we pilot the EHR program
    then as well before moving forward?
        Ms. Oakley. I am not certain of that answer. Maybe VA can
    answer that question. I am not sure I have been around long
    enough to know that.
        Ms. Kiggans. Mr. Christy, do you know?
        Mr. Christy. I am going to pass to Dr. Leslie Sofocleous.
        Ms. Sofocleous. Ma'am, I would say based off of the
    conversation here, it is probably not the same type of pilot.
    We were in Integrated Operations Center (IOC), and we had some
    initial sites, but I can say that, you know, there was an
    ability for us to probably have some lessons learned from the
    approach that was just referenced.
        Ms. Kiggans. Yes, I would agree with that. Just and
    agreeing with the value of piloting a program, I think going
    forward, and hindsight is always 2020, and lessons learned, but
    that probably would have been a great idea.
        Ms. Oakley, the VA's healthcare and acquisition management
    are on GAO's high-risk list. Could a supply chain management
    system focused on the VHA and with clear metrics help fix the
    VA's healthcare and acquisition management issues?
        Ms. Oakley. I think it would go a long way. It is certainly
    a driver of many of the challenges that we have identified in
    that area for VA over the years. I think one thing that you
    mentioned that is important to note is, you know, our work for
    product development, system development would indicate that
    kind of taking an incremental approach to developing a system
    as critical as the supply chain management system would give VA
    an opportunity to release initial capabilities, understand how
    those are working, and then continue to build on those
    capabilities going forward. I think your bill advocates for
    limiting the scope of the effort, at least initially, to then
    be able to understand how it could be expanded to VA's
    enterprise-wide supply chain. We think that that is a good,
    measured approach.
        Ms. Kiggans. Thank you. Thank you, and I concur. I look
    forward to seeing bill to fruition. Next, I will turn to
    Ranking Member Mrvan for his questions.
        Mr. Mrvan. Thank you, Chairwoman. Ms. Oakley, my first
    question for you is regarding H.R. 1659, Ranking Member
    Takano's IT Modernization Improvement Act. Specifically, from
    your experience with independent verification and validation,
    is there any major IT program that VA that you think would not
    benefit from the IV&V?
        Ms. Oakley. I definitely do not think I can think of any
    program that would be considered under this bill that could not
    benefit from additional quality information to support
    decisionmaking. In fact, one of the criteria that we have, one
    of our best practices for IV&V would focus on risk-based
    criteria for determining which programs are suitable for IV&V,
    or which aspects of programs are suitable for IV&V. That would
    be things like the maturity of the technology, the criticality
    of the system to the mission, things like that, that would
    drive the decisions. I think the programs that you mentioned
    are all pretty critical to VA. I can not think of one that
    would not benefit.
        Mr. Mrvan. Specifically for a program like EHRM, do you
    feel like the program is too far along for the IV&V to be a
    benefit going forward?
        Ms. Oakley. I do not think it is ever too late to do the
    right thing. You know, the program is in the pretty early
    stages with only five sites rolled out. There is a lot more
    work that needs to be done from a development perspective. I
    think it is also important to note that each location has
    different needs, and so there might be different requirements
    for each location. Having a concerted IV&V effort for a program
    like EHRM as it continues to roll out, I think is critically
    important to provide that really good quality information to
    make those go-no-go decisions, and the certifications that are
    outlined in the bill.
        Mr. Mrvan. Mr. Christy, from your testimony, I see that you
    have some good constructive technical amendments to the bill,
    which we will definitely consider. From your perspective
    overall, I would really like to hear your opinion of this bill
    and the IV&V overall as it relates to these large IT
    modernization programs at VA.
        Mr. Christy. Yes, I think through the identification of
    what we talked about earlier with many GAO reports, an IV&V
    support of those modernization efforts or any large programs is
    extremely helpful to the VA. Fully support this.
        Back to the comments by Ms. Oakley. You know, I think the
    key thing there is I wanted to kind of lock in, is that we
    believe in all the best practices that were put out into those
    different reports, you know, the criteria when you are using
    the independents, the upfront rules, making sure what we are
    paying for, and that there is oversight of itself of the IV&V
    program. From an acquisition and a VA perspective, this is a
    good thing for the VA and veterans. We are going to start
    getting help with making sure the money that is spent we are
    getting the buck--getting the money that we are--getting the
    value from the money we are spending on veterans. Again, fully
    support this.
        Mr. Mrvan. I appreciate those comments and appreciate your
    attention to helping to increase accountability and results
    from these programs. I want to give you the opportunity as well
    right now to offer any thoughts you may have on the support
    outside of IV&V that you need in the Office of Acquisitions,
    Logistics and Construction (OALC). I realize that Congress has
    put an enormous burden on your office in executing these large
    acquisitions, and I want to give you the opportunity to let us
    know what else you need from us to help increase effective
    acquisitions at VA.
        Mr. Christy. Yes, I am going to pull a line from GAO's
    testimony. If you saw in there, there was 147 percent increase
    in procurement in the last 10 years. That is just the
    procurement piece, not the program management. I am using that
    to kind of highlight how much work has come to the VA, how much
    responsibility that is laid on acquisition officials. Both
    contracting folks but also program folks.
        I will share with you the steady State of how many
    acquisition folks we have at the VA has not grown with that 147
    percent spike in 10 years. You got a huge workload on the
    acquisition workforce here. We would welcome opportunities to
    discuss how can we approach that, streamline, you know,
    procurements, program oversight, et cetera. As the IV&V, now,
    that is another great example of help the VA needs to improve
    acquisition and program management accountability and
    jointness.
        Some of this gets down to resources that I think, you know,
    maybe an offline TA or discussion would be really helpful to
    that conversation. Generally speaking, the acquisition
    workforce has a huge workload on it and the requirements are
    growing without corresponding growth of the workforce.
        Mr. Mrvan. With that, I yield back. Thank you.
        Ms. Kiggans. Thank you very much, Mr. Mrvan. Now, the chair
    would like to recognize Mr. Rosendale for 5 minutes.
        Mr. Rosendale. Thank you, Madam Chair. I appreciate it.
    While it was not designated as such, unfortunately, the Oracle
    Cerner EHR system has been a multibillion-dollar pilot project
    that has not even vaguely worked out and stands to consume
    billions of valuable resources in the future with no
    foreseeable improvement if not stopped.
        Ms. Sofocleous, 2 weeks ago, the VA announced through an
    email from the Director of VISN 10 that implementation of the
    Oracle Cerner EHR will be postponed in Saginaw, Michigan. That
    announcement left a lot of things unsaid. I will not allow you
    to set the record straight today. Are there other upcoming
    sites also postponed, including Battle Creek, Detroit,
    Chillicothe, Dayton, and elsewhere in Michigan, Ohio, Indiana,
    and Wisconsin?
        Ms. Sofocleous. Sir, thank you for the question. We have
    said that we would evaluate the sites as we move forward to
    ensure that we do not have any of the additional patient safety
    issues we have talked about. We make the improvements in terms
    of system uptime and performance and then we also address some
    of the change management and adoption issues. We will continue
    to do that and make informed decisions moving forward on those
    additional sites. We can see that veterans and the clinicians
    need to have a system that works for them and we will continue
    to do that as we move forward, sir.
        Mr. Rosendale. Will you be setting another go-live date for
    any of these sites?
        Ms. Sofocleous. Sir----
        Mr. Rosendale. How much lead time will you be giving this
    committee in advance of going live in those additional sites?
        Ms. Sofocleous. Sir, we will inform this committee of any
    decisions we will make and we will assure that there is
    informed time so that there are questions and that the sites
    are aware of our plans moving forward. Obviously, we want to
    make sure that we have all stakeholder involvement in any
    decisions we make moving forward.
        Mr. Rosendale. Before we are announcing, I am trying to
    narrow down some timeframes so I know what I am going to be
    dealing with, okay? Are we looking at 30 days' notice, 60 days'
    notice, 180 days' notice? What kind of notice do you commit to
    this committee giving us before we go live on any additional
    sites?
        Ms. Sofocleous. Sir, I will take that of record to come
    back with a timeframe on that.
        Mr. Rosendale. Thank you very much.
        Ms. Sofocleous. You are welcome, sir.
        Mr. Rosendale. Appreciate it. Thank you. Ms. Sofocleous,
    tell me about the decision not to proceed with implementing the
    Oracle Cerner system in Ann Arbor, Saginaw, and elsewhere. Who
    made the decisions, how were they made, and what was the role
    of the medical center directors from each of these VISNs?
        Ms. Sofocleous. Yes, sir. In other sites, we have--I think
    we have briefed before previously, we have the site readiness,
    which we use in our previous sites, you know, albeit we have
    had some issues after our previous deployments that look at key
    categories in terms of, you know, training, adoption, whether
    or not we have technology in place, interfaces in place. Those
    are all decisions that we use to evaluate. We have, based off
    of the Sprint Report and assess and address, come up with
    additional operational metrics that we want to incorporate. As
    we use that, we will use that to inform decisions, in terms of
    joint decisions, I might say in terms of whether or not we want
    to proceed with any deployments at the site. That framework was
    used for Ann Arbor and Saginaw. Ann Arbor, we did reference
    that that had pharmacy tied to it--sorry, research tied to it.
    We wanted to make sure that we had that effectively addressed.
    Then for Saginaw, we still had additional work that had to be
    performed in terms of the site readiness.
        Those decisions are collaborative decision. They are not
    made in a vacuum. We do involve the VISN and site leadership.
    VHA is involved and Office Of Information and Technology (OIT),
    and then obviously, the Deputy Secretary is informed and
    provides the final viewpoint and a vote on us to proceed. It is
    a collaborative process under governance.
        Mr. Rosendale. This local decisionmaking process sounds
    like a lot like H.R. 592, the EHR Improvement Act, would
    require. Would you agree with that?
        Ms. Sofocleous. Yes, sir, it does, in a sense. Yes, sir.
        Mr. Rosendale. Okay. When you go through this analysis and
    this collaboration, are you deferring to the directors of those
    facilities to give them any type of veto power whatsoever?
        Ms. Sofocleous. I think we allow them----
        Mr. Rosendale. I mean, if they identify deficiencies, they
    identify areas that they just are not ready, are we going to
    defer to the people on the ground?
        Ms. Sofocleous. We make informed decisions. I think the key
    part here is mitigations that we have in place, and that is a
    conversation that we would have. Like, hypothetically, we would
    have to talk about whether or not the mitigations are in place,
    the mitigations are effective, and also whether or not they are
    going to impact operations at the ground to make that decision.
    I think that is the approach we would take and what we have
    made previously in terms of whether or not the mitigations are
    the effective mitigations to allow the sites to continue to
    perform effectively.
        Mr. Rosendale. Okay. Not to put words in your mouth, but it
    still sounds to me like what we have is a discussion, a
    collaboration. At the end of the day, the heavy hand of the
    Veterans Administration is going to make the decision about
    whether something is going to be implemented or not.
        Ms. Sofocleous. Sir----
        Mr. Rosendale. Thank you, I yield back, Madam Chair.
        Ms. Kiggans. Thank you, Mr. Rosendale. The chair now
    recognizes Ms. McCormick for 5 minutes.
        Ms. Cherfilus-McCormick. Thank you. Ms. Love-Holmon, I
    realize that the VA feels that they do not need an
    undersecretary for management and that the Deputy Secretary has
    had this authority previously. Unfortunately, I think that we
    all know that proficiency in the business of government is not
    a prerequisite for the Deputy Secretary. I know that in your
    current position, you are performing some of the governance
    that we are looking for. I would like to hear from you the
    opportunity to answer these questions. The current governance
    structure for the management of the VA, what is your view on
    it? Two, what improvements would you recommend?
        Ms. Love-Holmon. Thank you very much for the opportunity to
    speak. I would first like to start off by just saying this is
    an organization that I am very proud to work for VA, and we
    have an amazing mission. Specifically with regard to the
    current structure, I have had the pleasure of being there from
    the ground up in creating the enterprise governance framework
    that we have now. We have the VA Operations Board that is
    chaired by the Deputy Secretary, who serves as our chief
    operating Officer. We have the VA Executive Board that is
    chaired by the Secretary of Veterans Affairs.
        As we have put these two boards together, we were very
    thoughtful about who needs to participate in these boards.
    There is a mix of participants from the political staff, the
    career staff, participants from VA Central Office, as well as
    field leadership to ensure that we have representation from
    across the organization. Also, the chief executive officers
    participate as well, the chief acquisition officer, information
    officer, et cetera, to ensure that everyone has a seat at the
    table.
        There are really three parts to these boards that I am very
    proud of, and we really did look also at the GAO report and try
    to understand the intent there and those comments and the
    criteria for what it looks like to create a good Chief
    Operating Officer (COO). The governance framework is around
    transparency, making sure that all folks that are going to be
    impacted by a decision are brought to the table. Going back to
    a previous comment, that means that if there is something that
    is happening about you, we are bringing you there to the table
    to have an opportunity to talk about it.
        Also, about accountability in terms of making sure that we
    have accountable officials for the various projects or programs
    that are there at the table, but there is also accountability
    across the table, meaning even if you are not the chief for a
    particular program, what is my responsibility as the Acting
    Assistant Secretary in supporting this initiative? What is the
    Chief Information Officer's (CIO's) responsibility in
    supporting it, in supporting the various initiatives?
        Last, we have also tried to be grounded in evidence-based
    and principle-based decisionmaking in terms of as decisions are
    coming through governance, really understanding what is the
    data telling us about the decisions and the recommendations
    that are coming. Also, from a principles-based perspective,
    ensuring that we are really looking at is this the best
    decision for veterans and our employees as we are moving
    forward.
        In terms of opportunities for improvement, I think I would
    agree with my colleagues and the comments that have been made
    with regard to our opportunity to put in more disciplined
    management framework, particularly around some of our program
    management. We have already begun that for several of our
    strategic initiatives, many of which are being discussed here
    today. We have bringing those projects through the governance
    framework where we are asking those hard questions. Sometimes
    the hard question is what is the problem we are trying to solve
    and making sure that everyone at the table understands what the
    problem is, understands what the plan is to move forward so
    that we are moving forward and creating strategy into action.
    Again, I think that is my response.
        Ms. Cherfilus-McCormick. Thank you. My next question is for
    Ms. Christy--Mr. Christy. I know in your position you are under
    tremendous pressure to execute a giant acquisition program. I
    know you have had issues with resources. Would it be beneficial
    to have an advocate in upper management for the VA to champion
    your needs?
        Mr. Christy. We will always welcome advocates, no matter
    where we are and what we are doing. I think to have somebody
    above the chief acquisition officer, so at the VA, that is the
    political appointed person for the acquisition. If it is even
    higher than that, obviously that helps with, you know, being at
    the table and communicating those risks and where we can get
    help within acquisition programs. Absolutely would welcome
    that.
        Now, back to the point of what Ms. Love-Holmon said, we do
    have governance, right? There are those avenues when there are
    concerns to bring those up. Those go to both the Deputy
    Secretary, and depending on what the issue is, it could go up
    to the executive board, which is chaired by the Secretary
    himself. I think we have those advocates through our governance
    process but would always welcome more voices at the table in
    support of acquisition.
        Ms. Cherfilus-McCormick. Thank you so much. I just want to
    emphasize that as the Ranking Member of Technology and
    Modernization Subcommittee, I am interested in finding ways I
    can support the VA to modernize its IT program. I think Ranking
    Member Takano's bills are a great start to get us back on track
    in delivering better healthcare benefits to our veterans and
    supporting the VA. Madam Chair, I yield back.
        Ms. Kiggans. Thank you very much for your comments. Just to
    wrap up and close, I just had a couple of extra questions for
    really just for personal knowledge. Mr. Christy and maybe Dr.
    Sofocleous, when looking at how we are assessing our electronic
    charting implementation in the five facilities that have begun
    that process, specifically, we have an outside group, this
    IV&V, coming in to do some just overarching critique, I guess,
    of how that is going. How long do we expect that this IV&V to
    be in place for?
        Ms. Sofocleous. You are talking about the new IV&V. I guess
    the new IV&V, based off of what was proposed, I would think we
    would want to have that in for long term for the program in
    order to be able to help assist with some of the program
    management and technical pieces of it. There are multiple
    components of that. I think, you know, Mr. Christy said we are
    already open into. It is probably not a one or done. I think we
    would be open to that.
        Ms. Kiggans. It is a long-term commitment?
        Mr. Christy. Yes, absolutely. I am sorry if I might have
    misunderstood. I was not sure, because there are some current
    IV&V efforts that are going on in the EHR program today. It is
    not as formalized as the bill talks about. If the question is
    geared toward the bill, yes. You will see in there, we are
    talking over the period of this and to follow the GAO
    recommendations, right? Risk-based, so there might be parts up
    front really heavy into many topics and areas. As you get to
    the back part of the acquisition of it, you might taper down on
    the risk of that. I would see IV&V going through the total
    lifecycle of an acquisition.
        Ms. Kiggans. I know it is a huge expense.
        Mr. Christy. Yes.
        Ms. Kiggans. I am wondering what other resources are out
    there for us to maybe do the same job. Does, for example, does
    Cerner Oracle now do they play any role in this transition
    process? Just as a nurse practitioner thinking through when we
    have gone to electronic charting systems, transition to that on
    a much smaller scale than what the VA is trying to do, we had
    the team come in from, you know, the company who owned the
    program. They sat there in a trailer next to the facility and
    they made sure every patient was, their records got
    transferred, that their current notes were getting transferred,
    that all the test results, and whatnot were getting
    transferred. What role is Cerner Oracle playing in this whole
    process?
        Mr. Christy. Yes, so, I think Dr. Sofocleous will answer
    this in a second, but I just want to quickly add, you know, we
    are in current negotiations with the Oracle Cerner team. A lot
    of these new standards are being negotiated. In a public
    hearing, we can not disclose them. I think we can get you that
    information.
        It is to the point you are asking it is like, hey, what is
    their involvement, and what are the standards, and how is that
    being wrapped back into the program office? You just do not get
    us to do all the work. You own the contract, deliver the
    results----
        Ms. Kiggans. Right.
        Mr. Christy [continuing]. that are expected of you----
        Ms. Kiggans. Right.
        Mr. Christy [continuing]. in that contract. Those things
    are ongoing, but I am going to have Les pile on to what I am
    saying here.
        Ms. Sofocleous. Ma'am, I think, you know, we have talked
    about like change management, some of the areas you were
    talking about change management, training, adoption issues, and
    we are talking about from the technical standpoint, which we do
    have IV&V already for testing. Obviously, Oracle Cerner is
    involved in that. I think if we are talking about independent,
    then obviously we want to take their input and then have a
    separate validation to ensure what they are providing is a
    service that we are paying for, it is effective, and it is of
    use to the sites and to VA. There are two components of that, I
    would say.
        Ms. Kiggans. I do not want too many cooks in the kitchen,
    you know. Sometimes we get so convoluted, like how many people
    and the most important people we need to be talking to are the
    providers, right? The people that are the end users of this
    program. Those are the people who have the responsibility to
    make sure that continuity of care piece and patient safety, all
    of those really big issues are the ones that we hear about in
    our offices, we want to make sure that end product is
    accomplished. Making sure the providers, the healthcare
    provider, the physicians, the nurses, those guys who are
    already busy and already hard to get in a room, and to say, we
    are going to have an hour meeting about how you feel about this
    electronic charting. Those should be the loudest voices at that
    table. I do not want all of us to get not only does it cost a
    lot of money to have all these outside groups looking at that,
    but just, you know, tightening that up and making sure we can
    make the best product possible for the end user, I think, is
    where I would like to see just to pass my priority along.
        Thank you. I know it is a work in progress and I am
    finished with my questioning. Ranking member Mrvan, do you have
    one?
        Mr. Mrvan. Just 5 minutes, yes.
        Ms. Kiggans. Yes, go ahead.
        Mr. Mrvan. For Mr. Christy, I am going to follow on that.
    What is the timeline do you believe for the negotiations to be
    complete and what are the outcomes that you are looking for
    from those negotiations?
        Mr. Christy. Right, and I will ask Les to assist me again.
    There is an option period that comes to May 16 that we have to
    get past those negotiations so we can move forward to the next
    options. For the initial, it was a 5-year period. We are coming
    up on that 5-year period, May 16, and we are negotiating the
    next 5 years currently. I will turn it over to Les a little bit
    more about the details of the outcomes of that.
        Ms. Sofocleous. Yes, sir. We are in negotiations. As Mr.
    Christy said, May 16 is the period. I think we had some
    productive negotiation conversations. Obviously, we are
    focusing on some of the areas we have talked about. Obviously,
    system performance is one of the big issues. Our ability to
    hold Oracle Center accountable, which we tend to continue to
    enforce in our negotiations. We do have backup strategies in
    place and we will be more than happy to provide updates as we
    move forward with the negotiations.
        Mr. Mrvan. Okay. I guess why I bring that up is because the
    disconnect between the pharmacy and the different type of
    results that we were talking about in past meetings, just
    making sure that those errors are being fixed. You are to kind
    of focus on what the chairwoman was saying, making sure that
    the providers are included and have a seat at the table is so
    vitally important. That is why I followed up with that question
    and just wanted to make sure I understand you do not want to
    negotiate here at the table, and so, your answer. The outcomes,
    making sure that the providers have a seat at the table seem to
    be one of the priorities through the past meetings, along with
    accountability. I thank you very much.
        Ms. Kiggans. Thank you, ranking member. Thank you to all of
    our witnesses for being here today. I ask unanimous consent
    that all members shall have 5 legislative days in which to
    revise and extend their remarks and include any extraneous
    material. Hearing no objections, so ordered. This hearing is
    now adjourned. Thank you.
        [Whereupon, at 10:28 a.m., the subcommittee was adjourned.]

    =======================================================================

                             A  P  P  E  N  D  I  X

    =======================================================================

                        Prepared Statement of Witnesses

                                  ----------

                     Prepared Statement of Phillip Christy

        Chairwoman Kiggans, Ranking Member Mrvan and other Members of the
    Subcommittee: thank you for inviting us here today to present our views
    on several bills that would affect VA programs and services. Joining me
    today is Dr. Leslie Sofocleous, Executive Director, Electronic Health
    Record Modernization (EHRM) Integration Office's (IO) Program
    Management Office (PMO), Ms. Shana Love-Holmon, Acting Assistant
    Secretary, Office of Enterprise Integration (OEI), and Catherine
    Cravens, Chief of Staff, Office of Information and Technology.

    H.R. 592 - Electronic Health Record Modernization Improvement Act

        Section 2(a) of the bill would prohibit the Secretary of Veterans
    Affairs from commencing a program activity at a Veterans Health
    Administration (VHA) facility where such activity is not being carried
    out as of the date of enactment until the Secretary of VA submits to
    the House and Senate Committees on Veterans' Affairs written
    certification that the electronic health record (EHR) system has met
    each of the following improvement objectives prior to implementation:
    (A) a monthly uptime for the electronic health record system of 99.9
    percent for 4 sequential months, and (B) the completion of all
    improvements or modifications of the EHR system required to be
    completed pursuant to a contract, task order, modification or other
    similar instrument, entered into before the date of the enactment of
    this Act.
        VA does not fully support section 2(a) of this bill. Specifically,
    VA does not support the prohibition of commencing program activities
    until the completion of section 2(a), which would pause program
    activities and cause significant cost impacts. However, adjustment to
    the ``program activities'' definitions outlined in section 2(c) would
    address this issue by allowing certain activities that support early
    pre-deployment to start, while limiting the commencement of full
    deployment.

        VA suggests the following:

          Modification: Update section 2(a)(1) to read: ``(1)
    Prohibition.--The Secretary of Veterans Affairs may not deploy the
    electronic health record system at a facility of the Veterans Health
    Administration until the date on which the Secretary of Veterans
    Affairs...''

        VA supports section 2(a)(2)(A) of this bill, in part. Improving
    system reliability and availability remains a VA focus. Corrective
    actions within the Cerner data base configuration have resulted in more
    than 6 months of system uptime above 99.9 percent without a complete
    outage. As written in section 2(a)(2)(A), if the 99.9 percent metric
    dropped the month prior to deployment then VA would not have the 4
    sequential months prior to deployment.

        VA suggests the following:

          Modification: Update section 2(a)(2)(A) to read: ``(A)
    monthly uptime for the electronic health record system of 99.9 percent
    for four sequential months or documented risk mitigation and
    certification for deployment under 99.9 percent.

        VA does not support section 2(a)(2)(B) of this bill. The Electronic
    Health Record Modernization Integration Office (EHRM-IO), VHA and
    Office of Information Technology have worked collaboratively to assess
    and remediate a subset of identified system challenges and continue
    work to expediently resolve all identified and validated issues.
        There are many improvements and proposed modifications that are
    already on task orders. These are all in flight, with varying dates of
    completion - some of which extend beyond 2023. Many of these
    improvements are important, but not essential, for a future go-live. To
    require all system modifications to be completed in their entirety
    before allowing resumption of any program activities would introduce
    significant delay. Additionally, given the complexity of heath care and
    potential policy changes it is anticipated that ongoing additional
    changes will be required. While all system modifications may not be
    completed prior to deployment, mitigations should be in place.

        VA suggests the following:

          Modification: Update section 2(a)(2)(B) to read: ``The
    completion of improvements or modifications of the electronic health
    record system as agreed upon by the VA Deputy Secretary, VA Under
    Secretary for Health, EHRM-IO and VISN leadership.''

        Section 2(b) would require the VHA facility director, the facility
    chief of staff, and the director of the VISN in which such facility is
    located to each submit written certification that: (1) the build and
    configuration of the EHR system, as proposed to be carried out at such
    facility, are accurate and complete; (2) the staff and infrastructure
    of such facility are adequately prepared to receive such system; and
    (3) the implementation of such system will not have significant,
    sustained adverse effects on patient safety, patient wait-times for
    medical care, or health care quality at such facility.
        VA supports section 2(b) of this bill, with amendments. VA uses a
    consistent process for each deployment of the EHR system to approve the
    decision to go-live. Infrastructure readiness is assessed through the
    current State review (CSR) process and addressed before deployment
    operations begin. Deployment kickoff starts 13 months prior to go-live,
    and there are weekly working deployment meetings with the facility,
    Change Leadership Team and change sponsor to walk through outstanding
    issues. Approximately 4-8 weeks before go-live, VHA, EHRM-IO, Veterans
    Integrated Service Network (VISN) and site leadership begin to meet
    weekly to review the readiness checklist and areas of concern. Last, a
    go/no-go decision meeting with VHA, EHRM-IO, the VISN and the facility
    is held no later than the week before go-live based on the elements of
    the readiness checklist, along with the people, process and technology
    elements of readiness for personnel at the site. The written
    certification outlined by the bill would support the existing
    concurrence process.

        VA suggests the following:

          Modification: Update section 2(b)(1) to read: ``(1) the
    build and configuration of the EHR system, as proposed to be carried
    out at such facility, are accurate and complete based on the approved
    enterprise standard.''

          Modification: Update section 2(b)(3) to read: ``(3) the
    implementation of such system will not have known significant,
    sustained adverse effects on patient safety, patient wait-times for
    medical care, or health care quality at such facility.''

        Section 2(c) includes definitions for EHR and program activity. VA
    supports this section with amendments.

          Modification: Update section 2(c)(2) to read: ``(2) The
    term ``program activity'' means any local or national workshop and/or
    training activities under the Electronic Health Record Modernization
    Program before the certification of the electronic health record
    system.''

    H.R. 608 - Terminate VA's EHRM Program

        Section 1(a) of the bill would require the Secretary of Veterans
    Affairs to terminate the Electronic Health Record Modernization (EHRM)
    program. VA opposes section 1(a) of this bill. Without a modern EHRM
    program, VA would not have an interoperable, longitudinal record with
    the Department of Defense and community care partners; therefore, VA
    could not provide the Veterans with an electronic health record (EHR)
    that tracks the first day of service delivery with DoD to through the
    transition to VA, thereby limiting care and services to the Veteran.
        Modernizing the electronic health record (EHR) system is critical
    to providing the best care for Veterans and facilitates advancements in
    delivery of care in the following ways:

        1. Increased access to new technologies both now and in the future.

        2. Standardized workflows and systems across VA and to automate and
    integrate manual processes, resulting in efficiencies and better
    service and care to Veterans.

        3. Standardized EHR system reducing training and delivers a more
    integrated and skilled workforce.

        4. Facilities use of telehealth services to share clinical
    expertise across VA's expansive health care delivery network.

        5. Improved scheduling and smarter clinical decision support,
    driven by a comprehensive view of a Veteran's medical history and
    service record.

        6. Reduced sustainment costs of an enterprise EHR system.

        If enacted, section 1(a) would have additional costs. VA may need
    to initiate ``stop work'' and/or termination activities depending on
    timing of enactment Claims resulting from government stop work and/or
    termination activities could vary by a wide range, are contract
    dependent, and would need to be evaluated on a case-by-case basis to
    determine the costs to the government.
        Section 1(b) would require the Secretary to carry out the following
    activities within 180 days of enactment: (1) Abolish the Electronic
    Health Record Modernization Integration Office (EHRM-IO); (2) Transfer
    any activities or functions carried out under such office that are not
    terminated pursuant to this section to the Veterans Health
    Administration or the Office of Information and Technology of the
    Department of Veterans Affairs; (3) With respect to each facility of
    the Veterans Health Administration that uses the EHR system implemented
    pursuant to the EHRM Program, revert the facility to instead use the
    Veterans Health Information Systems and Technology Architecture (VistA)
    and the Computerized Patient Record System (CPRS) of the Department.
        VA opposes section 1(b) of this bill. VA's existing EHR system,
    VistA, is almost 40 years old. In its current State, however, VistA is
    comprised of 130 distinct instances and cannot deliver the benefits of
    a modern, enterprise system or provide a seamless health record system
    from military service to Veteran status. Previous attempts to upgrade
    VistA have been unsuccessful; there is potential risk in repeated
    efforts.
        Integration with DoD would not be as strong on separate platforms
    and there would be decreased access to innovations being driven by a
    commercial provider. Moreover, critical solutions that have been
    deployed to enhance interoperability between VA and DoD, such as the
    Joint Health Information Exchange (JHIE), are reliant on the joint
    platform and do not have a replacement. Previous solutions that enabled
    interoperability have been sunsetted. Significant resources and funding
    would be required to develop a replacement platform that could
    effectively and efficiently handle the clinical data exchange volumes
    and adheres to current and upcoming regulatory requirements.
    Connections with national health care organizations that enable health
    information exchange with community providers would also have to be
    reestablished.
        Lastly, section 1(b) would have significant personnel impacts
    across the enterprise. EHRM-IO alone has approximately 300 Federal
    staff, in addition to contractors, nonpermanent staff and staff hired
    to VHA, OIT and EHRM in support of the EHRM program. The timeframe for
    this change in personnel is extremely narrow and will not afford VA the
    time needed to ensure personnel are appropriately relocated to
    positions elsewhere within the Department and would result in
    significant loss in institutional knowledge and subject matter
    expertise.
        Given the breadth and complexity of the impacts of EHRM
    termination, VA does not have an estimate for section 1(b) of this
    bill. However, VA anticipates cost considerations to include (1)
    resources required to sustain the existing EHR solution at deployed
    sites; (2) additional costs for VA to execute a plan to revert back to
    VistA, which would not be feasible within the specified 180-day
    timeframe; and (3) significant additional costs and resourcing required
    to modernize VistA. Appropriations language would also need to be
    updated, since the EHRM program is funded as a separate appropriation.

    H.R. 1659 - VA IT Modernization Improvement Act of 2023

        This bill would direct the VA Chief Acquisition Officer (CAO) to
    contract for the independent verification and validation (IV&V) of
    certain modernization efforts of the Department within 90 days of
    enactment. It prescribes the characteristics and experience (linked to
    the Department of Defense Acquisition Program) required of entities
    eligible to compete and details the oversight functions to be
    accomplished under the IV&V contract.
        The bill defines ``covered programs'' to include ongoing VA
    modernization efforts, e.g., EHRM, Supply Chain Modernization,
    Financial Management Business Transformation (FMBT), Human Resources
    (HR) Systems and Veterans Benefits Management Systems (VBMS) and
    excludes any entity currently performing or having performed on a
    contract for VA within the 5 years preceding issuance of the
    solicitation, including contracts or subcontract related to a covered
    program. The bill also institutes a new annual reporting requirement
    and directs the CFO to work with heads of department offices to ensure
    the amount of the IV&V contract awarded is paid proportionately from
    respective appropriations.
        VA supports this bill if amended, and subject to the availability
    of appropriations. Section 2(a) of the bill directs VA's CAO not later
    than 90 days after the date of the enactment of this Act to enter into
    a contract with an eligible entity under subsection (b) to carry out
    the oversight functions described in subsection (c). VA strongly
    supports the importance of and need for IV&V for VA modernization
    programs. Although VA does not object to the direction given to the
    CAO, it may be more appropriate ``to direct the Secretary of Veterans
    Affairs'' given that ``covered programs'' defined in the bill, e.g.,
    EHRM, FMBT, SC Modernization and H.R. Systems, have major IT components
    and impact across the enterprise.
        The requirement in section 2(a) to, ``enter into a contract within
    90 days,'' is not sufficient time to conduct market research, identify
    qualified entities and award a contract. VA proposes the following for
    section 2(a): ``conduct market research to identify one or more
    eligible entities as described in subsection (b).'' Initiation of
    market research within 90 days is feasible; awarding a large and
    comprehensive IV&V contract or contracts within a 90-day timeframe is
    not realistic.
        Alternatively, VA suggest the language and format of Public Law
    114-286, The Faster Care for Veterans Act of 2016. Specifically,

            2(a) CONTRACTS-

                (1) AUTHORITY. -Not later than 120 days after the date of
            enactment of this Act, the Secretary of Veterans Affairs shall
            enter into a contract with an eligible entity under subsection
            (b) to carry out the oversight functions described in
            subsection (c).

                (2) NOTICE OF COMPETITION.--Not later than 60 days after
            the date of the enactment of this Act, the Secretary shall
            issue a request for proposals for the contract described in
            paragraph (1). Such request shall be full and open to any
            eligible entity as described in subsection (b) and has the
            capacity detailed in subsection (c).

                (3) SELECTION.--Not later than 120 days after the date of
            the enactment of the Act, the Secretary shall award a contract
            to one or more contractors pursuant to the request for
            proposals under paragraph (2).

        Section 2(b) ELIGIBILITY. - describes the characteristics of an
    eligible entity.

        VA supports section 2(b) of this bill, with amendments. VA notes
    the criteria in paragraph (1) coupled with the exclusion in paragraph
    (2) may severely limit the pool of eligible entities and potentially
    frustrate VA's ability to award a contract. Paragraph (2) as written,
    will likely exclude many vendors and could result in legal challenges.
    VA suggests replacing the proposed text with the following:

              ``(2) performed the work at a satisfactory or better level as
            indicated by the past performance information in the Contractor
            Performance Assessment Reporting System for any contract used
            to demonstrate eligibility under subsection (b)(1).''

        Section 2(c) FUNCTIONS. - describes the oversight functions to be
    carried out by the contract awardee. Paragraph (3) of subsection 2(c)
    currently reads - (3) Conducting continuous oversight of the activities
    carried out under, and the system associated with each covered program,
    including oversight of the status, compliance, performance, and
    implementation of recommendations...

        VA supports section 2(c) of this bill, with amendments. VA
    recommends revising paragraph (3) of subsection 2(c) to acknowledges
    the need for a VA adjudication process regarding the IV&V findings and
    recommendations. VA recommends revision as follows:

            ``Conducting periodic oversight of the activities carried out
            under, and the system associated with each covered program,
            including oversight of the status, compliance, performance,
            `and adjudication' and implementation of recommendations...''

        VA recommends amending subsection 2(c) (3) subparagraph (A) to
    read:

            ``(A) Program management, including but not limited to,
            management of the governance of the program...A comprehensive
            IV&V assessment would incorporate a broader range of assessment
            areas than stated in the proposed text.

            Subparagraph (F) of subsection 2(c) (3) lists several items
            with respect to associated systems for evaluation. However,
            validation of the measurable benefit of the system (i.e.,
            business impact, outcomes, value, return on investment...) is
            not listed. These measures of benefit would be a subset of the
            overall set of measures of effectiveness for the program.
        VA recommends adding ``vi'' validation of measurable benefit of the
    system at the end of subparagraph (F) and following that a subparagraph
    (G) Change management approach. Change management and realization of
    program value must be tightly connected, i.e., the connection to the
    proposed value/impact/business-functional outcomes of the program. The
    revised paragraph (3) would appear as follows:

            ``(3) Conducting continuous oversight of the activities carried
            out under, and the systems associated with, each covered
            program, including oversight of the status, compliance,
            performance, and implementation of recommendations with respect
            to, for each covered program, the following:

              (A) Management, including governance, costs, and
            implementation milestones and timelines.

              (B) Contracts for implementation, including financial metrics
            and performance benchmarks for contractors.

              (C) Effect on the functions, business operations, or clinical
            organizational structure of the health care system of the
            Department of Veterans Affairs.

              (D) Supply chain risk management, controls, and compliance.

              (E) Data management.

              (F) With respect to such systems, the following:

                (i) Technical architectural design, development, and
            stability of the systems.
                (ii) System interoperability and integration with related
            information technology systems.
                (iii) System testing.
                (iv) Functional system training pro-vided to users.
                (v) System adoption and use.
                (vi) Measurable benefit of the system as measured by the
            program's approved base line Objective Key Results (OKR) and
            Key Performance Indicators (KPI), (i.e., business impact,
            outcomes, value, ROI''
              (G) Change Management approach effectiveness''

        VA believes these amendments, if adopted, would strengthen the bill
    consistent with congressional intent.

        Subsection 2(e) AWARDED AMOUNTS.--Not later than 90 days after the
    date on which the Chief Acquisition Officer of the Department enters
    into the contract under subsection (a), the Chief Financial Officer of
    the Department, in coordination with the heads of such office of the
    Department responsible for the management of a covered program, shall
    ensure that amounts awarded to an eligible entity under such contract
    are derived, in proportionate amounts, from amounts otherwise
    authorized to be appropriated for each such office of the Department,
    respectively. VA supports subsection 2 (2e) of this bill and has no
    objection to this provision.
        Subsection 2(f) DEFINITIONS - list key terms and authorities that
    are referenced throughout the bill, e.g., ``covered program.'' The bill
    identifies the Electronic Health Record Modernization Program (EHRM),
    the Financial Management and Business Transformation Program (FBMT),
    the Veterans Benefits Management system (VBMS), any program related to
    supply chain modernization, and any program related to the
    modernization of information technology systems associated with human
    resources as the ``covered programs''.
        VA offers for consideration that the scope of this undertaking is
    likely going to create Organizational Conflicts of Interest (OCI) at a
    level which will dissuade many vendors. VA currently has IV&V contracts
    in place for EHRM and FMBT. It is unclear how enactment of this law
    would affect existing contracts. Ideally, VA would have an in-house
    team with the expertise to conduct IV&V of its major modernization
    efforts.
        Contracting for those services as VA builds internal capacity makes
    practical sense and will help to expedite the resulting delivery of
    benefits and services to Veterans, their caregivers and family members.
    VA does not have cost estimates for this bill but anticipates an IV&V
    contract of this size would be extremely expensive. Appropriate and
    timely funding of this bill is critical.

    H.R. 1658 Manage VA Act

        H.R. 1658 would add 38 U.S.C. Sec.  307A which would establish in
    the Department of Veterans Affairs (VA) an Under Secretary for
    Management (USM). The new subsection would establish a new USM to serve
    as the Chief Management Officer of the Department, reporting directly
    to the Deputy Secretary and as a principal advisor to the Secretary on
    matters related to the management of the Department, including
    management integration and transformation in support of Veterans
    operations and programs. The USM responsibilities would include budget
    and finance, procurement, human resources, information technology,
    management integration and transformation, development of transition
    and succession plans, certain GAO reporting, management of the Office
    of Enterprise Integration, and the supervision of the Director of
    Construction and Facilities.
        VA does not support this bill. Integrating the Department's efforts
    and creating operational jointness in our support for Veterans, their
    families, caregivers and survivors is essential to Veterans choosing VA
    for care, benefits and services. VA appreciates that this bill
    generally seeks to address management, integration, and transformation
    issues within the Department, however, VA already has established and
    continues to mature its joint oversight and decisionmaking roles and
    processes, focused on the integrated customer journey it needs to work
    toward these outcomes. Together these are successfully driving the
    integration envisioned by this legislation without the need for a new
    position such as an Undersecretary for Management.

        Oversight and Accountability. The VA Deputy Secretary serves as the
    Department's Chief Operating Officer, supported by a robust governance
    structure that ensures the Chief Executive Officer (CXO) roles (i.e.,
    Chief Acquisition Officer, Chief Information Officer, Chief Financial
    Officer, Chief Human Capital Officer, and Chief Experience Officer) are
    brought together regularly for joint decisionmaking. The Deputy
    Secretary chairs the VA Operations Board, which serves as the most
    senior operations implementation management body for the Department
    providing oversight of the implementation and execution of the
    Secretary's strategic direction. Its purpose is to enable the Deputy
    Secretary to critically evaluate evidence-based, risk-informed
    recommendations about the operational implementation and execution of
    the Department's Strategic Plan and provide Department-level oversight
    and operational direction of key enterprise programs (e.g., Electronic
    Health Record Modernization (EHRM), Financial Management Business
    Transformation (FBMT), Supply Chain transformation), to support well
    integrated operational plans and impactful outcomes. Department of
    Veterans Affairs Operations Board (VAOB) membership includes all the
    CXO roles as well as the Administrations and other key VA leaders.

        Robust Governance with Integrated Customer Focus. VA already has
    implemented robust governance to drive jointness and integration, as
    outlined in VA Notice 22-15 (September 15, 2022). The purpose of the VA
    Governance is to enable evidence-based, risk-informed decisionmaking
    that advances the mission of VA and enables VA to meet its promise to
    provide timely access to world-class health care and earned benefits
    and services to all Veterans.
        Departmental governance includes the VA Executive Board chaired by
    the Secretary and the VA Operations Board chaired by the Deputy
    Secretary that ensure critical risks and opportunities are discussed by
    all leaders from across VA and result in well-integrated decisions that
    matter to Veterans. These two boards are supported by the Evidence
    Based Policy Council, which ensures policy options are developed
    jointly and founded on rigorous evidence, and the Investment Review
    Council, which ensures investment decisions reflect an enterprise-wide
    view of what will make the biggest impact for Veterans.
        Likewise, VA has one of the most outstanding customer experience
    offices in the Federal Government, the Veterans Experience Office
    (VEO). Our Chief Experience Officer is a key partner within our
    enterprise governance framework, facilitating human centered design
    efforts that ensure the Veteran's journey through VA is seamless and
    that each policy and operational decision impacting one of VA's
    components naturally contributes to a well-integrated customer
    experience. The Assistant Secretary for Enterprise Integration serves
    as the VA accountable executive for enterprise management and
    governance in support of the Office of the Secretary. Serving as the
    Governance Executive Secretariat for these four principal Department-
    level Governance bodies.
        VA does not have a cost estimate for this bill.

    H.R. XXX - VA Supply Chain Management System Authorization Act

        This bill would authorize the Secretary of Veterans Affairs to
    carry out an information technology (IT) system and prioritize certain
    requirements to manage supply chains for medical facilities of the
    Department of Veterans Affairs. Specifically, it would give VA
    discretion to procure an IT System to manage the supply chains for the
    Veterans Health Administration (VHA). It details the desirable
    functions and capabilities of such a system and lists specific items to
    be included or excluded. It requires the prioritization of inventory
    management capability and specifies, that should the Secretary choose
    to carry out such a system, it must first be piloted at a VHA facility,
    and that full implementation be completed within three (3) years of
    enactment of this Act. The bill also provides for the system to apply
    across the enterprise, e.g., to the Veterans Benefits Administration
    (VBA) and the National Cemetery Administration (NCA) to the extent
    items VBA and NCA procure can be accommodated by VHA processes.

        VA cites concerns with this bill. The reason for VA's concern is
    twofold. First, as written, the bill may impede ongoing efforts toward
    an enterprise supply chain solution. Second, the timeline does not
    accurately reflect the complexities involved in successful procurement
    and execution. As such, VA welcomes the opportunity to continue working
    with the Committee to provide additional technical assistance that will
    create the flexibility and scope of timing needed to ensure success of
    the mission.
        VA began an enterprise-wide supply chain assessment in October
    2021. Leveraging previous internal and external investigations,
    assessments and reports, VA mapped and validated all current supply
    chain processes including, facilities, High Tech medical equipment, IT,
    medical supplies, the National Cemetery Administration,
    pharmaceuticals, prosthetics, and the Veterans Benefits Administration.
    VA also completed a detailed gap analysis comparing the ``as-is'' State
    with the desired objective of an Easy to Use, Integrated and
    Intelligent Supply Chain system.
        VA is far along in the process that will culminate in the
    identification and eventual selection of an IT system or systems that
    will provide a modernized enterprise-wide solution for the supply chain
    and logistics management. VA has engaged with industry on multiple
    occasions for feedback and to gain a better perspective on what best
    practices can be leveraged in our efforts to modernize. We recognize
    that the most critical aspect of this endeavor is to ensure the
    continued and consistent delivery of high-quality health care products
    and services for our providers, Veterans, Caregivers, and their
    families. VA is committed to an approach focused on lessons learned,
    end-user input and phased implementation.
        Although VA expected to solicit proposals and complete evaluations
    in January 2023, that timeline has shifted to the right as we learn
    more from internal and industry feedback. VA continues to socialize the
    anticipated organizational and staff changes needed to properly execute
    the mission. This methodical approach enables VA to better understand
    the issues to be solved, effect change management, and refine and
    revise our requirements before determining which potential technical
    solutions will be needed.
        VA is nearing completion of the acquisition strategy for the
    enterprise supply chain modernization effort which will enable VA to
    develop an Independent Lifecycle Cost Estimate for the overall
    enterprise supply chain modernization effort. Currently, VA is
    preparing to issue a Request for Proposals and expects to issue the
    solicitation by late April or early May. VA does not currently have a
    cost estimate for this bill.

    Conclusion

        This concludes my statement. We would be happy to answer any
    questions you or other members of the Subcommittee may have.
                                     ______

                      Prepared Statement of Shelby Oakley

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                           Statements for the Record

                                  ----------

                   Prepared Statement of The American Legion

        Chairwoman Kiggans, Ranking Member Mrvan, and distinguished members
    of the subcommittee, on behalf of National Commander Vincent J. ``Jim''
    Troiola and more than 1.6 million dues-paying members of The American
    Legion, we thank you for the opportunity to comment on H.R. 592 -
    Department of Veterans Affairs Electronic Health Record Modernization
    Improvement Act.
        The American Legion is directed by active Legionnaires who dedicate
    their time and resources to serve veterans and their families. As a
    resolution-based organization, our positions are guided by more than
    104 years of advocacy and resolutions that originate at the grassroots
    level of our organization. Every time The American Legion testifies, we
    offer a direct voice from the veteran community to Congress.

      H.R. 592 - Department of Veterans Affairs Electronic Health Record
                         Modernization Improvement Act

    To prohibit the Secretary of Veterans Affairs from carrying out certain
      activities under the Electronic Health Record Modernization Program
       until certification of system improvements and facility readiness.

        In 2018, the Department of Veterans Affairs (VA) began its
    Electronic Health Record Modernization (EHRM) program to replace its
    current operating system, Veterans Health Information Systems and
    Technology Architecture (VistA), which originally dates to 1977.\1\ The
    VA's new EHR system, Oracle Cerner Millennium, is intended to bring new
    capabilities to VA, such as a more efficient process for identifying
    potential health risks, scheduling features that would improve wait
    times, and a seamless experience across VA, Department of Defense
    (DOD), and civilian healthcare facilities and their departments.\2\ The
    EHRM program aims to provide veterans with an easily updated health
    record that follows a veteran for life, from when the service member
    joins the military to their time in VA healthcare. The American Legion
    strongly supports these goals.\3\
    ---------------------------------------------------------------------------
        \1\ Allen, Arthur. n.d. ``A 40-Year `Conspiracy' at the VA.'' The
    Agenda. Politico.com. https://www.politico.com/agenda/story/2017/03/
    vista-computer-history-va-conspiracy-000367/.Unless otherwise noted,
    all cited hyperlinks accessed March 28, 2023.
        \2\ Communication, IT Strategic. 2022. ``What Veterans Need to Know
    about How VA's Health Record System Is Changing--VA EHR
    Modernization.'' Digital.va.gov. July 21, 2022. https://digital.va.gov/
    ehr-modernization/resources/fact-sheets/what-veterans-need-to-know-
    about-how-vas-health-record-system-is-changing/.
        \3\  ``Resolution No. 83: Virtual Lifetime Electronic Record.''
    2016. https://archive.legion.org/node/329.; ``Resolution No. 12:
    Implementation of the MISSION Act.'' 2022. https://archive.legion.org/
    node/14050.
    ---------------------------------------------------------------------------
        The first deployment of Oracle Cerner Millennium began in 2020 at
    Mann-Grandstaff VA Medical Center in Spokane, Washington. It
    immediately faced problems with transferring medical records to the new
    system.\4\ For example, it imported outdated emergency contact
    information and eliminated essential prescription histories. As
    detailed in two VA Office of Inspector General (OIG) reports, the
    rollout also had training and reporting issues, and caused multiple
    incidents where veterans were harmed.\5\ On one occasion, the Oracle
    Cerner Millennium system shut down for over 4 hours at Mann-Grandstaff,
    causing medical center staff to rely on outdated paper records and
    leaving veterans at risk of medical error.\6\
    ---------------------------------------------------------------------------
        \4\ VA OIG Details Continued Deficiencies with VA's EHRM.'' n.d.
    www.meritalk.com. https://www.meritalk.com/articles/va-oig-details-
    continued-deficiencies-with-vas-ehrm/.
        \5\ Department of Veterans Affairs Office of Inspector General.
    ``The New Electronic Health Record's Unknown Queue Caused Multiple
    Events of Patient Harm.'' 2022. va.gov https://www.va.gov/oig/pubs/
    VAOIG-22-01137-204.pdf.
        \6\ Krishan, Nihal. ``VA Cerner Ehr System Goes down for over 4
    Hours Due to Patient Data base Corruption Issue .'' FedScoop,
    August 5, 2022. https://fedscoop.com/va-cerner-ehr-system-goes-down-
    for-3-hours-due-to-patient-data base-corruption-issue/.
    ---------------------------------------------------------------------------
        After several more deployments, the system continued to experience
    installment and operational issues, eventually leading to VA's decision
    to put the rollout on hold. The most recent pause started in October
    2022 and was indefinitely extended in April 2023. During this time, VA
    established an EHRM Sprint Project Team to identify the solutions
    necessary to move forward. \7\ After reviewing more than 450 issues,
    the Sprint Project Team released a report focusing on 30 current
    critical issue areas in the EHRM implementation.
    ---------------------------------------------------------------------------
        \7\ Department of Veterans Affairs Veterans Health Administration.
    ``EHRM Sprint Report.'' 2023. veterans.senate.gov. https://
    www.veterans.senate.gov/services/files/5B5776E7-8765-4303-9B93-
    D2BCBF8D5A33.
    ---------------------------------------------------------------------------
        The critical issues identified include diagnostic echocardiogram
    orders being entered incorrectly, problems with home oxygen
    requisition, lost prosthetic orders, medication lists disappearing, and
    prescription delays and omissions. In these areas of care, patient
    safety must remain a top priority - where one mistake can kill or
    severely harm a veteran and their quality of life. In its current
    State, the Oracle Cerner Millennium system makes these levels of care
    vulnerable and potentially harm veterans in the future. Last month, on
    March 21, 2023, VA informed the Senate Veterans Affairs Committee that
    EHRM issues were linked to at least four veteran deaths and two
    additional instances of critical harm to veterans.\8\
    ---------------------------------------------------------------------------
        \8\ Rodriguez, Sarai. (2023, March 21). ``VA Admits Oracle Cerner
    EHRM Issues Contributed to 4 Veteran Deaths.'' ehrintelligence.com. VA
    Admits Oracle Cerner EHRM Issues Contributed to 4 Veteran Deaths
    (ehrintelligence.com).
    ---------------------------------------------------------------------------
        It is important to note that the report is not intended to fix
    issues with the EHRM program but rather to identify and recommend
    solutions, leaving VA and Oracle Cerner to further develop and
    implement them. The American Legion recognizes this is a complex, time-
    consuming process, and fixes will take time and effort.
        H.R. 592 would address some of the major problems facing the EHRM
    program rollout. The act implements reasonable recommendations and
    requires two main certifications from current facilities using the
    Oracle Cerner Millennium system before it is deployed to further
    facilities.\9\
    ---------------------------------------------------------------------------
        \9\ Congress.gov. ``Text--H.R. 592--118th Congress (2023-2024):
    Department of Veterans Affairs Electronic Health Record Modernization
    Improvement Act.'' February 16, 2023. https://www.Congress.gov/bill/
    118th-congress/house-bill/592/text's=1&r=28.
    ---------------------------------------------------------------------------
        The first such requirement is a monthly average uptime of 99.9
    percent for facilities currently using the Oracle Cerner Millennium
    system, which is key for any system, especially one meant to care for
    veterans. The American Legion believes an average monthly uptime of
    99.9 percent would allow the maximum ability for VA to deliver world-
    class care to our veterans.
        The second requirement is that any new EHR system will not launch
    in a new facility unless the facility's director, chief of staff, and
    Veterans Integrated Services Network (VISN) director certify that the
    facility and its staff are prepared for system deployment and use. VISN
    and facility leadership are the most qualified to assess a facility's
    readiness. Furthermore, if leadership and staff are properly prepared
    and ready to receive the new system, the willingness to learn and
    operate the system will likely assist in a successful implementation.
    Together, these requirements are sensible safeguards moving forward to
    ensure the success of the EHRM program.
        Through Resolution No. 83: Virtual Lifetime Electronic Record, The
    American Legion supports the implementation of an electronic health
    record and wants the EHRM program to succeed and serve veterans
    safely.\10\ The VA and veteran service organizations, like The American
    Legion, work tirelessly to improve the lives of our Nation's veterans.
    H.R. 592 and the Oracle Cerner Millennium system will provide the
    capabilities to ensure that American veterans receive the world-class
    care they deserve.
    ---------------------------------------------------------------------------
        \10\  The American Legion Resolution No. 83 (2016): Resolution No.
    83: Virtual Lifetime Electronic Record : Digital Archive (legion.org).

    ---------------------------------------------------------------------------
        The American Legion supports H.R. 592 as currently written.

        Conclusion
        Chairwoman Kiggans, Ranking Member Mrvan, and distinguished members
    of the subcommittee, The American Legion thanks you for your leadership
    on this matter and for allowing us the opportunity to share the
    position of our more than 1.6 million members. For additional
    information or questions regarding this testimony, please contact
    Legislative Associate, John Kamin, at The American Legion's Legislative
    Division at (202) 861-2700 or jkamin@legion.org.
                                     ______

                Prepared Statement of Fleet Reserve Association

                                    The FRA

                            ``Heading to 1OO Years''

        The Fleet Reserve Association (FRA) is the oldest and largest
    organization serving enlisted men and women in the active, reserve, and
    retired communities plus veterans of the Navy, Marine Corps, and Coast
    Guard. The Association is congressionally Chartered, recognized by the
    Department of Veterans Affairs (VA), and entrusted to serve all
    veterans who seek its help.
        FRA started in 1924 and its name is derived from the Navy's program
    for personnel transferring to the Fleet Reserve after 20 or more years
    of active duty, but less than 30 years for retirement purposes. During
    the required period of service in the Fleet Reserve, assigned personnel
    earn retainer pay and are subject to recall by the Secretary of the
    Navy.
        The Association testifies regularly before the House and Senate
    Veterans' Affairs Committees, and it is actively involved in the
    Veterans Affairs Voluntary Services (VAVS) program. A member of the
    National Headquarters' staff serves as FRA's National Veterans Service
    Officer (NVSO) and as a representative on the VAVS National Advisory
    Committee (NAC). FRA's VSOs oversee the Association's Veterans Service
    Officer program and represent veterans throughout the claims process
    and before the Board of Veteran's Appeals.
        In 2016, FRA membership overwhelmingly approved the establishment
    of the Fleet Reserve Association Veterans Service Foundation (VSF). The
    main strategy for the VSF is to improve and grow the FRA Veterans
    Service Officers (VSO) program. The newly formed foundation has a
    501(c) 3 tax exempt status and nearly 800 accredited service officers
    with FRA.
        FRA became a member of the Veterans Day National Committee in
    2007,joining 24 other nationally recognized VSOs on this important
    committee that coordinates National Veterans' Day ceremonies at
    Arlington National Cemetery. FRA will host the ceremony in their
    centennial year, 2024. The Association is a leading organization in The
    Military Coalition (TMC), a group of 35 nationally recognized military
    and veteran groups jointly representing the concerns of over five
    million members.
        The Association's motto is ``Loyalty, Protection, and Service.''

                                  Introduction

        The FRA welcomes this and other numerous oversight hearings because
    the Association believes congressional oversight of the VA technology
    program is vital to ensuring improvements to the system. The VA
    healthcare structure is a hybrid system consisting of inpatient and
    outpatient care, telehealth, and community care. Ensuring that the VA
    is equipped to meet the unique needs of veterans requires the VA to
    fully leverage all components of the VA healthcare system and create a
    seamless and paperless transition from active-duty service to veterans
    status. The Electronic Health Record Modernization (EHRM) is an
    essential element in modernization of the VA healthcare system.

                                      EHRM

        ``The VA uses the Veterans Health Information Systems and
    Technology Architecture (VistA), which includes the VA's Electronic
    Health Record (EHR) system to provide healthcare to patients. In June
    2017 the agency initiated the EHRM program to replace VistA because it
    is technically complex, costly to maintain, and does not fully support
    the need to exchange health data with other organizations.'' \1\ The VA
    has spent more than $9.42 billion on the EHRM program.
    ---------------------------------------------------------------------------
        \1\ GAO report -23-106685, March 15, 2023
    ---------------------------------------------------------------------------
        FRA appreciates the House Veterans Affairs Committee oversight
    hearings on the Electronic Health Record Modernization at the VA. The
    plan has been plagued with ongoing problems dating back to its initial
    launch at the VA Medical Center in Spokane, Washington. Serious issues
    related to patient safety, training, employee morale, and several other
    deployment problems still exist, though some progress has been made.
    Office of Inspector General (OIG) report revealing serious issues with
    the deployment of VA's new Electronic Health Record Modernization
    (EHRM) program.
        The VA first launched its new electronic health record (EHR) system
    more than 25 months ago. The program was scheduled in July 2022 to
    expand to include the VA Medical Center in Boise, Idaho. The expansion
    was delayed from October 2022 until June 2023 when VA wanted to expand
    the software to new VA medical centers.
        Oversight committees were told that the VA is using this pause to
    make system enhancements and to perform tests to ensure the system is
    stable, resilient, and provides the capability VA employees and
    veterans need to improve access and quality of care. Department of
    Veterans (VA) Secretary McDonough has extended the pause for
    implementing the Electronic Health Record Modernization (EHRM) program.
    There is growing concern on Capitol Hill about the long-term cost,
    safety, and reliability of the program. This new delay did not specify
    when implementation would resume. When the program started it was
    estimated that the cost would be $16 billion over 10 years. However, a
    more recent independent estimate predicts $33-36 billion over 13 years.
        Nevertheless, progress has occurred since the VA joined with the
    DoD in a joint contract to modernize its EHR system in 2017. The huge
    $16 billion project raised lots of concerns with lawmakers after
    decades of attempts by both departments to develop a joint
    interoperable health record that never materialized.
        The House and Senate passed the ``Electronic Health Record
    Transparency Act'' (H.R. 4591) to require the VA to submit to Congress
    quarterly reports that evaluate the performance of the EHR, and it was
    signed into law in June 2022. The FRA wants to ensure adequate funding
    for DoD and the VA health care resources delivering seamless, cost-
    effective, quality services to personnel wounded in combat and other
    veterans and their families. Some Members of Congress have expressed
    concern about the cost and length of time to fully implement this
    program. The cost and the long time for implementation notwithstanding,
    the FRA believes there is a tremendous opportunity with the two
    departments using the same Electronic Health Records.

                            Implementation Problems

        The recent acquisition of the Cerner system by Oracle has come with
    a wide variety of challenges. The VA staff has experienced difficulties
    adjusting to the new system. The VA claims this is due to a lack of
    proper training. The new system created an ``unknown queue,'' a
    problematic feature that has caused referral orders to effectively go
    missing at the VA. Additionally, an audit by the Office of Inspector
    General (OIG) claims that the VA lacked a reliable integrated master
    schedule consistent with scheduling standards, which increases the risk
    of missing milestones and delaying the delivery of a system to provide
    timely, quality care to veterans. Schedule delays that extend the
    program are also likely to result in about $1.95 billion in annual cost
    overruns and may determine the VA's other modernization efforts on
    supply chain and financial management system. The report claims that
    Cerner failed to deliver more than 11,000 orders for specialty care,
    lab work and other services--without alerting health care providers the
    orders had been lost. Those lost orders, resulted in delayed care and
    what a VA patient safety team classified as dozens of cases of
    ``moderate harm'' and one case of ``major harm.'' It should be noted
    that the Department of Defense (DoD) waited for roughly 2 years after
    implementing the EHR at its first four sites, and the glitches DoD was
    focused on fixing (primarily with its networks) were smaller than what
    VA is trying to fix. As VA leadership has confirmed, they will not
    deploy the new EHR system at any facility until they are certain it is
    ready to deliver for veterans and VA providers. Based on recent
    assessments, the VA has determined that the new EHR is not yet ready
    for further deployment at this time.

                               Legislative Action

        There have been two legislative proposals introduced in the House
    that pertain to the VA's EHRM program. FRA believes congressional
    oversight of VA technology is vital to ensuring improvements in the
    system. Legislation introduced in the House the ``EHRM Improvement
    Act'' (H.R. 592) to block further implementations of the system until
    the medical centers determine they are well- equipped to receive and
    use it, without hindering the delivery of care to veterans and hurting
    productivity. The HVAC Chairman and sponsor of the bill, Rep. Mike Bost
    (IL) believes that the Oracle Cerner system should not be implemented
    at any more VA sites until the VA Medical Centers leadership certifies
    that the medical center is ready.
        Other legislation introduced ``the EHRM Termination Act'' (H.R.
    608) which would end the project altogether if VA and Oracle Cerner are
    unable to make significant improvements. FRA supports H.R. 592 and has
    not taken a position on H.R. 608.

                                   Conclusion

        In closing, FRA wants to express its sincere appreciation for the
    opportunity to present its views on the EHRM program to this
    distinguished Subcommittee. The FRA believes there is a tremendous
    opportunity with the two departments using the same Electronic Health
    Records.

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