[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.]


    
      
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                         A  P  P  E  N  D  I  X

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                    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.
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    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.
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    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.
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    \10\  The American Legion Resolution No. 83 (2016): Resolution No. 
83: Virtual Lifetime Electronic Record : Digital Archive (legion.org).

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    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 [email protected].
                                 ______
                                 

            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.
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    \1\ GAO report -23-106685, March 15, 2023
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    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.

                                 [all]