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

                            ENSURING TIMELY ACCESS:
                          CHALLENGES IN VA SCHEDULING
    =======================================================================

                                    HEARING

                                   BEFORE THE

                            SUBCOMMITTEE ON TECHNOLOGY
                                 MODERNIZATION

                                    OF THE

                         COMMITTEE ON VETERANS' AFFAIRS

                         U.S. HOUSE OF REPRESENTATIVES

                        ONE HUNDRED EIGHTEENTH CONGRESS

                                 SECOND SESSION

                                   __________

                          THURSDAY, SEPTEMBER 26, 2024

                                   __________

                               Serial No. 118-85

                                   __________

           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
    58-232                  WASHINGTON : 2026
    =======================================================================

                         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 TECHNOLOGY MODERNIZATION

                  MATTHEW M. ROSENDALE, SR., Montana, Chairman

    NANCY MACE, South Carolina           SHEILA CHERFILUS-MCCORMICK,
    KEITH SELF, Texas                        Florida, Ranking Member
                                         GREG LANDSMAN, Ohio

    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

                                  ----------

                          THURSDAY, SEPTEMBER 26, 2024

                                                                       Page

                               OPENING STATEMENTS

    The Honorable Matthew M. Rosendale, Sr., Chairman................     1
    The Honorable Sheila Cherfilus-McCormick, Ranking Member.........     2

                                   WITNESSES
                                    Panel I

    Ms. Cherri Waters, Executive Director, Health Portfolio, Office
      of Information & Technology, U.S. Department of Veterans
      Affairs........................................................     4

            Accompanied by:

        Ms. Hillary Peabody, Acting Assistant Under Secretary for
            Health for Integrated Veteran Care, Veterans Health
            Administration, U.S. Department of Veterans Affairs

        Mr. Mark Hausman, M.D., Executive Director for Integrated
            Access, Veterans Health Administration, U.S. Department
            of Veterans Affairs

                                    APPENDIX
                        Prepared Statements Of Witnesses

    Ms. Cherri Waters Prepared Statement.............................    23

                           Statements For The Record

    Questions for the Record Submitted by The Honorable Matthew M.
      Rosendale, U.S. House of Representatives, (MT-02)..............    25
    U.S. Department of Veterans Affairs Response to Questions for the
      Record.........................................................    27

                            ENSURING TIMELY ACCESS:
                          CHALLENGES IN VA SCHEDULING

                                  ----------

                          THURSDAY, SEPTEMBER 26, 2024

      Subcommittee on Technology Modernization,
                        Committee on Veterans' Affairs,
                                 U.S. House of Representatives,
                                                        Washington, DC.
        The subcommittee met, pursuant to notice, at 9:07 a.m., in
    room 360, Cannon House Office Building, Hon. Matt Rosendale
    (chairman of the subcommittee) presiding.
        Present: Representatives Rosendale, and Cherfilus-
    McCormick.

          OPENING STATEMENT OF MATTHEW M. ROSENDALE, CHAIRMAN

        Mr. Rosendale. Good morning. The subcommittee will come to
    order. I want to welcome our witnesses to discuss the efforts
    to modernize the U.S. Department of Veterans Affairs' (VA)
    appointment scheduling process. Ten years after the wait time
    scandal, it is still too difficult for veterans to get
    appointments in the Veterans Health Administration (VHA) or in
    the community. Some members of this committee have been eager
    to get into arguments about VHA care versus community care. I
    believe veterans should have all the information and the VA
    should respect their choices. I was charged with making sure
    our veterans get the care that they have earned when they want
    it, where they want it, period.
        I can tell you, in Montana, community care is an absolute
    necessity, but the reality is both systems are still far too
    bureaucratic and difficult to navigate. It is also still too
    complicated for the VA employees to manage scheduling. These
    Information Technology (IT) systems have not been a high
    priority, and the projects that are consuming the lion's share
    of the IT budget do little to solve the problem. I am glad to
    see our witnesses working on the integrated scheduling
    solution, the clinical capacity search tool, and the clinic
    configuration manager to improve VHA scheduling. I question why
    the Department waited so long to start these projects and why
    some of them will take so many years to complete, but without a
    doubt, the goals are worthy. I expect our witnesses to stay the
    course and deliver these systems on schedule and on budget,
    which is another big problem that we have had with many of the
    IT programs.
        Our veterans would have been much better served if the VA
    had not abandoned the medical appointment scheduling system,
    MASS in 2019. This project had implemented Epic's scheduling
    system and patient portal in Columbus, Ohio, and they were
    working well. The VA leaders at the time made a special effort
    to eliminate it, paving the way for Cerner, a name that we have
    had come up in this committee many, many times, not under good
    circumstances, to duplicate the work and install an inferior
    system. This was a disastrous decision that we are all still
    paying for.
        I also expect our witnesses to explain how they are going
    to fully implement the External Provider Scheduling (EPS)
    system, which includes the software of a company called
    WellHive. WellHive enables direct scheduling, which means VA
    schedulers no longer have to play phone tag for hours to hunt
    down open appointments with community care providers. Instead,
    they can see each participating community care provider's
    scheduling availability in real time on one screen. They can
    schedule the veteran's desired appointment with one call.
    WellHive's software has proven successful in the medical
    centers that have been permitted to use it. According to VA's
    own statistics, it has accelerated the overall community care
    referral and scheduling process from 26.6 to 17 days. The
    status quo phone tag method takes days or weeks and many phone
    calls before a veteran can get scheduled. I know many veterans
    who are watching this can certainly relate to this problem.
        According to the VA's website, WellHive enables staff to
    schedule appointments in under 6 minutes. The medical center
    employees have given it rave reviews during the committee
    staff's oversight visits. It seems to be working, yet we
    continue to see VA make confusing decisions that hold the
    project back. Early on, there were caps on how many schedulers
    at each medical center could use WellHive. More recently, the
    company has complained that its efforts to sign up new
    healthcare providers are restricted. Now VA tells us that
    WellHive's system will be turned off in four medical centers
    where it was already implemented, and the planned rollout in
    Fiscal Year 2025 will be dramatically scaled back.
        I am well aware of the VHA budget shortfall. I think the
    House made the right decision yesterday to get a complete
    explanation of the shortfall rather than to hand over a $12
    billion supplemental appropriation right away. I have no doubt
    that Congress will get to the bottom of the situation and
    prevent any veterans' care from being disrupted. That being
    said, it would be incredibly short sighted to cause lasting
    damage to this project with budget cuts that will quickly
    disappear everywhere else. I have serious concerns that the
    current leaders of the Department of Veterans Affairs might be
    intentionally undermining this project and making veterans'
    health care slower and more difficult out of political
    hostility to community care. I hope that is not the case.
        Today we are going to dig into these decisions and the
    thinking behind them because veterans' appointment scheduling
    is too important, and the status quo is too broken to let any
    of the projects we are discussing today slip into failure or
    neglect. With that, I will yield time to Ranking Member Sheila
    Cherfilus-McCormick for her opening statement.

    OPENING STATEMENT OF SHEILA CHERFILUS-MCCORMICK, RANKING MEMBER

        Ms. Cherfilus-McCormick. Thank you so much, Mr. Chairman,
    and thank you so much to our witnesses for being here today.
    This subcommittee has spent a lot of time discussing VA's
    transition to its new Oracle Electronic Health Record (EHR).
    Lost in the conversation has been the Veterans Health
    Administration's critical need for a new appointment scheduling
    solution. Appointment scheduling is the foundation of veteran
    access to care, the current process and the system that support
    it. Weeks or months to the time that the veterans wait for
    their critical medical appointments. This should not be the
    case. Instead, we should be creating solutions that provide
    better visibility to care. Whether it is sought at VA or in the
    community, veterans deserve as much.
        For more than 20 years, VA has attempted to modernize or
    replace its scheduling IT system. It has been decades of
    modernization efforts with little to no success. In fact, most
    of the efforts have been abandoned. In just the last 10 years,
    we have seen four partial efforts to create this functionality
    for veterans, all of which have suffered from the same feeling
    as most of VA's IT modernization struggles--poor requirements
    development. In 2014, VA updated Veterans Health Information
    Systems and Technology Architecture (VISTA) legacy by
    developing a graphical user interface, or GUI, and automated
    some of the scheduling rules. The project, dubbed VistA
    scheduling enhancement (VSE) for VSA, did not address data
    quality issues and did not bring VA much closer to the then
    current state of healthcare information systems, effectively
    putting lipstick on a pig.
        In 2015, VA has changed directions and contracted for 624
    million to implement a commercial off the shelf or COTS
    scheduling system the medical appointment scheduling system
    MASS, which has later downgraded to a pilot. By all reports,
    including VA's own assessment, that pilot was a huge success.
    VA found increasing scheduling system efficiencies, improved
    timely access to services for veterans, increased productivity,
    and a substantial decrease in overtime. However, 8 months after
    the implementation of MASS and the signing of a contract with
    Cerner, now Oracle Health, VA halted the pilot.
        In 2019, VA shifted again, announcing plans to implement
    the scheduling solution that it had purchased as part of the
    Cerner contract, known as the centralized scheduling solution,
    or CSS, but on a separate and accelerated deployment schedule
    from the rest of the electronic health record. The plan at the
    time was to have the Cerner application deployed by 2023. This
    plan, similar to VSE and MASS, was also abandoned. Instead, VA
    has spent the past 5 years developing its own software. The
    integrated scheduling solution, or ISS, a system that is
    currently being scheduled, will now take as long or even longer
    than planned CSS timelines and is being developed and deployed
    only to eventually be replaced by CSS anyway.
        I still do not understand the logic behind this. It seems
    like a waste of time, energy, taxpayer money to be spent 5
    years developing something that would presumably be replaced in
    the next 10 years, especially when called systems have already
    been tested and integrated at VA, with some success. Further,
    despite these efforts, the ISS is still unable to compare
    direct care schedules to availability in the community,
    something it desperately needs as community care referrals
    continue to rise. The exploiting community care cost is having
    dire impacts on VA's budget, especially as community care is
    more expensive than VA direct care. If we do not find a way to
    balance it, there may not be a VA for future generations of
    veterans. While community care is valuable resource for
    ensuring that veterans have access to the care they need, VA
    lacks the ability to prove that veterans could be seen faster
    in community care than they can at VA.
        In fact, in a broader swath in the country, VA's access is
    better than that of the community. Central to the oversight of
    this committee provides is ensuring that veterans, whether they
    are seen as VA or in the community, have access to health care
    that is both timely and high quality. Without visibility into
    the community, we are not able to make these quality assurances
    for veterans as they deserve. I urge VA to implement a solution
    that allows for apples-to-apples comparisons between VA care
    and community care. Veterans should be able to make decisions
    about their healthcare with the full breadth of information
    available. Thank you to our witnesses and I yield back.
        Mr. Rosendale. Thank you very much, Ranking Member Sheila
    Cherfilus-McCormick. I will now introduce the witnesses on our
    first and only panel.
        First, from the Department of Veterans Affairs, we have Ms.
    Cherri Waters, Executive Director for the health portfolio in
    the Office of Information and Technology (OIT). Welcome back,
    Ms. Waters. From the Veterans Health Administration, we have
    Ms. Hillary Peabody, the Acting Assistant Under Secretary for
    Health for Integrated Veteran Care (IVC). Finally, we have Dr.
    Mark Hausman, the Executive Director for the Access
    Transformation in the Office of Integrated Veteran Care. If you
    all could please rise and raise your right hands.
        Do you solemnly swear, under penalty of perjury, that the
    testimony you are about to provide is the truth, the whole
    truth and nothing but the truth? Thank you very much and let
    the record reflect that all witnesses have answered in the
    affirmative.
        [Witnesses sworn.]
        Mr. Rosendale. Ms. Waters, you are now recognized for 5
    minutes to deliver the opening statement on behalf of the VA.

                       STATEMENT OF CHERRI WATERS

        Ms. Waters. Good morning. Chairman Rosendale, Ranking
    Member Cherfilus-McCormick and distinguished members of the
    subcommittee thank you for the opportunity to testify on the
    Office of Information and Technology and Veteran Health
    Administration's efforts to modernize the Department of
    Veterans Affairs scheduling systems. I am accompanied by my
    colleagues from VHA, Ms. Hillary Peabody, Acting Assistant
    Under Secretary for Integrated Veteran Care, and Dr. Mark
    Hausman, Executive Director for Access Transformation, IVC. I
    am honored to highlight the collaborative efforts that are
    transforming the future of veteran care.
        VA's enterprise scheduling modernization effort, a joint
    endeavor between VHA and OIT, is a testament to our commitment
    to streamline and enhance VA scheduling systems. To provide the
    best outcomes for veterans, VA must invest in modern scheduling
    tools that offer near term benefits and ultimately facilitate a
    long-term scheduling solution. The introduction of new
    functionalities through VA's modernization efforts is a
    significant step toward improving access to care for veterans.
    The ability to schedule both virtual and in person
    appointments, consolidate scheduling functions, and implement
    provider-based scheduling is pivotal in aligning VA scheduling
    systems with industry standards. These enhancements are
    designed to provide greater flexibility and efficiency in
    scheduling appointments, ultimately connecting veterans with
    the best available resources for their needs.
        One of the key tools driving this effort is the Integrated
    Scheduling Solution, ISS, which represents a significant
    improvement from our legacy system VistA scheduling enhancement
    graphical user interface, or VSE GUI. ISS streamlines the
    scheduling process, offering a more integrated and intuitive
    platform for VA staff to schedule various appointment types
    across multiple sites of care. Transitioning users from VSE GUI
    to ISS is in progress and is expected to be fully completed by
    February 2025, representing a significant milestone in our
    journey toward a more cohesive scheduling system. We have
    already received significant staff praise during the initial
    testing and implementation. The Clinic Capacity Search Tool,
    CCST, and the Clinic Configuration Manager, CCM, are enhancing
    the scheduling experience for veterans by providing quicker
    access to care, reducing discrepancies and increasing
    efficiency.
        CCST currently allows VA staff to quickly search and view
    telehealth appointments across multiple facilities. Starting in
    January 2025, we will begin rolling out enhancements to CCST
    that will enable staff to view appointments for both telehealth
    and in person visits. Furthermore, we are working on
    enhancements to CCM for managing the provider's appointment
    availability. These enhancements will enable the implementation
    of provider-based scheduling across VA, providing a unified
    view of provider availability and significantly streamlining
    the scheduling process. In support of community care, the
    External Provider Scheduling platform simplifies the process of
    connecting veterans with community care providers. EPS enables
    VA staff to directly schedule community care appointments
    electronically, enhancing coordination and ensuring timely
    access to care.
        As we look toward the future, our focus remains on
    improving timeliness, ensuring veterans receive the best
    available resources, and enhancing coordination between VA and
    community care providers. These efforts will ultimately
    converge under the ISS platform, which will integrate multiple
    scheduling tools into a single, streamlined experience across
    the enterprise. This will provide veterans with faster access
    to care, whether through VA facilities or community providers,
    while simultaneously reducing the administrative burden on VA
    staff.
        Chairman Rosendale, Ranking Member Sheila Cherfilus-
    McCormick, and members of the subcommittee, thank you for the
    opportunity to appear today. We are proud of the progress we
    have made and remain committed to continuing this journey of
    improvement for the benefit of our veterans and the dedicated
    staff who serve them. This concludes my testimony, and I look
    forward to answering your questions.

        [The Prepared Statement Of Cherri Waters Appears In The
    Appendix]

        Mr. Rosendale. Thank you, Ms. Waters the written statement
    of Ms. Waters will be entered into the hearing record. We are
    now going to proceed to questioning and I will recognize myself
    for 5 minutes. Ms. Waters, how is the clinical capacity search
    tool going to make the appointment scheduling process easier
    and better?
        Ms. Waters. Thank you for that question, Chairman. The
    clinical capacity search tool will allow a staff scheduler to
    be able to see available appointments across multiple sites in
    a single unified view. Currently, this is available to see all
    telehealth appointments. As I mentioned in my opening
    testimony, in January 2025, we are rolling out the next
    enhancement to CCST, which will allow you to see schedules
    across multiple sites.
        Mr. Rosendale. What are CCST's capabilities today, and when
    do you expect the system to be fully functional? Fully
    functional is a term that I have been using since the day I
    arrived in Washington, and we have not had it, experienced it
    anywhere in anything. That is the big part of this.
        Ms. Waters. I appreciate the question. It is very difficult
    when we talk about IT tools to talk about what is fully
    functional. One of the things that we do is we look----
        Mr. Rosendale. Where all of the features that are being
    promised by the vendor are fully functional. They are working,
    they are available, they are ready.
        Ms. Waters. As I mentioned, the current state of CCST
    allows you to see available telehealth appointments across the
    enterprise. In January 2025, we are rolling out the next
    enhancement, which will allow us to see available in person
    appointments in that same unified view.
        Mr. Rosendale. Will all the features then be functioning?
        Ms. Waters. Again with IT systems it is always our hope
    that we are continuously making incremental improvements, and
    we will be working with our partners in IVC.
        Mr. Rosendale. I will take that as a no. All of the
    features will not be fully functional in January 2025?
        Ms. Waters. All of the features that we have defined today
    will be available in January 2025. That is correct. We are
    always looking for opportunities to enhance and improve things.
        Mr. Rosendale. You just began rolling out the integrated
    scheduling solution this month. Will it improve the scheduling
    process and what are its initial capabilities?
        Ms. Waters. Yes, so ISS is going to vastly improve the
    ability to schedule appointments. ISS is initially designed as
    a replacement for VSE GUI, but we are already seeing incredible
    improvements with this tool. Examples of this include the fact
    that it is designed to be in a web browser, so it is got a much
    more modern user interface. It is not dependent on a desktop
    application, so it runs faster for the scheduler to be able to
    utilize, and it allows them to then move from one VistA system
    into another VistA system to schedule appointments without re-
    authenticating. It makes that experience much better for the
    user. The redesign of the system also makes it much easier for
    us to do enhancements to the system because it is no longer
    dependent on a desktop application that will sit on 600,000
    desktops. We are not beholden to that as we want to do
    incremental enhancements and do improvements to the project.
        Mr. Rosendale. What will its full capabilities look like
    and when will those be implemented throughout VHA?
        Ms. Waters. Again, with IT systems, we are hoping to always
    build requirements and do enhancements to it. Right now, on our
    roadmap for ISS, not only do we have the ability to schedule
    across multiple facilities, we will be working to integrate the
    view from the CCST tool and to work on the ability to schedule
    external provider appointments or through EPS through the ISS
    platform.
        Mr. Rosendale. When do you expect all of this to be
    implemented throughout VHA?
        Ms. Waters. I do not have that date at this point. We are
    still working on the requirements that we need to refine that
    date, but I am happy to come back and brief you on that.
        Mr. Rosendale. Thank you. Thank you very much. Ms. Waters,
    why are these two systems, CCST and ISS, being developed
    separately, and what will it entail to eventually combine them?
        Ms. Waters. They are being developed separately at this
    point, it allowed us to do a much more rapid glide path to
    build those tools out. They use the same back-end
    infrastructure and architecture and refer back to the back end
    EAS system. It was simply for ease of convenience and the
    ability to rapidly deploy them that we did them separately with
    the full intention to combine them in the future.
        Mr. Rosendale. Okay, thank you very much. I will yield
    back. I now recognize Ranking Member Sheila Cherfilus-McCormick
    for 5 minutes of questioning.
        Ms. Cherfilus-McCormick. Thank you, Mr. Chairman. Ms.
    Peabody. At this subcommittee's last hearing on VA's patient
    scheduling IT system, the witnesses discussed VA's plan to
    separate CSS from the rest of the Cerner suite of applications
    and deploying in ahead of the rest of the EHR. That plan was
    abandoned during the pandemic, and I am still unclear as to
    why. What is the VA's logic for choosing to develop another
    homegrown solution versus deploying the tool that the
    department had already purchased?
        Ms. Peabody. Thank you for that question, Ranking Member. I
    am actually going to hand that one to Dr. Hausman.
        Dr. Hausman. Thank you, Ranking Member. Yes, in Columbus,
    the central scheduling solution, or Cerner based scheduling
    solution, was implemented in August 2020, and following that
    implementation an evaluation was performed. Ultimately, the
    decision based on the evaluation was that while this can work
    layered on a VistA electronic health record, the cost and the
    disruption to clinical operations outweighed the value gained
    by moving forward with this strategy. Specifically, in order to
    implement the scheduling solution thousands of clinics had to
    be rebuilt and reconfigured in a way that is compatible with
    Cerner, which puts capacity limitations and access limitations
    on the medical center for weeks to months to get this done.
        One other point is there is an incremental cost with
    licensing with this, so there would be additional expense to
    license the scheduling product across the enterprise. In
    summary, the thought was instead of having two disruptive
    events implementing scheduling, Cerner scheduling, and then
    later implementing the Cerner EHR, it made more sense to
    implement both at the same time.
        Ms. Cherfilus-McCormick. Are you not doing the clinic
    rebuild for ISS?
        Dr. Hausman. We are not. ISS is currently, as of this
    month, being deployed in its initial phases, and that
    deployment is going to run over the next 5 months. We are able
    to seamlessly integrate this version of ISS with all existing
    VistA clinics.
        Ms. Cherfilus-McCormick. What would the cost difference be
    between the, what would the cost difference have been before
    been for VA to deploy CSS versus the development of ISS?
        Dr. Hausman. I do not have those figures. That is something
    we can take back and get you an answer.
        Ms. Cherfilus-McCormick. What was the decision-making
    process for this strategy and who ultimately made that
    decision?
        Dr. Hausman. I think that is another question we will need
    to take back to get you the right answer.
        Ms. Cherfilus-McCormick. Ms. Waters, VA has a long history
    of IT. Modernization efforts suffering from the lack of
    effective project management and requirements development does
    not meet the VA's needs. How does the planning for a Cerner
    scheduling solution deployment differ from what has been going
    on in the past?
        Ms. Waters. I am not sure, and let me please clarify. Are
    you speaking to the Cerner scheduling deployment or the
    integrated ISS scheduling deployment?
        Ms. Cherfilus-McCormick. ISS.
        Ms. Waters. Thank you for that clarification and thank you
    for the question. One of the things that we are trying to do
    with ISS is adopt an incremental approach. That is again, goes
    back to that answer of fully deployed versus deploying a tool
    and then making enhancements to it. We firmly believe that when
    we do an incremental approach the way that we are doing, you
    will see a quicker rollout and adoption across the enterprise
    that then allows us to move the organization with each
    enhancement that we deploy.
        Ms. Cherfilus-McCormick. How does the VA plan to avoid or
    mitigate the risk of outcomes similar to the past failed IT
    projects?
        Ms. Waters. What I can say is that we are working very
    diligently in a collaborative effort in IT with VHA to work
    together. With any one of these implementations, it really
    requires movement in both people, process and technology. If
    you only move one of those things, you are likely to suffer
    failures.
        Ms. Cherfilus-McCormick. There is no plan? My time is
    running out, so there is no plan?
        Ms. Waters. I guess I am not sure that I understand your
    question.
        Ms. Cherfilus-McCormick. You do not have a plan to avoid
    and mitigate the past failures?
        Ms. Waters. Our plan to mitigate the past failures is to
    ensure that we are working in a collaborative format, doing
    incremental improvements so that we can ensure success at every
    step along the way. I think we are demonstrating that with our
    current rollouts.
        Ms. Cherfilus-McCormick. You have made an assessment of all
    the failures and now have committed to avoiding that?
        Ms. Waters. I cannot speak for what happened before me, so
    I cannot say that we have done an assessment of all the
    failures. Certainly, we do have an understanding of why we have
    stepped away from other solutions.
        Ms. Cherfilus-McCormick. Thank you. I yield back.
        Mr. Rosendale. Thank you very much. Ms. Waters, we just
    touched on, and Dr. Hausman just touched on, the MASS medical
    appointment scheduling system Ranking Member was asking about.
    I do want to make sure that we get the information on the
    record about what the thought process was and who was
    responsible for the decision to end that system. That is very
    important. We will be looking for that information to come back
    to us. Dr. Hausman, could you briefly describe the steps the VA
    schedulers go through to schedule veterans' community care
    appointments without WellHive?
        Dr. Hausman. Yes, Mr. Chairman. It starts with a referral
    or a request for care, and from there we have referral
    coordination teams that evaluate that request to determine if a
    veteran is community care eligible based on access standards.
    Once eligibility is determined, a veteran is offered community
    care, the best community care option we can find, as well as
    the best VA option that we have. If a veteran opts into
    community care, then we begin the process of collecting
    preferences. Where geographically would you like to see your
    provider? What days and times tend to work best for you? Those
    types of things.
        From that point, we begin the process of telephoning. We
    need to reach community provider offices to determine if they
    have available appointments, when those appointments are
    available. We, of course, target that search based on the
    preferences the veteran gives us. That really can be one of the
    areas for delay in getting veterans appointed to the community
    is the need to have synchronous communication through a
    telephone, and that could take some time.
        Mr. Rosendale. If anybody was trying to create a flowchart
    just now on that process, it did not really look good. Okay.
    From my standpoint, because there is a long, long path before
    the veteran actually gets that care. Okay. Where we need to get
    a more direct path, if you will. How long does this process
    take with and without WellHive?
        Dr. Hausman. This last quarter, quarter three of this
    current fiscal year, we are scheduling veterans from the moment
    in time care is requested to when they are first appointed in
    the community in just over 21 days. If you look at a head-to-
    head comparison of scheduling veterans to like care using our
    traditional process versus WellHive, it is about a 26 day with
    a traditional process versus 17 days with WellHive. That is the
    difference. Substantial time savings and improvement in
    timeliness with using the EPS solution.
        Mr. Rosendale. Okay. On average, how many community care
    appointments are VA staff able to schedule per day using
    WellHive versus the current system?
        Dr. Hausman. Using the WellHive software, a trained, season
    scheduler can schedule upwards of 20, maybe 25 appointments per
    day.
        Mr. Rosendale. Without?
        Dr. Hausman. About eight appointments.
        Mr. Rosendale. About eight. Okay, what are the VA
    schedulers saying about WellHive, either in surveys or
    anecdotally? What kind feedback are you getting?
        Dr. Hausman. You know, the feedback for those that have
    used the system, which is now numbers in the hundreds, has been
    uniformly positive. I think the greatest challenge is having
    appointments available in this system. In other words----
        Mr. Rosendale. If slots open, availability.
        Dr. Hausman. In the right specialties for the right type of
    care. That is correct.
        Mr. Rosendale. Okay. Okay. Please explain what File Entry
    Date (FED) to first appointment means.
        Dr. Hausman. File entry date is the moment in time when
    care is requested by a veteran, or in the event of a primary
    care provider and a veteran generating a referral for specialty
    care. It is that moment in time that referral is generated.
    That is file entry date. First appointment is the moment in
    time when the appointment for that care is scheduled.
        Mr. Rosendale. Okay. One of the things that I have seen in
    the past is that the first appointment date sometimes gets
    skewed because it gets canceled, and then the initial
    appointment for the veteran gets transferred out and
    transferred out, sometimes several times, so that their true
    first appointment may not be for many months after that. I
    would really like to see if there is some way that we can get
    more of an accurate reflection of those times as well.
        Not just the first appointment date, when it is set, but
    when it is actually experienced, if you will. Okay. When it
    takes place, so that we can see the true timeframe between when
    they contact and when they are getting that. That initial care
    for healthcare. Okay, I am close enough. I will go ahead and
    yield time to the Ranking Member.
        Ms. Cherfilus-McCormick. Thank you. Ms. Waters. I cannot
    help but recall your response of not knowing what happened
    before you were there. It just makes me feel like if we do not
    understand the mistakes we did in the past, then we are capable
    of repeating it. The committee really wants to make sure that
    implementation going forward is not repeating the mistakes of
    the past. You know, hopefully we can get back and you guys can
    actually take a real good assessment of that, and we can make
    sure that we are not repeating that.
        My next question is also for Ms. Peabody. What is the OIT's
    role in the ISS role in the ISS project?
        Ms. Peabody. Thank you for that question. I will start and
    then I will ask Dr. Hausman to add on, because really, it is
    his team and Ms. Waters teams that have been working in the
    trenches together on this. OIT has been a really valuable
    partner for us in VHA. Dr. Hausman's worked very closely in
    partnership with our colleagues in OIT to actually stand up a
    very unique governance structure where we have a working group
    that includes our OIT counterparts and key VHA stakeholders,
    and they are working hand in hand to develop that scheduling
    roadmap.
        OIT's role, coming back to your question, is really to take
    the business requirements that VHA puts forward and help us
    design the solution and then be able to fund that. Anything to
    add, Dr. Hausman?
        Dr. Hausman. Thanks, Ms. Peabody. That is correct. A strong
    partnership between VHA and OIT on this project is critical. I
    believe we have a strong partnership in place. We set the
    requirements, we set the priorities. We do the testing of the
    initial versions of the product, the user acceptance testing.
    We also do the training, deployment, change management. OIT
    takes our requirements and our prioritizations and develops
    these products or enhances the products. Also, those
    prioritizations and requirements inform the roadmap for the
    timing for some of these bigger milestones that we are working
    toward.
        Ms. Cherfilus-McCormick. Is OIT's is role prominent enough
    to support solid project management and to help prevent. Oh,
    Ms. Waters, is OIT's role prominent enough to support solid
    project management and to help prevent previous mistakes?
        Ms. Waters. Thank you for that question. Please also let me
    clarify that my answer when I reflected that I personally was
    not aware of some of those challenges and decisions that were
    made in the past, rest assured that there are strong teams
    behind me in OIT that are very aware of them and are taking
    them into account. I probably misspoke when I said I was not
    aware of them.
        Let me also share that on this initiative, it is critical
    that we have strong PM's available and working with the team,
    and we have teams that are working day in and day out with Dr.
    Hausman and his team that are dedicated to making this effort a
    success.
        Ms. Cherfilus-McCormick. How is the requirements
    development for this project different from VA's previous
    struggles to modernize patient scheduling applications?
        Ms. Waters. Again, with this adoption that we are doing, we
    are doing it in a collaborative, shoulder to shoulder format,
    day in and day out, working with our partners to ensure that we
    are doing it together.
        Ms. Cherfilus-McCormick. Wonderful. Ms. Waters, you are
    leading your teams, correct?
        Ms. Waters. That is correct.
        Ms. Cherfilus-McCormick. As a leader of your teams, do you
    feel like you should be aware and do that analysis for your own
    knowledge to lead your team?
        Ms. Waters. Yes, of course. I also trust my teams and the
    leaders that I have on my teams.
        Ms. Cherfilus-McCormick. Thank you, Ms. Peabody. I
    understand that VA is rethinking a strategy for the external
    provider scheduling project that you are looking at, pairing
    back the number of sites using the EPS tool. What is the VA's
    goal in this reformatting effort?
        Ms. Peabody. Thank you for that question. Our goal is
    really to take the lessons that we have learned from the first
    two phases of the rollout this year and refocus our strategy to
    secure more success. One of the biggest challenges that we have
    had in rolling this out is getting enough providers enrolled on
    the platform so that the scheduler, when they log into the EPS
    system, they can actually find a provider and they are not
    having to then revert back to the standard processes of looking
    for a provider elsewhere.
        Ms. Cherfilus-McCormick. How many facilities are using EPS?
        Ms. Peabody. I will tag that to Dr. Hausman.
        Dr. Hausman. 16 facilities are currently live on EPS.
        Ms. Cherfilus-McCormick. All right, thank you. I yield
    back.
        Mr. Rosendale. Thank you, Dr. Hausman. I want to go back to
    the file entry date, first appointment issue again. With all of
    this advances in technology and improvements that we are
    making, is it true that the goal was recently changed from
    seven to 14 days to actually extend it out?
        Dr. Hausman. For community care appointments? I know there
    was discussion on changing that goal. I am not sure if that
    decision has yet been made.
        Mr. Rosendale. If we are having improvements, Ms. Waters,
    and things are flowing better and we are making all these
    investments in the technology, that just seems counterintuitive
    to me that if it is working well, if we are making
    improvements, that we would be setting the goal out longer,
    doubling it, literally doubling it from seven to 14 days. Have
    you seen that information? Are you telling me that you have not
    seen and participated in discussions in that regard?
        Dr. Hausman. I will defer to Ms. Peabody to answer that,
    sir.
        Ms. Peabody. Thank you for that question. I want to clarify
    that these metrics, when we are talking about FED to first
    scheduled, that is what we call internal schedule timeliness.
    It is very different from wait times. Now, both of those
    measures are important for us to track and monitor within VHA,
    and we set goals around that schedule timeliness because that
    is really our measure for our schedulers within VHA to be able
    to do the piece of this that is their responsibility.
        We have been exploring changing what are those goals. We
    had some very strong feedback and a report from the U.S.
    Government Accountability Office (GAO) several years ago, and
    we have had an open recommendation to relook at that schedule
    timeliness metric and to reconsider it to something that is
    more realistic for our facilities. We have undertaken through
    our access committee, a look at different options for that we
    have recently just brought up through the VHA governance
    structure.
        Mr. Rosendale. Okay, so Ms. Peabody, you have seen this
    recommendation then, or consideration from the seven to 14
    days?
        Ms. Peabody. Yes.
        Mr. Rosendale. Okay. Again, counterintuitive to everybody
    that is sitting in this room. If we are making improvements, if
    we are making investments and everybody is telling us that we
    are making these strides toward a smoother system, why would we
    not be taking the goal and pushing it the other direction? This
    just does not make sense to me that we are talking about
    extending it, doubling it from seven to 14 days.
        Ms. Peabody. Thank you for that question. I would add there
    are some nuances and we can take it back for the record to get
    you the specifics of what we are looking at changing in that
    metric.
        Mr. Rosendale. Why has it changed? Whether it is Dr.
    Hausman or Ms. Peabody, why would they change this number
    again, if we are making improvements?
        Ms. Peabody. We have looked at different options for
    changing that measure in several different ways to measure
    that. What is most important is that for any urgent consults,
    our measure continues to be that those need to be scheduled
    within 2 days. I looked at that measure this morning, and we
    are sitting at 100 percent of those. For those non urgent
    consults, we do want to allow our schedulers enough time to be
    able to make contact with the community provider and with the
    veteran to schedule that. We have----
        Mr. Rosendale. Okay, working on my time here. I just do not
    understand. Okay. As a person who has always had his
    compensation based on performance, how in the world you can
    never expect better performance if you set the goal lower. That
    just is, again, it is counterintuitive. If you take the goal
    and you make it lower, that matrix. You are never going to
    improve the situation. If you set goals that are less than what
    you have now, standards that are lower than you have now, how
    are you ever going to make an improvement? It just does not
    work. You have a section touting external provider scheduling,
    aka WellHive, on your community care network page, on your
    information website for providers. Does the department endorse
    this system and encourage community care providers to sign up
    and use it?
        Ms. Peabody. We do encourage community care providers to
    sign up for our external provider scheduling platform.
        Mr. Rosendale. Okay, what is the process to solicit and
    recruit providers into external provider scheduling, Ms.
    Peabody?
        Ms. Peabody. If I could, I would like to hand that to Dr.
    Hausman.
        Dr. Hausman. Thank you, Mr. Chairman. The process begins
    with selecting from our community care provider network of 1.3
    million the highest potential providers with whom to engage,
    and engaging with them to explain the program, explain the
    value of the program, the importance of this program, the
    vision. Then from there discuss, make sure we get with the
    right decision-makers and discuss the process. How does a
    community provider system participate in this? We get into the
    technical requirements and then from there, if we have an
    agreement, we do the process of onboarding, which actually is
    the technical integration of their schedules into our WellHive
    user interface.
        Mr. Rosendale. My time is expired. Ranking Member, I yield
    5 minutes for questions.
        Ms. Cherfilus-McCormick. Thank you Mr. Chairman. Ms.
    Peabody, what do you believe is limiting provider enrollment in
    EPA in EPS?
        Ms. Peabody. The thank you for that question, as Dr.
    Hausman was just articulating, the longer piece of the
    onboarding is actually that technical integration, and there is
    a fair bit of work on the provider. The provider has to have
    the ability to actually know their appointment availability and
    to be able to pass that into our system and be able to do that
    technical integration with our team that can be very lengthy
    and a significant investment of time for them.
        At this time, we have not put in place any types of
    incentives or run this through our community care network
    contract. We have done a significant amount of market research
    actually through our CCN next generation contract recompete
    efforts to gather some market research on how do we actually
    incentivize providers to do that. We have received a good
    amount of feedback on what that would look like. As we look
    further on down the road, how we will make this successful, we
    know that we are going to have to have some sort of carrot, if
    you will, for providers.
        Ms. Cherfilus-McCormick. Also, when we took a look at it,
    South Carolina was successful, whereas Orlando really
    struggled. One of the different factors we saw was that the
    staff and the providers were more involved, and so really
    supporting the system made a huge difference. We did not see
    that in Orlando. Is the VHA properly supporting their
    enrollment efforts?
        Ms. Peabody. Yes, we have made this a priority, and in
    fact, this has been an initiative that myself and Dr. Hausman
    have briefed several times to our governance board, which is
    VHA's highest governing body. We have got full support behind
    this. It is just important that we really step back and take
    some of those lessons we have learned over the last several
    months and pivot a little bit in that approach, because we need
    to do that to make it successful.
        Ms. Cherfilus-McCormick. The lessons that you learned from
    doing the analysis of these two sites, that has not been done
    yet, the analysis?
        Ms. Peabody. Yes, that has been done, and our refocused
    strategy is a direct result of that analysis.
        Ms. Cherfilus-McCormick. Can you tell us some of the pieces
    that you are plugging in to make sure that they are actually,
    that other clinics do not have this kind of struggle?
        Ms. Peabody. I will start and then I will ask Dr. Hausman
    to help fill in any gaps here since he has been leading this
    effort. The biggest thing that we have learned is that when we
    try to do this big bang approach across the entire system, it
    is a pretty significant level of effort for us to do that
    provider outreach and start integrating each of those
    providers. When we initially took this approach of let us just
    do it everywhere at the same time, we found that we got several
    providers here and there, and it was sort of a smattering. When
    the scheduler logs into the system, if there is only a handful
    or a few handfuls of providers, they are having to go back and
    forth between systems, and it is impacting the trust that they
    have in the data that is in that system. We feel taking that
    focused approach so that we can really, really do it well at a
    few sites and then be able to expand from there, that is going
    to be more successful.
        Ms. Cherfilus-McCormick. Thank you. Also, is VA planning on
    pulling the tools from any facilities?
        Ms. Peabody. Yes.
        Ms. Cherfilus-McCormick. What is the long-term plan for
    EPS?
        Ms. Peabody. Dr. Hausman, do you want to address that?
        Dr. Hausman. Yes, I am happy to. Thank you. We do see EPS
    as the enterprise solution for community care scheduling. At
    the end of the 2025 fiscal year, we intend to have EPS live in
    approximately one third of our VA medical centers. That is
    about 50 sites across the enterprise in focused regions. We
    anticipate being successful. What I mean by that is attracting
    and enlisting the participation of a large number of larger,
    higher volume community care providers into this program over
    the next year and then booking more appointments through EPS.
    Specifically, we are looking at least a tenfold increase in
    provider participation as well as appointments booked compared
    to what we are looking at this year. That is how we define
    success for next year. Now beyond 2025, we intend to continue
    to roll this out across the enterprise to the other medical
    centers and other Veterans Integrated Service Networks (VISN)
    that are not part of the 25 plan.
        Ms. Cherfilus-McCormick. Thank you. I yield back.
        Mr. Rosendale. Thank you very much. Ms. Peabody, what is
    the process to solicit and recruit providers into the external
    provider scheduling?
        Ms. Peabody. Thank you for that question, Chairman. We have
    both a team within Dr. Hausman's team as well as a vendor that
    we have been using to support some of those onboarding efforts.
    We take several steps in this process. One, our team has been
    traveling to conferences, doing webinars, posting in our
    newsletters just to get the word out. Then the provider that is
    interested can reach out to us and our team will start that
    process of onboarding and walk them through that.
        Mr. Rosendale. When you were talking earlier about focusing
    your attention instead of trying to do just what I will call a
    shotgun approach and cover the whole country focusing in, and
    we are going to use a rifle and a scope and we are going to
    zero in on some areas and concentrate the effort to try and get
    those providers. That is starting to make a little bit of sense
    to me. Is that why there is such a discrepancy in the number of
    participating providers in WellHive, in, say, South Carolina,
    which has numerous, and Montana, which has a couple of dozen.
        Ms. Peabody. Thank you for that question. Yes, I would
    agree with that assessment. I think in some areas, if we are
    able to get the affiliate or one or two of the large hospital
    systems, this works really well in more urban areas where you
    have one hospital system, you can bring that whole system in.
    It has been really successful. In areas like Montana, it is a
    little more sparse.
        Mr. Rosendale. It is rural. That is exactly right. What is
    the thought process or how are you identifying where to focus
    those resources, okay. To go in and recruit and get these
    providers listed? You know, what does that list look like and
    what is the criteria that you are using?
        Ms. Peabody. Yes, so I will start and Dr. Hausman will
    definitely help make sure I do not miss anything here. We
    started actually by sitting down with our CCN contractors and
    getting some feedback from them because it is their network of
    providers predominantly, and so they know which providers are
    most likely to be open to doing this. The team actually focused
    which VISNs and medical centers where, you know, we would go
    next around some of that feedback. We also gathered that just
    from our own experience. We have to consider just where is
    their appetite to do this. This is very leading edge kind of
    stuff. The private sector, you do not see a whole lot of this.
    We are starting to get there with more providers being willing
    to open up their clinic grids and do the work to integrate into
    some of these.
        Mr. Rosendale. I have to stop you. The one concern that I
    have is that what is the input from the actual patient? What is
    the input from the veterans themselves? If we start basing too
    much of our information on these large providers, forgive me
    for using the term, but there is a medical industrial complex
    out there. They will try to completely dominate the services.
    As a former commissioner of securities and insurance, I can
    tell you that every single study that has ever been put out
    shows that the bigger the organization is, the bigger the
    administration is, the bigger the corporation, the medical
    corporation is, that the lower the quality of care is and the
    higher the cost is. I need to hear something that says we are
    talking to those veterans, especially in the rural communities
    like Montana, that maybe are not going to have access to a
    large facility, that we have a team that understands this and
    is going to go out and recruit and sign up physicians that the
    veterans want to access.
        Ms. Peabody. Thank you for that question, Chairman. Yes,
    absolutely. In fact, our team did, I am sure you are very
    familiar with Veterans Signals (VSignals). That is how we get
    the most, a big portion of our feedback from veterans. We
    actually rolled out a VSignal specifically for EPS, and we got
    some really, really impressive results. We are continuing to
    get that feedback from veterans as well.
        Mr. Rosendale. Again, what would it look like to have a
    team if we are going to go out, and I understand we have the
    electronics and everything, but to actually have a team to go
    out and start trying to go around to these areas that not
    necessarily are urban, the very rural areas and start getting
    some, some providers to sign up.
        Ms. Peabody. Thank you for that question. We do have that
    in place today, and that is that separate vendor contract that
    is supporting us with going out and doing that onboarding. Then
    we are also looking at options perhaps in the future to be able
    to leverage our CCN contractors to help us with that.
        Mr. Rosendale. Okay, thank you. I yield back and recognize
    the Ranking Member.
        Ms. Cherfilus-McCormick. Thank you, Ms. Peabody. As I said
    in my opening, I am convinced that VA must address the lack of
    a fully integrated scheduling solution. We are extremely
    concerned by the exploding community care costs. I am
    particularly concerned that much of the cost may be
    unnecessary, but VA cannot prove that, as they cannot compare
    access in apples-to-apples manner. What is the VA's plan to
    address this shortcoming?
        Ms. Peabody. Thank you for that question. VA is committed
    to making sure that the care that our veterans are getting in
    the community is clinically appropriate and that they are
    getting that care at the right time and place. Since I stepped
    into this role as the Acting Assistant Under Secretary for
    Health for Integrated Veteran Care in February, I actually
    spent some time resetting what our mission statement is and
    what our three priorities are as an office. One of those three
    priorities is ensuring that when our veterans do go out to the
    community, that the care that they are getting is high value
    care. We would be happy to do a briefing on several of the
    initiatives that we are doing, but that includes making sure
    that we have a high performing provider network, and we are
    able to see where the providers that are in our network are
    actually highest performing and have the best quality measures
    and be able to give that information to our veterans. That also
    includes doing a more robust utilization management program in
    the future.
        Ms. Cherfilus-McCormick. Thank you. The vendor who supports
    the EPS, the project has this capability. It was part of the
    pilot program. Why did the VA choose to shut it down?
        Ms. Peabody. Thank you for that question. VHA has not
    chosen to shut down. In fact, based on the pilot, we did a, we
    gathered market research from industry to identify options for
    how we could procure a similar solution in the future and then
    moved forward with an acquisition plan to do that, which
    resulted in actually having the same vendor from that pilot.
        Ms. Cherfilus-McCormick. It seems to me that the VA is
    making short sighted decisions that are focusing veterans to
    continue waiting. Is there anything that you would recommend
    this committee do to help and support, make sure that there are
    not any feelings and that this is actually sufficient moving
    forward?
        Ms. Peabody. Thank you for that question. We appreciate
    your continued support for efforts like this one and for
    continuing to hold us accountable for ensuring that our
    veterans get the care that they have earned and deserve.
        Ms. Cherfilus-McCormick. Thank you. I yield back.
        Mr. Rosendale. Thank you very much. Ms. Peabody, I
    understand your office has decided to make cuts to the external
    provider scheduling. We are going to get into the reasoning in
    a moment, but I want to understand what the cuts actually
    entail first. Is it correct that the VA medical centers in West
    Haven, Connecticut, Hudson Valley, New York, and Ann Arbor and
    Iron Mountain, Michigan currently have WellHive activated and
    that it will be turned off?
        Ms. Peabody. Thank you for that question. I definitely want
    to ask Dr. Hausman to make sure I get this right.
        Dr. Hausman. That is correct.
        Mr. Rosendale. Okay. Dr. Hausman, I really do not
    understand this because when we were just talking about the
    final entry date to first appointment and the time that it is
    reducing, that it is making these improvements, why would this
    be being turned off?
        Dr. Hausman. We are active at 16 medical centers. We will
    continue to be active in 12 of those 16 medical centers moving
    into the next fiscal year, plus adding five additional entire
    VISNs into the mix. This was a decision made by our VHA
    governance board. I think the decision was around solving the
    issue of having acquired licenses this year that we simply
    cannot use because we do not have adequate number of community
    care providers yet participating in this program.
        The strategy that we are putting forward and we are going
    to be working toward next year will allow us to focus on key
    areas or markets that we think are highest potential for a lot
    of the considerations that Ms. Peabody already mentioned with
    this revised strategy, there are four medical centers, two in
    Michigan and the other two that you mentioned that will be
    paused for this next year.
        Mr. Rosendale. Dr. Hausman, Iron Mountain, Michigan has
    very few community care providers signed up, but Hudson Valley,
    New York already has hundreds. Why did you decide to turn off
    both of these facilities? What message does that send to
    providers that WellHive already has in New York and the
    providers you are hoping to recruit in Michigan?
        Dr. Hausman. Well, we hope the message will be that we
    believe in this program, and we are going to be back to
    building and activating this program in these areas very soon.
    In the instance of Hudson Valley, while we do have around 300,
    almost 300 providers that are on board, this was the first area
    that we built out, and we did not focus in the way that we
    should have in terms of engaging providers that do higher
    volume of care, more veteran care, higher quality care. We
    built this out in a way that we learned from. Strategically, we
    are going to be focusing on working with providers that do
    higher volume of care, that are known to do high quality care,
    and that also have a good relationship, that we have a good
    relationship with, for example, academic affiliates.
        Mr. Rosendale. Again, I just, to me, as a consumer, I hear
    somebody shutting down after they have opened up a system, a
    facility, whatever, and they are telling me how great it is,
    but yet they come in and say, but you are not going to have it
    available to you. We are going to go out and try and sell. I do
    not see how that is going to help efforts going forward to get
    other providers to sign up. I just do not.
        I think it is a very, very poor marketing concept. Are you
    concerned that when you decide to turn, WellHive on again in
    Connecticut, New York and Michigan, the providers will be
    frustrated and suspicious about working with VA?
        Dr. Hausman. We appreciate that those sentiments may exist
    as we go to reactivate. I do believe that the messaging that we
    put forward, the communications that we are going to be putting
    forward to these community partners now, is going to be very
    important in how we message this decision and why we are doing
    this, and also the idea that we will be coming back likely in
    the beginning of `26. There is definitely some communication
    that will be taking place that will hopefully keep the
    relationship with these providers strong and keep them
    interested in participating in the future.
        Mr. Rosendale. Even again, the future providers that you
    are trying to sign up, when they look and see that you are
    basically pulling the rug on the other providers, I cannot
    believe that it is going to give them a level of faith in
    participating. I mean, can you understand that?
        Dr. Hausman. I do understand that concern.
        Mr. Rosendale. How much is the cut to the external provider
    scheduling project? You told the committee staff that $20
    million during a meeting, is that correct?
        Dr. Hausman. That is approximately our budget for this
    program in `25.
        Mr. Rosendale. The system that seems to be working that is
    helping us schedule a better, that is providing better
    healthcare, is the place that we are going to have a $20
    million cut?
        Dr. Hausman. Approximately.
        Mr. Rosendale. Ms. Peabody, was this cut your decision? If
    you did not make that decision, who did?
        Ms. Peabody. Thank you for that question. Our VHA
    governance board made that decision unanimous to take on----
        Mr. Rosendale. Did you make it as a recommendation to them
    or did they come up with this, amongst their collaboration and
    their work?
        Ms. Peabody. That was IVC's recommendation. Yes.
        Mr. Rosendale. That was your recommendation?
        Ms. Peabody. Yes, sir, that was my recommendation based on
    the inputs from Dr. Hausman and his team.
        Mr. Rosendale. Okay. I will now yield 5 minutes. I think
    that that puts a pin on it. Then I am good. Okay. I would
    recognize the Ranking Member for any closing remarks that you
    may have. Do not have any. Okay. No closing remarks. Okay. I
    want to thank our witnesses for joining us today. VA scheduling
    process and technology directly affect veterans' healthcare.
    Obviously. Outdated, dysfunctional systems increase veterans
    wait times and may discourage them from getting care from the
    VA altogether.
        We have to remember that most veterans also have Medicare
    or private insurance. As the billboards say, the Department of
    Veterans Affairs want veterans to choose VA. That means getting
    an appointment has to be user friendly. This morning, we have
    heard about some real accomplishments in internal scheduling
    and direct scheduling that are improving veterans experiences.
        We also know that the VA has a troubling history of
    snatching defeat from the jaws of victory when it comes to
    technology projects. I urge the committee to continue rigorous
    oversight in the next Congress to prevent that from happening
    again. I ask unanimous consent that all members have five
    legislative days to revise and extend their remarks and include
    extraneous material. Without objection. So, ordered. This
    hearing is adjourned.
        [Whereupon, at 10:09 a.m., the subcommittee was adjourned.]
    =======================================================================

                             A  P  P  E  N  D  I  X

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

                        Prepared Statements of Witnesses

                                  ----------

                      Prepared Statement of Cherri Waters

        Good morning, Chairman Rosendale, Ranking Member Cherfilus-
    McCormick, and distinguished Members of the Subcommittee. Thank you for
    the opportunity to testify on the Office of Information and
    Technology's (OIT) and Veterans Health Administration's (VHA) efforts
    to modernize the Department of Veterans Affairs' (VA's) scheduling
    systems. I am accompanied by my colleagues from VHA, Ms. Hillary
    Peabody, Acting Assistant Under Secretary for Health for Integrated
    Veteran Care (IVC), and Dr. Mark Hausman, Executive Director, Access
    Transformation, IVC.

    Enterprise Scheduling Modernization: A Collaborative Effort

        VHA and OIT are working together on the Enterprise Scheduling
    Modernization effort, which aims to streamline and enhance VA
    scheduling systems. The modernization of our scheduling tools is
    essential for ensuring Veterans receive the best and most timely care
    while simplifying processes for Veterans and VA staff. By consolidating
    and upgrading our scheduling systems, we are laying the foundation for
    a seamless, more efficient, and more Veteran-centered health care
    system.
        VA's Enterprise Scheduling Modernization efforts introduce new
    functionalities designed to improve access to care for Veterans. These
    include the ability to schedule virtual and in-person appointments
    across VA facilities, consolidating multiple scheduling functions into
    a unified platform, and provider-based scheduling that integrates
    various appointment types into a single scheduling application. Our
    modernization efforts are crucial in bringing VA scheduling systems up
    to industry standards, enabling us to schedule any type of appointment
    with greater flexibility and efficiency. Our ultimate goal for these
    scheduling improvements is to connect Veterans with the best available
    resources for the most convenient and most appropriate care. To provide
    the best health outcomes for Veterans, VA must invest in modern
    scheduling tools that have near-term benefits and ultimately
    facilitates a long-term scheduling solution.

    Key Scheduling Tools and Benefits

    Integrated Scheduling Solution

        The Integrated Scheduling Solution (ISS) is a staff-facing, web-
    based application currently used for scheduling Veteran appointments
    that ultimately consolidates functionalities from multiple scheduling
    applications into a single enterprise scheduling solution for care in
    VA health care facilities. ISS represents a significant leap forward
    from our legacy system, VistA Scheduling Enhancement Graphical User
    Interface (VSE GUI) by offering a more integrated, intuitive, and
    efficient scheduling process. We began the enterprise-wide rollout of
    ISS September 2024, and full implementation is expected by February
    2025. Enhancements, including additional appointment types and
    telehealth capabilities are underway, and we anticipate retiring VSE
    GUI by June 2025. Ultimately, ISS will be the future single scheduling
    system that will house all scheduling tools and functionalities; this
    will allow VA staff to schedule appointments in a single platform
    across multiple sites of care.

    Clinic Capacity Search Tool

        The Clinic Capacity Search Tool (CCST) is a simplified web
    application providing the ability to search and view all available
    appointments for requested service and modality across multiple
    facilities. Currently, CCST enables the scheduling of telehealth
    appointments, providing Veterans with quicker access to care and a
    broader range of available options. We are enhancing CCST to include
    additional in-person clinical resources, and we are scheduled to begin
    rolling out of these new features in January 2025.

    Clinic Configuration Manager

        The Clinic Configuration Manager (CCM) is a web-based tool VHA
    administrative staff use to provide a standardized approach to managing
    availability with providers anywhere in VA. Fully implemented in March
    2024, CCM reduces discrepancies, increases efficiency and improves
    scheduling.

    Community Care Scheduling: External Provider Scheduling (EPS) Platform

        External Provider Scheduling (EPS) is a technology platform that
    will be able to improve the process of scheduling Veterans with
    community care providers by supplying information on care availability
    and allowing VA staff to schedule Veterans directly into available
    community care provider appointment slots through a singular user
    interface. EPS connects VA and community care providers to streamline
    care navigation and coordination activities. EPS offers information on
    who, where, and when community care providers and services are
    available to support informed Veteran decision-making.

    Moving Forward

        VA's scheduling modernization efforts aim to improve timeliness
    between a Veteran's request for care and the scheduling of their
    appointment, ensure Veterans receive the best available resources, and
    enhance coordination and information sharing between VA and community
    care providers. Our multiple scheduling efforts strengthen the
    collaboration between VA, Veterans, and community care providers and
    will ultimately unite under our ISS platform. ISS will integrate these
    tools and processes to create a streamlined scheduling experience
    across the enterprise, which will lead to faster, more flexible care
    for Veterans. Our efforts enable VA staff to increase efficiency,
    reduce administrative burdens, and improve care delivery for Veterans
    in a sustainable and effective manner. Veterans will experience
    enhanced access to the best care more quickly, whether within VA or
    through community providers.

    Conclusion

        Chairman Rosendale, Ranking Member Cherfilus-McCormick, and Members
    of the Subcommittee, thank you for the opportunity to appear today.
    VA's modernization efforts are transforming the way we deliver care to
    Veterans and support VA staff and providers. We are proud of the
    progress we have made and remain committed to continuing this journey
    of improvement for the benefit of our Veterans and the dedicated staff
    who serve them. This concludes my testimony, and I look forward to
    answering your questions.

                           Statements for the Record

                                  ----------

           Questions for the Record Submitted by Matthew M. Rosendale
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

       U.S. Department of Veterans Affairs Response to Questions for the
                                     Record
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

                                     [all]