[House Report 115-691]
[From the U.S. Government Publishing Office]


115th Congress   }                                            {    Report
                         HOUSE OF REPRESENTATIVES
 2d Session      }                                            {   115-691

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



 
 VETERANS' ELECTRONIC HEALTH RECORD MODERNIZATION OVERSIGHT ACT OF 2017

                                _______
                                

  May 21, 2018.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

    Mr. Roe of Tennessee, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 4245]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 4245) to direct the Secretary of Veterans 
Affairs to submit to Congress certain documents relating to the 
Electronic Health Record Modernization Program of the 
Department of Veterans Affairs, having considered the same, 
report favorably thereon without amendment and recommend that 
the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     3
Subcommittee Consideration.......................................     3
Committee Consideration..........................................     3
Committee Votes..................................................     3
Committee Oversight Findings.....................................     3
Statement of General Performance Goals and Objectives............     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     4
Earmarks and Tax and Tariff Benefits.............................     4
Committee Cost Estimate..........................................     4
Congressional Budget Office Estimate.............................     4
Federal Mandates Statement.......................................     5
Advisory Committee Statement.....................................     5
Constitutional Authority Statement...............................     5
Applicability to Legislative Branch..............................     5
Statement on Duplication of Federal Programs.....................     5
Disclosure of Directed Rulemaking................................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill as Reported.............     6

                          PURPOSE AND SUMMARY

    H.R. 4245, the `Veterans' Electronic Health Record 
Modernization Oversight Act of 2017, would: direct the 
Department of Veterans Affairs (VA) to provide Congress with 
the key planning and implementation documents related to its 
Electronic Health Record Modernization (EHRM) program, in 
addition to copies of its underlying contracts, to indicate the 
effort's progress and how money is being spent. This bill would 
also require VA to notify Congress in the event of any 
significant cost increase, schedule delay, loss of veteran 
health data, or breach of privacy. Representative Tim Walz, the 
Ranking Member of the Committee on Veterans' Affairs, 
introduced H.R. 4245 on November 3, 2017.

                  BACKGROUND AND NEED FOR LEGISLATION

    In July 2015, the Department of Defense (DoD) commenced its 
electronic health record (EHR) modernization effort, called MHS 
GENESIS, by awarding a contract to the Leidos Partnership for 
Defense Health. The objective of MHS GENESIS is to implement 
the Cerner Corporation's Millennium EHR and Henry Schein, 
Inc.'s Dentrix Enterprise software, with Leidos serving as the 
prime integrator, to replace the Armed Forces Health 
Longitudinal Technology Application and the Composite Health 
Care System in waves consisting of groups of military treatment 
facilities through 2022.
    In June 2017, then-Secretary of Veterans Affairs David 
Shulkin signed a determination and findings document utilizing 
the public interest exception of the Federal Acquisition 
Regulation to authorize issuance of a sole-source contract 
solicitation to Cerner to purchase and implement its Millennium 
EHR to replace the Veterans Health Information Systems and 
Technology Architecture in VA. The overarching goal of VA's 
EHRM program is to implement a common EHR throughout VA and the 
DoD Military Health System capable of seamless interoperability 
to facilitate transition of active duty military members into 
VA, improve their timely access to care, and enable a single, 
accurate, lifetime health record. VA's implementation is 
similarly structured as a series of waves consisting of groups 
of medical centers, closely corresponding to the MHS GENESIS 
waves, through 2027.
    In February, July, September, and October 2017, MHS GENESIS 
completed implementations at the Fairchild Air Force Base 
clinic, Naval Hospital Oak Harbor, Naval Hospital Bremerton, 
and Madigan Army Medical Center, respectively. Early reports 
from these facilities indicate several issues of concern for 
the Committee with respect to VA's forthcoming EHRM 
implementation. As of this report's filing, VA has not yet 
awarded the EHRM contract to Cerner. VA tasked the MITRE 
Corporation to conduct a review of the intended contract's 
interoperability requirements, from which a report was issued 
in January 2018. Additional reviews of the intended contract 
have continued. In April 2018, Acting Secretary of Veterans 
Affairs Robert Wilkie announced his near-term priority to 
finalize a decision on EHRM.
    Given the high cost, length, level of risk, and 
transformational importance of the EHRM program, it is 
necessary for the Committee to devote to it rigorous oversight. 
This entails monitoring the program's strategic conception, 
organizational construction, contractual activity, technical 
soundness, and actual progress. These factors are established 
and recorded in key programmatic and contractual documents.

                                HEARINGS

    On March 7, 2018, the Subcommittee on Oversight and 
Investigations held a legislative hearing that included a 
discussion of H.R. 4245.
    The following witnesses testified:
          The Honorable Cathy McMorris Rodgers, U.S. House of 
        Representatives, 5th District, Washington; Fred Mingo, 
        Director of Program Control, Program Executive Office, 
        Electronic Health Record Modernization Program, U.S. 
        Department of Veterans Affairs, accompanied by Ricky 
        Lemmon, Acting Deputy Chief Procurement Officer, 
        Veterans Health Administration, U.S. Department of 
        Veterans Affairs, John Adams, Director of Corporate 
        Travel, Office of Management, U.S. Department of 
        Veterans Affairs, and Katrina Tuisamatatele, Health 
        Portfolio Director, Office of Information and 
        Technology, U.S. Department of Veterans Affairs; Louis 
        Celli, Jr., Director, Veterans Affairs & Rehabilitation 
        Division, The American Legion; and Scott Denniston, 
        Executive Director National Veterans Small Business 
        Coalition.
    Statements for the record were provided by:
          The Honorable Cathy McMorris Rodgers, U.S. House of 
        Representatives, 5th District, Washington; and Veterans 
        of Foreign Wars.

                       SUBCOMMITTEE CONSIDERATION

    There was no Subcommittee markup of H.R. 4245.

                        COMMITTEE CONSIDERATION

    On May 8, 2018, the full Committee met in open markup 
session, a quorum being present, and ordered H.R. 4245 
favorably reported to the House of Representatives by voice 
vote. A motion by Representative Tim Walz of Minnesota to 
report H.R. 4245 favorably to the House of Representatives was 
adopted by voice vote.

                            COMMITTEE VOTES

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, there were no recorded votes 
taken on amendments or in connection with ordering H.R. 4245 
reported to the House. A motion by Representative Tim Walz of 
Minnesota to report H.R. 4245 favorably to the House of 
Representatives was adopted by voice vote.

                      COMMITTEE OVERSIGHT FINDINGS

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

         STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are to ensure VA provides the Committee 
with the appropriate information and documentation to conduct 
rigorous oversight over the EHRM program.

   NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee adopts as its 
own the estimate of new budget authority, entitlement 
authority, or tax expenditures or revenues contained in the 
cost estimate prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

                  EARMARKS AND TAX AND TARIFF BENEFITS

    H.R. 4245 does not contain any Congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        COMMITTEE COST ESTIMATE

    The Committee adopts as its own the cost estimate on H.R. 
4245 prepared by the Director of the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974.

               CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 4245 provided by the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                              Congresssional Budget Office,
                                       Washington, DC, May 9, 2018.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 4245, the 
Veterans' Electronic Health Record Modernization Oversight Act 
of 2017.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
            Sincerely,
                                                Keith Hall,
                                                          Director.
    Enclosure.

H.R. 4245--Veterans' Electronic Health Record Modernization Oversight 
        Act of 2017

    Within a month of enactment, H.R. 4245 would require the 
Department of Veterans Affairs (VA) to submit to the Congress 
documents related to managing the Electronic Health Record 
Modernization (EHRM) program. The bill also would require VA to 
provide the Congress with quarterly reports on the program and 
information regarding related contractual agreements. Under the 
EHRM program, VA plans on adopting the electronic health 
records used by the Department of Defense.
    The documents that the bill would require VA to submit will 
already be prepared in conjunction with the EHRM Program. As a 
result, CBO estimates that implementing the bill would cost 
less than $500,000 over the 2019-2023 period to compile and 
submit the necessary program documents to the Congress. That 
spending would be subject to the availability of appropriated 
funds.
    Enacting H.R. 4245 would not affect direct spending or 
revenues; therefore, pay-as-you-go procedures do not apply.
    CBO estimates that enacting H.R. 4245 would not increase 
net direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2029.
    H.R. 4245 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act.
    The CBO staff contact for this estimate is Ann E. Futrell. 
The estimate was reviewed by Leo Lex, Deputy Assistant Director 
for Budget Analysis.

                       FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 4245 prepared by the Director of the 
Congressional Budget Office pursuant to section 423 of the 
Unfunded Mandates Reform Act.

                      ADVISORY COMMITTEE STATEMENT

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
4245.

                 STATEMENT OF CONSTITUTIONAL AUTHORITY

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 4245 is authorized by Congress' power to 
``provide for the common Defense and general Welfare of the 
United States.''

                  APPLICABILITY TO LEGISLATIVE BRANCH

    The Committee finds that H.R. 4245 does not relate to the 
terms and conditions of employment or access to public services 
or accommodations within the meaning of section 102(b)(3) of 
the Congressional Accountability Act.

              STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that no provision 
of H.R. 4245 establishes or reauthorizes a program of the 
Federal Government known to be duplicative of another Federal 
program, a program that was included in any report from the 
Government Accountability Office to Congress pursuant to 
section 21 of Public Law 111-139, or a program related to a 
program identified in the most recent Catalog of Federal 
Domestic Assistance.

                   DISCLOSURE OF DIRECTED RULEMAKING

    Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017), 
the Committee estimates that H.R. 4245 contains no directed 
rulemaking that would require the Secretary to prescribe 
regulations.

             SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title

    Section 1 of the bill would establish the short title as 
the ``Veterans' Electronic Health Record Modernization 
Oversight Act of 2017.''

Section 2. Oversight of Electronic Health Record Modernization program

    Section 2(a) of the bill would require that, not later than 
30 days after enactment, the Secretary of Veterans Affairs 
shall submit to the Committees on Veterans' Affairs and 
Appropriations of the House and Senate copies of 15 documents 
produced in the EHRM program.
    Section 2(b) of the bill would require that, not later than 
30 days after the end of each fiscal quarter, the Secretary 
shall provide quarterly updates of six of the documents 
required in section 2(a).
    Section 2(c) of the bill would require the Secretary to 
provide to the Committees copies of all contracts, orders, 
agreements, or modifications thereto, not later than five days 
after their award.
    Section 2(d) of the bill would require the Secretary to 
provide notification to the Committees not later than 10 days 
after the occurrence of any delay of any milestone or 
deliverable exceeding 30 days, request for equitable adjustment 
by the contractor or change order exceeding $1 million, 
submission of any protest, claim, dispute, and resolution of 
the same, loss of clinical or other data, or breach of patient 
privacy.
    Section 2(e) of the bill would provide relevant 
definitions.

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    If enacted, this bill would make no changes to existing 
law.