[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1125 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 1125
To authorize an electronic health record modernization program of the
Department of Veterans Affairs and increase oversight and
accountability of the program to better serve veterans, medical
professionals of the Department, and taxpayers, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 30, 2023
Mr. Tester (for himself, Mrs. Murray, and Mr. Brown) introduced the
following bill; which was read twice and referred to the Committee on
Veterans' Affairs
_______________________________________________________________________
A BILL
To authorize an electronic health record modernization program of the
Department of Veterans Affairs and increase oversight and
accountability of the program to better serve veterans, medical
professionals of the Department, and taxpayers, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Electronic Health
Record Program Restructure, Enhance, Strengthen, and Empower Technology
Act of 2023'' or the ``EHR Program RESET Act of 2023''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
TITLE I--PROGRAM ESTABLISHMENT, STRUCTURE, MANAGEMENT, AND OBJECTIVES
Sec. 101. Establishment of electronic health record and health
information technology modernization
program and program office of Department of
Veterans Affairs.
Sec. 102. Establishment of Department of Veterans Affairs advisory
subcommittee on electronic health record
and health information technology
modernization.
TITLE II--DEPLOYMENT CRITERIA AND THRESHOLDS TO ADVANCE
Sec. 201. Requirement to exceed or meet certain health care performance
baseline or national metrics for
continuation of electronic health record
modernization program of Department of
Veterans Affairs.
Sec. 202. Requirements before continued deployment of new electronic
health record by Department of Veterans
Affairs at additional locations and
facilities.
Sec. 203. Sense of Congress on training and change management
activities for deployment of new electronic
health record.
TITLE III--ENHANCED SUPPORT FOR HEALTH CARE AND OTHER FACILITIES
DEPLOYING NEW ELECTRONIC HEALTH RECORD
Sec. 301. Report on support to facilities for new electronic health
record deployment by Department of Veterans
Affairs.
Sec. 302. Modification of quarterly report to include information on
system stability, satisfaction, morale,
retention of staff, training, and change
management with respect to new electronic
health record of Department of Veterans
Affairs.
TITLE IV--CONTRACTING AND ACQUISITION OVERSIGHT AND REFORM
Sec. 401. Termination of contract with Oracle Cerner for training and
change management.
Sec. 402. Strengthening contract negotiation by Department of Veterans
Affairs with respect to new electronic
health record and designation of lead
contract negotiator.
Sec. 403. Independent verification and validation of certain major
modernization efforts of Department of
Veterans Affairs.
Sec. 404. Annual report on efforts to maintain VistA electronic health
record system.
Sec. 405. Report on alternatives to current electronic health record
technology and contract for Department of
Veterans Affairs.
Sec. 406. Report on leadership, acquisition, and contracting oversight
lessons learned.
Sec. 407. Report on contract savings, services provided at no cost to
the Department, and contract cost incurred
with respect to Oracle-Cerner product.
TITLE V--COORDINATION WITH DEPARTMENT OF DEFENSE
Sec. 501. Quarterly reports on system uptime, modernization, and
coordination activities for information
technology systems and policies of
Department of Defense affecting operations
of Department of Veterans Affairs.
Sec. 502. Coordination with Department of Defense regarding information
technology programs, systems, and services.
TITLE VI--OTHER MATTERS
Sec. 601. Report on legislative action required.
Sec. 602. Report on current and future State interoperability with
legacy electronic health record, new
electronic health record, and future
potential electronic health record and
other health information technology and
exchanges.
SEC. 2. DEFINITIONS.
Except as otherwise provided, in this Act:
(1) Appropriate committees of congress.--The term
``appropriate committees of Congress'' means--
(A) the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of
Representatives.
(2) Department.--The term ``Department'' means the
Department of Veterans Affairs.
(3) Deputy secretary.--The term ``Deputy Secretary'' means
the Deputy Secretary of Veterans Affairs.
(4) Fourth mission.--The term ``Fourth Mission'' means the
mission of the Department to improve the preparedness of the
United States for response to war, terrorism, national
emergency, and natural disaster.
(5) Modernization; modernize.--The terms ``modernization''
and ``modernize'', with respect to the electronic health record
and other relevant health information technology systems of the
Department, means to replace, in whole or in part, overhaul, or
upgrade such record or other system in a manner that gives such
record or other system longevity and ability to constantly be
updated to meet the needs of veterans, employees of the
Department, and the Department.
(6) New electronic health record.--The term ``new
electronic health record'' means any electronic health record
provided for the Department on or after the date of the
enactment of this Act, including pursuant to a contract entered
into by the Department.
(7) Oracle-cerner product.--The term ``Oracle-Cerner
product'' means the product provided under the contract entered
into by the Department with Cerner pursuant to the electronic
health record modernization program of the Department before
the date of the enactment of this Act.
(8) Secretary.--The term ``Secretary'' means the Secretary
of Veterans Affairs.
(9) Under secretary.--The term ``Under Secretary'' means
the Under Secretary for Health of the Department of Veterans
Affairs.
TITLE I--PROGRAM ESTABLISHMENT, STRUCTURE, MANAGEMENT, AND OBJECTIVES
SEC. 101. ESTABLISHMENT OF ELECTRONIC HEALTH RECORD AND HEALTH
INFORMATION TECHNOLOGY MODERNIZATION PROGRAM AND PROGRAM
OFFICE OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Establishment of Program.--
(1) Establishment.--There is established within the
Veterans Health Administration a program to modernize the
electronic health record and other relevant health information
technology systems of the Department (in this section referred
to as the ``Program'').
(2) Purpose and goals.--The purpose and goals of the
Program are as follows:
(A) To deliver an electronic health record,
platform, and related systems that allow the Department
to deliver, as measured by quantifiable industry and
Department-specific metrics, improved standardized
workflows and consistent, quality health care to
veterans through a modern, user-friendly, electronic
health record and related systems that allow medical
professionals of the Department to deliver health care
to veterans safely.
(B) To increase the productivity, efficiency,
retention, satisfaction, and experience of such medical
professionals.
(C) To improve veteran experience and health
outcomes.
(D) To improve quality and coordination of care,
reduce unnecessary variation, and improve data
management.
(E) To maintain, strengthen, and expand the
research and development activities of the Department
to include those activities required under title 38,
United States Code.
(F) To maintain and strengthen the ability of the
Department to carry out Fourth Mission requirements, to
include the requirements under title 38, United States
Code.
(G) To protect the health and other personal
identifying information of veterans from being
monetized, sold, or otherwise misused by any internal
or external entity conducting work for, with, or on
behalf of the Department.
(H) To protect the health and other personal
identifying information of veterans or other users of
the electronic health record or other programs or
services of the Department from cyber attacks, identity
theft, and other cyber and security threats.
(I) To deliver--
(i) operational value to the Department
from the use of the electronic health record
and related systems;
(ii) business value and return on
investment to the Department from improvement
to the electronic health record and related
systems across all relevant domains, to include
cyber and other security, business, and
financial operations; and
(iii) an evolving level of advanced
interoperability of the electronic health
record with the greatest number of electronic
health record systems, platforms, services, and
related interfaces in the Federal, private,
nonprofit, and other relevant health sectors.
(J) To develop health information technology
modernization strategies and implementation plans that
provide the Department with the most flexibility to
continuously modernize the health information
technology systems of the Department in an agile
manner, not committed to any one particular vendor or
vendors or technology solution or solutions, commonly
known as ``vendor lock'', and respond to new trends in
the health information technology industry in real
time, allowing for relevant and appropriate integration
with other health information technology platforms and
services.
(K) To aggressively manage and monitor the
implementation of all contracts and services procured
by the Department related to such electronic health
record and related services to control cost, ensure
best value, monitor, and evaluate delivery of the
services procured in line with program goals and
desired outcomes.
(L) To carry out the purposes and goals described
in subparagraphs (A) through (K) at the most effective
short-, medium-, and long-term cost to the Federal
Government using industry and government best practices
so as to protect taxpayers.
(M) Such other purposes or goals as determined--
(i) pursuant to the report submitted under
subsection (b)(6); or
(ii) by the Secretary, the Deputy
Secretary, or the Under Secretary pursuant to a
report submitted to the appropriate committees
of Congress describing any new purpose or goal
for the Program not later than 90 days after
adding such purpose or goal to the Program.
(b) Establishment of Program Management Office.--
(1) In general.--There is established within the Veterans
Health Administration the Electronic Health Record and Health
Information Technology Modernization Program Management Office
(referred to in this section as the ``Office''). The Secretary
or the Deputy Secretary may rename the Office and upon renaming
such office shall notify Congress not later than 60 days after
such renaming.
(2) Organizational location of office.--
(A) In general.--The Under Secretary shall
determine the appropriate organizational location
within the Veterans Health Administration for the
Office so as to align responsibilities within existing
or newly formed clinical, patient safety, health
informatics, finance, and other business operations of
the Veterans Health Administration.
(B) Reorganization of office.--The Secretary, the
Deputy Secretary, and the Under Secretary may move or
reorganize the organizational location of the Office
only after notifying the appropriate committees of
Congress not later than 90 days before such move or
reorganization.
(3) Leadership and staff.--
(A) Executive director.--The Under Secretary shall
establish a leader to be responsible for the Office, to
be known as the ``Executive Director of the Electronic
Health Record and Health Information Technology
Modernization Program Management Office''.
(B) Program functional champion.--
(i) In general.--The Under Secretary shall
establish a Functional Champion of the Program
who will serve with the Executive Director of
the Office.
(ii) Duties.--The duties of the Functional
Champion are--
(I) to be the lead clinical
executive to guide and address
functional initiatives to support
medical personnel of the Department in
the deployment of a new electronic
health record and other health
information technology products; and
(II) to carry out such additional
duties as the Under Secretary and the
Executive Director of the Office may
prescribe.
(C) Other offices and positions.--
(i) In general.--The Under Secretary shall
direct the establishment of various other
relevant sub-offices and positions for the
Office as the Under Secretary considers
necessary drawing upon best practices from the
Department, the Department of Defense, and
other government, private sector, and nonprofit
models and develop an organizational model
tailored to the Department for business and
management effectiveness.
(ii) Types of sub-offices.--At a minimum,
within the Office there shall be offices
dedicated to--
(I) training;
(II) change management;
(III) communications;
(IV) field support;
(V) contract task order
development, monitoring, and oversight;
(VI) metrics, performance, and
value; and
(VII) quality and safety.
(iii) Sense of congress.--It is the sense
of Congress that--
(I) the Department should develop a
model under clause (i) that is driven
by best practices from government and
industry but not replicate for the sake
of replication structures used by the
Department of Defense or elsewhere that
do not factor in the patient
population, unique mission, Fourth
Mission requirements, and research
requirements of the Department, and
other relevant factors; and
(II) the structure of such model
should be driven by the objectives of
the Office and the desired end state to
improve value and quality of care and
health outcomes for veterans while
improving provider efficiency and
productivity and operations of the
Department.
(4) Function and duties.--
(A) Function.--The function of the Office shall be,
with respect to all aspects of the modernization or
replacement of the electronic health record and other
key health information technology and services of the
Department--
(i) to develop and execute strategy in
coordination with relevant offices and entities
of the Department; and
(ii) to perform management, oversight, and
accountability, including over all contracts,
coordination, planning, management, and
implementation.
(B) Duties.--The duties of the Office shall include
the following:
(i) Ensuring the Program delivers the tools
medical professionals of the Department need to
safely deliver care to veterans while
increasing productivity, satisfaction, and
efficiency as measured by metrics.
(ii) Organizing all of the relevant health,
business, informatics, and related offices of
the Veterans Health Administration to ensure a
coordinated strategy regarding the new
electronic health record and other current and
future key health information technology and
services of the Department.
(iii) Coordinating with other offices and
entities of the Department with key
dependencies and responsibilities in the
success of the Program or operational needs for
the services of the Program, including the
Office of Information and Technology, the
Veterans Benefits Administration, and other
relevant offices.
(iv) Ensuring the stability and security of
the new electronic health record and other
current and future key health information
technology and services of the Department.
(v) Oversight of work performed by
contractors regarding such record, technology,
and services.
(vi) Developing a health information
technology strategy of the Department--
(I) to increase quality of care,
health outcomes, and experience of care
received by veterans;
(II) to increase value to business
and health operations of the
Department;
(III) to enable the further
recruitment and retention of medical
professionals; and
(IV) to coherently define how
disparate health information technology
efforts of the Department can be
aligned to deliver on that strategy
with concrete goals, metrics, and
outcomes.
(vii) Developing goals, key performance
indicators, and metrics to evaluate such
record, technology, and services, including
with respect to financial performance, provider
productivity, and health performance.
(viii) Monitoring such goals, performance
indicators, and metrics to develop actions for
when such goals, performance indicators, and
metrics have not been met.
(ix) Improvement of business operations of
the Department relating to such record,
technology, and services.
(x) Such other matters as the Secretary,
the Deputy Secretary, or the Under Secretary
consider appropriate.
(5) Report on establishment of office.--
(A) In general.--Not later than 90 days after the
date of the enactment of this Act, the Deputy
Secretary, the Under Secretary, and the Chief
Information Officer of the Department shall submit to
the appropriate committees of Congress a single report
outlining the establishment of the Office and its
current strengths and weaknesses.
(B) Elements.--The report required under
subparagraph (A) shall include--
(i) a clear articulation of the objective
of the Program and how that objective is tied
to the broader health information technology
modernization strategy and health care mission
of the Department, which shall include
functional and technical quality standards to
define success of the Program based on clear
demonstration of improved health and business
operational metrics;
(ii) a strategy describing how technology
procured by the Department shall be part of a
comprehensive approach for using health
information technology, models of care
delivery, and research conducted by the
Department to strengthen services for veterans
and veteran engagement;
(iii) concrete steps for how the Department
will use internal and external resources to
operationalize the strategy under clause (ii)
through technical and functional engineering
expertise to streamline the organization and
governance of the Office of Information and
Technology, the Veterans Health Administration,
and other relevant offices or entities of the
Department to enact that strategy;
(iv) an assessment of the current and
desired future state, with timelines to achieve
such future state, of enterprise business and
technical architecture, information technology
product consolidation and management,
information technology governance, business and
clinical process standardization and quality
control of the Department and the steps that
are or will be taken in response to that
assessment, including a timeline for execution
of those reforms; and
(v) a description, as of the date of the
report, of the current status of the objectives
of the Office, whether those objectives are
being met, and if they are not being met the
steps the Department will take, including a
timeline, to achieve those objectives.
(c) Deputy Chief Information Officer for Electronic Health Record
and Health Information Technology.--
(1) Establishment.--There is established within the Office
of Information and Technology of the Department a Deputy Chief
Information Officer for Electronic Health Record and Health
Information Technology who shall be accountable for all
technical implementation of the modernization of the electronic
health record and health information technology, in
coordination with the Program and the Office.
(2) Renaming.--The Chief Information Officer of the
Department may rename the position established under paragraph
(1) and upon renaming such position shall notify Congress not
later than 90 days after such renaming.
(3) Chain of command.--The Deputy Chief Information Officer
for Electronic Health Record and Health Information Technology
of the Department shall report to the Chief Information Officer
and the Assistant Secretary for Information and Technology of
the Department.
(4) Duties.--The Deputy Chief Information Officer for
Electronic Health Record and Health Information Technology of
the Department shall be responsible for organizing all
functions of the Office of Information and Technology of the
Department to support the modernization of the electronic
health record and health information technology of the
Department, including cyber security, system stability and
uptime, system performance, and integration with relevant
platforms, systems, and services, including those of the
Department of Defense and other Federal agencies.
(5) Additional guidance.--The Chief Information Officer of
the Department may provide additional or modified guidance for
the role of Deputy Chief Information Officer for Electronic
Health Record and Health Information Technology of the
Department.
(d) Administrative Matters.--
(1) Accountability and oversight for program.--The Deputy
Secretary shall be the accountable official for the Program,
oversee the Program, and may direct resources, subject to
appropriations, throughout the Department, particularly to the
Veterans Health Administration and the Office of Information
and Technology of the Department, to facilitate successful
planning, management, oversight, and execution of the Program.
(2) Responsibility for program and office.--The Under
Secretary shall be the responsible official for the Program and
the Office, working together with the Executive Director of the
Office. The Under Secretary and the Executive Director of the
Office shall be directly responsible and in charge of the daily
work of the Program and the Office.
(3) Tracking and reporting of funds.--Any funds directed by
the Deputy Secretary to other entities of the Department to
support the Program or the Office shall be tracked and reported
as falling under the Program regardless of the office that
manages and executes those particular funds.
SEC. 102. ESTABLISHMENT OF DEPARTMENT OF VETERANS AFFAIRS ADVISORY
SUBCOMMITTEE ON ELECTRONIC HEALTH RECORD AND HEALTH
INFORMATION TECHNOLOGY MODERNIZATION.
(a) In General.--Not later than 60 days after the date of the
enactment of this Act, the Secretary, acting in coordination with and
through the Under Secretary, shall establish a permanent subcommittee
of the special medical advisory group established under section 7312 of
title 38, United States Code, focused on electronic health record and
health information technology modernization of the Department, to be
known as the Subcommittee on Electronic Health Record and Health
Information Technology Modernization (in this section referred to as
the ``Subcommittee'').
(b) Composition of Subcommittee.--
(1) In general.--The Subcommittee shall be composed of not
fewer than 5 and not more than 10 individuals selected by the
Under Secretary who have a current or previous documented and
relevant deep professional background within a leading health
care organization or organizations of the United States in the
private or nonprofit health sector, including--
(A) experience with health systems;
(B) experience as a health executive, chief health
information or informatics officer, chief medical
information officer, clinician, or nurse with deep
experience implementing or overseeing medium- or large-
scale health information technology transformation,
including electronic health record deployments and
business modernizations;
(C) experience improving health care outcomes;
(D) experience managing change; or
(E) experience in developing and implementing
electronic health record training.
(2) Nurse or nurse executive.--At least one member of the
Subcommittee shall be a nurse or nurse executive.
(3) Member of veterans service organization.--At least one
member of the Subcommittee shall be a representative of a
Federally chartered, membership-based veterans service
organization.
(4) Limitation.--An individual is not eligible to be a
member of the Subcommittee if the individual--
(A) is from the information technology vendor or
technology development sector; or
(B) had a role in the Oracle or Cerner procurement
by the Department or related contracts for program
management services for the electronic health record
modernization program of the Department.
(c) Duties.--The Subcommittee shall produce periodic reports and
recommendations as directed or requested by the Secretary or the Under
Secretary on plans and opportunities for the Department to improve its
strategy, goals, and implementation for and deployment of electronic
health records and health information technology to better improve
quality of care, patient outcomes, operational efficiency and
productivity, provider productivity and engagement, and related matters
based on national best practices that are relevant to the Department.
(d) Administration.--Administration of the Subcommittee, including
terms of service and replacement of members, shall be guided by the
rules and charter of the special medical advisory group established
under section 7312 of title 38, United States Code.
(e) Termination.--This section shall terminate on the date on which
the Secretary determines that a modernized electronic health record has
been deployed to every medical center and other relevant medical
facility of the Department.
TITLE II--DEPLOYMENT CRITERIA AND THRESHOLDS TO ADVANCE
SEC. 201. REQUIREMENT TO EXCEED OR MEET CERTAIN HEALTH CARE PERFORMANCE
BASELINE OR NATIONAL METRICS FOR CONTINUATION OF
ELECTRONIC HEALTH RECORD MODERNIZATION PROGRAM OF
DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--The Secretary may not initiate a new go-live
deployment of the electronic health record modernization program until
the quality, access, productivity, and all other health and operational
performance metrics data of the Veterans Health Administration and the
Office of Information and Technology of the Department at each facility
of the Department (including any subsidiary facilities, such as
community-based outpatient clinics) that is using the Oracle-Cerner
product under such program as of January 31, 2023, has either--
(1) exceeded the health and information technology
operational levels of the facility before deploying such
product; or
(2) met national standards set forth by the Veterans Health
Administration for quality, safety, efficiency, and financial
performance as established by the Program established under
section 101(a) and the Under Secretary.
(b) Establishment of National Standards.--
(1) In general.--The Under Secretary and the Program
established under section 101(a) shall establish national
standards required under subsection (a)(2) to create a common
health performance standard of the Veterans Health
Administration under which all medical facilities of the
Department may be evaluated under that subsection that takes
into account relevant differences in size, complexity, and
market of each facility.
(2) Common metric and standard.--In establishing standards
under paragraph (1), the Under Secretary and the Program
established under section 101(a) shall establish a common data
driven metric and service delivery standard for care for
veterans by which medical facilities of the Department can be
evaluated.
(3) Reports.--
(A) Initial report.--Not later than 60 days after
the establishment of standards under paragraph (1), the
Program established under section 101(a) shall submit
to the appropriate committees of Congress a report on
such standards.
(B) Modification to standards.--Not later than 30
days before the modification to any standards
established under paragraph (1), the Program
established under section 101(a) shall submit to the
appropriate committees of Congress a report on such
modification.
(c) Termination or Continuation of Use.--
(1) In general.--If, by the date that is 180 days after the
date of the enactment of this Act, the data from the first five
facilities of the Department as well as any relevant remote
sites, consolidated patient account centers, subsidiary
facilities, such as community-based outpatient clinics that
deployed the Oracle-Cerner product, have not reached the
requirements under subsection (a)--
(A) not later than 13 months after such date of
enactment, the Secretary, in consultation with the
Deputy Secretary, the Under Secretary for Health, the
Chief Information Officer, and the Executive Director
of the Office, shall--
(i) submit to the appropriate committees of
Congress a plan on how the Department will meet
the requirements under such subsection either
through the existing technology strategy of the
Department, a new procurement, or some other
combination or approach; and
(ii) publicly announce a replacement
technology solution or solutions or contract or
contracts, including a new timeline and
strategy to implement such solution or
solutions; and
(B) not later than 180 days after completing the
requirements under subparagraph (A), the Secretary
shall--
(i) terminate, cancel, or modify the
contract for the Oracle-Cerner product; and
(ii) develop appropriate coordination and
transition plans for the transition of use of
technology from the Oracle-Cerner product back
to VistA or from the Oracle-Cerner product to
an alternate electronic health record
technology.
(2) Limitation on cancellation of existing contract.--In
carrying out paragraph (1), to ensure a smooth transition and
reduce operational and care delivery disturbance, the Secretary
may not terminate any existing electronic health record
contract until a replacement contract and strategy for such
electronic health record are in place or near award and
commencement.
(3) Extension of time.--
(A) In general.--Not later than 120 days after the
date of the enactment of this Act, the Secretary may,
for one time only, temporarily delay each of the
requirements of paragraph (1) for a period not to
exceed 180 days if the Secretary determines such delay
is necessary due to mission critical, national
emergency, national security, patient safety, quality
and access to care, protection of taxpayer investments,
or other unforeseen reasons.
(B) Justification for extension.--If the Secretary
determines that a delay under subparagraph (A) is
necessary, not later than 105 days after the date of
the enactment of this Act, the Secretary shall submit
to the appropriate committees of Congress a report
setting forth the justification of the Secretary for
such delay.
SEC. 202. REQUIREMENTS BEFORE CONTINUED DEPLOYMENT OF NEW ELECTRONIC
HEALTH RECORD BY DEPARTMENT OF VETERANS AFFAIRS AT
ADDITIONAL LOCATIONS AND FACILITIES.
(a) Report on Metrics To Determine Continued Deployment.--
(1) In general.--Not later than 30 days after the date of
the enactment of this Act, the Deputy Secretary shall submit to
the appropriate committees of Congress a report containing the
metrics, readiness criteria, and governance decision process
that the Department will use to determine whether continued
deployment of the electronic health record technology of the
Department is appropriate in June 2023, or whether a further
pause in such deployment is warranted to address system issues,
patient safety, technology features, provider efficiency, and
related matters.
(2) Metrics.--The metrics included in the report submitted
under paragraph (1) shall--
(A) be data driven based on industry standards,
metrics of the Department, and the unique health care
delivery needs of the Department to serve veterans,
perform research, and support Fourth Mission
requirements;
(B) ensure patient safety, quality of and access to
care, system stability, cyber security, and sound
financial and business administration activities are
successfully evaluated as stable and functional at
desired performance levels and in place to proceed;
(C) ensure completion of relevant training and
change management activities; and
(D) include any other specific readiness criteria
that each location of the Department is required to
meet before moving forward with continued deployment of
the electronic health record technology of the
Department, as determined by the Department.
(3) Other elements.--The report submitted under paragraph
(1) shall--
(A) indicate how the metrics required under the
report are or will be adjusted to incorporate the
research function and health complexity levels of
facilities of the Department and whether additional or
different metrics are or will be added based on more or
less complex facilities or facilities with a greater
research function;
(B) explain how the metrics and readiness criteria
under the report incorporate appropriate input and
findings of the National Center for Patient Safety, the
Clinical Episode Review Team, or the Office of the
Assistant Under Secretary for Health for Quality and
Patient Safety of the Veterans Health Administration,
or any successor office, and resolve any issues raised
by those offices to the satisfaction of those offices
through information technology changes, functionality,
training, and other areas, including regarding patient
record flags, behavioral health and suicide risks,
configuration of roles and responsibilities, referrals,
ambulatory care, pharmacy, identity, orders, medication
administration, and other areas, which shall include a
specific description of how each issue identified in
the March 2023 report of the Department entitled,
``EHRM Sprint Report'' has been resolved or mitigated;
and
(C) provide a clear process description
reflecting--
(i) the repeatable method for how decisions
relating to deployment of electronic health
record technology are made within the
Department from the field level up to the
Secretary; and
(ii) the input received from each relevant
element of the Department before such a
decision is made, to include input from the
National Center for Patient Safety.
(4) Certification.--In submitting metrics under paragraph
(1), the Deputy Secretary shall certify that the metrics have
been approved by the Under Secretary, the Executive Director of
the Office, and the Chief Information Officer of the
Department.
SEC. 203. SENSE OF CONGRESS ON TRAINING AND CHANGE MANAGEMENT
ACTIVITIES FOR DEPLOYMENT OF NEW ELECTRONIC HEALTH
RECORD.
It is the sense of Congress that--
(1) training and change management with respect to any new
electronic health record shall be led by the Department and
employees of the Department who are uniquely positioned to
understand the legacy VistA system of the Department, the
existing and future standardized workflow of the Department,
and the history, culture, and mission of the Department; and
(2) any contractors of the Department involved in the
implementation of any new electronic health record should serve
in a support function to the Department rather than lead and
conduct all training and change management activities.
TITLE III--ENHANCED SUPPORT FOR HEALTH CARE AND OTHER FACILITIES
DEPLOYING NEW ELECTRONIC HEALTH RECORD
SEC. 301. REPORT ON SUPPORT TO FACILITIES FOR NEW ELECTRONIC HEALTH
RECORD DEPLOYMENT BY DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Not later than 90 days after the date of the
enactment of this Act, the Deputy Secretary shall submit to the
appropriate committees of Congress a report summarizing the standard
support services that the Department does or intends to provide to each
facility in preparation for potential future deployment of the new
electronic health record of the Department at such facility and in the
period after such deployment.
(b) Support To Be Provided.--The support required to be provided to
a facility by the Department and included in the report under
subsection (a) shall include, at a minimum, the following:
(1) Budgetary resources and support to address the need for
increased staffing at the facility, reduced productivity and
collections, increased use of community care networks, and
other issues identified in the report of the Institute for
Defense Analyses dated October 2022, entitled ``Independent
Cost Estimate for Veterans Affairs Electronic Health Record
Modernization Program''.
(2) Increased staffing level surge at the facility,
including temporary and permanent staff.
(3) Steps to be taken by the Department to reduce burnout
and turnover.
(4) Enhanced training to include government or vendor
supplied trainers to maintain a presence until dismissed by the
director or other relevant leader of the facility after
deployment of the new electronic health record.
(5) A description of any additional legislative action
requested to improve the level of support services required at
each such facility for such deployment.
(6) Such other support as the Deputy Secretary determines
necessary in consultation with the Under Secretary, the
Executive Director of the Electronic Health Record and Health
Information Technology Modernization Program Management Office,
and the Chief Information Officer.
SEC. 302. MODIFICATION OF QUARTERLY REPORT TO INCLUDE INFORMATION ON
SYSTEM STABILITY, SATISFACTION, MORALE, RETENTION OF
STAFF, TRAINING, AND CHANGE MANAGEMENT WITH RESPECT TO
NEW ELECTRONIC HEALTH RECORD OF DEPARTMENT OF VETERANS
AFFAIRS.
Section 503(b) of the Veterans Benefits and Transition Act of 2018
(Public Law 115-407; 38 U.S.C. 5701 note prec.) is amended--
(1) by redesignating paragraphs (1) through (6) as
subparagraphs (A) through (F), respectively, and moving those
subparagraphs, as so redesignated, two ems to the right;
(2) in the matter preceding subparagraph (A), as designated
by paragraph (1), by striking ``Not later than 30 days'' and
inserting the following:
``(1) In general.--Not later than 30 days''; and
(3) by adding at the end the following new paragraph:
``(2) Additional matters to be included.--
``(A) In general.--The Secretary shall include with
any update submitted under paragraph (1) on or after
the date of the enactment of the Electronic Health
Record Program Restructure, Enhance, Strengthen, and
Empower Technology Act of 2023, with respect to the
quarter covered by the report, the following:
``(i) Data on employee satisfaction with
the new electronic health record of the
Department of Veterans Affairs using credible,
industry standard surveys and data analysis.
``(ii) Data on retention, morale, and
turnover at sites using such new record.
``(iii) Data on satisfaction with training
and change management activities provided to
employees and facilities of the Department
regarding such record.
``(iv) Data on ticket resolution and
closure.
``(v) The specific system enhancements to
include configuration changes and new service
requests that have been tested and put into
production for electronic health record system
users and a list and description of remaining
configuration changes and new service requests
under development or in requirements
development and the estimated date for such
improvements to be tested and put into
production for electronic health record system
users.
``(vi) The system performance statistics
for such record, to include--
``(I) cause, length, and source of
or responsible entity for performance
issues; and
``(II) corrective steps taken to
rectify outages, performance
degradations, incomplete functionality,
and loss of redundancy.
``(vii) The health operations,
productivity, and quality metrics of each
facility using such new record as of the end of
the quarter covered by the report compared to
the health operations, productivity, and
quality metrics of that facility before
deployment of the new record while using the
legacy VistA and related systems and compared
to the national quality and access standards
established by the Veterans Health
Administration to evaluate performances of
medical facilities under section 201(b) of the
Electronic Health Record Program Restructure,
Enhance, Strengthen, and Empower Technology Act
of 2023.
``(viii) Revenue, collections, and all
other financial data at facilities using such
new record, including an assessment of planned
versus actual revenue and collections and steps
taken to remediate performance challenges as
well as a comparison to revenue, collections,
and all other financial data collected before
the new record was in use.
``(ix) A description of the number of cure
notices, letters of concern, and other relevant
corrective contracting actions taken by the
Department, the responses to those actions by
relevant contractor or contractors and any
credits, reimbursements, or other relevant
repayment or corrective action agreed upon or
issued and the dates, purposes, and reasons for
issuance of such cure notices, letters of
concern, and other relevant requests for
corrective actions and the status or resolution
of those matters.
``(B) Compilation of information.--The information
provided under subparagraph (A) shall be--
``(i) compiled in a manner that shows the
information over time, at the facility level
and aggregated for all facilities;
``(ii) compiled using industry-based
questions, standards, and metrics; and
``(iii) informed by the unique veteran care
delivery services and functions of the
Department.''.
TITLE IV--CONTRACTING AND ACQUISITION OVERSIGHT AND REFORM
SEC. 401. TERMINATION OF CONTRACT WITH ORACLE CERNER FOR TRAINING AND
CHANGE MANAGEMENT.
(a) In General.--Not later than 275 days after the date of the
enactment of this Act, the Secretary shall--
(1) terminate all contracts of the Department with Oracle
Cerner for training and change management related to electronic
health record modernization; and
(2) cease to issue task orders for training and change
management activities from Oracle Cerner or subcontractors of
Oracle Cerner.
(b) Replacement of Services.--Before terminating all contracts of
the Department with Oracle Cerner as required under subsection (a)(1),
the Secretary, as the Secretary determines necessary and consistent
with section 203 of this Act, shall put plans in place to replace the
services provided under those contracts with a new contract or
contracts, competitively procured, with companies with a proven track-
record in delivering electronic health record and health information
technology training and change management in medium or large health
systems in the United States.
(c) Report.--Not later than 200 days after the date of the
enactment of this Act, the Secretary shall submit to the appropriate
committees of Congress a report on the implementation of this section.
SEC. 402. STRENGTHENING CONTRACT NEGOTIATION BY DEPARTMENT OF VETERANS
AFFAIRS WITH RESPECT TO NEW ELECTRONIC HEALTH RECORD AND
DESIGNATION OF LEAD CONTRACT NEGOTIATOR.
(a) Designation of Lead Negotiator for New Electronic Health
Record.--
(1) In general.--The Secretary shall designate one senior
career official of the Department, at grade GS-15 of the
General Schedule or an equivalent or higher grade, as the lead
negotiator for the Department on all current and future
contracts relating to the new electronic health record of the
Department (in this section referred to as the ``Negotiator'').
(2) Organization.--The Negotiator shall reside within the
Office of Acquisition, Logistics, and Construction of the
Department and report to the Chief Acquisition Officer of the
Department.
(3) Notification.--Not later than 15 days after designating
the Negotiator under paragraph (1), the Secretary shall notify
the appropriate committees of Congress of such designation.
(b) Objective of Negotiations.--The goal of contract negotiations
and activities conducted by the Negotiator with respect to contracts
relating to the new electronic health record of the Department are, at
a minimum--
(1) to ensure that any future contracts or task orders for
such a record, including modifications of existing contracts or
new awards, shall--
(A) seek to protect the interest of taxpayers to
the greatest extent practicable; and
(B) recover, by whatever means available, direct
and indirect costs that the Department and veterans
have already incurred due to patient harm, poor
performance, inadequate training, insufficient ticket
resolution, system crashes, inefficient processes
driven by new technology, extra Department personnel
hours, and other factors relating to the use of the
Oracle-Cerner product;
(2) to consider options to descope existing contracts and
secure discounted rates on future work and sustainment work;
(3) to achieve aggressive industry standard service-level
agreements and significant financial penalties for failure to
meet those standards;
(4) to contractually codify the services, technology
features, and other elements that have been verbally offered to
the Department at no cost by a contractor or contractors
related to such new record;
(5) to develop an organized and properly phased contract
cancellation, transition, and replacement strategy should the
negotiations not result in best value terms for the taxpayer,
veterans, and medical personnel of the Department; and
(6) to address issues of conflicting or duplicative
contracting requirements to include those between contractors
deploying various aspects of such new record and the program
management office contract, including potential conflicts of
interest and perverse incentives for one set of contractors to
inhibit or slow the work of other contractors for potential
financial gain and leverage for current and future work for the
Department.
(c) Coordination of Activities.--The Negotiator shall closely
coordinate with individuals in the Program and the Office established
under section 101 who have day-to-day responsibility for existing
contract oversight with respect to health record contracts and relevant
health information technology contracts.
(d) Consultation.--The Negotiator shall leverage and consult with
all relevant stakeholders of the Department, but at a minimum the
Secretary, the Deputy Secretary, the Office of General Counsel, the
Under Secretary, and the Chief Information Officer and the Assistant
Secretary for Information and Technology of the Department, in
conducting negotiations relating to the electronic health record of the
Department.
(e) Assistance.--
(1) Other federal agencies.--In conducting negotiations
relating to the new electronic health record of the Department,
the Negotiator or the Secretary may request assistance from the
other Federal agencies that have experienced contract
negotiators, legal counsel, litigators, and other relevant
personnel, particularly those with specialties and experience
in health information technology acquisitions, contracts,
negotiations, and litigation.
(2) Outside entities.--
(A) In general.--In conducting negotiations, the
Negotiator or the Secretary may engage non-Federal,
private sector, or nonprofit entities to perform
independent contract and legal advisory services for
the Department so as to advise the Department on
options and strategies to achieve a revised, modified,
or new contract for a new electronic health record that
is of better value to the taxpayer or where necessary
for appropriate cancellation terms and transition
planning.
(B) Types of entities.--In procuring services under
subparagraph (A), the Negotiator and the Secretary--
(i) shall only engage with entities that
have a proven, long-term experience in
delivering value and resolution to entities
through high-dollar contracts, agreements,
settlements, or litigation structured to
deliver performance, accountability, and value
to taxpayers, governments, or clients, as the
case may be; and
(ii) shall not engage with a company that
works for Oracle, Oracle Cerner, or any
subcontractor of either such company.
(f) Terms Relating to Protection of Data.--Any contract of the
Department related to electronic health records entered into on or
after January 1, 2018, shall include a clause or clauses, or be
modified to include such clause or clauses, protecting the health and
other personal identifying data of veterans to include a total
prohibition on that data being monetized, sold, controlled, or
otherwise misused by any internal or external entity conducting work
for, with, or on behalf of the Department, including data that has gone
through anonymization.
SEC. 403. INDEPENDENT VERIFICATION AND VALIDATION OF CERTAIN MAJOR
MODERNIZATION EFFORTS OF DEPARTMENT OF VETERANS AFFAIRS.
(a) Contracting Authority.--Not later than 90 days after the date
of the enactment of this Act, the Chief Acquisition Officer of the
Department of Veterans Affairs established pursuant to section 1702 of
title 41, United States Code, shall enter into a contract with an
eligible entity under subsection (b) to carry out the oversight
functions described in subsection (c).
(b) Eligibility.--An entity is eligible under this subsection if
the Chief Acquisition Officer of the Department determines that, with
respect to the solicitation by the Department for a contract under
subsection (a), the entity--
(1) is currently performing or has performed, during the
three-year period preceding the date of the issuance of such
solicitation, not fewer than three prime contracts for the
independent verification and validation, or equivalent
technical and program oversight support, of major defense
acquisition programs or priority defense business systems, in
accordance with guidance of the Department of Defense relating
to such acquisition programs or such business systems; and
(2) is not currently performing and has not performed, for
at least the five-year period preceding the date of the
issuance of such solicitation, any contract or subcontract for
the Department of Veterans Affairs (including such a contract
or subcontract relating to a covered program).
(c) Functions.--The oversight functions described in this
subsection are the following:
(1) Conducting an initial assessment of each covered
program and submitting to the Secretary a report containing the
findings of such assessment.
(2) On an annual basis, conducting an overall assessment of
each covered program and submitting to the Secretary a report
containing the findings of each such assessment.
(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.
(D) Supply chain risk management, controls, and
compliance.
(E) Data management.
(F) With respect to associated 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 provided to
users.
(v) System adoption and use.
(d) Submission to Congress.--Not later than 30 days after the date
on which the Secretary receives any annual report under subsection
(c)(2), the Secretary shall submit to the Committee on Veterans'
Affairs of the Senate and the Committee on Veterans' Affairs of the
House of Representatives such report.
(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.
(f) Definitions.--In this section:
(1) Covered program.--The term ``covered program'' means
the following:
(A) The electronic health record modernization
program (or any successor program).
(B) The Financial Management and Business
Transformation Program (or any successor program).
(C) Any program of the Department relating to
supply chain modernization.
(D) Any program of the Department relating to the
modernization of information technology systems
associated with human resources.
(E) Any program of the Department relating to the
Veterans Benefits Management System.
(2) Priority defense business system.--The term ``priority
defense business system'' has the meaning given such term in
section 2222(i) of title 10, United States Code.
(3) Major defense acquisition program.--The term ``major
defense acquisition program'' has the meaning given such term
in section 4201 of title 10, United States Code.
SEC. 404. ANNUAL REPORT ON EFFORTS TO MAINTAIN VISTA ELECTRONIC HEALTH
RECORD SYSTEM.
(a) In General.--Not later than 60 days after the date of the
enactment of this Act, and not later than 90 days after the beginning
of each fiscal year thereafter, the Secretary shall submit to the
appropriate committees of Congress a report on the VistA system used by
the Department.
(b) Elements.--The report required by subsection (a) shall include
the following:
(1) The cost to maintain and strengthen the VistA system
for each of fiscal years 2018 through 2022, for funding
relating to both development and operations and maintenance.
(2) The projected cost to maintain and strengthen such
system for fiscal year 2023, for funding relating to both
development and operations and maintenance.
(3) The projected cost to maintain and strengthen such
system for each of fiscal years 2024 through 2033, for funding
relating to both development and operations and maintenance.
(4) The planned enhancements underway to strengthen and
secure the VistA system until its features and modules are no
longer needed by the Department through such system, or have
been subsumed or replaced by other programs and information
technology services and systems, including cyber security
enhancements, movement to the cloud, and new features and
services.
(5) A list of modules or features of the VistA system that
are not planned to be replaced, subsumed, or otherwise
incorporated into a new electronic health record or other
health information technology and are planned to reside in a
remnant VistA system, or successor remnant system.
(c) Initial Report.--The first report required by subsection (a)
shall include a description of any enhancements to the VistA system
that have occurred during the one-year period preceding the date of the
report and those planned for the fiscal year in which the report is
submitted.
(d) Subsequent Reports.--Each report after the first report
required by subsection (a) shall include a description of any
enhancements to the VistA system that have occurred during fiscal year
immediately preceding the date of the report, those planned, but not
implemented and an explanation for such lack of implementation and
those planned for the fiscal year in which the report is submitted.
(e) Termination.--This section shall terminate on the date that is
15 years after the date of the enactment of this Act.
SEC. 405. REPORT ON ALTERNATIVES TO CURRENT ELECTRONIC HEALTH RECORD
TECHNOLOGY AND CONTRACT FOR DEPARTMENT OF VETERANS
AFFAIRS.
(a) In General.--Not later than 60 days after the date of the
enactment of this Act, the Secretary shall submit to the appropriate
committees of Congress a report on paths the Department and Congress
should consider to achieve a modernized electronic health record as an
alternative to the Oracle-Cerner product.
(b) Elements.--The report required under subsection (a) shall
include the following with respect to an alternative path or paths to
be considered by the Department and Congress:
(1) Considerations for and against such alternative path or
paths.
(2) Accurate reinvestment analysis of expenditures,
developed consistent with cost estimation and other relevant
guidance issued by the Comptroller General of the United
States, already made on the modernized electronic health record
as of the date of the report, including an assessment of which
of those expenditures would have to be made again and which
would not based on an alternative technology and contract path
chosen and the ability to repurpose investments.
(3) The capabilities and weaknesses of other technology
solutions the Department could pursue, including an assessment
of long-term value and return on investment from a health
delivery, health quality, and operational perspective, and the
acquisition process that could be used to procure such
solutions.
(4) An analysis of electronic health record and health
information technology market trends, capabilities, and market
leaders to include user satisfaction and health outcome
statistics to the extent they are relevant to the goals and
strategy of the Department.
(5) An analysis of whether the Department choosing an
alternative path or paths would, and to what extent, or would
not impact necessary alignment with the electronic health
record modernization conducted by the Department of Defense
commonly known as MHS GENESIS.
(6) An analysis of whether the ability to share and
exchange records in an interoperable manner, and with what
level of interoperability, with the Department of Defense would
be negatively impacted or positively enhanced, or neither, by
an alternative technology path or contract.
(7) An analysis of whether the ability share and exchange
records in an interoperable manner, and with what level of
interoperability, with non-Federal health entities would be
negatively impacted or positively enhanced, or neither, by an
alternative technology path or contract.
(8) An estimated timeline to restart deployment of a new
electronic health record of the Department with a different
vendor based on an alternative technology path or contract.
(9) An assessment of options that may include--
(A) a narrow or descoped contract supplemented by
other contracts to strengthen areas in which the
Oracle-Cerner product performs in a substandard fashion
or is inadequate to the health delivery and operational
needs of the Department; or
(B) any other combination of possibilities.
(10) An analysis of the strengths and weaknesses of the
alternative path or paths towards the Department meeting or
exceeding the highest industry interoperability standards.
(11) An analysis of whether the interoperability of the
Oracle-Cerner product with the private sector, the community
care networks of the Department, academic hospitals, Federal
health entities, and other relevant health providers, systems,
and networks is demonstrably superior to other electronic
health records in the health technology industry.
(12) A description of which path or paths the Secretary has
selected to take or not take, the reason for such selection,
and the key milestones to achieve any new course of action
described, including any new Departmental structures, estimated
life cycle costs, and timelines.
(13) Such other matters as the Secretary considers
appropriate.
SEC. 406. REPORT ON LEADERSHIP, ACQUISITION, AND CONTRACTING OVERSIGHT
LESSONS LEARNED.
(a) In General.--Not later than 180 days after the date of the
enactment of this Act, the Secretary, through the Chief Acquisition
Officer, the Under Secretary for Health, and the Executive Director of
the Electronic Health Record and Health Information Technology
Modernization Program Management Office, shall submit to the
appropriate committees of Congress a report detailing the structural
controls, programs, and processes the Department has or will put in to
place to prevent current or future failures with respect to leadership
engagement and management, strategic planning, contracting and contract
oversight, and program management in--
(1) the implementation of the electronic health record
modernization program of the Department from 2017 to the date
of the report; and
(2) any large acquisitions and major modernizations
conducted, including those that are ongoing or planned by the
Department after the date of the report.
(b) Elements.--The report required under subsection (a) shall
include--
(1) steps to improve the composition of and management of
task orders placed on the current and any future electronic
health record contract or other major acquisition or
modernization, including covered programs (as defined in
section 403(f));
(2) a timeline to achieve the reforms described in the
report or the date upon which reforms already put in place were
finalized and implemented;
(3) a description of lessons learned regarding the need for
stable consistent leadership, strategy, and management of large
modernization programs and how to prevent such challenges as
experienced with the electronic health record modernization
initiated in 2017 from occurring again in any major program of
the Department; and
(4) a description of the number of acting or Senate-
confirmed Deputy Secretaries of the Department and the number
of leaders of the program management office of the electronic
health record modernization program of the Department from 2017
to the date of the report.
(c) Legislative or Administrative Action.--The report required by
subsection (a) shall include a description of any legislative or
administrative action necessary to achieve the structural controls
described in such subsection.
SEC. 407. REPORT ON CONTRACT SAVINGS, SERVICES PROVIDED AT NO COST TO
THE DEPARTMENT, AND CONTRACT COST INCURRED WITH RESPECT
TO ORACLE-CERNER PRODUCT.
Not later than 90 days after the date of the enactment of this Act,
the Deputy Secretary shall submit to the appropriate committees of
Congress a report that contains the following:
(1) A detailed list of the services, functions, or other
matters that Oracle-Cerner provided to the Department without
compensation since assuming ownership of Cerner in June 2022.
(2) A list of specific credits or reimbursements, to
include dollar amounts and an indication of the specific
failure for which those credits or reimbursements are provided,
Cerner or Oracle-Cerner has provided to the Department across
all domains for contract failure, service-level agreement
failure, performance failure, training and change management
failure, ticket system failure, and related issues during the
period beginning on the award of the contract to Cerner on May
17, 2018, and ending on the date of the report.
(3) The estimated and known costs, both direct and
indirect, incurred by all facilities using the Oracle-Cerner
product as of the date of the report due to--
(A) increased staffing;
(B) lost productivity;
(C) increased referrals to community care;
(D) copayment and debt management actions;
(E) staff turnover;
(F) reduced collections; and
(G) other factors as determined by the Secretary.
TITLE V--COORDINATION WITH DEPARTMENT OF DEFENSE
SEC. 501. QUARTERLY REPORTS ON SYSTEM UPTIME, MODERNIZATION, AND
COORDINATION ACTIVITIES FOR INFORMATION TECHNOLOGY
SYSTEMS AND POLICIES OF DEPARTMENT OF DEFENSE AFFECTING
OPERATIONS OF DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Not later than 90 days after the date of the
enactment of this Act, and not less frequently than quarterly
thereafter, the Secretary of Defense shall submit to the appropriate
committees of Congress a report on the system uptime, modernization,
and coordination activities for information technology systems of the
Department of Defense that are relied upon by the Department of
Veterans Affairs to deliver health care, compensation, memorial
benefits, and other services required to be provided under the laws
administered by the Secretary of Veterans Affairs.
(b) Elements.--Each report required by subsection (a)--
(1) shall identify steps taken by the Secretary of Defense
to improve governance, coordination, and policy decisions
conducted with the Secretary of Veterans Affairs related to
information technology of the Department of Defense and related
systems upon which the Department of Veterans Affairs has an
operational dependency;
(2) shall include a schedule for the modernization or
replacement of key information technology and related systems
of the Department of Defense upon which the Department of
Veterans Affairs has an operational dependency, including the
Defense Enrollment Eligibility Reporting System, or successor
system;
(3) shall include a schedule for the movement by the
Department of Defense of the MHS GENESIS software and related
systems to the cloud;
(4) shall include information regarding goals for and
actual uptime and stability of all information technology and
related systems of the Department of Defense--
(A) that the Department of Veterans Affairs relies
on to operate, manage, or administer the current or any
future electronic health record of the Department of
Veterans Affairs;
(B) on which the Department of Veterans Affairs has
an operational dependency; or
(C) that is a critical system or service relied
upon by the Department of Veterans Affairs for the
delivery of health care, compensation, memorial
benefits, or other services;
(5) shall identify--
(A) any system or systems, infrastructure, or
related entities of the Department of Defense that are
critical to operations of the Department of Veterans
Affairs;
(B) any performance issues with respect to those
systems, infrastructure, or related entities;
(C) steps taken by the Secretary of Defense to
remediate any such issues in the short, medium, and
long term and timelines for such remediation;
(D) the accountable offices within the Department
of Defense for the maintenance, replacement, and
stability of those systems, infrastructure, or related
entities; and
(E) policies and governance structures regarding
collaboration and coordination with the Department of
Veterans Affairs with respect to changes to those
systems, infrastructure, or related entities;
(6) shall include a description of the definitions,
monitoring, and reporting of service level agreements between
the Department of Defense and the Department of Veterans
Affairs, including specific critical infrastructure
availability targets, incident reporting mean time to
resolution, and related matters;
(7) shall include a description of the service reliability
measurements in use and the previous quarter's actual
reliability data by the Department of Defense as it relates to
services relied upon by the Department of Veterans Affairs
measured as experienced by the Department of Veterans Affairs,
inclusive of any Department of Defense network, identity, and
security services dependencies;
(8) shall include a complete list of incident reporting,
root cause analyses, after action reporting, and preventive
measures for each event in which a Department of Defense system
or service's degraded performance or outage caused operational
harm to the Department of Veterans Affairs inclusive of network
and security services degradations, outages, and related
matters; and
(9) may include an identification of legislative or
administrative action required to accomplish the goals in the
report.
(c) Initial Report.--The first report required under subsection (a)
shall include baseline information, including current system uptime and
goals and targets with respect to system uptime, and steps the
Department of Defense is taking to better meet standards, goals, and
targets with respect to system uptime.
(d) Subsequent Reports.--Each report after the first report
required under subsection (a) shall, for the quarter covered by the
report--
(1) discuss updates on the information provided in previous
reports, including system uptime performance;
(2) indicate the performance of the Department of Defense
in meeting the goals established in previous reports;
(3) indicate the steps the Department of Defense is taking
to address the areas in which the Department is not meeting
those goals; and
(4) indicate improvements to and work in progress toward
strengthening policies and governance structures regarding
collaboration and coordination with the Department of Veterans
Affairs with respect to changes to the systems, infrastructure,
or related entities with respect to which the Department of
Veterans Affairs has an operational dependency.
(e) Termination.--This section shall terminate on the date that is
10 years after the date of the enactment of this Act.
(f) Appropriate Committees of Congress Defined.--In this section,
the term ``appropriate committees of Congress'' means--
(1) the Committee on Armed Services and the Committee on
Veterans' Affairs of the Senate; and
(2) the Committee on Armed Services and the Committee on
Veterans' Affairs of the House of Representatives.
SEC. 502. COORDINATION WITH DEPARTMENT OF DEFENSE REGARDING INFORMATION
TECHNOLOGY PROGRAMS, SYSTEMS, AND SERVICES.
(a) In General.--Not later than 45 days after the date of the
enactment of this Act, the Deputy Secretary shall submit to the
appropriate committees of Congress, the Committee on Armed Services of
the Senate, and the Committee on Armed Services of the House of
Representatives a report indicating the additional support needed by
the Department from the Department of Defense to make the current and
future delivery of health, benefits, memorial affairs and other
services of the Department stable and successful, including through
reliable availability of data and services of the information
technology systems and programs of the Department of Defense, including
the legacy VistA and new electronic health record of the Department.
(b) Elements.--The report required under subsection (a) shall
include a description of support, collaboration, and coordination,
needed by the Department from the Department of Defense relating to--
(1) governance between the Department of Defense and the
Department of Veterans Affairs related to information
technology, systems, services, networks, and related
infrastructure;
(2) coordination and policy between the Department of
Defense and the Department of Veterans Affairs related to
information technology, systems, services, networks, and
related infrastructure;
(3) system availability, stability, and uptime standards of
critical information technology systems, systems, services,
networks, and related infrastructure;
(4) definition, monitoring, and reporting of service level
agreements between the Department of Defense and the Department
of Veterans Affairs related to information technology, systems,
services, networks, and related infrastructure;
(5) service reliability measurements as experienced by the
Department of Veterans Affairs, including any network,
identity, and security service dependencies with the Department
of Defense;
(6) the current state and desired future state transparency
in incident reporting, root cause, after action reporting, and
preventative measures for information technology, systems,
services, networks, and related infrastructure events of the
Department of Defense in which the Department of Veterans
Affairs has an operational dependency;
(7) the current state and desired future state of network
and security services of the Department of Defense on which the
Department of Veterans Affairs has an operational dependency or
that significantly impact the Department of Veterans Affairs;
(8) a description of the key systems of the Department of
Defense that the Department of Veterans Affairs believes need
modernization or replacement so as to improve delivery of
services to veterans and operations of the Department of
Veterans Affairs; and
(9) Such other related matters as the Deputy Secretary may
choose to include.
TITLE VI--OTHER MATTERS
SEC. 601. REPORT ON LEGISLATIVE ACTION REQUIRED.
Not later than 180 days after the date of the enactment of this
Act, and periodically thereafter as the Secretary considers
appropriate, the Secretary shall submit to the appropriate committees
of Congress a report regarding any legislative action, including
resources, required to carry out this Act or implement a modernized
electronic health record and related health information technology
systems.
SEC. 602. REPORT ON CURRENT AND FUTURE STATE INTEROPERABILITY WITH
LEGACY ELECTRONIC HEALTH RECORD, NEW ELECTRONIC HEALTH
RECORD, AND FUTURE POTENTIAL ELECTRONIC HEALTH RECORD AND
OTHER HEALTH INFORMATION TECHNOLOGY AND EXCHANGES.
(a) Report Required.--Not later than 180 days after the date of the
enactment of this Act, the Secretary shall, acting through the Under
Secretary for Health, submit to the appropriate committees of Congress
a report on the current state of interoperability, including the level
of interoperability, with the Department's legacy VistA electronic
health record and legacy applications, including the Joint Longitudinal
Viewer, as well as with the Oracle-Cerner product in use at five
facilities of the Department between such systems, applications, and
records and the Department of Defense, the private sector, the
community care networks of the Department, academic hospitals, other
Federal health entities, and other relevant non-Federal health
providers and systems.
(b) Contents.--The report submitted under subsection (a) shall
include a description of the following:
(1) The level of interoperability that existed before the
contract with Cerner entered into on May 17, 2018, between the
Department and the Department of Defense, the private sector,
the community care networks of the Department, academic
hospitals, other Federal health entities, and other relevant
non-Federal health providers and systems, including strengths
and limitations, and a description of the applications and
exchanges in use by the Department to facilitate such
interoperability.
(2) The level of interoperability that exists as of the
date of the report between the Department and the Department of
Defense, the private sector, the community care networks of the
Department, academic hospitals, other Federal health entities,
and other relevant non-Federal health providers and systems,
including strengths and limitations, and a description of the
applications and exchanges in use by the Department to
facilitate such interoperability that are not those procured as
part of the contract with Cerner entered into on May 17, 2018.
(3) The level of interoperability that exists as of the
date of the report between the Department and the Department of
Defense, the private sector, the community care networks of the
Department, academic hospitals, other Federal health entities,
and other relevant non-Federal health providers and systems,
including strengths and limitations, and a description of the
applications and exchanges in use by the Department to
facilitate such interoperability that are solely those procured
as part of the contract with Cerner entered into on May 17,
2018, and that are in use at each facility of the Department
(including any subsidiary facilities, such as community-based
outpatient clinics) that is using the Oracle-Cerner product
under such program as of the date of the report.
(4) A discussion of the limitation of the Department's
interoperability with whom and of what nature, if any,
described in paragraphs (2) and (3) and how the Secretary
foresees such limitations being resolved in whole, in part, or
in no way through a continued deployment of the Oracle-Cerner
product, a procurement of another electronic health record,
other health information exchanges, networks, applications or
solutions.
(5) A comprehensive interoperability roadmap and strategy
for the next five fiscal years, including goals,
interoperability levels, partners, timelines, regulatory and
legal limitations and challenges, and required resources and
authorities to achieve such goals.
(6) A description of the role interoperable data exchange
plays in improving health care outcomes and care coordination
for veterans who are eligible to receive health care through
programs and services of the Department and whether
interoperability alone improves health care outcomes, access,
and quality or whether it must be part of a larger functioning
electronic health record that can facilitate, among other
actions, the delivery of physician orders, referrals, dispense
prescriptions, schedule appointments, and other such
foundational and routine elements of modern health care
delivery.
(7) Such other such matters as the Secretary considers
appropriate, including recommendations for legislative action
to achieve the goals set forth in the report.
(c) Discussion.--The discussion included under subsection (b)(4)
shall include the following:
(1) A clear indication of what entities the Department
experiences the greatest level of interoperability limitations
in current state such as the Department of Defense, community
care networks of the Department, academic hospitals and the
Department's solution or solutions for remedying those
limitations.
(2) A description of what current health care referral
patterns, patient volumes, and networks it currently
experiences the greatest volume of care referral, data exchange
and interoperability transactions and how such patterns and
volumes are projected to evolve and change over the next one,
five, and ten fiscal years.
(3) In providing the description required by paragraph (2),
an indication of whether the volume of care coordination,
record exchange, and related matters is expected to be greater
with the Department of Defense in the next one, five, and ten
fiscal years or with community care networks of the Department,
academic hospitals, and other Federal and non-Federal health
entities.
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