[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.