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VA AND DOD IT: ELECTRONIC HEALTH RECORDS 

INTEROPERABILITY 

JOINT HEARING 

BEFORE THE

SUBCOMMITTEE ON 

INFORMATION TECHNOLOGY 

OF THE

COMMITTEE ON OVERSIGHT 

AND GOVERNMENT REFORM 

AND THE

SUBCOMMITTEE ON OVERSIGHT AND 

INVESTIGATIONS 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED FOURTEENTH CONGRESS 

FIRST SESSION 

OCTOBER 27, 2015 

Serial No. 114–147 

Printed for the use of the Committee on Oversight and Government Reform 

( 

Available via the World Wide Web: http://www.fdsys.gov 

http://www.house.gov/reform 


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COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM 

JASON CHAFFETZ, Utah, Chairman 

JOHN L. MICA, Florida 

MICHAEL R. TURNER, Ohio 

JOHN J. DUNCAN, JR., Tennessee 

JIM JORDAN, Ohio 

TIM WALBERG, Michigan 

JUSTIN AMASH, Michigan 

PAUL A. GOSAR, Arizona 

SCOTT DESJARLAIS, Tennessee 

TREY GOWDY, South Carolina 

BLAKE FARENTHOLD, Texas 

CYNTHIA M. LUMMIS, Wyoming 

THOMAS MASSIE, Kentucky 

MARK MEADOWS, North Carolina 

RON DESANTIS, Florida 

MICK, MULVANEY, South Carolina 

KEN BUCK, Colorado 

MARK WALKER, North Carolina 

ROD BLUM, Iowa 

JODY B. HICE, Georgia 

STEVE RUSSELL, Oklahoma 

EARL L. ‘‘BUDDY’’ CARTER, Georgia 

GLENN GROTHMAN, Wisconsin 

WILL HURD, Texas 

GARY J. PALMER, Alabama 

ELIJAH E. CUMMINGS, Maryland, Ranking 

Minority Member 

CAROLYN B. MALONEY, New York 

ELEANOR HOLMES NORTON, District of 

Columbia 

WM. LACY CLAY, Missouri 

STEPHEN F. LYNCH, Massachusetts 

JIM COOPER, Tennessee 

GERALD E. CONNOLLY, Virginia 

MATT CARTWRIGHT, Pennsylvania 

TAMMY DUCKWORTH, Illinois 

ROBIN L. KELLY, Illinois 

BRENDA L. LAWRENCE, Michigan 

TED LIEU, California 

BONNIE WATSON COLEMAN, New Jersey 

STACEY E. PLASKETT, Virgin Islands 

MARK DESAULNIER, California 

BRENDAN F. BOYLE, Pennsylvania 

PETER WELCH, Vermont 

MICHELLE LUJAN GRISHAM, New Mexico 

SEAN MCLAUGHLIN, Staff Director 

TROY STOCK, Subcommittee on Information Technology Staff Director 

DAVID RAPALLO, Minority Staff Director 

SARAH VANCE, Clerk 

SUBCOMMITTEE ON INFORMATION TECHNOLOGY 

WILL HURD, Texas, Chairman 

BLAKE FARENTHOLD, Texas, Vice Chair 

MARK WALKER, North Carolina 

ROD BLUM, Iowa 

PAUL A. GOSAR, Arizona 

ROBIN L. KELLY, Illinois, Ranking Member 

GERALD E. CONNOLLY, Virginia 

TAMMY DUCKWORTH, Illinois 

TED LIEU, California 


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COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Florida, Chairman 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida, Vice-Chairman 

DAVID P. ROE, Tennessee 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

JACKIE WALORSKI, Indiana 

RALPH ABRAHAM, Louisiana 

LEE ZELDIN, New York 

RYAN COSTELLO, Pennsylvania 

AMATA COLEMAN RADEWAGEN, American 

Samoa 

MIKE BOST, Illinois 

CORRINE BROWN, Florida, Ranking 

Minority Member 

MARK TAKANO, California 

JULIA BROWNLEY, California 

DINA TITUS, Nevada 

RAUL RUIZ, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

KATHLEEN RICE, New York 

TIMOTHY J. WALZ, Minnesota 

JERRY MCKNERNEY, CALIFORNIA

JON TOWERS, Majority Staff Director 

ERIC HANNEL, Subcommittee on Oversight and Investigtions Staff Director 

JESSICA EGGIMANN, Chief Clerk 

DON PHILLIPS, Minority Staff Director 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 

MIKE COFFMAN, Colorado, Chairman 

DOUG LAMBORN, Colorado 

DAVID P. ROE, Tennessee 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

JACKIE WALORSKI, Indiana 

ANN M. KUSTER, New Hampshire, Ranking 

Member 

BETO O’ROURKE, Texas 

KATHLEEN RICE, New York 

TIMOTHY J. WALZ, Minnesota 


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C O N T E N T S 

Page 

Hearing held on October 27, 2015 .......................................................................... 1 

WITNESSES 

The Hon. Laverne Council, Assistant Secretary for Information Technology, 

Chief Information Officer, U.S. Department of Veterans Affairs 

Oral Statement ................................................................................................. 7 

Written Statement ............................................................................................ 9 

Mr. Brian P. Burns, Deputy Director, Warfighter Systems Integration, Office 

of Information Dominance, U.S. Department of Veterans Affairs 

Mr. Christopher A. Miller, Program Executive Officer, Defense Healthcare 

Management Systems, U.S. Department of Defense 

Oral Statement ................................................................................................. 20 

Written Statement ............................................................................................ 22 

Mr. David Devries, Principal Deputy Chief Information Officer, U.S. Department of Defense 

Oral Statement ................................................................................................. 30 

Written Statement ............................................................................................ 32 

Ms. Valerie C. Melvin, Director of Information Management and Technology 

Resources Issues, U.S. Government Accountability Office 

Oral Statement ................................................................................................. 40 

Written Statement ............................................................................................ 42 

APPENDIX 

Congressman Gerald E. Connolly Opening Statement ......................................... 96 

Questions for the Record for the Hon. LaVerne Council, submitted by Chairman Hurd ............................................................................................................. 99 

Questions for the Record for Mr. Christopher Miller, Submitted by Chairman 

Hurd ...................................................................................................................... 103 


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VA AND DOD IT: ELECTRONIC HEALTH 

RECORDS INTEROPERABILITY 

Tuesday, October 27, 2015 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON INFORMATION TECHNOLOGY, 

COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM, 

JOINT WITH THE SUBCOMMITTEE ON OVERSIGHT AND

INVESTIGATIONS, COMMITTEE ON VETERANS’ AFFAIRS

Washington, D.C. 

The subcommittees met, pursuant to call, at 2:50 p.m., in Room 

2154, Rayburn House Office Building, Hon. Will Hurd [chairman of 

the Subcommittee on Information Technology, Committee on Oversight and Government Reform] presiding. 

Present from the Committee on Oversight and Government Reform: Representatives Hurd, Farenthold, Walker, Blum, Kelly, 

Connolly, Duckworth, Lieu, and Moulton. 

Present from the Committee on Veterans’ Affairs: Representatives Coffman, Lamborn, Roe, Benishek, Huelskamp, Walorski, 

Kuster, O’Rourke, and Walz. 

Mr. HURD. The Subcommittee on Information Technology of the 

Committee on Oversight and Government Reform and the Subcommittee on Oversight and Investigations of the Committee on 

Veterans’ Affairs will come to order. 

Without objection, the chair is authorized to declare a recess at 

any time. 

Let me start today’s hearing by trying to simply state my frustration. It’s the year 2015. We live in a complex interconnected society with self-driving cars, wearable technology, and complex algorithms that can predict when a critical mechanical component is 

going to break, but our soldiers, sailors, airmen, and marines who 

are making the transition from DOD to VA healthcare are literally 

told to print out hard copies of their medical records and then walk 

them to the VA. 

We have sent men to the moon and robots to Mars. I feel like 

we should be able to move one electronic file no matter how big, 

no matter how old, from one computer system to another. I don’t 

mean to understate the enormity of the challenge of integrating the 

two largest Federal bureaucracies, but it’s clear to me that our inability to integrate these two systems is a problem of leadership 

rather than technical feasibility. 

The story of the interoperable electronic health record starts in 

1998 with the government computer-based patient record initiative. 

Since then, I’ve counted six programs or other initiatives from 2002 


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to 2013 designed to increase the exchange of healthcare data between the VA and the DOD. 

In that time, we’ve had three Presidents and two wars, and the 

members of our Armed Forces are still coming home to find that 

two decades was not long enough for these two Departments to get 

together and develop a workable and fully interoperable electronic 

health record. 

While today’s hearing could include a conversation laced with 

technical terminology, interoperability, mapping national data 

standards, graphical user interfaces, and health data domains, at 

its core, this is not a problem of technology. This is an issue of 

management. 

Why do these two departments abandon the integrated health 

record program? Cost-effectiveness was the answer given after 

spending, according to the Interagency Program Office, $564 million on the integrated health record. But continual failures to make 

deadlines and deliver on capabilities led to these two Departments 

doing what they so often have done in the past: go their separate 

ways. 

The current plan for DOD and the VA to modernize their 

healthcare IT infrastructure in order to achieve full interoperability 

lacks metrics and goals. These are not issues of data standardization. This is management 101. In fiscal year 2014, the Department 

of Veterans Affairs spent 3.2 billion on outdated legacy technology 

while Department of Defense spent 24.3 billion. Over the summer, DOD awarded a $4.3 billion contract award to 

upgrade DOD’s DHMSM program, which is DOD’s program to modernize its health IT systems. But what concerns me are the statements by Mr. Frank Kendall, the Under Secretary of Defense for 

Acquisition, Technology, and Logistics, who downplayed the role of 

DHMSM in interoperability. Mr. Kendall made these two comments about DHMSM, ‘‘It’s a big misconception out there that this 

software system we’re buying is about interoperability, period. 

There is not a big interoperability problem with the VA and DOD 

today.’’ 

This is the problem I keep coming back to. Does management understand the depth of the problem when it comes to interoperability? Let me say this right now, just to get it out of the way. 

The Joint Legacy Viewer, the JLV, is not real interoperability, and 

I hope that is not any one of you all’s answers today to any of our 

questions about interoperability. The ability to view patient data 

and the ability to access and use in realtime patient data are two 

profoundly different things. Missed deadlines, cost overruns, and 

failures to deliver on expectations leave me with a series of doubts 

about these two Departments’ ability to work towards this common 

goal. 

When can DOD and the VA actually implement their planned IT 

improvements? When can DOD and the VA modernize their systems? When can DOD and the VA achieve full interoperability? I 

am looking forward to exploring these topics today. 

My colleagues and I recognize these are big challenges. Interoperability of health records is something the private sector is still 

struggling with, but if DOD and the VA get it right, they can be 

a model for the rest of the world. At the end of the day, when we 


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cut through all the technical jargon, the myriad of acronyms and 

the countless PowerPoints on this topic, we have two very simple 

questions that must be answered: When will our men and women 

in uniform be able to walk across the street the day they are discharged from service to a VA medical facility and have their health 

record waiting for them, and who is in charge of making this happen? 

It’s now my pleasure to recognize the ranking member of the 

Subcommittee on Information Technology, Ms. Kelly from Illinois, 

for her opening statement. 

Ms. KELLY. Thank you, Mr. Chairman. 

According to the American Hospital Association, only 23 percent 

of all hospitals are equipped with the technology that would allow 

them to find, send, receive, and use electronic health records. The 

ability of different healthcare providers to share and use electronic 

health information with one another, regardless of their location, is 

often referred to as interoperability. The American Hospital Association’s findings made clear that achieving the full interoperability 

of electronic health records among different healthcare providers is 

a challenge the entire healthcare industry is struggling to meet. 

Nowhere is this challenge more prevalent, as my chairperson 

said, than with the Department of Defense and the Department of 

Veterans Affairs, operators of two of the Nation’s largest healthcare 

systems. For our military personnel and veterans, the interoperability of electronic health records is crucial for ensuring they receive the best medical care. 

While on Active Duty and later on as veterans, many DOD and 

VA personnel tend to be highly mobile and are more likely to have 

health records residing at multiple medical facilities within and 

outside of the United States. For several years now, the VA and 

the DOD have been working to achieve interoperability. Both report that so far, as interoperability concerns, the exchange and use 

of electronic health records between their two systems, this goal 

has been achieved. 

However, as GAO’s August report on the status of interoperability at both the VA and the DOD makes clear, both Departments are still years away from achieving full interoperability so 

that the electronic health records can be exchanged and used not 

just between their two systems but with any private medical provider in the country. 

GAO recommended that VA and DOD promptly develop outcomeoriented metrics and goals for defining and measuring their 

progress on achieving full interoperability. As GAO noted in its report, and I quote, ‘‘using an effective outcome-based metric approach could provide DOD and VA a more accurate ongoing picture 

of their progress toward achieving interoperability and the value 

and benefits generated.’’ 

I look forward to hearing in more detail from today’s witnesses 

on their plans for ensuring that the VA and DOD have in place a 

fully modernized interoperable electronic health records system. 

Today’s hearing also raises valid cybersecurity concerns with respect to what each Department is doing to ensure that medical 

records stored on their networks are adequately protected from 

hackers. As we’ve learned from this year’s cyber attacks against 


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leading health insurers, like Anthem and Premera or Blue Cross, 

hackers are now targeting medical records in an effort to obtain 

highly sensitive information about individuals. 

As the operators of two of the Nation’s largest healthcare systems, it is critical that DOD and the VA invest in and deploy the 

most advanced cybersecurity tools to safeguard the sensitive medical information that is stored on their networks. 

Thank you, Mr. Chair, for the hearing, and I yield the balance 

of my time. 

Mr. HURD. Thank you, Ms. Kelly. I now welcome and recognize 

the chairman of the Subcommittee on Oversight and Investigations, the Committee on Veterans’ Affairs, Mr. Coffman from Colorado, who has been showing leadership on supporting our veterans 

for many years. 

I welcome you for your opening statement, sir. 

Mr. COFFMAN. Thank you, Chairman Hurd. 

I would like to welcome everyone to today’s joint hearing to address ongoing issues with the electronic health records or EHR’s of 

the Department of Defense and Veterans Affairs. VA and DOD 

have been attempting to harmonize their EHRs for decades, leading to an erratic history where billions of dollars have been expended to reach that goal. 

Initially, they sought to make their systems interoperable, the 

plan being that they could keep their separate systems but make 

them able to seamlessly transmit critical data. Later, the agencies 

abandoned that idea and decided that it would be better to create 

a new, integrated system that would be shared by both agencies. 

In a February 2014 report, GAO found that the VA and DOD 

Interagency Program Office charged with overseeing these efforts 

estimated the cost of this integrated system would be $29 billion 

from fiscal year 2013 through fiscal year 2029. Notably, this figure 

does not include the pre-2013 attempts by the agency to join their 

health records dating back to at least 1998. 

Yet, again, the decision was made to switch course, this time 

abandoning the efforts to create an integrated system after spending at least $564 million on it and resuming pursuit of separate 

systems that would ideally achieve full interoperability. 

There have been numerous subcommittee investigations, hearings, and GAO reports highlighting the extreme dysfunction occurring in this process. The National Defense Authorization Acts for 

fiscal year 2008 and 2014 were explicit in their requirements for 

VA and DOD to jointly develop fully interoperable EHR systems as 

well as to ensure that all healthcare data contained in both agencies’ systems complied with national standards and were computable in realtime. 

Both agencies have failed to meet this legal requirement by missing the October 1, 2014 deadline. To do so, and GAO has found 

that full interoperability will not occur before 2018. Additionally, 

the Centers for Medicare and Medicaid Services developed criteria 

to incentivize meaningful use of certified EHRs in order to help 

promote health data interoperability. In the private sector, the 

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Use of successfully deployed off-the-shelf software lowers risk of 

project failure, reduces time to get to the desired capability, and, 

generally speaking, costs less at implementation and sustainment, 

none of which appeared to matter to VA. Instead, VA opted to create a proprietary system which many of its healthcare facilities 

across the country have further customized, leading to 130 different electronic healthcare systems. 

Unfortunately, this sort of disarray and failure to produce positive results has become the hallmark of VA’s Office of Information 

and Technology. There has been a substantial personnel change in 

that office, which is encouraging, but there is a tremendous amount 

of damage that must be undone before these agencies’ EHRs can 

meaningfully interact. 

The National Defense Authorization Act—I look forward to hearing from the witnesses today about the rationale for the decisions 

that have been made as well as the plans to correct decades of information security weaknesses within both Departments. 

With that, I yield back to Chairman Hurd. 

Mr. HURD. Thank you, Chairman Coffman. 

I now recognize the ranking member of the Subcommittee on 

Oversight and Investigations, Ms. Kuster, for an opening statement. 

Ms. KUSTER. Thank you, Chairman Hurd, Chairman Coffman, 

and Ranking Member Kelly for holding this hearing on issues with 

DOD and VA electronic health records. Both agencies have been 

working for almost 20 years to achieve true interoperability for 

their health records, and one of my very first hearings at the VA 

committee was on this topic. The goal of real interoperability and 

the seamless sharing of health information has seemed in reach, 

but unfortunately, never quite achieved. 

In an August 2015 GAO report, GAO noted that both agencies 

had failed the October 2014 deadline imposed by the 2014 National 

Defense Authorization Act, as referenced by my chair, to certify 

that all healthcare data complies with national data standards and 

is computable in realtime. DOD and VA now report that they may 

be, quote, ‘‘weeks away’’ from meeting this deadline a full year 

later, but it is still unclear whether VA and DOD will achieve 

interoperability between their electronic health records by the end 

of 2016. 

This raises what I believe to be the heart of this decade-long effort and why the achievement of this goal always seems to be just 

out of reach. What, in practical terms, does interoperability mean 

to DOD, VA, and private providers? GAO refers to this as, quote, 

‘‘the criticality of these Departments needing to define what they 

aim to accomplish through these efforts and identify meaningful 

outcome-oriented goals and metrics that indicate not only the extent to which progress is being made toward achieving full interoperability but also the measures to which they will be held accountable.’’ 

If we are not clear as to what we all mean by interoperability 

and what we’re hoping to achieve in the case of an individual veteran or servicemember in the healthcare they receive, then we will 

never achieve what we need to and interoperability will only be in 

the eye of the beholder. The search for real interoperability goes 


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beyond DOD and VA and raises questions as to our expectations 

regarding how healthcare data flows between agencies, and now 

with the VA Choice Card, between those agencies and private 

healthcare providers. 

In addition, we must always ensure to the fullest extent practicable that this healthcare data is secure and safe. Until VA is 

able to demonstrate that its providers are able to readily access the 

relevant information from DOD records to make the most informed 

decisions on treatment options, neither agency can declare mission 

accomplished. 

As DOD pursues an overall of its EHR through the latest partnership for defense health and VA continues with its incremental 

plan to modernize the VistA EHR under the new VistA Evolution 

Program, I remain concerned that interoperability will no longer be 

a DOD and VA focus. I’m concerned that these separate efforts, at 

the end of the day, might not fully match the capabilities we envision while coming with a higher price tag for the American taxpayer. 

The recent VA independent assessment found that VistA is in 

danger of become obsolete and that VA lacks standard clinical documentation, making it difficult to exchange EHR information 

among all VA medical centers. We need to take a realistic look at 

whether the VistA evolution program is the best means for VA to 

modernize its EHR system and achieve all the benefits and capabilities of interoperability with DOD and private providers. 

As more servicemembers leave the military and as more veterans 

and servicemembers receive their healthcare from a combination of 

VA, DOD, and private providers, it is vitally important that DOD 

and VA work to achieve interoperability not only between the two 

agencies but with other healthcare providers treating veterans. 

And, with that, I yield back, and thank you, Mr. Chairman, for 

scheduling this hearing. 

Mr. HURD. Thank you, Ms. Kuster. 

I will hold the record open for 5 legislative days for any members 

who would like to submit a written statement. And I want to thank 

the staffs of all the committees for helping us to be prepared for 

such an important hearing that we have going on today. 

I’d like to also note the presence of our fellow colleague from the 

full Committee on Oversight and Government Reform, Mr. Hice 

and also Seth Moulton, Mr. Seth Moulton. 

Without objection, Mr. Hice and Mr. Moulton are welcome to 

fully participate in today’s hearing. 

We will now recognize our witnesses. I am pleased to welcome 

Ms. LaVerne Council, Assistant Secretary for Information Technology and Chief Information Officer at the U.S. Department of 

Veterans Affairs. 

Thank you for being here, Ms. Council. 

Mr. Brian Burns, Deputy Director of Warfighter Systems Integration at the Office of Information Dominance at the U.S. Department of Veterans Affairs; Mr. Christopher Miller, program executive officer of Defense Healthcare Management Systems at the U.S. 

Department of Defense; Mr. David DeVries, Principal Deputy Chief 

Information Officer at the U.S. Department of Defense; and Ms. 

Valerie Melvin, Director of Information Management and TechVerDate Nov 24 2008 10:28 Jul 13, 2017 Jkt 000000 PO 00000 Frm 00012 Fmt 6633 Sfmt 6633 H:\25915.TXT APRIL

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nology Resources Issues at the U.S. Government Accountability Office. 

Welcome to you all, and thank you for being here. 

Pursuant to Oversight and Government Reform Committee rules, 

all witnesses will be sworn in before they testify. Please rise and 

raise your right hand. 

Do you solemnly swear or affirm that the testimony you are 

about to give will be the truth, the whole truth, and nothing but 

the truth? 

Thank you. Please be seated, and let the record reflect that all 

witnesses answered in the affirmative. 

In order to allow time for discussion, we would appreciate if you 

would limit your oral testimony to 5 minutes. Your entire written 

statement will be part of the record. 

Assistant Secretary Council, you are recognized for 5 minutes. 

Thank you for being here. 

WITNESS STATEMENTS 

STATEMENT OF LAVERNE COUNCIL 

Ms. COUNCIL. Thank you. 

Chairman Hurd and Coffman, Ranking Members Kelly and 

Kuster, and members of the House Oversight and Government Reform Subcommittee and Information Technology and the House 

Veteran Affairs Subcommittee. Thank you for the opportunity to 

appear before you today to discuss interoperability, electronic 

health records, cybersecurity, and the state of the Office of Information and Technology, or OI&T, at the Department of Veterans 

Affairs. 

I’m accompanied today by OI&T’s lead for the Interagency Program Office, Deputy Director Brian Burns. Over the last 3–1/2 

months, I’ve had the privilege to be a part of VA, where we have 

the greatest mission in government: to care for the Nation’s veterans. 

VA’s Office of Information and Technology is at a critical inflection point. Persistent internal challenges exist in delivering IT 

services, and external pressures are compelling OI&T to change 

and adapt. OI&T supports each of VA’s diverse lines of business, 

including the largest integrated healthcare system in the United 

States, a benefits processing organization equivalent to a mediumsized insurance company, one of the largest integrated memorial 

and cemetery organizations in the country, a court system, and 

many other components. 

I believe we can and must do better to deliver excellent health 

care and benefits to our veterans through world class technology, 

and I’m delighted to discuss our new OI&T strategy with you 

today. 

Our vision is to become a world class organization that provides 

a seamless unified veteran experience through the delivery of stateof-art technology. Our guiding principles are transparency, accountability, innovation, and teamwork. We will measure success, ensure 

accountability, invest in the capabilities of the OI&T employees 

and collaborate across VA to build trust. 


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One of our key organizational changes is the establishment of an 

Enterprise Program Management Office or EPMO. The EPMO will 

ensure visibility and governance of all programs and projects. As 

we establish EPMO, we will be integrate our four largest programs 

first VistA Evolution, health data interoperability; the Veterans 

Benefit Management System, or VBMS; and Medical Appointment 

Scheduling System, or MASS. For VistA Evolution, I have tasked 

the program leads, David Waltman from VHA and Alan 

Constantian from OI&T to deliver a business case that explains 

measurable outcomes for the program. After reviewing the business 

case, Under Secretary for Health, Dr. David Shulkin and I will determine the next steps. The development of a business case will be 

the standard from all programs from their inception. 

Chairman Hurd, I agree, interoperability isn’t just technology. It 

is clear to me that we need to establish a strong technical foundation through data visibility, accessibility, and interoperability. This 

is a precursor to the work happening in the IPO as well as improving the veteran experience. As you know, VA and DOD systems already share millions of health records. Having a veteran’s complete 

health history from DOD and VA, as well as community providers, 

is critical to providing seamless, high-quality access to care and 

benefits. 

We will continue to work closely with the IPO and Office of the 

National Coordinator to ensure national standard codes are used 

when describing our health information. I think that VA and DOD 

together should be leaders in this area. 

When you think of data, you must also consider cybersecurity. As 

part of our overall strategy, our first area of focus is cybersecurity. 

We delivered an actionable far-reaching cybersecurity strategy and 

implementation plan to Congress on September 28 of this year. 

OI&T is committed to protecting all veterans’ information and VA 

data and limiting access only to those with proper authority. The 

strategy establishes an ambitious yet carefully crafted approach to 

cybersecurity and privacy protections. Our strategy includes taking 

immediate steps to address the material weakness and includes 

many efforts already underway and scheduled to complete within 

the next quarter. 

Chairman and ranking members, thank you again for the opportunity to discuss our new VA IT strategy with you. Throughout this 

transformation, our number one priority is always the veteran, by 

ensuring a safe and secure environment for their information as 

well as an overall improved experience with VA. I’m committed to 

seeing this strategy through and leaving behind a transformed 

OI&T when my term is over. 

I’m happy to take your questions at this time. Thank you. 

[Prepared statement of Ms. Council follows:] 


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Mr. HURD. Ms. Council, thank you for being here. I know you’re 

pretty fresh to the job. You’re stepping into a big role. I’m looking 

forward to working with you on this topic. 

Mr. Miller you are now recognized for 5 minutes. 

STATEMENT OF CHRISTOPHER A. MILLER 

Mr. MILLER. Chairman Hurd, Ranking Member Kelly, Chairman 

Coffman, and Ranking Member Kuster, distinguished members of 

the committee, thank you for the opportunity to address you today 

on the state of information technology within the Department of 

Defense and our efforts to achieve interoperability with the Department of Veterans Affairs. 

I am honored to represent DOD as the secretary’s program executive officer responsible for the Department’s efforts to improve 

interoperability and modernize our electronic health record. Our 

servicemembers, veterans, retirees, and their families deserve innovating less than the best possible health care and services that 

DOD and VA can provide. DOD is committed to ensuring 

servicemembers and their families are ready to support operational 

mission requirements and ensuring continuity of care as members 

transition to veteran status. 

Our DOD healthcare providers have requested and need a modern system that can support increasing demands, including data 

sharing. To this end, DOD is committed to two equally important 

objectives, improving data interoperability with both VA and our 

private sector healthcare partners and successfully transitioning to 

a state of the market electronic health records that is interoperable 

with VA and the commercial healthcare systems used by TRICARE 

partners. 

Since October 2013, we have made significant progress in achieving both of these objectives. Our actions speak louder than our 

words and demonstrate our steadfast commitment. Today, DOD 

and VA share a significant amount of health data, more than any 

other two major health systems. Over the past 24 months, we have 

deployed four major interoperability software releases, conducted 

numerous test events, mapped more than a million terms to national standards, and deployed the system to over 200 DOD and 

VA sites. 

Clinicians are currently able to use our existing software applications to view records of more than 7.4 million shared patients who 

have received care from both Departments. Both Departments’ 

healthcare providers and VA claim adjudicators successfully 

accessed the system nearly a quarter million times per week. This 

data is available in realtime, and the number of records viewable 

by both Departments continues to increase. 

As a result of this progress, DOD will certify to Congress that it 

has complied with the Fiscal Year 2014 National Defense Authorization Act requirements for interoperability with the VA by the 

end of this month. Most importantly, we are getting a tremendous 

amount of feedback from our users in both Departments. 

On a parallel path, DOD’s modernization effort is well under 

way. Our goal is a system for the future which is open and flexible 

so that it can easily adapt to meet changing requirements. 


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After a rigorous and comprehensive evaluation of industry proposals, DOD awarded a contract without protest in July 2015 to a 

team led by Leidos that includes 34 other partners. The contractor 

team will provide an off-the-shelf suite of products that is ONC certified, secure, interoperable, and meets our operational requirement. The system must support the full range of military operations to include health readiness, casualty care, humanitarian assistance, disaster response, and population health. 

As a result of this competitive acquisition strategy, DOD’s 

lifecycle costs have been reduced from $16 billion the previous 

iEHR strategy to less than $9 billion today. We are on track to 

begin testing the system this coming winter to support our initial 

fielding in the Pacific Northwest. 

Through our close collaboration with the Office of National Coordinator for Health IT, we are aligning our modernization interoperability efforts with nationally recognized data standards and industry best practices. The adoption of these will ensure that the health 

data of our servicemembers and veterans is interoperable with the 

health systems of our private sector healthcare providers, which account for over 60 percent of the care provided within the military 

health system. 

We have the opportunity to save time, save money, and most importantly, save lives. Our progress the past 24 months has been a 

matter of getting back to acquisition basics, getting the requirement right, thinking like a taxpayer, delivering on our promises, 

and developing our technical work force. We clearly understand 

that our mission is not complete. To remain successful, we must 

continue to stay focused, innovate, and hold ourselves to the highest standards of excellence. 

Chairman Hurd, Ranking Member Kelly, Chairman Coffman, 

and Ranking Member Kuster, thank you again for the opportunity 

to testify today. The Department greatly appreciates the Congress’ 

continued interest and efforts to help us deliver the healthcare that 

our Nation’s veterans, servicemembers, and their dependants deserve. The Department of Defense and our colleagues at the Department of Veterans Affairs will continue to work closely together 

in partnership with Congress to deliver the benefits and services 

to those who sacrifice so willingly for our Nation, whether it’s on 

the battlefield, at home with their families, or after they have 

faithfully concluded their military service. Again, thank you for 

this opportunity, and I look forward to your questions. 

[Prepared statement of Mr. Miller follows:] 


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Mr. HURD. Mr. Miller, I appreciate you being here today. 

And now I’d like to recognize Mr. DeVries for 5 minutes for your 

opening statement. 

STATEMENT OF DAVID DEVRIES 

Mr. DEVRIES. Good afternoon, Chairman Hurd, ranking members, distinguished members of both subcommittees. Thank you for 

the opportunity to testify here today on the Department’s 

cybersecurity posture and our information technology in this very 

important topic called, ‘‘electronic health record.’’ I am a veteran. 

I still serve in today’s Nation here because I care about the 

servicemember and our families and the commitment to the quality 

there for the care. 

I am Dave DeVries, the Department of Defense Principal Deputy 

Chief Information Officer. Simply put, the deputy DOD CIO. I 

share one imperative with the CIO, Mr. Terry Halvorsen, to ensure 

the Department has access to the information, the communication 

networks, the decision support tools needed to successfully execute 

while warfighting and business support missions of today. 

Today I’m going to talk to you briefly about some of our efforts 

underway to ensure that DOD can execute its missions in the face 

of increasingly cyber-aggressive threats and also how we’re working with the government, industry, and international partners to 

accomplish our secure information sharing capabilities, our 

cybersecurity missions while improving our ability to share securely with both industry and the public. 

We are in the business of defense. That requires us to be integrated in almost every discipline you can think of, acquisitions, 

health, logistics, real estate, food, distribution, industry control systems, and many, many more. Every sector out there in the public 

side, we represent inside DOD and need to protect that information 

as well as share it securely. 

While our top goal is to deliver capabilities more effectively and 

efficiently, we also need to maximize security in a budget-constrained environment worldwide. Our cyber adversaries are agile, 

diverse, and sophisticated, and we must be able to maneuver in 

several worlds at unprecedented speeds to protect our Nation’s assets. 

The Department’s fiscal year 2016 IT budget request is 36.9 billion. This request included funding for a broad variety of IT, ranging from DOD warfighting command-and-control communication 

system, our computing services; cybersecurity; enterprise services, 

like collaboration and electronic mail; and intelligence support systems; and business systems. These investments support mission 

critical operations. They must be delivered both on the battlefield 

and in an office environment. 

We will continue to focus attention on cybersecurity and take aggressive action to counter cyber threats to our networks and weapons systems. In today’s networked world, this requires collaboration and cooperation of many partners, other government agencies, 

industry partners and allies to ensure we are mitigating these 

threats and vulnerabilities to our national security interests. You 

have my written comments as we prepared them before coming in 


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here. I welcome the questions in our upcoming discussions. Thank 

you. 

[Prepared statement of Mr. DeVries follows:] 


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Mr. HURD. Thank you, sir. 

Director Melvin, you are now recognized for 5 minutes. 

STATEMENT OF VALERIE C. MELVIN 

Ms. MELVIN. Chairman Hurd and Coffman, Ranking Members 

Kelly and Kuster, and members of subcommittees, thank you for 

inviting me to this important discussion of VA’s and DOD’s 

progress toward developing interoperable electronic health records. 

We have been reviewing the Department’s initiatives for many 

years, and this past August, as you mentioned, issued a report on 

their efforts to plan for and measure progress toward achieving 

interoperability. My remarks this afternoon summarize our findings from that report. 

As you’ve stressed, VA and DOD have been undertaking initiatives to exchange health information and increase interoperability 

for almost two decades. Among others, these have included initiatives to share viewable health data in their existing systems and 

link and share computable data between their repositories. 

As you’ve stated, the Department also took steps toward developing a single joint system and approach aimed at sidestepping 

challenges to achieving interoperability between their separate systems. However, while increased data sharing has occurred in various ways, the Departments did not follow through with developing 

a single system, and persistent management challenges over the 

years have hindered progress and elevated the uncertainty about 

when and how fully interoperable capabilities will be achieved. 

With this uncertainty, the National Defense Authorization Act 

for fiscal year 2014 established the two deadlines for VA and DOD 

to first ensure that all their health data complied with national 

standards and with computable and realtime by October 1, 2014, 

and second, to deploy, modernize, and fully interoperable electronic 

health records by December 2016. In response, the Departments 

mapped selected health data in their existing systems to national 

standards and began planning and working toward their implementation of separate modernization system—modernized systems. 

However, of significant concern is that the Departments have not 

identified outcome-oriented goals and metrics to clearly define what 

they aim to achieve from their interoperability efforts and the results and benefits anticipated. 

Such metrics can help in assessing the progress of the Department’s efforts, identifying areas that need attention, and ensuring 

accountability for end results such as improved quality of care for 

veterans and servicemembers. 

Further, the Department’s most recent decision to pursue separate interoperable systems rather than a single joint system adds 

to our concern. Taking separate paths to modernize their systems 

increases the risk that there will not be the effective collaboration 

and coordination needed to establish and convey a joint position on 

what fully interoperable capabilities will look like and how and 

when they will be achieved. 

Over the long history of the Department’s efforts, reaching such 

a state of clarity has been elusive and is further evidence of the 

need for outcome-oriented goals and metrics to help gauge and encourage progress on this latest effort. 


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DOD and VA agreed with our recommendation that they develop 

such measures, and we look forward to following their actions to 

do so. Nevertheless, the Department’s longstanding attempts to 

achieve interoperable electronic health records is an example of the 

larger problem with ineffective management of IT projects across 

the Federal Government as we have highlighted in our 2015 highrisk update. 

The history of these Departments’ efforts also highlights the importance of continued congressional oversight as you are providing 

by holding this hearing today. VA and DOD must now do their part 

to more efficiently and effectively bring this challenging endeavor 

to a successful outcome. Recommendations that we and others have 

made, along with the important IT acquisition reform provisions 

outlined in FITARA, should give the Departments a more clear 

basis for demonstrating further success. This concludes my oral 

statement, and I would be pleased to respond to your questions. 

[Prepared statement of Ms. Melvin follows:] 


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Mr. COFFMAN. [presiding.] All right. Thank you, Ms. Melvin. I’ll 

begin with questions. 

Ms. Council, as required by the NDAA of 2014, all VistA data 

was to be in a compliant format established by the Office of the National Coordinator for Health Information Technology, or the ONC, 

but VA stated it would not certify until later in 2015. Has VA certified its compliance to the standard? 

Ms. COUNCIL. You want to take that, Brian? 

Mr. BURNS. Yeah. 

Mr. COFFMAN. Mr. Burns 

Ms. COUNCIL. Yes, I’ll have Mr. Brian respond because I want to 

make sure we’re precise on this answer. 

Mr. COFFMAN. Okay. 

Mr. BURNS. At this point, we have not certified to the 2014 requirement, the October 1, 2014, requirement. The approach we 

took is we identified 25 domains. From those 25 domains, we 

prioritized those. The first seven we looked at were the most frequently used, the most high volume, and what we consider the 

most relevant terms. Those we did do data mapping to, and then 

we continued to map from there, and we’re still continuing to do 

that process 

As we go forward, we also do updates to each one of those respective domains to make sure that any additional terms that come in 

are also mapped. Those then are used in data maps that go into 

the capability of sharing the information with JLV. So, at this 

point, we have data maps for most of the sets. We have partial 

mapping for most of the sets at this point 

Mr. COFFMAN. Okay. Mr. Miller, nearly 6 years after a 2010 GAO 

report discussed the need for VA and DOD to address unstructured 

data, what has the IPO done to accomplish the interoperability of 

unstructured data or the development of a national standard? 

Mr. MILLER. Sir, I would offer a couple of things, sir. We do have 

a dedicated IPO, Dr. Lauren Thompson. She reported in on the 

board in May. For sometime I was wearing two hats. I’m no longer 

wearing two hats. I think that’s reflective of our commitment to the 

IPO and the work that they do. 

With regards to national standards, you heard in my opening 

comments, our strategy has been to partner with the Office of National Coordinator for Health IT in identifying those areas and 

what standards we need to have and to leverage things like ONC 

certification and then to bring those forward between the two Departments and let’s determine jointly what those standards needs 

to be and then promulgate those back out to both Departments. 

I think you will see on both the DOD and the VA, those standards are incorporated. If you were to go look inside the DOD’s acquisition program, you would see where those were required as 

part of our modernization. They are part of our technical package. 

Those things are currently flowing back to both Departments. 

The IPO is basically responsible for working between the two Departments, providing technical leadership to make sure that those 

standards apply, and then—and bringing things back to the Office 

of National Coordinator where we need refined standards and improvements in standard. 


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Just recently, the IPO took a very strong leadership role in looking at things like the CCVA document, which is a consolidated document that provides the transition of care within the commercial 

side that DOD and VA are both using as part of our exchange with 

our commercial providers, and so those are the kinds of activities 

where the IPO is taking strong technical leadership and helping us 

understand what the appropriate national standards are. 

I think, as everybody’s highlighted today, the national standards 

piece is much bigger than its DOD and VA, and we need to have 

a strong collaboration with the leadership of HHS. 

Mr. COFFMAN. Ms. Melvin, in February 2014, GAO reported that 

VA and DOD failed to correctly implement the IPO and further 

noted the diminished role the IPO plays between VA and DOD. 

Considering this finding, what purpose does the IPO serve in its 

current state, and similarly, is there a need for the IPO at all? 

Ms. MELVIN. I would like to start by saying that the IPO was established by the National Defense Authorization Act for 2008, so it 

has a specific function in statute to be the single point of accountability for VA and DOD achieving the electronic health record. 

Several of our reports, in fact, have noted that the position of the 

office has not been specific to or as connected to the overall function for which it was assigned. We have seen it having a limited 

role in the Department’s current efforts over time. It’s been what 

I would describe as more of an evolving role, and it’s one that it 

is reasonable that one would question its current responsibilities 

and whether it should exist. 

Having said that, the IPO is currently responsible for developing 

the national standards or at least identifying the national standards that VA and DOD ought to adhere to, so they do have an important function. I think the important thing about it is it must be 

clear what the role of that office is going to be. If it’s not going to 

be at the level of a role of authority, a single accountability office 

for authority, then it is important for the agencies and for Congress 

to determine what their role should be. 

Mr. COFFMAN. Thank you. Ms. Kelly, you are now recognized for 

5 minutes. 

Ms. KELLY. Thank you, Mr. Chair. 

Mr. Miller, why is it important that your Department first ensure that all healthcare data comply with national standards? 

Mr. MILLER. Because, ma’am, as we’ve highlighted today, our 

care is provided in a number of different settings. In the case of 

DOD, more than 60 percent of our care is provided out in the market through our TRICARE contracts, and the way that we get the 

ability to really share and use information is by adopting these national standards. 

And I think it’s important that we all recognize that both DOD 

and VA were well ahead of where the larger national effort was 

that started really in the HITECH Act in 2008, 2009, and so part 

of our struggle has been taking a lot of legacy data that we were 

leaders in and then working towards and getting on board with 

these national standards that have fairly rapidly evolved over the 

past few years as part of our EHR adoption. 

But simply put, ma’am, DOD generates veterans. Those veterans 

need to have seamless care no matter where they go, and the way 


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that we make sure that there is a common meaning and common 

understanding of that information is by all of us agreeing at the 

national level to what those standards are. The challenge is there’s 

a lot of them, and the other challenge is that we all have to agree 

at a little bit lower level than just adopting a top level standard. 

There have to be some lower level agreement about what we mean 

with certain standards, and so again, that reinforces where the IPO 

fits, because the IPO provides a critical linkage between our 2 Departments and the Office of National Coordinator because we provide a lot of feedback. 

We do believe we can be on the leading edge in many of these 

efforts, and it’s that IPO function that really provides the strong 

leadership role to make sure that we implement the national 

standards correctly, ma’am. 

Ms. KELLY. Well, Mr. Miller and Ms. Council, can you tell me 

when your respective Departments will be able to certified that the 

data complies with national standards? When’s your goal? What 

are you looking at? 

Mr. MILLER. So ma’am, I’ll state from DOD, I just reviewed our 

letter for certification. I do want to highlight one of the reasons 

why DOD is a little bit late here is that the NDAA, which I have 

a copy of, if you really want to look at it, it refers only to DOD’s 

AHLTA data. AHLTA data is our outpatient data, and the reason 

why I want to make a second and explain this is, when we met 

with our functionals—and I’m here to tell you, I don’t measure success for DOD. I measure success by what our users say, and so 

when we started down this journey to do this data mapping and 

understand what they wanted to be able to access in an integrated 

view, as the NDAA required, they came back and said it’s much 

more than your outpatient data. It’s your inpatient data. It’s your 

data from the private sector. It’s the data from in theater and our 

theater systems, and so because of that, DOD took the last year to 

integrate much more than what the NDAA required because I felt 

like that was the right thing to do. 

And so I will defend, you know, the time we took because it is 

what our functional users really asked for, and so along with making that data available, we also had to work through a series of 

data maps, and over the last year, we went through four iterative 

builds. Those builds were reviewed by subject matter experts in the 

DOD as well as the IPO before we put them in production, and so 

those things took a little time. 

I am here to say that some of this stuff is incredibly complicated. 

We are dealing with a large number of terms, and it was important 

that we did this right. The last thing I want to do, as an acquisition person, is put a bad tool in my users hands because they will 

not like it. They will get turned off from it. And we have been very 

careful about how we’ve deployed the things and how we have increased access. And I’m here to tell you today, our results are pretty staggering when you look at the demands and the feedback 

we’re getting for the use of this information. 

It is not about JLV. What really JLV provides is a view into the 

data that’s flowing between the two Departments. In the reality 

what will happen is, is that the VA—any of their systems will use 

that data, whether it’s eHMP, their VistA follow-ons, and they will 


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use it however it best makes sense within their healthcare setting. 

The same in DOD. 

We are working right now to make you sure that data coming 

back from VA is provided to our new system as part of our integration and testing over the next year, so thank you, ma’am. 

Ms. KELLY. Ms. Council. 

Ms. COUNCIL. Yes. As far as our data is concerned and spending 

some team with the team, certainly we receive the data from DOD, 

and then we have to map it to the standards to our system. The 

team says that we should be well on time to certify in 2016, but 

the veteran—the VA issue around data is much broader than that. 

A veteran has more than just health data that we’re concerned 

about. It’s general, Active Duty, other sets of data that we’ll be 

bringing together. 

One of the key factors of our new strategy is starting and establishing a strong data management capability to give us a wholistic 

look at the veteran and be able to interchange and engage with 

that veteran in a very different way than we do today. So for the 

VA, our look is not just the health—we will certify that in 2016— 

but broader so that we can change the veteran’s experience by having a holistic look at their information that’s important and germane to the benefits, the healthcare, as well as the end care that 

they receive. 

Ms. KELLY. So can you two currently exchange patient health 

data between one another? 

Ms. COUNCIL. We currently do today exchange health information between each other. 

Ms. KELLY. You can do that, and do all users have access to 

interoperable electronic health records system? 

Mr. BURNS. At this point, we have, depending on the system, we 

have users that use the existing system, CPRS. We also, through 

the viewers, we are adding users on a regular basis. This time last 

year we had—with JLV, we had 600 users. We now have up to 

19,000 users, and we continue to add more users every single week 

in doing that. That’s just one tool. 

That said, there’s other tools that are accessed to in our Webbased solutions as we move forward and even our follow-on modernization, so we continue to add users on a regular basis. This 

year also we added VBA, Veterans Benefits Administration, users, 

which was a significant help to help in getting them to be able to 

look at the records in addition just from the health standpoint. 

Ms. KELLY. Thank you. I’m out of time. 

I yield back. 

Mr. COFFMAN. Thank you, Ms. Kelly. 

Mr. Farenthold of Texas, you are now recognized for 5 minutes. 

Mr. FARENTHOLD. Thank you very much, and I’d like to follow up 

on that a little bit, Mr. Burns, if you will. You say you’ve added 

19,000 users in a viewer. I mean, is that—that really isn’t interoperability where everybody can access the data that needs to access the data and doctors can and nurses can input the data. I 

mean, that’s just, okay, I’m able to look at it, right? 

Mr. BURNS. With the current—with JLV, it is a viewer, so you’re 

able to look at the data. The one thing that we did add through 

that is that we have where data is mapped. We can then demVerDate Nov 24 2008 10:28 Jul 13, 2017 Jkt 000000 PO 00000 Frm 00065 Fmt 6633 Sfmt 6633 H:\25915.TXT APRIL

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onstrate and show the mapping of the data in addition to the original data, so—— 

Mr. FARENTHOLD. That isn’t where I wanted to go, but I wanted—— 

Mr. BURNS. Okay. 

Mr. FARENTHOLD. —to follow up on that question. 

Ms. Council, the Secretary of the VA, Mr. McDonald was recently 

in south Texas and said, you know, one of reasons it was such a 

slow-paced system is some of legacy systems are still operating in 

the COBOL programming language, I mean, 1960s technology. You 

know, it just seems like there’s not a focus there. 

You spoke a little bit about, you know, making the business case 

for what products in IT that you work on. You know, can you tell 

me a little bit what the business case is? To me, the number one 

focus should not be the business case but should be providing quality service to veterans. I mean, I could make a business case for 

making veterans wait months for service so we don’t have to make 

more doctors. I mean, what constitutes business case? 

Ms. COUNCIL. It really gets to the point that was raised earlier. 

How do we measure success? How do we know we’re actually accomplishing what we said we would accomplish, and how do we 

know we are spending our time and monies on the right things to 

enable help for the veteran? So that’s what we mean by business 

case. 

Mr. FARENTHOLD. All right. So let’s look at what’s happening 

now. There was just a report out today that in San Antonio, just 

north of the district I represent, that we have the highest wait 

times since May. We are up to 12,000 veterans waiting over 30 

days to get care. That’s the worst in the entire VA. 

I mean, I thought we were trying to address these wait times. 

Shouldn’t that be—the wait times be one of the top priorities of 

getting veterans the care that they need in a timely fashion? 

Ms. COUNCIL. It certainly should, sir. And at the end of the day, 

that’s what the MASS project is scheduled—set scheduled so we 

can really handle the capacity that we have. It is our responsibility 

to ensure that we change the veteran’s experience at the VA, and 

my intent as leading the IT organization is to modernize this organization and gets us to make the decisions that we need to make 

to focus on the right things. 

Mr. FARENTHOLD. We’ve looked at—we started talking about this 

in Congress in 2008, 2009. I just—you know, you look at 2008, 

2009, Uber didn’t exist. They’ve come up with a complete data infrastructure of the world’s largest taxi service without a single 

driver that can be wherever you—you know, in most cities, can 

pick you up in a matter of minutes. 

Square technologies has come online where you can plug something into your iPad and do credit card. Pinterest wasn’t in existence in 2007. I mean, the technology can be done in a timely fashion. Is there a culture problem? What is the problem within the VA 

that makes IT such a struggle? 

Ms. COUNCIL. I think part of the issue is many of the examples 

you gave are independents, and they’re not trying to enable an enterprise. They’re not trying to enable H.R. And finance and all the 

other things that come with it. But I also say part of it has been, 


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frankly, making some hard decisions and holding people accountable to achieve things we said we will do and making sure we have 

focus. 

We cannot do everything. We’ve got to do the right things. So 

when we start a program, we have to complete a program. We need 

to be relentless in our execution, and we have to focus. And the 

bottom line is, the team has not done that. We will do that, and 

that’s part of our current new strategy. 

Mr. FARENTHOLD. And you know, one of the things Mr. Miller 

said, he doesn’t want to deploy a bad app to turn people off, but 

part of any IT system—and I remember this back in the 1980s and 

1990s when I was a computer consultant. You had to get buy-in 

from your folks that this was going to make their jobs easier and 

that it was going to be good for them. 

It sounds like that’s one of the struggles you’re talking about. I 

mean, this is the 21st century. In almost every case, especially in 

the private sector, you see the implementation of IT really greatly 

improve efficiency. Now, some people may argue they have to work 

harder with fewer people with it, but the level of customer service 

that people have come to expect as a result of the technology revolution is higher. How can the folks within the VA not get that? 

Ms. COUNCIL. You are 100 percent correct. At the end of the day, 

our opportunity is to bring the system forward and do it in a way 

that’s going to change the environment for the veteran, and up to 

this point, we have not had core portfolios for our various business 

groups. We will be putting in, as part of this strategy, new account 

managers that actually work within the business, with customer 

relationship people within the business to create portfolio and a 

ranked stack against the things that need to get done to change 

this perspective. 

If you don’t have the business perspective working in conjunction 

with IT, you don’t end up with that kind of system. It’s going to 

make a difference, and so that’s where we’re focussing. 

Mr. FARENTHOLD. Well, I see my time has expired. I would like 

to take 1 second and urge you to maybe take some lessons from the 

private sector and develop a entrepreneurial spirit within the VA 

and the IT department to get her done. Thank you. 

Mr. COFFMAN. Ms. Kuster of New Hampshire. 

Ms. KUSTER. Thank you very much. My comments and questions 

are focused on the VA. 

Ms. Council and Mr. Burns, Ms. Council just talked about hard 

decisions and focus. Some have said, and in fact, the recent independent assessment found, that the VistA program was in danger 

of becoming obsolete. 

My question is: Are we at the point where we just can’t keep trying to re-jigger the technology, but that we would have better outcomes. And you’re focused on the different business activities. And 

one that I am very focused on is the scheduling to bring down the 

wait times. You’ve got the health records. We’ve now got outside 

providers. 

Could you just give me, if you have an opinion on this, since 

you’ve arrived. Or, Mr. Burns, if you’ve been around longer. Do you 

feel that maybe we’re at the point where we should be considering 


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more an approach from the bottom up rather than trying to change 

what we’re currently working with? 

Ms. COUNCIL. I come from the private industry. I’ve spent 30 

years in private industry. So this is my first foray into any kind 

of government appointment. And what I look for and what I really 

want to understand with any large business investment or any system investment, like a VistA Evolution, is what do we expect to be 

the outcome? What are we really trying to play for, and what do 

we think that it’s going to do for us, not just now, but also in the 

future. 

So to answer your question, that is the reason why Dr. Shulkin 

and I requested the business case. We wanted to have a fact-based 

conversation about what the right next steps should be with VistA. 

We didn’t want to take it from the cuff. We didn’t want to take it 

from pulling various data. We really wanted to go into understanding where we are today, where we’re hoping to go, and will 

that take us where we need to go for the veteran in the future? He 

and I will be looking at that case and spending a concerted amount 

of time—the timing just didn’t work out, but it’s this week—to really decide on those core next steps. It’s the right thing to do. It’s the 

coherent thing to do. But we want to do it based on having real 

facts behind us and making sure that we’re making the right decision for the veterans long term. 

At the end of the day, VistA is a clinical, focused system. It is 

focused on the patient. And it has enabled that capability to really 

drive many breakthroughs. What we’ve got to figure out is what 

opportunities do we have to continue with it as a backbone, and 

should we be moving with different levels of technology that we 

haven’t used before, and thinking about it differently 

architecturally, and thinking about it differently, how the veterans 

should engage with it, and how it should engage with the clinician? 

We are leveraging the program managers’ Mr. Waltman’s and 

Mr. Costantian’s business report with Dr. Shulkin and myself, and 

we will make a decision. 

Ms. KUSTER. Great. Well, I hope you will keep us apprised. But 

I think we will be well served by that analysis. 

Sometimes we talk about this interoperability, and I wonder 

whether we are agreeing on what it is that we are trying to describe. It seems to me that there are three different levels: The 

foundational is just the very basic, where you’re looking at the page 

on the screen and it doesn’t allow for the interpretation of the data, 

or the sharing of the data; structural, the intermediate level, defining the structure or format of the exchange; and then semantic, the 

highest level, the ability to exchange and use the exchange information. And I know going forward—and certainly the practitioners 

that I’ve spoken to—the providers in the VA want to be able to use 

the data for research, for trends. We have a terrible opioid addiction problem going on. Can we look at the population, learn from 

the best practices? 

Could you just comment on where you feel the VA is right now— 

what level we are at, and where we might expect to be a year from 

now? 


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Ms. COUNCIL. Sure. Actually, Brian and I have been talking 

about this a lot. So I’m going to give him an opportunity to answer 

your question. 

Mr. BURNS. In the terms that you laid out, first of all, the first 

level is foundational, or another way of saying it is technical; we 

do technical exchange 

day-to-day. And that’s is the fundamental basic level. So we’re 

pretty good there. 

Ms. KUSTER. And that’s happening right now throughout the VA? 

Mr. BURNS. That is happening throughout the VA. It’s been happening actually for over a decade of transferring data. Speaking of 

transmission of data, it is showing the data as is, or, to some degree, with the standards. 

The next level, the intermediate level, gets more into how do you 

begin to use the data. And that’s where we’re focusing, at least 

from the IPO perspective of what are the use cases; how do we actually want to use that data, and what is pertinent? What are the 

key components? What are the key elements? And then how much 

of that needs to be beyond the technical level? 

So we’re focusing on that and bringing in the subject matter experts from DOD and VA to have those conversations. That’s a continuing, evolving process. 

The highest level, as you mentioned, semantic—or another way 

of saying it is process—that is really looking at the work flows. And 

that’s going across the organizations. That’s a much more future 

issue. And candidly, that’s an issue that even ONC is working 

with, with a strategic plan of how do we get from the current sharing data at the rudimentary levels moving forward. 

So to answer your question, I think from a technical standpoint, 

or foundational standpoint, we are really close. We are there. If we 

get into the intermediate level, we have pieces of it that we actually can do today. And ultimately, we are trying to go with the 

modernization beyond just the NDAA, is really to have to monitor 

our system where we get the work flows and the semantics down 

that it’s 

machine-to-machine, and you can do the trend analysis and you 

do the look-at-the-patient data far better to make decisions real 

quick, much quicker, and actually seeing more patients as we go. 

And that’s fundamentally, too, with the VistA Evolution solution, 

where we are really transforming to look at patient-centric and 

team-centric and data-centric approaches to the information far beyond what we have traditionally done in our existing systems. 

Ms. KUSTER. Thank you very much. And I apologize for going 

over. Thank you. 

Mr. COFFMAN. Mr. Lamborn of Colorado, you’re now recognized 

for 5 minutes. 

Mr. LAMBORN. Thank you, Mr. Chairman. I want to thank both 

the chairmen for having this meeting today. This is a huge, monumental, massive project. And I have to ask a preliminary—I want 

to back up a step—a preliminary question. So for someone from the 

VA and someone from DOD, as you work on this interoperability, 

and I agree with the GAO conclusion, there has to be goals and 

metrics as you do this. But let me back up and ask about 

cybersecurity. 


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Can you assure us that, as you build this forward, that hackers 

can’t come in like they did at OPM, and access medical records of 

our veterans or of our active duty military? 

Ms. COUNCIL. What I will tell you is that our—everything that 

we’re doing around our new cyber strategy is what we also currently do with our defense in-depth, is to protect that data at all 

cost. Our data is not only in the system, but our data is also on 

paper. And so ensuring that we’re educating the workforce, that 

we’re being diligent about our information and where we leave it, 

how we mail it, what we do with it, are all a part of what OI&T 

has to do with ensuring that we keep the veterans safe. 

When you look at where we went with our cybersecurity strategy, it’s the most holistic strategy that we have ever had in our history. It is focused on eight key domains, including medical cyber. 

And the whole focus is no one on a team ever wants to happen to 

a veteran what happened to them through OPM. So that is our 

focus, that’s our key, and that’s our mission. 

Mr. LAMBORN. Thank you. Mr. Miller, or DeVries? 

Mr. DEVRIES. I would just like to add on to that. The 

cybersecurity is one very important aspect of it, but just as we 

talked about the standards for the health record that’s based on 

the ONC model, all of us in the government are conforming to the 

same security standards set up by NIST that we all participate in. 

It’s important that we have those common standards and that we 

all conform to them and rigorously enforce the adoption of those. 

So that’s the biggest push. VA has been doing the same thing. DOD 

is doing it. We have been pushing now the cybersecurity aspect and 

the need to conform to the standards that have been put out and 

then measure it by leadership. 

Just recently, DOD has put out its cybersecurity. We have published that. We have not come up with a common 

scorecard. With that whole aspect is, no matter what the mission 

area is—and medical, it’s just one of those mission areas for us— 

it must be about protecting the identity of the person, protecting 

the data, where it is in storage, but also in transport, and then how 

it’s being consumed. 

Mr. LAMBORN. Okay. Well, thank you both. 

Ms. Council or Mr. Burns, VA interoperability, just among yourselves, is a concern of mine. Leaving aside DOD. There are 1,700 

points of healthcare providers among the VA nationwide. What is 

the interoperability, just among VA health care providers? 

Ms. COUNCIL. That is the core part of why we are putting a data 

management process in place. 

Today, when you look at the OI&T organization, we actually 

have the best opportunity to bring the information together on the 

veteran’s behalf. So you have the health side. And, of course, we 

have to be able to work with our community providers. But, again, 

remember, there is a whole benefit level side, and many veterans 

that don’t use the health side, that also creates a level of data and 

information for the veteran and to their end. 

And so our issue, and our opportunity, is really to bring together 

the entirety of that set of information and start to leverage it on 

behalf of the veteran and sharing with the veteran what the opportunities are, where the benefit opportunities are, as well as what 


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they should be thinking of in relationship to their health. That is 

core to this strategy. We’ve got to do it. And today, health data sort 

of sits separately from the benefits data. And that’s not appropriate 

for the veteran. 

Mr. LAMBORN. So, if someone moves from Portland, Maine, to 

San Diego, a veteran, their records go with them electronically 

today? 

Ms. COUNCIL. They do not go with them electronically today. 

That is what we are working on. 

Mr. LAMBORN. Okay. Because, obviously, that has to happen before you can interact with the DOD, and vice versa. 

Ms. COUNCIL. Well, interacting with the DOD, information is 

from active duty to becoming a veteran on active duty. The issue 

with topography and moving from one location to another is making sure that another location can take that information and use 

it. 

So unless the veteran ports that information, or we send that information on their behalf, it won’t be there. We can send the information, but the key is we want to be in a situation where the information is everywhere the veteran is, regardless of their location. 

And that’s what we’re working toward. 

Mr. LAMBORN. Okay. Thank you. 

Mr. COFFMAN. Mr. Lieu of California, you are now recognized for 

5 minutes. 

Mr. LIEU. Thank you. 

Over 45 years ago, the United States of America sent a human 

being to the Moon and brought that person back. The DOD and VA 

can certainly have interoperable health records. The fact that you 

haven’t been able to do it for nearly two decades is not excusable. 

There’s a failure of prior leadership at the VA and the DOD. And 

I believe what compounds this is a decision made in 2013 for both 

agencies to now pursue separate modernizations. I think that’s a 

ridiculous decision. 

And the GAO, in fact, has noted that the 2013 decision to pursue 

separate modernization rather than a single joint system indicates 

that achieving interoperability will be an ongoing concern for years 

to come. 

So what I want to know is, why can’t you all just pick one system, whether it’s a DOD system, or the VA system, and implement 

it? Why do you have to pursue two separate modernizations? I 

don’t understand that. 

Mr. MILLER. So my first reaction is I think it’s important we understand that the two departments have different healthcare missions. I think—— 

Mr. LIEU. But you’re not customer-focused, you’re not focused on 

taking care of the active-duty person? 

Mr. MILLER. But I’m worried about making sure it works on a 

submarine at beyond periscope depth; I’m worried about it working 

in Afghanistan on SATCOM; I’m worried about it taking care of 

children. I think it’s important that we do share a common veterans population, but I think we also need to recognize that the 

two departments do have two different organizational missions 

when it comes to healthcare delivery. 


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Mr. LIEU. Are your systems lesser systems? Are they more basic 

because they’ve got to work on a submarine? Are they not as robust? 

Mr. MILLER. I wouldn’t say they’re more basic. I think we have 

different operating environments. And so, when you’re taking care 

of veterans in the United States CONUS, and you have the ability 

to do certain things, that environment does not exist in theater for 

our people that are taking care of our soldiers, sailors, airmen, and 

marines that go in harm’s way. 

So I think we have to recognize they’re a different operating environment. Additionally—— 

Mr. LIEU. Okay. So if your system can work in a submarine— 

let me ask the VA: Why don’t you just take their system? If it 

works on a submarine, it’s going to work in your VA hospital. Why 

don’t you just use that system? 

Ms. COUNCIL. I can’t speak for what decisions were made in 

2013, but I certainly can say that our clinical capabilities and what 

we have to do for the veteran from the time they become a veteran 

to the time that they leave this Earth is a much more holistic calling. And for us, it is about the total health and capability of that 

veteran, and for us managing that care of that veteran during that 

time. 

It is a different transaction, I think, is what Mr. Miller is getting 

to. The timing of that transaction, our situation, our alignment, is 

a lifelong alignment. And so our decision base probably would not 

work with the level of transactional focus that they would have. 

Mr. LIEU. So you’re saying that when the two Secretaries in 2011 

said you all could have a single joint system, that they were just 

wrong? 

Ms. COUNCIL. I have no idea what the requirements were. 

Mr. LIEU. Now, let me ask you, do any private sector hospitals 

use VistA? 

Ms. COUNCIL. Not that I’m aware of, sir, inside the United 

States. Outside the United States, yes. 

Mr. LIEU. Okay. And do any private sector hospitals use your 

DOD system that also works on submarines? 

Mr. MILLER. Yes, sir. It’s one of the largest used in the United 

States today. 

Mr. LIEU. Okay. A question about the viewer that you all are 

talking about. Can you search on this viewer for terms, or anything 

else, or is it just a viewer? Interoperable viewer? 

Mr. MILLER. I wish we could give you a demo. I think it would 

explain a lot here. I think—when you think about health care, a 

lot of the information that your providers or our providers are accessing is just information they’re referencing. Right. The decision’s 

going to get documented in their primary care system. But when 

you think about this viewer that we’ve been working together on— 

oh, by the way, it’s been jointly done between the two departments—you can configure your displays, you can search for VA patients, you can search for DOD patients. 

Mr. LIEU. Can you search for, I don’t know, blood test results, or 

for—— 

Mr. MILLER. So if you’re talking about getting down to a lower 

level of search capability, that is one of the things that we’re workVerDate Nov 24 2008 10:28 Jul 13, 2017 Jkt 000000 PO 00000 Frm 00072 Fmt 6633 Sfmt 6633 H:\25915.TXT APRIL

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ing on. Right now, we’ve been asked to be able to show all those 

different domains. And now we’re taking a look at the next level, 

which would be lower level search capabilities within those domains. 

Mr. LIEU. What can you currently search for? 

Mr. MILLER. When you bring up—it would be easier to display 

it. When you bring up the patient, it actually shows you all their 

information, so—— 

Mr. LIEU. And can you search for something in that document? 

Mr. MILLER. Right. So it’s not like you’re doing business—deep 

business analytics through the tool. The tool basically presents an 

integrated record. 

Mr. LIEU. Is there any difference between that and someone 

handing you a Xerox of the file? 

Mr. MILLER. Absolutely. 

Mr. LIEU. Because you can search for things. 

Mr. MILLER. Right. You can search for things. You can configure 

only what you want to see. So if there’s a module you care about, 

or that you don’t want to see, depending on your role, whether 

you’re an ED doctor or you’re an outpatient doctor, you can configure that view. 

Mr. LIEU. My time is up, so let me just conclude. I believe that 

two separate modernizations are a mistake. I think that DOD 

should just take the VistA system and make it applicable on submarines. It shouldn’t be that hard. 

I yield back. 

Mr. COFFMAN. Thank you, Mr. Lieu. 

Mr. Walker from North Carolina, you’re now recognized for 5 

minutes. 

Mr. WALKER. Thank you, Mr. Chairman, and thank you to the 

witness panel. I appreciate your time in being here today and sharing your thoughts and the information that’s so crucial to this 

hearing. 

As part of the Cloud Computing Caucus, I have got a few questions from that particular perspective in the world of cyber arena 

that we are entering in. And let me start with Mr. DeVries, and 

then maybe we’ll come back to Mr. Miller. 

How are the VA and the Department of Defense taking advantage of these commercial cloud services to streamline the EHR, the 

electronic health record, interoperability, and then reduce cost? It’s 

a two-part question there. First, how are we doing that? And how 

do you perceive it to reduce the cost? 

Mr. DEVRIES. I think it’s important to lay out where we are 

today. Today, the Department of Defense health records system, 

the medical records themselves, sit in a centralized data repository 

that allows us to have access to it globally down to the submarine, 

as Chris talked about there. 

We are moving aggressively now into the commercial environment. The DHMSM contract that we talked about here in the opening statements, that’s on the street. We’re aggressively now looking 

at where are we going to put the medical records, and I will let Mr. 

Miller talk more about that. But we have laid open, through the 

Federal standards as well as inside DOD, to grossly pursue, if you 

meet the security requirements and standards, then let’s go ahead 


KING-6430 with DISTILLER
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with the most economic and feasible way of doing it. It may not be 

a cloud, but it may be a commercially-provided data storage. 

Mr. WALKER. Mr. Miller? 

Mr. MILLER. So as part of our modernization strategy, I would 

tell everyone that we’re trying to take advantage of those emerging 

technologies because we know it’ll simplify things and allow us to 

accelerate our deployment. 

So if I were to go back to our previous systems, we would be installing software and things inside of our hospitals. Well, today— 

and I think you will see this if you go to any commercial health 

care provider—really, you don’t provide anything to the hospital 

anymore. That system is basically hosted centrally somewhere, 

whether in a data center, a cloud, or part of a managed service, 

and basically, you just have to have a network connection and a 

device that can support it, just like your smartphone or something 

else. And that’s the same strategy we’re pursuing. 

Mr. WALKER. I’m aware of how it works. But my question is— 

I hear you say future tense, we are pursuing. Are there action 

steps that we’re taking? 

Mr. MILLER. Absolutely, sir. The proposals that we evaluated all 

banked on that technology being a key enabler. And so as part of 

our testing here in a couple of months, we will be testing how well 

that works. And as part of our deployment, that’s our hosting strategy that we’re currently under the process of finalizing. But our 

hosting strategy will be centrally done so that we can take advantage of those technologies. 

Mr. WALKER. I appreciate the timeline there. Let me ask this 

question as well: If agencies that have sensitive information, such 

as the Health and Human Services Department, can leverage commercial cloud services, can I ask, then, why isn’t the VA? 

Ms. Council, then I will come back to Mr. Miller. 

Ms. COUNCIL. Yes. Fundamentally, that is where we’re moving 

to. Part of our new strategy is a buy first and looking at the platform. 

Initially, when I first arrived, I met with the inspector general 

to understand what their concerns were around us using the cloud. 

I also looked at our FISMA posture around our data. We had 

ranked all of our data FISMA-high. And a cloud environment, that 

is incredibly difficult to be in a FISMA-high platform, and use the 

cloud. We have reassessed that and re-looked at our policy so that 

we can move to the cloud. 

In addition, our electronic health management platform, which is 

the platform that is being placed on top of VistA, basically prepares 

us to move to the cloud. It moves the data into a new platform. So 

it’ll be much more fungible and move us at a location. And we are 

currently now looking at key applications and virtualization with 

cloud technology. 

Mr. WALKER. Mr. Miller, if I have time, I will come back. But Ms. 

Melvin, I do have a question for you, making sure that I am crystal 

clear on this. What is the statutory deadline for deploying modernized electronic health records software with interoperability? 

Ms. MELVIN. The deadline that we spoke to in our report was December 31, 2016. That was based on what the 2014 National Defense Authorization Act is currently calling for. 


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Mr. WALKER. And that’s a self-imposed deadline? 

Ms. MELVIN. That’s the deadline that is called for in the Act. 

Mr. WALKER. All right. And you feel good that you are on track? 

Ms. MELVIN. Well, from my—from GAO’s perspective, our review 

looked at that and we found that through the plans that both VA 

and DOD provided to us, no, they are not on track to meet the 

2016 deadline. They are in the process of implementing capabilities. They do have initial capabilities I know within the departments. 

Mr. WALKER. I’m going to cut you off. That’s my concern. We 

have a deadline, and we are here and we’re working towards that. 

But my time has expired. I will throw it at Mr. Miller, if you want 

to respond to that, and then I’ll yield back to the chairman. 

Mr. MILLER. Yes, I would just highlight that the NDAA was silent about what deployment actually meant. And I think, based on 

any industry best practice, there is no way physically possible for 

us to take a 2014 NDAA and fully deploy it within the Department 

of Defense at over 1,200 locations in that timeline. I have to go to 

ships. I have to go in theater. I have to go around the world. 

And so we have provided numerous feedback to the Armed Services Committee. They understand our plan. We met all their NDAA 

requirements. We got our funding restrictions lifted. They understand that. I think it’s important that—I understand the desire to 

go faster, but there is reality in some of these. We are talking laws 

of physics about how fast we can modernize this system within the 

Department of Defense. Because it is much more than just documentation. It drives our scheduling, it drives our registration, it 

drives our people engagement. It is a fundamental business transformation about how we do business. It not simply a small app that 

you will have on your smartphone that has to go to a lot of places. 

So we need to be incredibly smart here. This is not something 

we should rush to. And so I understand the GAO report, but I 

think that the language, as written, was not clear about what deployment actually meant, sir. 

Mr. COFFMAN. Mr. O’Rourke of Texas, you’re now recognized for 

5 minutes. 

Mr. O’ROURKE. Thank you, Mr. Chairman. 

I have yet to hear a compelling answer to Mr. Lieu’s questions 

about why we can’t unify within a single system. I understand the 

system has to run on submarines, I understand that within the VA 

we are taking care of veterans from the point at which they transition out of active duty service until, as you said, Secretary Council, 

they leave this Earth. But I think the fundamentals of the system 

seem to be basic enough. And given the leverage that you two departments have as the two largest departments within the Federal 

bureaucracy, there’s got to be a way that you can figure this out. 

Ms. Melvin, has the GAO arrived at an assessment of the conclusions that these two departments have that they simply not work 

together? Is that conclusion shared by the GAO, or have you asked 

yourselves that question? 

Ms. MELVIN. Our concern is with the departments going down 

separate paths. We do think that it has inherent duplication in 

that approach. 


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What I would say over time is that as we’ve looked at both departments’ initiatives, I think back in 2013, we issued a report that 

looked at some of the fundamental reasons, or barriers, if you will, 

for why these departments weren’t able to do that. I mean, inherently, each department has its own culture. And we understand 

that. What we found, though, that there was a lack of joint strategic planning on the part of the two departments to really look at 

what it is that they can do collectively to achieve this end state in 

terms of a joint system. We also saw that—and reported on the fact 

that there was a lack of a joint architecture, or an overall investment management plan for getting them there. 

Mr. O’ROURKE. Let me ask you this—and I’m sorry to interrupt 

you—but is part of the problem that there are no consequences? 

Congress mandates a requirement and an 

outcome back in 2008, 2009, and Mr. Miller and Secretary Council have given us lots of great excuses for why they can’t get it 

done. You’ve suggested some of the roadblocks that were in the 

way. But was there a consequence? Was anybody held accountable? 

Could these two departments just come to the conclusion that this 

is just too hard to do; we don’t want to do it, for whatever reasons, 

and they don’t do it. And now we are marching down these two 

paths that may or may not be parallel; may or may not be interoperable; may or may not work together; may or may not waste billions of taxpayer dollars; and there’s no consequence. 

I’ve reached the conclusion that the only person who can referee 

this dispute between these two departments is the President. And 

it must become a priority of his. And he must—unless there’s—and 

I’m all ears on a compelling reason why we can’t do this—unless 

he says to the Secretary of Defense and the Secretary of the VA: 

You have to find a way to get to a unified system that works for 

every active duty servicemember, their family members, dependents, and the veterans. It is certainly possible for all the reasons 

that everyone has given. Do you agree with that assessment? Do 

you think it is possible? Or do you agree with Mr. Miller and Secretary Council that this is impossible? 

Ms. MELVIN. I won’t say that it’s impossible. I think our concern 

is that over the years, the history of looking at this, we’ve had a 

lot of concerns about the starts and stops with this initiative. There 

have been mandates. The 2008 National Defense Authorization 

Act, for example, directed them to have fully interoperable capabilities. 

It has been a history of the two departments going down particular paths that they wanted to pursue for this, changing at certain points. And there has not, in our view, been the accountability 

for them doing it. They have changed gears along the way; the 

most clear being moving from two systems to a joint system, and 

back to two systems again. 

So, it is a matter of the leadership taking the stand and saying 

we’re going to make this happen, and working to do that. We have 

not seen the dedication on the part of the two departments to take 

a stand on that and actually make it stick. 

Mr. O’ROURKE. I would just say to my colleagues that if we are 

satisfied by the excuses given today, then we share in the culpability for the consequences that I think we are going to be hearing 


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about at a hearing in 2, 4, 6, 8, 10 years about why these systems 

can’t work together, why we’ve spent billions of dollars, and why 

we haven’t been able to get the job done. I think we have to insist 

on consequences and accountability and performance. And we have 

not done that effectively to date. So I look forward to joining my 

colleagues in working on that and demanding that of the administration. 

With that, I yield back. 

Mr. COFFMAN. Dr. Benishek of Michigan, you’re now recognized 

for 5 minutes. 

Mr. BENISHEK. Thank you, Mr. Chairman. 

Frankly, I agree strongly with Mr. O’Rourke and Mr. Lieu. Some 

of the answers I heard today, like from you, Ms. Council, you 

talked about we can’t work together with the DOD until we actually get a system that works with the private sector as well. Well, 

the private sector is not going to be interoperable at any time in 

the near future that I can ever see. And to just link that together, 

it gives you another excuse as to why this is not happening. 

Frankly, I agree that the President really needs to make this a 

priority to make this happen. I think I was at that hearing with 

the Secretary of Defense and the Secretary of the VA a while back, 

maybe this is 2011, where $1 billion has been spent and given up. 

And we just can’t stand the fact that we are spending $1 billion 

on integrating health care, and you tell us it can’t be done. I know 

that a lot of you are new. But we get sick of this. Really, I want 

the President to be involved. 

I want to go into something else here now that I heard about just 

today, and that is, the Orlando Sentinel described a project of the 

VA as making a virtual hospital with 3–D graphics in which veterans will create avatars and walk around examining their 

healthcare records searching for medical information, and walking 

to a virtual medical adviser doing e-consults with physicians. 

Is anybody aware of this program? Are you, Ms. Council? 

Ms. COUNCIL. No, I am not. 

Mr. BENISHEK. To me, this is something—do the DOD guys know 

anything about this? Apparently, this was rejected by the DOD? 

Mr. MILLER. No, sir. 

Mr. BENISHEK. It’s just that it’s kind of funny to see the VA 

doing some kind of a weird virtual hospital as a pilot program 

when we don’t even have—we can’t be working the real hospital. 

So you guys just aren’t aware of that. And especially since the fact 

that most of the veterans have no idea what an avatar and all that 

stuff is. 

Do you know how much—is anyone aware of how much money 

that the VA has spent in trying to integrate this system? Ms. Melvin, do you know? Or Ms. Council, you’re new, so I don’t expect 

much from you. Ms. Melvin, do you know the amount of money? 

They told me over $1 billion. 

Ms. MELVIN. We don’t have a credible number. The most credible 

number we had was actually in the millions, at $564 million for the 

couple of years of doing the integrated electronic health record. We 

have asked for figures to try to understand more specifically what 

that number is. I think I would say just over the history of the iniVerDate Nov 24 2008 10:28 Jul 13, 2017 Jkt 000000 PO 00000 Frm 00077 Fmt 6633 Sfmt 6633 H:\25915.TXT APRIL

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tiatives that we are looking at, to have it be above $1 billion would 

not be a surprise to me. 

Mr. BENISHEK. Let me ask another question. This is more like 

a philosophical question. I had a subcommittee hearing in the VA 

this morning, and one of the things about IT in the public sector 

is that I see changes so fast, that there’s a new iPhone every 6 

months. So the IT stuff changes really fast, but it seems like the 

VA and the DOD, they take years and years and years to develop 

a change in their IT system. And they have to, like, consider every 

possibility before they implement it, and that process takes like 8 

years, by which time the thing is obsolete. 

Ms. Council, you have some kind of a software background. Why 

can’t we institute the kinds of changes incrementally all the time, 

rather than have to build a system that takes 8 years to build 

them, and then by the time it’s implemented, it doesn’t work? 

Ms. COUNCIL. I totally concur with you. I think that since my arrival 3–1/2 months ago into government, it’s been an eye-opener of 

how long it takes to move technology. 

There are a number of different governance processes in place 

that don’t hinder in private industry because our focus is on productivity and moving things forward, and at a very different aggressive manner. 

What I will tell you we have done with our new strategy is to 

put a framework forward to push us to much more of an execution 

focus by having a now, near, and future timeframe. I think we need 

to time-box our work, and think about what is really going to give 

us the most bang for our effort and get those things done, and done 

quickly. 

Mr. BENISHEK. Well, that’s what I’m talking about. We can’t expect to fix the comprehensive repair of the entire system. Let’s just 

move along incrementally and do some changes. You have probably 

been on VistA, it’s like a disaster. But it’s like the best thing out 

there, because nobody has any interoperativity at all. 

So I just encourage you and I encourage the President to focus 

on making sure that you two guys get this all figured out. 

Thanks. 

Mr. COFFMAN. Retired Sergeant Major Walz of Minnesota, you 

are now recognized for 5 minutes. 

Mr. WALZ. I thank the chairman and my colleagues. I thank each 

of you for being here. I just came from a roundtable with the 40 

largest veteran service organizations. They understand how key 

this is. Any reform is going to hinge on this. 

I also say I understand your expertise that many of you have. I 

represent the Mayo Clinic. And so, I have at least a working 

knowledge now over the years of how electronic medical records are 

diagnostic tools, and all the importance and all the challenges 

you’re up against. 

I also know my friend, Dr. Roe and I, years ago, traveled to Afghanistan to watch five different databases be opened as they were 

operating on someone. Watch MRI—or, in that case, I guess it was 

an x-ray—not have the bandwidth to move it from Afghanistan, to 

tape it on their chest on the way to Landstuhl. 

So we get this. We were looking at it. We were trying to piece 

it all together. And our goal is to follow that soldier back from that 


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injury on the battlefield from right at the aid station all the way 

back to the VA hospital in Tennessee, or wherever in Minnesota. 

So we’ve been on this. We were there and celebrated on April 9, 

2009, when the Virtual Lifetime Record President Obama signed. 

And I say that to you not to grandstand, not to highlight back-tothe-future week, or something like that. I say it to you because 

you’re hearing it up here from members who have been down this 

road. And it’s not for lack of commitment, it’s not for lack of expertise, but something has got to break. And you’re probably right, Mr. 

Miller. And I look back at the NDAA on the issue of what deployment means, the spirit and letter of the law. The spirit is, obviously, we just want them to be able to access and make it work. 

And I get that we’ve got to clarify and get at specifics. 

I guess I’m throwing it out there, and maybe it’s more rhetorical 

than anything, because, again, I do not question your commitment. 

I think we’ve got very bright people here. In all fairness, there 

were very bright people that sat there before you in these very 

same jobs. 

And I hear the deployment date we set. And you’re telling us, 

again, not because you’re not working hard or you’re not trying, or 

don’t want to get it, or we’re saying we’re not going to get there. 

My question might be to all of you, is this, again, like, my question: 

Can we do this? I mean, I know it goes against the American spirit. 

I kind of feel like Churchill was right on this. You can always 

count on America to get it right after they try everything else first. 

Dang, we’re trying a lot of stuff here. When do we get it right? 

Mr. MILLER. Sir, I guess just let me make a couple of comments. 

One is, I think we get it right when our users are happy. And I 

would offer I really do think if you were to sit down and talk to 

our users and they see what we’ve done, we’ve delivered four releases in 22 months jointly between the DOD and VA focused on 

improving interoperability, getting feedback back, incorporating it 

in. So I can show you, just like Apple does, just like Microsoft does, 

four releases, 22 months. That’s actually a little faster than Apple 

rolls out their iPhone every year. So we have demonstrated that we 

can make this move faster. I think the bigger thing is that we’ve 

all got to remember, it’s bigger than the IT, right? The IT is actually the easy part of what we’re talking about today. What we don’t 

seem to every want to tackle are the people stuff, the process stuff. 

All the things that make business systems really hard. 

And so I hear what GAO says. I would like to believe a single 

system between DOD and VA would be able to be there tomorrow. 

But the reality is, we’ve got a lot of hard things that make joint 

programs in DOD incredibly hard. Adding another level with the 

VA makes it even more hard. 

And so I would just offer to everybody, we have to view this as 

an incremental progression. And I personally believe that what 

DOD and the VA are doing right now are getting both houses in 

order to position us, in the future, where we are actually ready to 

have the discussion about moving to a single system, there is actually a business case. 

I think what we tried to do back in 2010 was way ahead of the 

technology, it was way ahead of where our processes were, it was 

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selves up to fail. It’s not because we didn’t have people that believed. It’s not because I couldn’t show you a pretty technology slide 

that shows you all these cool wiz-bang things are going to happen. 

We failed for nontechnical reasons. And those things are things 

that we have to understand and we have to deal with. 

That is why I think you’ve seen more progress the last 2 years 

between the two departments, because we learned from that. And 

now we’re focused on getting our collective houses in order and 

really addressing the interoperability thing. 

And just let me say, a single system does not guarantee interoperability. You can go talk to any major national healthcare provider, and they will tell you that they struggle when you’re talking 

about regions or they’re talking about working across large geographic areas. 

It’s not, again, because of the technology; it’s because at the local 

level, they generate different processes, they do business differently. 

And so, for us to think that just adopting a single system is going 

to solve all that, I think it’s a little naive. I actually believe we 

need have the discussion about how do we actually get ourselves 

to a level of maturity and readiness so that when we want to make 

the smart business decision, because at the end of the day, this is 

all about the taxpayer, and it’s all about a beneficiary. And I think 

I can show you very clearly where, using the power of competition 

and using technology the right way, at least in the DOD, we have 

been able to drive this cost down and really save on the Department of Defense and make sure our users are getting what they 

need without, in any way, shape, or form, jeopardizing interoperability. 

Mr. WALZ. I appreciate that. My time is up, but I appreciate your 

candidness. I think that is a question we’re going to have to do. 

We’re going to have to dig deep on this. Again, the taxpayers are 

going to ask for results. And I think you’re on the right place there. 

I yield back. Thank you, Chairman. 

Mr. COFFMAN. Thank you, Mr. Walz. 

Mr. Huelskamp of Kansas, you’re now recognized for 5 minutes. 

Mr. HUELSKAMP. Thank you, Mr. Chairman. Excellent questions. 

I appreciate the joint hearing on this. 

I want to follow up with Mr. Miller, if I might. You’ve indicated 

you thought there was no way possible to deploy and meet the 

interoperability requirements of NDAA, is that the case? 

Mr. MILLER. Sir, what I’ve said is we will have an initial capability that is in line with the NDAA. What I said is not possible, 

based on industry experience, based on on all feedback from everybody we’ve engaged with, is to think that I can deploy to more than 

1,200 locations within that short of time—— 

Mr. HUELSKAMP. But you’ve been in your position for 2 years. Is 

that what you told us 2 years ago? 

Mr. MILLER. Yes, sir. 

Mr. HUELSKAMP. Is that what you told the VA 2 years ago? This 

was not possible? 

Mr. MILLER. The deployment date for 2016, sir? 

Mr. HUELSKAMP. You’ve have been in this position for 2 years. 

Now you’re telling us that this was never, ever possible, if I underVerDate Nov 24 2008 10:28 Jul 13, 2017 Jkt 000000 PO 00000 Frm 00080 Fmt 6633 Sfmt 6633 H:\25915.TXT APRIL

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stood correctly, and $564 million later, we are now saying, well, 

this is really not possible. 

Mr. MILLER. The $564 million dealt with IHR, which is a prior 

strategy. The 2014 NDAA directed us to deploy a modernized electronic healthcare software supporting clinicians at the Department 

no later than 31 December 2016. 

What I have routinely said, in my engagements on the Hill, has 

been, we will provide that software capability at our IOC sites in 

the Pacific northwest, but it is not physically possible to touch over 

1,200 locations around the globe to deploy that software and have 

a remote chance of being successful. 

Mr. HUELSKAMP. So do you have interoperability within DOD 

currently? 

Mr. MILLER. Yes, sir. As I mentioned earlier—— 

Mr. HUELSKAMP. Or in the NDAA definition? 

Mr. MILLER. Yes, sir, I do. 

Mr. HUELSKAMP. Okay. I’ll ask the VA. Do you have interoperability currently within the VA? 

Mr. BURNS. As I said earlier, we have, at the fundamental level, 

we have the capability of sharing the data, and with data standards. We are doing the ‘‘use’’ case analysis to look at more of the 

semantic level at this point. So we have pieces of it at this point. 

Mr. HUELSKAMP. I’m confused. Yes or no, do you have interoperability within the VA? 

Mr. BURNS. We have interoperability within the VA in terms of 

the data that we have. I don’t want to get too technical on this. 

Mr. HUELSKAMP. I’m just asking for a yes or no, as defined within the NDAA. 

Mr. BURNS. Within the VA, we are able to bring the data together to share it across the areas. 

Mr. HUELSKAMP. Yes or no, we have interoperability today in the 

VA? I thought earlier you said we did not. 

Mr. BURNS. What I’m saying was the interoperability, we were 

talking about DOD and VA. So, within VA—— 

Mr. HUELSKAMP. There’s 1,700 locations in the VA. And we’ve 

got thousands of non-VA care locations. I definitely know there is 

not interoperability between the VA and the non-VA care. Is that 

correct? My question is within the VA. 

Mr. BURNS. Within the VA, we have interoperability to share the 

data, yes. 

Mr. HUELSKAMP. I wonder about that. 

A follow-up I have with the VA is, according to the VA, less than 

8 percent of medical records are marked as sensitive, based on the 

aggregate of all VistA systems. In a briefing with IOG, the subcommittee staff was informed that unless records are classified as 

sensitive, VA does not have the capability to track when those 

records have been accessed. So does this mean the VA has no visibility on who accesses over 92 percent of medical records at the 

VA? 

Ms. COUNCIL. I think, if your question is related to who actually—that’s called segmentation, who actually looks in logs. There 

is audit and logging into those systems. You know who goes into 

the system and who’s looking at which records. Is it beyond that? 


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Mr. HUELSKAMP. This is different information. From what I understood, you told our subcommittee staff, you said unless the 

records are classified as sensitive, you do not know who accesses 

those records. Is that inaccurate? Is that a change? Or, are you 

tracking? This is pretty critical. I want to know who’s really getting 

into these systems. 

Ms. COUNCIL. I wasn’t part of the testimony, sir. I don’t know 

what you’re referring to. 

Mr. HUELSKAMP. Mr. Burns, do you know what percentage of 

your records, or do you track the access of those records? 

Mr. BURNS. I’m not aware of that statistic, no. 

Mr. HUELSKAMP. Would you be willing to provide that to the 

committee? 

Ms. COUNCIL. We can come back to you. 

Mr. HUELSKAMP. Would you agree that if you do not know who 

accesses those records, that we have a problem with privacy of that 

particular data? 

Ms. COUNCIL. I would say yes. And today, what happens with 

our PII and PHI information, doctors log in, we follow who logs in, 

as well as the nurses. They log into those records and out. But we 

will be happy to furnish you with the further information. 

Mr. HUELSKAMP. Based on what we find out, if the 8 percent 

matches, again, we are seeing 92 percent you don’t track the access 

to those records. A follow-up would be later, once we figure out that 

number is, I want to know what the VA is doing to improve audit 

details in VistA to ensure that the veteran’s PI is not inappropriately accessed. 

With that, Mr. Chairman, I yield back. 

Mr. COFFMAN. Thank you, Mr. Huelskamp. 

Mr. Connolly of Virginia, you’re now recognized for 5 minutes. 

Mr. CONNOLLY. Thank you, Mr. Chairman. Welcome, to the 

panel. 

This really is so much more important than 

recordkeeping or how we deploy technology. This is about how we 

treat our active duty and military veterans. Is that not correct? 

Anyone disagree with that? Would you agree we haven’t done so 

good? 

Mr. DeVries, you cited FITARA. We prefer to call it the IssaConnolly bill, but FITARA is fine. And I think you cited it because 

it is a new tool, that had it been available, might have helped us 

in looking at the investments we made in the past. I don’t want 

to put words in your mouth, but is that what you cited it? 

Mr. DEVRIES. So the FITARA ruling has come out—— 

Mr. CONNOLLY. I’m sorry, what? 

Mr. DEVRIES. The FITARA rule has come out, and I think it has 

been a great leveling set for the other agencies across the Federal 

side of the house, providing the tools for the CIO to look at. It also 

reinforced a lot of the behaviors that we were exercising already inside the DOD. 

In the case of here, for the medical records, I don’t think we had 

enough authorities, we had enough oversight on it. I would challenge to the committee here. As we were talking about this discussion, we kept using the words system. FITARA, in itself, kind of 

deals with a system. But it is not a single system. It’s about a caVerDate Nov 24 2008 10:28 Jul 13, 2017 Jkt 000000 PO 00000 Frm 00082 Fmt 6633 Sfmt 6633 H:\25915.TXT APRIL

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pability. It’s about understanding the data. It’s about understanding the individual, both the patient, but also the provider for 

it, and I really don’t care how the provider accesses or what tools 

he used, as long as he takes care of me, the customer. 

Mr. CONNOLLY. Right. 

Mr. DEVRIES. I think that is where we are going. 

Mr. CONNOLLY. I would just note for the record, had FITARA 

been in law at the time, it would have required a cost-risk analysis 

to substantiate whether the current approach is, in fact, less expensive and faster to implement, as the Departments have asserted, 

before the 2013 change was made to pull the plug. And GAO, of 

course, has repeatedly asked for data to substantiate that decision. 

So it would have been an analytic tool to help us through. 

Ms. Council, you’re familiar with FITARA? 

Ms. COUNCIL. Yes, sir. 

Mr. CONNOLLY. And you’re moving to implement in the VA? 

Ms. COUNCIL. We’re fully implementing it within the VA. 

Mr. CONNOLLY. Good. Do you think it could have been a useful 

tool? I know you are only there 3–1/2 months, but that gives you 

the one benefit of looking back and thinking, How could we have 

avoided some of the problems? 

Ms. COUNCIL. It’s always great to have solid data and understand how decisions were made, so you can decide and people understand, at that point in time, this is what we knew, and this is 

a decision that we made. 

Mr. CONNOLLY. Mr. Miller, I wish I had lots of time to talk to 

you. You said we failed for nontechnical reasons. What did you 

mean? 

Mr. MILLER. Sir, what I mean is, with business systems, you’re 

really changing how the work is done. Right? So you’ve got to think 

about the training, you’ve got to think about changed management. 

You’ve got to think about communications. The reality is, is that 

these tools on the business side exist to enable work flows and to 

make decisions. And my comment really is, is that oftentimes 

where we fail, is that we haven’t done a very good job of making 

sure that we account for the user adoption; we don’t account for the 

over-the-shoulder training; we don’t account for all those things 

that have to happen to really make sure that the system is successful. 

Mr. CONNOLLY. Yeah. And I think that’s a fair point. It’s not just 

about technology. And technology is a tool, not an end in and of 

itself. But it’s important. I’ve gone to oncology centers where doctors initially really resisted electronic recordkeeping. And now they 

wouldn’t live without it, because they can now see instantly the 

protocols in place for dozens of patients and make instant modifications. It may be more efficacious. It’s saving lives. 

What we’re about here today is saving lives. It is vital that if I’m 

active duty and you’ve got my medical records, they would be 

seamlessly transferred to VA when I become a veteran. So we’re 

not worried about whether I need to reinvent the wheel on testing 

and data, but that we’re getting to my medical condition and treating it. 

And that is what concerns me; that by pulling the plug on an integrated system in 2013 and deciding to reinvest in our two parVerDate Nov 24 2008 10:28 Jul 13, 2017 Jkt 000000 PO 00000 Frm 00083 Fmt 6633 Sfmt 6633 H:\25915.TXT APRIL

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allel systems that are not interoperable, how do we get to the point 

where it’s interoperable? Maybe you perfect the two parallel systems. But when I cease being active duty, I have to go into a brand 

new system and start all over again. 

Mr. MILLER. Sir, it’s important to remember, that requirement is 

not unique to DOD and VA. I’m a Marine. I took my medical record 

home. But just as importantly, I’m a cancer survivor. I had cancer 

as a civilian. When I moved from San Diego to Charleston, my provider in Charleston told me to call back to Kaiser Permanente, who 

had an electronic system, and have them fax it to me. 

I understand the importance of taking care of our veterans. 

Mr. CONNOLLY. And did that work? 

Mr. MILLER. No, sir, it did not. So I think it’s important we recognize this is a national issue. How we take care of people, how we 

provide health care, how people move around between our systems 

is something that the national community has to figure out. And 

they are attacking this issue. It has been very clear, if you watch 

during the procurement that we went through this past year, how 

much the debate ensued on interoperability and how much 

progress you got out of some of our—— 

Mr. CONNOLLY. Mr. Miller, it is a national issue. But we are talking about two Federal agencies that deal with a specific population 

in our care. And when we talk about taxpayers, they want to know 

our military, our veterans are getting the best we can possibly deliver. And we’re not delivering the best. 

And one of the problems is, we’ve had bureaucratic inertia between two agencies that can’t get their acts together on behalf of 

the men and women we are serving. That’s the issue, not that 

there is some national problem that is bigger than all of this. This 

is conquerable. This is within our purview. You’re Federal agencies. 

And you owe more to the men and women who’ve served this country than they’re getting. And that’s why we’re having this hearing. 

I yield back. 

Mr. COFFMAN. Thank you, Mr. Connolly. 

Dr. Roe from Tennessee, you’re now recognized for 5 minutes. 

Mr. ROE. Thank you, Chairman. I’m going to probably go down 

a little different road. 

I was here, and probably other than Mr. Walz, I’ve been here on 

the Veterans’ Affairs Committee longer than anyone. I served in 

the U.S. Army as a physician, as a doctor. I trained in the VA. So 

I’ve been in both systems. I was in the system when this was your 

health record. And you carried it back with you. And it worked 

okay. And this electronic system we’ve got in the VA now works so 

smoothly that the primary care doctors can see about 10 or 12 people a day, and me using this technology, I could see 25 people a 

day, easily. 

Now, there are—we have transitioned to a more modern system, 

there is no question. And Mr. Miller, you are 100 percent right. I 

went from paper to an electronic health record. It is not easy. What 

you’re trying to do is not easy. But I agree with Mr. Connolly. 

Ditto, right on. What has got to happen is we have got to have one 

system, or 20 years from now we’re going to be sitting here having 

exactly the same conversation. And very smart people 5 years ago 

sat down and told us, We can make these interoperable. 


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I went to Great Lakes, Illinois in January, that wasn’t a lot of 

fun, to see how interoperable the system was at the VA and the 

Navy. And guess what? In about 5 minutes, they could give me, the 

doctor, a CBC. Well, I haven’t got 5 minutes to wait. I can wait on 

a fax machine that quick, to be able to pull it up. 

Let me tell you what $1 billion is that was wasted. And to do 

this day, I asked the Secretary, What happened to that $1 billion 

when you two were trying to work together—not you all, but the 

previous DOD and VA—to make this work? 

I served in a hospital system in Johnson City, Tennessee, that 

is $1 billion system. It has 9,000 employees, 13 hospitals, 70,000 

admissions, 250,000 ER visits, and they service a $600 million 

debt. That is what a billion can do. And that’s what the VA and 

DOD managed to waste. And I have no idea where it even is. It’s 

hard for me, with a straight face, to go home and say what we did 

with this money. 

Now, I appreciate the fact that like the VA has a legacy, you 

guys at DOD have a legacy system. I think you were smart to get 

rid of it and go to something more modern. That does make sense. 

But what should have happened in that time was your partner, 

which are taking care of exactly the same patients—one day I was 

an active duty military, the next day I was a veteran. It happened 

to you. It happened to me. It’s going to happen eventually to everybody after their 30 is in. 

So I think that the President should step up and say we’re going 

to put these two department heads together and they’re going to 

work on one system. It may take 5 or 6 years to implement this 

system. But me personally, I’m not going to be part of another system that 10 years from now, we have the same thing, where you 

can’t even pull up a CBC when you separate from the military. 

So, Ms. Council, you have a legacy system you’re trying to make 

work. And I’m not asking you to say it’s up to you to switch systems. That’s above your pay grade. But wouldn’t you think it would 

be simple if both of you had the same system? 

Ms. COUNCIL. Life is always easier when we’re looking at the 

same map, yes, sir. 

Mr. ROE. That’s what I thought. And the data—and I understand 

being able to format data where you can see it. I’ve got that. I 

know how that works. In our own ACO at home, we have 40 different electronic health systems. I’ve got it. I understand that. 

That’s why if you can get to one, everybody benefits. And I think 

if we’re going to spend billions of dollars, we ought to go deep in 

and convert both systems. 

And the VA is comfortable, the DOD was comfortable with what 

they had, but they couldn’t work together. And look, smart people 

tried. I don’t think there was any fraud or anything. I think a lot 

of smart people tried to make this work, and just couldn’t. 

Ms. Melvin, you said that, no single system, no identifiable goals. 

And I think that pretty much felt it out. 

Ms. MELVIN. I would agree with you. Our concern throughout the 

history of this initiative is that there has never been a really defined end state for what it was that the agencies were trying to 

achieve, and how they could go about really determining what 


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interoperability is, and then establishing and identifying how they 

were going to get there. 

Mr. ROE. That’s what we asked the Secretaries to do in 2013. I 

was at the hearing when both Secretaries came in and gave us that 

information that it wouldn’t work. So they just stopped. And then 

that’s when the DOD went a separate route. And, again, I have no 

problem with that. I think it’s probably a good idea. 

Mr. Miller, you said that this was hard. Well, hard isn’t an excuse not to do this. And it’s something that I think we have to do 

going forward for our veterans and for our active duty people. And 

the fact that a private system will work, you sort of made the system that it wouldn’t work at the VA. Well, if it works in a submarine, it works in the private sector. And as Mr. Walz said, we 

have been to Afghanistan and looked at that wounded warrior 

there. It will work at a VA, I would think, with perhaps some 

modifications. 

Mr. MILLER. Sir, I’m not going to disagree with you. I think what 

we also have to recognize is the two departments have a culture 

of how they go about doing acquisition. In the case of the Department of Defense, I think what we’ve recognized over the past 5 

years has really been we are not in the health IT development 

business, really. We want to be somebody that leverages the commercial market. We want to be somebody that kind of rides that. 

When I was a Marine, we had Banyan VINES. It no longer exists. 

We now use Microsoft products. 

I think what has to happen here is we have to attack the problem the same way. The reason why I say it is, it’s about bigger 

than the technology is, when the two organizations budget differently, they do acquisition differently, they view their role in 

health IT differently, it sounds really—— 

Mr. ROE. But to interrupt you though, the whole purpose has 

been stated a thousands times up here. The mission is to take care 

of both the wounded warrior when they are on active duty, and 

then the veteran. Nobody cares about all this stuff. What they care 

about is do I get the care for me and my family? That’s what they 

care about. 

Mr. MILLER. Yes, sir, I completely agree. I just think as an acquisition person, I can solve that problem more cost effectively for the 

American taxpayer by solving interoperability while letting the two 

departments go through the necessary modernization that needs to 

happens. The reality, sir, like you recognized, DOD stopped their 

last deployment of the system in 2006. My niece’s husband is an 

Air Force doctor down in Biloxi, Mississippi. He calls me routinely 

to talk about how bad his system is. Because he went through residency using commercial systems. He cannot believe the impact on 

his productivity by not having a system that is as modern and as 

advanced as what he needs. 

So the reason I say that is because we can solve the interoperability challenge. What I can’t afford to do is go back to my clinical 

users who have demanded a new system and tell them I’ve got 5 

more years while we work through all these other hard things. I 

just think we need to come back for the record and show what the 

business case is. 


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Mr. ROE. I’m over my time, Mr. Chairman. One last thing is, is 

that I’ve been hearing for 7 years we’re going the make this work 

and interoperable by smart people. It hadn’t worked yet. 

I yield back. 

Mr. COFFMAN. Thank you, Dr. Roe. 

Ms. Duckworth of Illinois, you’re now recognized for 5 minutes. 

Ms. DUCKWORTH. Thank you, Mr. Chairman. 

I’m thanking the witnesses for being here today. When I left 

Walter Reed as a patient, I left with a CD–ROM with my entire 

record, including the notes from the surgeons who performed my 

amputation. 

In order to get into the VA system, I had to wait 90 days for an 

appointment, and that consisted of me going in to see a physician’s 

assistant for whom I had to disrobe to show him that I was still 

an amputee, that in those 90 days my limbs had not grown back. 

Now, in that time period, that physician’s assistant did not want 

to see me. He had other patients to see. There was a backlog of patients waiting to be seen. He was not able to just accept DOD’s 

records. And so it was a waste of time for him. It was a waste of 

time for me. It was a waste of resources for other veterans. 

I say this because as a patient of the VA and as a former patient 

of DOD, I am proud of both healthcare systems, and I am proud 

of the people who work in both systems, but I am also equally frustrated by both sides because I have been a member of the leadership at VA. In fact, my frustration with this very issue is one of 

the reasons that I quit VA in 2011 to go run for Congress because 

of the posturing, the inability to work with each other, and the continued strife, and the waste of sheer taxpayer dollars. 

It’s literally one of the reasons why I ran for office because I sat 

in those meetings every week at the Pentagon where, let me tell 

you, from my personal opinion, Tammy Duckworth’s personal opinion, the VA got rolled by the DOD on a weekly basis. 

Mr. Miller, what you can tell your folks about—your clinicians 

about what you can do to get them a good system and not wait 5 

years, you can tell them we’re going to adopt VistA, and then together, while we’re using VistA, we can work toward something 

else. That’s how you get them a better system immediately. But let 

me tell you that I was there week after week, and then when it 

went onto months, it would be a new one-star or a new two-star 

who would rotate in, the old one would leave, and the new one 

would come in, and goes: Oh, I need a new study, you know, because I wasn’t here for all of those weekly meetings, I need a new 

study, we need to figure out what’s going on. 

And, Ms. Counsel, I know that you testified earlier, I was watching from my office that the—you have to actually send the data 

from one VA hospital to another in order to be able see that. I have 

to tell you that you’ve undersold VA a little bit because I’ve gone 

to different VA facilities and actually have had my doctors know 

how to log out of the system for that hospital and then log into the 

correct system and been able to see my records, which has been 

very helpful. 

And following Hurricane Katrina, veterans who were affected by 

Hurricane Katrina could actually go to other VA facilities and get 

the prescriptions they needed wherever they were. Whether that 


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was in Texas or Missouri or Mississippi, wherever they ended up, 

they were able to get, so there is a way for that to happen. 

But, look, this is about a longstanding deeply embedded culture 

that prioritizes in both agencies turf battles over the well-being of 

our service members. It’s about a VA system that struggles with 

the growing demand for the Department’s medical services that is 

burdened by policies and written rules that says you have to go in 

to see a physician’s assistant before he can confirm that your legs 

didn’t grow back. I’m not a gecko. They don’t grow back on their 

own. 

It’s also about, you know, the fact that we’re wasting hours and 

resources to conduct medical examinations. We should be treating 

veterans. It’s really been disheartening for me personally to watch 

the massive DOD bureaucracy repeatedly, and I say this again, repeatedly, roll VA over and over and over again, which despite its 

serious problems at VA, VA has real problems, it was actually one 

of the earliest organizations to implement EHRs, and let me—I just 

finished my Ph.D. In October, and the topic of my Ph.D. Was actually electronic health records, and it was partially inspired because 

of my work on this issue. 

It was even more shocking to watch DOD not only roll VA but 

roll the Office of Management and Budget, which pushed in vain 

earlier in the administration to convince DOD that it needed to 

work with VA to develop a single integrated electronic health 

record system, and to this day, I harbor serious concerns about the 

decision to abandon the goal of a unified single integrated system 

for DOD and VA. If we’re going to spend $11 billion of taxpayer 

money, I don’t understand why we wouldn’t have invested this astronomical amount of money in a fully functional interoperable system. 

Now, having served on the committee—on this committee and 

Armed Services Committee—I have my suspicions about the motivations and incentives that explain DOD’s longstanding unwillingness to work with VA to modernize and enhance VistA to meet 21st 

century healthcare needs. And I’m not going to get into an argument with you. My personal opinion is everybody’s got bureaucratic 

turf battles. Everybody’s got a budget that you would like to hang 

on to and to supervise. That stuff has got to end because veterans 

are suffering. 

So my question is actually to Ms. Melvin. In your testimony, you 

noted that neither DOD nor VA could substantiate their claims 

that maintaining two separate EHR systems would be less expensive than developing a single integrated system and would be developed faster than creating a new unified DOD/VA system. Is that 

correct? 

Ms. MELVIN. That’s correct. 

Ms. DUCKWORTH. So they’re not able to substantiate it? 

Ms. MELVIN. They were not able to provide us the information. 

We asked—I suggest—recommended, I should say, that they provide or develop cost analyses for—cost estimates for the alternatives, the alternative to develop a single system as well as the 

new—two separate systems and to compare them and to provide information to us relative to—which was the more viable solution. 


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We’d like to see the justification for why going back to two systems is better than one system. That’s very important to really— 

the bottom line of whether this is a more reliable approach that 

they’re taking over what they had been going with before. 

Ms. DUCKWORTH. Are you expecting that information anytime 

soon? 

Ms. MELVIN. I don’t believe we are. I don’t think that we have 

any date yet to get that information. We are still working with 

them. We do still have our recommendations on record related to 

that, so we are still coordinating with the agencies about that. 

Ms. DUCKWORTH. Mr. Chairman, I am well over time. I apologize. 

But may I request that the two agencies provide that information 

to this committee? 

Mr. MILLER. Ma’am, we have provided that information. 

Mr. COFFMAN. If there are no objections, with unanimous consent, please submit the information that Ms. Duckworth has requested for the record. 

Ms. DUCKWORTH. Thank you, Mr. Chairman. I yield back. 

Mr. COFFMAN. Mr. Hurd of Texas. 

Mr. HURD. Dr. Duckworth, I like the sound of that. We may have 

to have you as a witness on the followup hearing. 

I like going at the end of the first round of questioning because 

you get to hear all the conversations, and this is an interesting 

topic to me. My dear old father is still upset with me for not taking 

a job with IBM to help them build databases, so this is something 

that’s a topic that’s near and dear to my heart. And I talked about 

my opening frustration, and that frustration is still here, despite 

all the testimony. 

And my first question, Ms. Melvin, you’ve alluded to this, and 

you’ve answered it, but I’m going to ask this question again. Who 

is in charge of interoperability of electronic health records between 

DOD and the VA? 

Ms. MELVIN. At this time, the interagency program office is designated as the single point of accountability. However, what we do 

know at this point and what we’ve reported is that VA has its own 

governing body, I think as Ms. Council has alluded to, and also 

DOD has its own governing body, so there actually are at least 

three different entities that are involved with this. 

Mr. HURD. Thank you. That’s helpful. 

Mr. Miller, you represent the IPO. Is that correct? 

Mr. MILLER. Sir, I represent the Department of Defense as a senior executive responsible for both our interoperability and our modernization efforts. Director of the IPO is Dr. Lauren Thompson, 

who reported back in May, and she actually runs that office. 

Mr. HURD. So is that Dr. Thompson? 

Mr. MILLER. Yes, sir. So she reports to—— 

Mr. HURD. Do you report to her? 

Mr. MILLER. No, sir. She works for me and Under Secretary Kendall. 

Mr. HURD. So you’re her boss? 

Mr. MILLER. Yes, sir. 

Mr. HURD. So—but you’re a DOD employee? 

Mr. MILLER. That’s correct, sir. 


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Mr. HURD. So who is this governing body within DOD that is 

looking about the interoperable medical health record? 

Mr. MILLER. So within both Departments, they have their own 

IT acquisition organization. So within the Department of Defense, 

that’s Under Secretary Kendall. He’s responsible for all of our acquisition, and so as on the acquisition and technology side, he is 

who we report to on our efforts within operability. The same goes 

on the VA with Ms. Council. What we do is we routinely meet between Ms. Council and Secretary Kendall to review—— 

Mr. HURD. I get that. I get that. Thank you. 

So my question, Mr. DeVries, a clinic, a VA clinic, and let’s just 

say San Antonio, can they have one computer that has access to 

the VA health system and the DOD health system? 

Mr. DEVRIES. They could, sir. 

Mr. HURD. Do many people have access to that? 

Mr. DEVRIES. Not today. 

Mr. HURD. It’s a good question. 

Mr. DEVRIES. Not today. 

Mr. HURD. Why is that? 

Mr. DEVRIES. I think it’s based upon technology, where we are 

today, and where the data is. Identity is a critical part, as I talked 

about before, from both the patient as well as the provider. 

Mr. HURD. And you’re responsible for that, correct, providing the 

accesses and the protections around that data, you specifically? 

Mr. DEVRIES. Correct. Overall policy is, yes. 

Mr. HURD. So if Mr. Miller—can Mr. Miller tell you what to do? 

Is he in your chain of command? 

Mr. DEVRIES. He is not in our chain of command. 

Mr. HURD. So the person that’s responsible for protecting the 

data, all right, of our health data, all right, which is a key part of 

interoperability, the person who’s charged with interoperability 

does not have control over those people making those decisions, is 

that correct, or am I confused? 

Mr. MILLER. Sir, I would offer just checks and balances. So my 

job within the Department of Defense is to lead the acquisition, the 

testing, and deployment, but I have to get approval from our CIO 

organization to make sure it meets the security requirement, we’re 

protecting data, so it’s a partnership. You know, there’s no single, 

if you want to, go up to the very senior level, but day-to-day, I don’t 

do anything without him, and obviously, they have to have something that we provide in order to assess our security and how we’re 

doing at protecting people’s information, sir. 

Mr. HURD. So, Mr. Miller, you said this is a national issue about 

interoperability of health care records. I agree with you, and I also 

agree with Mr. Connolly as well. This is about two Federal agencies sharing information amongst each other, and to me, it’s shocking that a doctor in San Antonio, Texas, can’t have one computer 

on their desk that accesses both the DOD records and the VA 

records. 

Mr. MILLER. Sir, he can, and I would love to—— 

Mr. HURD. But they’re not. Look, so how many doctors—how 

many—how many DOD doctors and how many VA doctors have 

you all talked to on the implementation of this system and what 

they need in a interoperable electronic health record? 


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Mr. MILLER. So let me talk about the requirements when you’re 

in interoperability. It is jointly led by easily, you know, 20 or more 

clinical leaders from both Departments, and so today, in San Antonio, on the DOD side, we provide access to—through what we call 

JLV, but it’s actually integrated her. 

Mr. HURD. Yeah. And let’s get to JLV. 

Mr. MILLER. So, sir, let me just explain. It’s in our her. It’s inside 

of AHLTA. There is access to be able to see the VA data and the 

data from the private sector. That is available to any DOD physician, PA, nurse—— 

Mr. HURD. How do they gain access to it? Who do they ask? How 

would—if I’m a doctor, how do I gain access to be able to see those 

both records? 

Mr. MILLER. So to be able to see both records, all they have to 

do is go—just like any other IT system, they go to the local administrator, they grant them the keys to access the system. We’ve gone 

in the DOD from about less than 500, now over 8,000 in about 6 

months, and we are continuing to rely. In fact—— 

Mr. HURD. And this is for JLV? 

Mr. MILLER. Yes, sir. In fact, at Brooke Army Medical, it is one 

of our largest users and actually where we’ve been doing the operational tests. So besides getting input back on the requirement 

side, we’ve actually gone and done operational testing at Brooke 

Army Medical in Alaska and at Walter Reed to get feedback from, 

no kidding, users, which has been rolled into the future enhancements of the system. So we have an incredible engagements with 

our clinical functional users to make sure we’re meeting their requirements. 

Mr. HURD. But a soldier, sailor, airmen, and marine, when they 

show up to a VA clinic for the first time, they still have to print 

out—— 

Mr. MILLER. No, sir. And I talk to people routinely. 

Mr. HURD. Okay. So let me ask you this. So you’re saying nobody 

has to do that? 

Mr. MILLER. So, sir, they print that record out because oftentimes our Active Duty, especially when they have been in the service a long time, predate our IT system, so I think it’s important to 

recognize that. We have not been fully electronic within the entire 

Department. 

Mr. HURD. Absolutely. So here’s the problem. You have—so quick 

question, and Mr. DeVries, you may be able to answer this question for me. If I’m in the Air Force and I go see a DOD doctor, is 

my record different than someone in the Army that goes and sees 

a DOD doctor? 

Mr. DEVRIES. It is not. 

Mr. HURD. It is not? 

Mr. DEVRIES. It is not. 

Mr. MILLER. Same system. 

Mr. DEVRIES. Same system. 

Mr. HURD. So all branches—okay. Air Force, Army. Is it the 

same for all branches of the military? 

Mr. DEVRIES. Yes. 

Mr. MILLER. Same system. 

Mr. DEVRIES. You have rights to the same data repository. 


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Ms. DUCKWORTH. Will the gentleman yield? 

Mr. HURD. Please. 

Ms. DUCKWORTH. Very briefly. I just have a little something. 

Mr. HURD. Please. 

Ms. DUCKWORTH. So I don’t know if the gentleman is aware of 

how frustrating this is when there’s even a hospital in Chicago that 

is a joint Federal VA/DOD facility. And in that hospital, they actually have two computers sitting next to each other, one with a VA 

system and one with a DOD system. And that hospital is supposed 

to be a joint facility treating simultaneously veterans and Navy 

personnel. And even there in the hallmark hospital that is the flagship of this effort, it’s two computers sitting next to each other. 

Shameful. 

Mr. HURD. It really is. You know, who is actually, so I look at 

this problem multiple ways. You have the various health facilities 

that a soldier, sailer, airman, marine may see in their time when 

they’re in DOD. Then you have all the facilities within the VA. 

Then you have if a veteran has to go to a private, a private 

healthcare provider. It’s a whole other set of issues with interoperability, which I recognize the complication of that. Then you have 

people that starting today, brand new, starting basic training in 

this new system in their lifetime. Then you have the people that 

have already been serving, that have served for 30, 40 years. And 

they have a number of old records in a legacy system that are 

super old and outdated. I get that. But what we haven’t heard from 

any of this is what is the plan to solve those different problem sets? 

We talk about mapping data. Do we not know what the format the 

various pieces of data are in? Do we not know? They’re all basically 

databases. And we know how many fields there are. There may be 

thousands of different fields. And each field may hold, it could hold 

text; it could hold imagery. I get the difficulty of that. But we 

should already know what that mapping theme is. And in order to 

do the map from DOD to the map at the VA system, why has it 

taken 4 years and $536 million to do that and then everybody 

throws up their hands and says: Our bad, this is really hard to do, 

and we’re going to have to go through separate systems. 

Now, I recognize, I don’t think anybody on this panel was around 

in 2008. 

Mr. DeVries, maybe you were. No? Okay. Not around, but you 

weren’t involved in this. 

So the first step is have we gone back and looked at the problems 

that this would solve, right? And, Ms. Council, I know you’re new. 

And I’m excited about you bringing some expertise, some experience from the private sector. I don’t know if you knew what you 

were stepping into when you took this job, but we’re glad you stood 

up and are willing to take on this challenge. But we have to look 

at the failures of the past. And, I’m sorry, 2 years is not acceptable. 

And saying that, you know, I wasn’t around, when we are talking 

about the fiscal year 2014 NDAA and that we’re going to comply 

with that requirement but at the end of this month, our soldiers 

are not going to be able to walk into a VA system and get access 

to their DOD record. They may be able to see it in JLV. But JLV 

is the equivalent of using microfiche. And you may be able to 

search for an individual patient, but you can’t search, what was 


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their blood pressure? And sometimes you have to have VA clinics 

do the same tests over because they can’t see the imagery that was 

included in their DOD system. That’s a huge waste of time. And 

what is shocking in all this, the men and women, these doctors, the 

healthcare providers in the VA and the DOD, they’re doing a damn 

good job, right, when they’re actually providing that service. And 

they’re the ones that are having to get these workarounds for their 

system to make sure that they’re providing the kind of health care 

that our soldiers, sailors, airmen, and marines have. 

Now, my last question, I’m way over time, and I apologize, Ms. 

Council, do you have all the tools, authorities in order to do this 

job? 

Ms. COUNCIL. I had this conversation with my team. I think it’s 

the first time in my career I can say yes. 

Mr. HURD. Excellent. If you need more, let us know. 

Ms. COUNCIL. Will do. 

Mr. HURD. And, with that, I yield back. 

Mr. COFFMAN. Ms. Kelly, you’re now recognized for 5 minutes. 

Ms. KELLY. Thank you, Mr. Chair. 

The GAO’s written testimony concludes that your decisions to 

pursue separate her EHR highlights, and I quote, ‘‘the criticality of 

these Departments needing to define what they aim to accomplish 

in these efforts and identify meaningful outcome-oriented goals and 

metrics.’’ DOD and VA, do you agree with GAO’s assessment that 

outcome-oriented goals would help measure progress toward interoperability and hold your Departments accountable for their 

progress? 

Ms. COUNCIL. Yes, I do. 

Mr. MILLER. Yes, we do. 

Ms. KELLY. So what do your respective agencies aim to achieve 

from your interoperability efforts. What do you want for your outcome? 

Ms. COUNCIL. From our point of view, we want to be able to have 

a medical, an electronic health record that is accurate for that veteran that can be used in any way, shape, or form that that veteran 

needs to have it used and be fully portable to be where the veteran 

needs to be. 

Mr. MILLER. Ma’am, I would say it kind of goes around what we 

use in the DOD, a quadruple aim, if you will. And those four vectors really are, the first is readiness. At the end of the day, the Department of Defense has to be operationally ready to execute the 

mission. That includes our servicemembers as well as our families 

who take care of them while they are on deployment. Secondly, we 

got to address quality. We got to look at our costs. And we got to 

look at improving decisions that actually impact the lives of our 

servicemembers, beneficiaries, and veterans. 

Ms. KELLY. And what value in benefits would all users gain from 

the deployment of modernized electronic health record systems 

with interoperability? 

Ms. COUNCIL. At the end of the day, it’s a seamless, unified point 

of view. And I think that’s what every patient wants. They want 

not to have to answer the question 10 times, not to have to fill out 

another form, not to have a missed record or a missed report or a 

missed test. They really want the doctor to have the best informaVerDate Nov 24 2008 10:28 Jul 13, 2017 Jkt 000000 PO 00000 Frm 00093 Fmt 6633 Sfmt 6633 H:\25915.TXT APRIL

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tion at their hands, at the time that they need to make the decisions about their health. 

Mr. MILLER. Can I take it a couple ways? One is I think our 

users really want a modern system that helps with decisionmaking, 

gives them productivity time back, looks at engaging modern technologies, like smartphones and some of the natural language processing, because at the end of the day, they’re busy. And we ought 

to be doing everything we can to provide them tools that are open 

and secure to enable them. The second thing I would highlight is 

we want to go after a modern system that is really about the patient, and it’s really about engaging the patient more. We have the 

ability today to provide our health record information to our beneficiaries. But I think when you see what’s going on in the commercial market, you really see where the more the patient is engaged 

in their healthcare decisions, the better the outcome. So one of the 

things we are really after here is making sure that we have a system that engages them and so we really can help drive. And, lastly 

I would say from our perspective on the IT side, it’s also about security and it’s about driving down sustainment costs. The system 

we have today, we, actually it’s multiple systems, we cannot sustain them forever. We have to adopt an enterprise system that handles a lot of that integration and continues to provide us new technologies so that we can drive our sustainment costs down so we can 

be affordable. 

Ms. KELLY. Both of you had great answers. My last question, 

what is the status in defining these outcome-oriented goals? You 

had the right answers. But what’s the status? 

Ms. COUNCIL. As far as we’re concerned, our goals and our new 

dashboard will be up in January for full visibility. We’re looking to 

make sure we’re measuring the right things and we’re measuring 

metrics that matter, not just a bunch of stuff that nobody really 

cares about. 

Mr. MILLER. Ma’am, the IT is actually taking the lead here. They 

actually had a series of summits and meetings, pulling together 

subject matter experts and people to kind of working our way 

through this. In fact, tomorrow is one of those meetings. In the 

case of the larger DOD side, just like the VA, we have a larger performance metrics and things that we monitor. What we’re working 

through right now is trying to understand is that the right map or 

are there things we’re missing. What we’re really trying to do is 

generate a first step that utilizes those. And, in parallel, what I’ve 

also asked that we look at is bringing in some really smart people 

who understand operations research. We have some great FFRDCs 

and activities that really understand how to look at some of these 

things, as well as some of the national health systems. So while 

we’re kind of doing this first effort, we’re also going to be doing a 

very strategic look in engaging some people and having them help 

us work our way through this. We aren’t the first people that have 

tried to figure some of this out. But we recognize that it’s important. And we recognize we got to get something in place that’s better than just measuring transactions between our two Departments. 


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Ms. KELLY. Mr. Chairman and both of you, I look forward to having another hearing so we can hold these Departments accountable 

and see what the progress is. Thank you. 

Mr. COFFMAN. Thank you, Ms. Kelly. Dr. Benishek, you’re now 

recognized for 5 minutes. 

Mr. BENISHEK. Thank you, Mr. Chairman. Ms. Council, I know 

that you’re new there. And I have a couple of specific questions. 

Has anyone reported to you that the Choice Card program participants, the database that’s maintained in the Health Eligibility 

Center is running out of space, and at some point, this issue will 

cause it to crash? Have you heard anything about that? 

Ms. COUNCIL. I have not. 

Dr. BENISHEK. Has anyone revealed to you that the Choice Card 

database apparently didn’t go through the normal security review 

process? 

Ms. COUNCIL. I’m not aware of that. 

Dr. BENISHEK. This Health Eligibility Center is in Atlanta. Do 

you think you could kind of look into these issues that have come 

up to the committee, see if you can go there and see if it’s a reality 

or what exactly the story is with that? 

Ms. COUNCIL. As far as the HEC is concerned, related to the 

other issues, but I’m not sure of the Choice issues that you mentioned but we—— 

Dr. BENISHEK. I’m just bringing this up because the committee 

has had these issues, and as long as you’re before me here, it sort 

of relates to the security question, because I’m on the O&I Subcommittee in the VA. We’ve been reported to that the VA health 

system has been hacked completely. And, you know, I would like 

to be sure that this does not continue to be the case. What’s your, 

what’s your, I saw Mr. Miller was worried about that with the 

DOD. And, certainly, we don’t want a system that gets hacked. 

Ms. COUNCIL. No one wants a system that gets hacked. I’m not 

aware of our systems being hacked, sir. I would love to look at that 

information to certainly understand it better. And we move with 

best diligence and quickly on this issue. And if you, as you’re 

aware, with the cyber strategy we put in place, we’ve tighten up 

our processes aggressively, reduced elevated privileges that people 

have had in our environments, and changed it aggressively. And in 

particular, with the HEC, as it related to the systems and the applications that were engaged with the veterans, we have remediated that system, which was not an OI&T system, but it is now. 

But the Choice program, I will certainly look into that. 

Dr. BENISHEK. I appreciate that. Thank you. 

That’s all I have, Mr. Chairman. Thank you. 

Mr. COFFMAN. Thank you, Dr. Benishek. 

Ms. Duckworth, you’re now recognized for 5 minutes. 

Ms. DUCKWORTH. Thank you, Mr. Chairman. 

There was earlier, Mr. Miller, I think you mentioned that VA 

and DOD have very different acquisition systems. But I believe 

that under the previous CIO at VA, he instituted a program called 

PMAS, Project Management Acquisition System, that, as I recall, 

was very well received and has saved significant amounts of money 

for the taxpayers in terms of how the VA acquires IT systems and 

programs. 


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Ms. Council, is VA sill using PMAS or something similar, a legacy from that? 

Ms. COUNCIL. PMAS is not our acquisition system as much as it’s 

a management system for how programs and product, how programming is done to create code. We are in the process of re-looking and reestablishing PMAS to reduce the overhead that it has 

started to create in order to make sure we can get code done faster 

with higher quality and security and different techniques we need 

built in. So it will be a more wholistic look at everything we do 

from end to end. It’s a solid process. But just like every other process, you need to look at it and constantly keep it up to date. 

Ms. DUCKWORTH. So is it something that would be used as you’re 

working toward improving the electronic medical record system, 

something that would be used with—perhaps work toward interoperability? 

Ms. COUNCIL. Our PMAS system is primarily used to develop 

software and to follow the gates and processes to ensure we have 

all the processes in place to develop software or to purchase software and to deploy it. So it is our management process for how we 

get things done. 

Ms. DUCKWORTH. Thank you. 

Ms. Melvin, can you explain to me in more detail the GAO’s concerns with the decision by DOD and VA to keep operating two separate EHR systems rather than establish a single, integrated system? 

Ms. MELVIN. Our concern is just the inherent duplication that 

comes with having two paths to developing systems that are serving a large body of population that’s very similar. Also there are 

a large number of functions that are for inpatient requirements 

that are the same. A prior report showed 97 percent of those requirements being the same for inpatient I should say. And our concern is from the standpoint of not having a common, whether the 

agencies will have a common goal that they work toward; whether, 

in fact, when they ultimately have this system and they’ve gone to 

these two separate paths, whether they, in fact, do end up with 

systems that have the interoperable capability between them that 

will allow them to serve patients in the way that we’ve talked 

about today and ultimately to improve the healthcare mission. So 

it’s about the cost of having duplicative systems. It’s about the 

overall management relative to your ability to deliver on those capabilities and serve a common mission for the servicemembers. 

Ms. DUCKWORTH. So 97 percent—— 

Ms. MELVIN. This was a study that was previously done that 

showed 97 percent or over 97 percent of their inpatient functional 

requirements were common across the two Departments. So that is 

a factor that goes into our concern that the agencies do need to 

look more closely at what their capability is to put in place a system that’s common for both Departments. 

Ms. DUCKWORTH. Is it a true statement that VA operates the 

largest hospital network in the Nation? 

Ms. MELVIN. The VA and DOD have two of the largest 

healthcare networks in the Nation, yes. 

Ms. DUCKWORTH. How big are they in relative size, the size of 

VA’s network compared to the DOD’s size? 


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Ms. MELVIN. I believe that DOD’s system is slightly larger. I 

don’t want to misspeak on that. But I believe their healthcare system is larger than VA’s. 

Ms. DUCKWORTH. Is it larger in terms of number of patients 

served? Or is it larger in terms of more facilities? 

Ms. MELVIN. I will defer—— 

Ms. DUCKWORTH. Ms. Council, you look like you have an answer. 

Ms. COUNCIL. The DOD is larger in terms of different outlets and 

facilities. We are larger in terms of the number of patients we see. 

Ms. DUCKWORTH. Do you know how many patients you serve? 

Ms. COUNCIL. The last time I saw the number, it was 10 million 

approximately in DOD; 24 million in the VA. 

Ms. DUCKWORTH. All right. So you have more than twice as 

many patients accessing your healthcare system than DOD does. 

Ms. COUNCIL. That information, if I’m recalling it properly, yes. 

Ms. DUCKWORTH. Okay. Ms. Melvin, can you explain how this decision for them to keep two different systems instead of a single, 

integrated system is going to affect interoperability well into the 

future? 

Ms. MELVIN. I don’t know the answer to that. I mean, one of our 

concerns is that the Departments haven’t provided a clear justification for why two systems is better than one. That’s the critical information that is needed to really justify moving toward the two 

systems. 

Again, the history of this has been that they’ve been down the 

path of two systems for many, many years. The single joint system, 

as we understood it, was intended to take care of some of the challenges that the two departments had had in their prior efforts to 

develop interoperable capabilities between two systems. So having 

a justification for why moving back to that, besides the obvious factors of cost and schedule that they have mentioned, are important 

to know. 

Ms. DUCKWORTH. Maybe you’ll get an answer to that question 

since you’ve not been able to get that information as the GAO. But 

maybe with the Congress asking for it, they will finally provide it. 

I’m out of time. 

I yield back. 

Mr. COFFMAN. I thank you, Ms. Duckworth. 

Mr. Hurd, you’re now recognized for 5 minutes. 

Mr. HURD. Ms. Melvin, would you be able to get us a list of the 

individuals by name at DOD and VA, including subcontractors, 

contractors, that worked on the interoperability project between 

2008 and 2013? 

Ms. MELVIN. We will look into the information that we have and 

provide you—— 

Mr. HURD. And I’m curious as to the number of people that 

worked on that project, the interoperability project, from 2008 to 

2013, who are still employed at both organizations, and which contractors we’re still using from that period when we spent over $500 

million and decided that instead of joining everything, we’re going 

to split it up. 

Ms. MELVIN. Chairman Hurd, that is not information that I 

know that we have in our records specifically at this point. But we 

would be glad to work with your staff to get that information. 


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Mr. HURD. Great. Thank you very much. 

Mr. Miller, what are your next two milestones for achieving 

interoperability? 

Mr. MILLER. Sir, on the interoperability front, I actually, just last 

night, we provided an update on our data maps. And so our next 

milestones are basically to continue to evolve those. Our next delivery on the maps because we are now entering a maintenance phase 

and getting feedback, will be in the December timeframe. And then 

we’re also in the process of doing our next software delivery which 

will be early next calendar year. And that software delivery is, basically, again, taking feedback. There’s areas that our functional 

users have requested. And we’re going to be working that software 

release in the January timeframe. 

Mr. HURD. Great. Thank you. 

Ms. Council or Mr. Burns? 

Mr. BURNS. A couple different fronts. One is, on the data mapping, we have a quarterly update that we do. The next one is coming up in November to give us the next set, as I mentioned earlier, 

the 25 domains. And then we update each one of the respective domains going forward. That’s just on data mapping. And that’s part 

of interoperability. In addition to that, we are testing and rolling 

out EHMP, otherwise known as the Electronic Health Management 

Platform. That is, in its current form, is we call version 1.2. And 

that is a read-only version right now. It’s been—it’s in delivery at 

two cites. And we’re going to continue to roll that out. 

Mr. HURD. It’s in delivery, so they’re the beta testers? 

Mr. BURNS. Yes. 

Mr. HURD. What are those cites? 

Mr. BURNS. Hampton and the other one, off the top of my head, 

I don’t recall. But I will get you the name of the other one. 

Mr. HURD. Great. 

Mr. BURNS. And then we are then going to the next phase, which 

is EHMP 1.3, in the January time frame to start what we call IOC, 

Initial Operation Testing, of that. That will give us the first capability of doing order and report write capability beyond the read capability we have. By the way, that also has a very good search engine built into it, the 1.2 version, that will allow you to do a lot 

more search capability and look up information, contextual and 

content capabilities. So those are two key things moving us in the 

interoperability direction to move out. And our goal is to have 1.3 

out by the end of the year so that we can meet the December 

31st—— 

Mr. HURD. Thank you, Mr. Burns and Ms. Council and Mr. 

DeVries. I’m looking forward to having further conversations with 

you all about the implementation of FITARA and ensuring that you 

all have all the tools you need in order to bring our IT infrastructure into the 21st century. Thank you all for being here. 

I yield back, Chairman. 

Mr. COFFMAN. Thanks to the panel. 

You’re now excused. 

Today, we have had a chance to hear about problems that exist 

with multiple efforts between the Department of Defense and Veterans Affairs to make their health records either integrated or 

interoperable. This hearing was necessary to identify the continued 


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failures that have allowed these efforts to remain ongoing after 

decades of attempts to join these two health—to join these two 

health records that cover patients of the largest healthcare systems 

in this Nation. 

As I mentioned in my opening statement, VA has expended billions of dollars in an attempt to improve its electronic health record 

system and make it interoperable with that of the DOD. Yet GAO 

has found that these agencies’ health records would not be fully 

interoperable until at least 2018. Unfortunately, based on VA’s 

track record regarding its information security failures and the numerous attempts made to join these two agencies’ records, I am not 

even convinced that it is a feasible completion date. I am encouraged, however, by the recent personnel changes that have occurred 

within VA’s Office of Information and Technology. But there is still 

much work to be done. 

I believe LaVerne Council has a sound plan and strives to fix 

VA’s OI&T. But the question is, how long will it take? I am angered by the fact that VA and DOD poorly structured and continued to misuse the IPO. It is no longer a, quote/unquote, ‘‘single’’ 

focal point mandated by Congress. It has become as divergent as 

the VA and DOD. And through it, both Departments have grossly 

misused money appropriated by Congress. 

As such, I am exploring ways to correct these problems once and 

for all, since VA and DOD have continued to disregard Congress 

on this matter. 

I ask unanimous consent that all members have 5 legislative 

days to revise and extend their remarks and include extraneous 

material. 

With that, without objection, so ordered. 

I would like to, once again, thank all of our witnesses and audience members for joining us in today’s conversation. And I would 

like to thank Chairman Hurd for holding this joint hearing on 

these very important issues. 

With that, this hearing is adjourned. 

[Whereupon, at 5:27 p.m., the subcommittees were adjourned.] 


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