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VA-DOD SHARED MEDICAL RECORDS—20 YEARS

AND WAITING

HEARING

BEFORE THE

SUBCOMMITTEE OVERSIGHT AND INVESTIGATIONS

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

HOUSE OF REPRESENTATIVES

ONE HUNDRED EIGHTH CONGRESS

FIRST SESSION

NOVEMBER 19, 2003

Printed for the use of the Committee on Veterans’ Affairs

Serial No. 108–28

(
COMMITTEE ON VETERANS’ AFFAIRS 

CHRISTOPHER H. SMITH, New Jersey, Chairman 

MICHAEL BILIRAKIS, Florida 

TERRY EVERETT, Alabama 

STEVE BUYER, Indiana 

JACK QUINN, New York 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

RICHARD H. BAKER, Louisiana 

ROB SIMMONS, Connecticut 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

JEB BRADLEY, New Hampshire 

BOB BEAUPREZ, Colorado 

GINNY BROWN-WAITE, Florida 

RICK RENZI, Arizona 

TIM MURPHY, Pennsylvania 

LANE EVANS, Illinois 

BOB FILNER, California 

LUIS V. GUTIERREZ, Illinois 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

CIRO D. RODRIGUEZ, Texas 

MICHAEL H. MICHAUD, Maine 

DARLENE HOOLEY, Oregon 

TED STRICKLAND, Ohio 

SHELLEY BERKLEY, Nevada 

TOM UDALL, New Mexico 

SUSAN A. DAVIS, California 

TIM RYAN, Ohio

PATRICK E. RYAN, Chief Counsel and Staff Director 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS 

STEPHEN E. BUYER, Indiana, Chairman 

MICHAEL BILIRAKIS, Florida 

TERRY EVERETT, Alabama 

JOHN BOOZMAN, Arkansas 

DARLENE HOOLEY, Oregon 

LANE EVANS, Illinois 

BOB FILNER, California 

TOM UDALL, New Mexico

(II) 
(III)

C O N T E N T S 

November 19, 2003

Page

VA-DOD Shared Medical Records—20 Years and Waiting .................................. 1

OPENING STATEMENTS 

Chairman Buyer ...................................................................................................... 1

Prepared statement of Chairman Buyer ........................................................ 39

Hon. Darlene Hooley ............................................................................................... 2

Prepared statement of Congresswoman Hooley ............................................. 41

Hon. Lane Evans ..................................................................................................... 7

Prepared statement of Congressman Evans .................................................. 43

WITNESSES 

Clawson, Kem, Director of Advanced Technology Solutions, EMC Corporation, 

McLean, VA .......................................................................................................... 34

Prepared statement of Mr. Clawson ............................................................... 105

Farmer, Jr., Maj. Gen. Kenneth L., Deputy Surgeon General, U.S. Army ......... 15

Prepared statement of General Farmer ......................................................... 99

Fites, Jeanne B., Deputy Under Secretary of Defense (Program Integration), 

Department of Defense ........................................................................................ 13

Prepared statement of Ms. Fites, with attachments, .................................... 71

Koontz, Linda D., Director, Information Management Issues, U.S. General 

Accounting Office; accompanied by Valerie Melvin, Assistant Director .......... 5

Prepared statement of Ms. Koontz .................................................................. 45

Murphy, Frances M., M.D., MPH, Deputy Under Secretary for Health Policy 

Coordination, Department of Veterans Affairs; accompanied by Meagher, 

Edward F., Acting Chief Information Officer, Department of Veterans Affairs ....................................................................................................................... 11

Prepared statement of Dr. Murphy ................................................................. 60

Reardon, James C., Chief Information Officer for Military Health System, 

Department of Defense ........................................................................................ 13

Prepared statement of Mr. Reardon ............................................................... 88

MATERIAL SUBMITTED FOR THE RECORD 

Written committee questions and their responses: 

Chairman Buyer to General Accounting Office ............................................. 111

Chairman Buyer to Department of Veterans Affairs .................................... 113

Chairman Buyer to Ms. Jeanne Fites, Department of Defense .................... 125

Chairman Buyer to Mr. James Reardon, Department of Defense ............... 148

Chairman Buyer to EMC Corporation ............................................................ 155

(1)

VA-DOD SHARED MEDICAL RECORDS—20 

YEARS AND WAITING 

WEDNESDAY, NOVEMBER 19, 2003

U.S. HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS, 

COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, DC 

The subcommittee met, pursuant to notice, at 10:30 a.m., in room 

334, Cannon House Office Building, Hon. Steve Buyer (chairman of 

the subcommittee) presiding. 

Present: Representatives Buyer, Bilirakis, Everett, Boozman, 

Evans, Filner, Hooley, and Udall. 

OPENING STATEMENT OF CHAIRMAN BUYER 

Mr. BUYER. Good morning. The Subcommittee on Oversight and 

Investigations on the Committee of Veterans’ Affairs shall come to 

order. 

This hearing is entitled, ‘‘The VA-DOD Shared Medical Records: 

20 Years and Waiting.’’ Since we currently have thousands of 

servicemembers who are transitioning from active duty to civilian, 

and who will need health care, and other veterans’ benefits, this 

hearing cannot be more timely. I believe it is critical that VA and 

DOD share medical information to ensure the continuation of 

health care to returning soldiers, sailors, and marines, and airmen. 

This is an essential component of the processing of VA claims for 

benefits to which the veteran may be entitled. It is very challenging for the VA to determine what is service-connected if the 

flow of information is not accessible and easily retrievable. 

What we are left with are servicemembers with duplicate or incomplete medical records. Earlier this year, the President’s Task 

Force to improve health care delivery for our nation’s veterans 

issued its final report. The Task Force summarized its findings this 

way: The VA and DOD’s responsibility for veterans’ health begins 

as soon as an individual enters the Armed Forces. And please let 

me interject here that should be—that should also include pre-and 

post-deployment medical examinations. 

The Task Force summary went on to say, collecting and capturing baseline medical information upon entry into the military 

and an interoperable, bidirectional, and standards-based electronic 

medical record is the first step in the process. 

I intend to ask both the VA and DOD how these stated goals are 

being met, and what specific progress has been made in these three 

critical areas. 
2

I understand that headway has finally been made on all of these 

issues regarding the setting of standards. 

It is an established fact that technology exists today to accomplish the mission, and I will acknowledge that there have been—

in fact, there has been movement in the last 14 months, perhaps 

even more so than the last 20 years. 

However, the endgame is not yet in sight. 

What we hope to learn today is what are the impressions of insurmountable obstacles that keep these two departments from accomplishing the goal that was first set back in 1982 by Public Law 

97-174. The repeated question is always the same: Why is it taking 

so long, and when will VA-DOD have systems that can talk to each 

other? 

Ever since the first Gulf War, I followed this issue with great interest because I believe it is our responsibility to ensure that we 

avoid the problems that the returning servicemembers face in the 

early 1990’s, which made it very difficult for the VA to make determinations on the disability of claims. 

Today, after some 20 years, and untold billions of dollars, we’re 

going to hear how close that horizon is that will allow our men and 

women that have bravely served our country to have a seamless, 

electronic medical record that captures and documents all of the 

data on their deployment and other issues, such as nuclear, chemical, or biological exposures; medical care and conditions during the 

service to their country. 

As I was reviewing all of the written testimony last night and 

this morning, I noted that DOD did not submit written testimony, 

and I find that unacceptable. And, in my first and only time as 

ever having been a Chairman, whether it was on the Armed Services Committee or on this Committee, have I ever confronted such 

a case. 

General Farmer, I’m pleased that you’re here today, but I am 

displeased that there is not written testimony, and I will 10 days 

to the Department of Defense to submit written testimony to back 

up the oral testimony for which you will give to the Committee. 

And, General Farmer, if you disagree with that, we’ll give you 

the opportunity when you testify to discuss that further. 

At this point, I will yield to Ms. Hooley for any comments that 

she may have at this point. 

OPENING STATEMENT OF HON. DARLENE HOOLEY 

Ms. HOOLEY. Thank you, Mr. Chairman. Obviously, the concept 

of DOD-VA sharing is not a new idea, but it is an idea whose time 

has come. With servicemembers returning from missions abroad, 

and with the VA responsible in many circumstances for assuming 

some important aspects of veterans’ health care, immediate transfer of personnel and medical data is more than just a convenience. 

It is a necessary to account for servicemembers in theatre, track 

their return, and assure that he appropriate care is tendered. 

We do in each of our offices a lot of case work, and I cannot tell 

you how many members’ veterans we work with who do not have 

their records. They don’t know where they are. No one can find 

them. But to have, certainly have the ability to keep those records 
3

electronically, and to transfer them is clearly important to every 

veteran. 

Accumulating this information will also assist in tracking of 

emergent and long-term medical problems of returning veterans. 

This could be readily accomplished today electronically. It should 

be an important element of DOD-VA sharing. But its level of development is not always what this Committee had anticipated. The 

time for meaningful electronic DOD-VA sharing, the time has 

come. 

Actually, it came in 1982, with Public Law 97-174, authorizing 

sharing activities between those two large agencies. So DOD-VA 

sharing is now of age. It turned 21. But this 21-year-old needs a 

lot of attention, and often more than a little encouragement. It cannot yet run nor even walk swiftly. At age 21, its performance is 

close to that in its developmental childhood, not yet possessing a 

two-way vocabulary that fully realizes electronic medical record 

transfer or the significant transfer of personnel data between two 

agencies that individually have far more robust data systems already in place in these areas. 

As Subcommittee clinicians to the body of law wishing to determine why this 21-year-old is not performing, we must ascertain if 

it now has the ability to do what we ask of it regarding electronic 

medical record transfers and other IT sharing issues. If the problem is in the maturity of the design of the DOD-VA sharing concept, we must be patient and wait for it to mature and wait for performance. 

But if we think the sharing concept is able to perform today, we 

must ask why it toddles behind the private sector in working out 

these basic sharing issues. If we determine that the ability to provide electronic medical records transfers and many other issues at 

the heart of the two-way data sharing between the agencies exist 

today, we must hold those agencies accountable for their non-performance. Lives are potentially at stake. And most certainly management efficiencies are on the line. 

At previous hearings by this Subcommittee, we have taken testimony about what will happen regarding some program or agenda. 

We sometimes get a date or set a milestone, only to have agency 

priorities change and a sharing issue moved from the front of the 

parade of ideas to the back burner priority. 

Twenty-one years of planning. Twenty-one years of promise. I 

ask what is the actual level of performance today regarding sharing 

of electronic medical and personnel data. The GAO statement offers 

us cause for hope, but the real performance questions must be answered by you and the stakeholders at field-level activities. It is 

their metrics that matter most. 

In testimony during the May 17, 2000 hearing, both principals 

from DOD and VA, Ms. Gwen Brown and Dr. Garthwaite, testified 

regarding the Government computer-based patient project. The testimony was then in terms of what will happen and notes that the 

agencies had entered agreements to share. 

The GAO tells us now that this precursor system to the current 

Federal Health Information Exchange is yielding one-way transfers 

of information today, and that’s a good beginning. DOD-VA sharing 

was 18 years old at the time of that hearing. 
4

A 1995 hearing on DOD/VA sharing included an agreement to 

develop joint and coordinated efforts with regard to developing telemedicine as a means to improve medicine and as a means to improve readiness and patient care and improve interoperability and 

interconnectivity between VA and DOD services. 

This was a strong portend of electronic medical records transfers. 

DOD-VA sharing was about 13 years old. 

In June of 1986 hearing, on implementation, Chairman Sonny 

Montgomery asked the DOD about its policy regarding the sharing 

of automatic data processing resources with VA. The DOD response 

to the number of working groups focused on sharing. A DOD-VA 

sharing was about three years old. 

We still await the full two-way exchange of patient health information between the agencies in a meaningful and useful way to all 

field-level activities. We do note substantive recent progress toward 

this goal. We have asked for a single form, the form DD–214, to 

be electronically created, archived, and readily available to VA to 

facilitate a myriad of issues regarding VA benefits. 

Is there technology to make the work available today? Is there 

anyone in this room who doubts that this is problematic today from 

a technical perspective. I think not. 

Real progress will be indicated when appropriate people at VA 

are able to access this timely information electronically and nationwide. 

Mr. Chairman, we have heard a litany of promises in the past 

on this and related sharing issues. Sometimes, there’s progress. 

Sometimes, there’s not. 

The technology available to facilitate DOD-VA sharing regarding 

medical and personnel record transfers has improved dramatically 

since 1982, when it was just a vision. 

The technology hurdles to achieve full two-way transfers are not 

difficult to overcome so long as the old cultural barriers to sharing 

between the agencies have been overcome. 

If any remaining cultural barriers to this level of sharing are 

overcome, the problem related to technology will be minor. 

I’m anxious to hear from our panel. Thank you. 

Mr. BUYER. Thank you very much. On the outset, to set the tone 

for this hearing, it is not the intent of the Chair to be combative 

with any of the witnesses today. The ranking member in her testimony I think did a good job of setting the tone. President Bush, 

when he put together his Task Force to Improve Health Care Delivery for Our Nation’s Veterans, one of the provisions, recommendation 3.1, VA and DOD should develop and deploy by Fiscal Year 2005, electronic medical records that are interoperable, 

bidirectional, and standards-based. 

When the VA and DOD create separate systems, and we begin 

to mature them, and now we’re trying to bring them together. We 

understand those key challenges, and this Committee will accept 

the oversight responsibility to make sure that the goals for which 

we are, I believe, in agreement and are congruent can be reached. 

And that’s the purpose of this hearing. And I want to find out 

where you are, and how are we going to get there. And the only 

time I think I’ll ever raise my voice is if I ever sense excuses. 
5

I now will recognize Ms. Linda Koontz, Director of the Information Management Issues, U.S. General Accounting Office, who will 

now be recognized. And, ma’am, would you please introduce who 

you have with you at the table. 

STATEMENT OF LINDA D. KOONTZ, DIRECTOR, INFORMATION 

MANAGEMENT ISSUES, U.S. GENERAL ACCOUNTING OFFICE; 

ACCOMPANIED BY VALERIE MELVIN, ASSISTANT DIRECTOR 

Ms. KOONTZ. Thank you. Mr. Chairman and members of the Subcommittee, thank you for inviting us to testify on actions of the Department of Veterans Affairs and the Department of Defense to 

achieve the ability to exchange patient health care data and create 

an electronic record for veterans and active duty personnel. 

With me today is Valerie Melvin, Assistant Director, who is responsible for managing our work at VA and who will assist me in 

answering your questions. 

VA and DOD, collectively, provided health care services to approximately 13 million veterans, military personnel, and dependents at a cost of about $47 billion in Fiscal Year 2002. 

While in military status and later as veterans, many patients 

tend to be highly mobile, and, consequently their health records 

may be at multiple federal and non-federal medical facilities, both 

in and outside the United States. Further, with soldiers returning 

from various armed conflicts, having readily accessible data on active duty personnel and veterans is important to facilitate providing them with high-quality health care. 

VA and DOD have been pursuing ways to share data in their 

health information systems and create electronic records since 

1998, their actions following the President’s call for the development of an interface to allow the two departments to share patient 

health information. Since undertaking this mission, however, the 

departments have faced considerable challenges, leading to repeated changes in the focus of their initiative and target dates for 

its accomplishment. 

Our prior reports discussing the initiative noted disappointing 

progress, exacerbated in large part by inadequate accountability, 

poor oversight, and planning, which raised doubts about the departments’ ability to achieve an electronic interface among their 

health care systems. When we last reported on the initiative in 

September 2002, DOD and VA had taken some actions aimed at 

strengthening their joint efforts. For example, they had clarified 

key roles and responsibilities for the initiative and begun executing 

near- and long-term strategies for achieving the electronic information exchange capability. 

My statement today will discuss our observations regarding VA’s 

and DOD’s continued actions over the past year to further their implementation of the electronic information exchange, including an 

update on the status of and reported benefits of the near-term initiative, the Federal Health Information Exchange, and the departments’ progress and challenges in achieving the longer term initiative, the HealthePeople (Federal). 

The current one-way transfer of health information resulting 

from the departments’ near-term solution represents a positive undertaking that has begun enabling information sharing between 
6

DOD and VA. As part of the initiative, electronic health data from 

separated servicemembers contained in DOD’s Composite Health 

Care System are being transmitted monthly to a repository, which 

VA clinicians access through the department’s existing system. As 

a result, VA clinicians now have more readily accessible health 

data, such as laboratory, pharmacy, and radiology records, on almost 2 million patients and have noted the benefits of this current 

capability in improving health care delivery. 

Realizing the departments’ longer term strategy, HealthePeople 

(Federal) is farther out on the horizon, VA officials have stated that 

the departments are on schedule to provide limited capability for 

an electronic, two-way exchange of patient health information by 

the end of 2005. However, DOD and VA face significant challenges 

in implementing a full data exchange capability. Although a highlevel strategy exists, the departments have not yet clearly articulated a common health information infrastructure and architecture 

to show how they intend to achieve the data exchange capability 

or what exactly they will be able to exchange by the end of 2005. 

In addition, critical to achieving the two-way exchange will be 

completing the standardization of the clinical data that these departments plan to share. Without standardization, the task of sharing meaningful data is made more complex and may not prove successful. 

Mr. Chairman, access to medical data that includes information 

on the entire lives of veterans and active duty personnel represents 

an enormous step toward enhanced and more efficient medical 

care. To their credit, VA and DOD have achieved short-term success by making DOD health care available to VA clinicians. 

However, critical challenges must still be addressed to successfully implement the longer-term strategy. Unless these challenges 

are adequately resolved, the departments’ goal of a virtual medical 

record based on a two-way exchange of data between VA and DOD 

may be at risk. 

That concludes my statement. We would be happy to answer any 

questions that you might have. 

[The prepared statement of Ms. Koontz appears on p. 45.] 

Mr. BUYER. Excuse me, would you recognize who’s sitting with 

you at the table, please? 

Ms. KOONTZ. Pardon? 

Mr. BUYER. Would you please recognize who’s sitting with you at 

the table? 

Ms. KOONTZ. Valerie Melvin, Assistant Director, GAO. 

Mr. BUYER. Thank you, Valerie. To the Committee Clerks, prior 

to the introduction of our first witness or the first panel, I was remiss when I turned to the right. I did not see the ranking member 

of the Full Committee was here, who wished to give an opening 

statement. So, to make the public record clear, what I would prefer 

that you do is I’m going to recognize two members who would like 

to give an opening statement. They’ll give their opening statement. 

Please insert that prior to the GAO’s testimony when you develop 

the record. And then we’ll seek regular order. 

I now recognize Mr. Lane Evans for an opening statement. 
7

OPENING STATEMENT OF HON. LANE EVANS 

Mr. EVANS. Thank you, Mr. Chairman. I am pleased that you’re 

holding this hearing. I was elected to Congress in the same year 

that this DOD/VA sharing was mandated by law. Over the years, 

the success of sharing has been a recurring theme on this Committee. 

Whenever we research or view this issue in search of a cause for 

sharing problems, discussion often turns to organizational culture. 

VA and DOD have always had opportunities to enhance effectiveness and services through sharing. Too often, they don’t avail 

themselves of those opportunities, at least without a general nudge 

from somewhere. 

Today’s hearing involves the electronic medical records transfers. 

I’m pleased that progress has been made and that an information 

flow now exists from DOD to VA for some medical records. 

Yet, timeliness, completeness, and bidirectional data flow limitations remain as problems. 

It’s not likely that these problems were caused by technological 

limitations. That they could not be solved, and could not be solved 

in a short order. It’s just that some cultural barrier remains at the 

progress in this area. We need to explore this. I thank you, Mr. 

Chairman, for giving this time, and I yield back the balance of time 

to you. 

Mr. BUYER. Thank you, Mr. Evans. Mr. Udall, you’re now recognized for an opening statement. 

Mr. UDALL. Thank you very much, Mr. Chairman. I don’t have 

an opening statement. Pleasure to be here, and happy to go to the 

witnesses. 

Mr. BUYER. Thank you. Ms. Koontz, in your testimony, you stated that our prior reports discussing the initiative noted disappointing progress, exasperated in large part inadequate accountability and poor planning and oversight, which raised doubts about 

the departments’ ability to achieve an electronic interface among 

health information systems. 

Give me your overall—I’ve read your report, but I just want to 

hear from your testimony orally, what’s your report card on their 

overall efforts to these two departments? 

Ms. KOONTZ. The near-term effort, the Federal Health Information Exchange, has clearly been a short-term success for both departments. And this occurred I think largely because both DOD 

and VA recognize the need for more accountability, better oversight, and better planning that they were able to execute this particular initiative, and by all reports this is working very well. VA 

clinicians are getting information that they never had before, and 

they find that the performance of the system is very quick. The 

data is accessible. It’s what they need. 

I think an assessment of the longer term effort remains more in 

question because we would like to see a more detailed plan, a more 

detailed architecture and infrastructure that would explain exactly 

how the interface is going to be accomplished. 

Mr. BUYER. VA officials have stated that the departments are on 

schedule to provide a limited capability for an electronic two-way 

exchange of patient health information by the end of 2005. Do you 
8

find their scheduled milestone realistic, and how did the VA, to 

you, define a limited capability? 

Ms. KOONTZ. The 2005 date seems generally realistic. But you 

have to keep in mind that it is dependent on many, many variables, including both DOD’s progress and VA’s progress in developing their own systems. And when you look at what’s going to be, 

it’s not clear to us at this point exactly what capability is going to 

be provided at 2005. However, it will be limited by the fact that 

VA’s data repository of health information won’t be ready until 

2006. It won’t be completed until then. So in 2005, they’re hoping 

that they would have enough capability to begin exchanging information. The capability at that time may also be limited by what 

extent standards are in place. As of right now, there is a laboratory 

results standard in place. But it’s unclear that the standards that 

would, you know, facilitate the exchange of information, which ones 

of those will be ready by 2005. 

Mr. BUYER. Would you please give your assessment on how much 

longer you believe it will take for the two departments to complete 

the standardization of clinical data? 

Ms. KOONTZ. According to the schedule that is in the joint VADOD strategy, I think they anticipated having health data information standardized by the end of this year. That appears as though 

that’s not going to happen. 

I would say it’s not completely unreasonable, though, that it’s difficult for anybody to say when the standardization is going to be 

complete, because this is part of a larger government-wide effort to 

standardize health data. And usually the development of standards 

involves a long sort of consensus-based discussion, with lots of negotiations, and it’s often very difficult to say when those discussions are going to be concluded. 

Mr. BUYER. On page 5 of your testimony, your written testimony, 

you provided a timeline for completion of health vet initiatives. 

When you look at the timeline, VA will have an appointing schedule capability in 2012. Does DOD currently have one in place? 

Ms. KOONTZ. What’s the capability in place by 2012? Oh, the full 

capability—they don’t have the full capability. Their target date is 

2008. 

Mr. BUYER. For DOD? 

Ms. KOONTZ. For DOD. DOD is going to be done sooner than 

that. 

Mr. BUYER. Why do you think it will take nine years for the VA 

to complete that initiative? 

Ms. KOONTZ. I would agree that the timeline looks very long. But 

I have to say that without a more—we have not yet done the work 

that would look at the detail of that system’s development——

Mr. BUYER. Okay. 

Ms. KOONTZ. We’ve been concentrating on the interoperability 

issues. So, without having looked at that detail, I can’t say if 

there’s opportunities to speed that up or whether that’s a reasonable time frame. 

Mr. BUYER. All right. Maybe that’s an answer that Dr. Murphy 

could give us. 

Ms. KOONTZ. Mm hmm. 

Mr. BUYER. Ms. Hooley, you’re now recognized. 
9

Ms. HOOLEY. Thank you, Mr. Chair. Ms. Koontz, you paint a 

promising picture in your testimony. The effective use of FHIE is 

already contributing to VA health care by providing ready access 

to DOD records. The Healthy People Program is a program designed to support two-way data exchange in a myriad of areas. 

What this system will eventually do does look impressive. The program includes a timeline, and I have two questions in regards to 

the timeline. 

Ms. KOONTZ. Uh-huh. 

Ms. HOOLEY. If you were to review past projections by DOD or 

VA in pursuing either department-wide or joint information technology based projects, have the estimates given for specific goals, 

have they usually been met? Are they too generous or too conservative in their estimates? That’s the first question. 

And two, what’s the state of the technology to accomplish the 

Healthy People Program goals? Is there a comparable system anywhere in the private sector? And when was that technology available? 

Ms. KOONTZ. As to the timelines, I think we have to admit that 

when you look at the, you know, the development of an interoperable health record over time that historically there has been problems with meeting timeframes. I mean there’s been problems with 

DOD in terms of developing its own medical records system, CHCS 

II. I would say that the record in the past would probably make 

one question whether moving forward, whether they can meet 

these dates. I think this is largely dependent on the more specific 

planning that we’re calling for, that I’m sure will be coming in the 

future. That was one of the issues that plagued the development 

of the prior system. 

So, with proper planning, I think that they’ll be able to give you 

a lot better idea of when these achievements are going to occur. 

The second one on technology. 

Ms. HOOLEY. Is there a comparable system in the private sector, 

and when was that technology available? I’m just trying to figure 

out is the technology there to do this, and it is available? 

Ms. KOONTZ. We’re not aware of any comparable situation in the 

private sector that we could point to in terms of a success on this. 

We’re just not aware of anything. 

Ms. HOOLEY. So the technology is not available? 

Ms. KOONTZ. I’m just not aware of it. I don’t know. And it is unclear to us at this point. Without the more detailed planning, it’s 

unclear exactly how it is that they plan to accomplish this interface 

between these two systems. I’m just not aware of that. 

Ms. HOOLEY. I have another question. This has been a very long 

planning process, and I know that there are a lot of things that 

take a long, you know, a long time to plan——

Ms. KOONTZ. Uh-huh. 

Ms. HOOLEY. You’re dealing with two huge agencies. You’re dealing with technology. But my question is: is there something that 

we should have done or should be doing to have made this happen 

more quickly. I mean, it seems like the progress we’ve made have 

been some, but in 21 years, it’s not what I would expect. 

Ms. KOONTZ. Like so often with any kind of systems development 

project, it comes down to how the project is managed. From the be-
10

ginning, I think the problems that we identified were the lack of 

accountability. There was not adequate planning, and there was inadequate oversight by management. And those were the things 

that prevented them at least since 1998 from making this a reality 

at that point. 

Ms. HOOLEY. Do you think those things are in place today? 

Ms. KOONTZ. I think that VA and DOD have made great progress 

in all those areas. 

Ms. HOOLEY. Do you think those are—do you think we have 

enough in place that we can move, actually make progress on this? 

Ms. KOONTZ. I don’t—— Ms. HOOLEY. I mean, this has a been long time in coming. 

Ms. KOONTZ. I agree with you. I think the key thing that we saw 

that one would need in order to move forward was when you look 

at—let me back up. When you look at the DOD—the joint DODVA strategy for achieving interoperability between the two systems, the strategy is articulated at an extremely high level. It’s 

very much at the level that we’re going to build an interface between these two systems. 

The thing that is needed next in order to move forward is a much 

more specific articulation of how that is going to be accomplished—

what technology will be used. What hardware and software? Specifically what information—what data will be exchanged? What are 

the requirements of the interface? What security will be needed? 

These are all the kinds of things one needs to know in order to 

progress with a disciplined approach to developing interoperability. 

Ms. HOOLEY. Do you think those have been articulated? 

Ms. KOONTZ. No, they have not been articulated yet. No. 

Ms. HOOLEY. Okay. All right. Thank you. 

Mr. BUYER. Mr. Evans. 

Mr. EVANS. Reflecting on my past experience from the House 

Armed Services Committee, the Composite Health Care System 1 

that Ike Skelton, then Chairman of the Personnel Committee, put 

a lot of time and effort in. And then I ended up with CHCS II. And 

my question is: when I look at the billions of dollars that have put 

into the system, do you believe it’s realistic that CHCS II is going 

to be online by 2005? 

Ms. KOONTZ. CHCS II is not scheduled to be totally online by 

2005. I understand that CHCS II release one, first release, is in 

limited deployment, and they recently got approval to go to full deployment. That deployment of the first release will occur, I understand in September 2005. There is a lot more work that needs to 

occur after that time. 

Mr. BUYER. Am I correct in my assumption that the VA is dependent upon DOD getting this done? 

Ms. KOONTZ. They are both dependent on each other getting 

their systems done——

Mr. BUYER. Right. 

Ms. KOONTZ. Because in order to exchange data, each of them— now, DOD has already built a data repository; that is, the storage 

of their health care information. It’s not fully populated yet, but 

they do have the repository. VA’s repository won’t be ready fully 

until 2006. It’s essential that both of them have those—they have 

to have the repositories. They have to have them populated with 
11

data, and they have to have the standards in order to exchange, 

and they have to have an interface that will allow that exchange. 

All those things need to happen, and they are dependent on each 

other to make this vision a reality. 

Mr. BUYER. Give me your, please, your educated best guess on 

when do you think this can be achieved, realistically, between 

these two departments? I know you set out the timelines. 

Ms. KOONTZ. Uh-huh. 

Mr. BUYER. Give me your best guess based on where you are 

right now. 

Ms. KOONTZ. We from GAO do not like to speculate, as you might 

imagine. 

Mr. BUYER. That’s why I said your educated best guess——

Ms. KOONTZ. And so——

Mr. BUYER. Personal opinion. 

Ms. KOONTZ. My personal opinion is that it can be achieved. Will 

it be achieved on this time frame? I just don’t know, and I would 

be hesitant to guess that. 

Mr. BUYER. All right. Thank you very much for your testimony. 

The first panel is now excused. 

Ms. KOONTZ. Thank you. 

Mr. BUYER. Please extend my compliments to your staff for their 

good work. 

The second panel will now come forward. We recognize Dr. 

Frances M. Murphy, Deputy Under Secretary for Health Policy Coordination, Department of Veterans Affairs. Also is Major General 

Kenneth L. Farmer, the Deputy Surgeon General of the U.S. Army, 

representing Dr. Winkenwerter. Also Ms. Jeanne Fites, Deputy 

Under Secretary of Defense for Program Integration; and Mr. 

James C. Reardon, Chief Information Officer for the Military 

Health System. 

Dr. Murphy, Good morning. 

STATEMENTS OF FRANCES M. MURPHY, M.D., MPH, DEPUTY 

UNDER SECRETARY FOR HEALTH POLICY COORDINATION, 

DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY 

EDWARD F. MEAGHER, ACTING CHIEF INFORMATION OFFICER, DEPARTMENT OF VETERANS AFFAIRS; JEANNE B. 

FITES, DEPUTY UNDER SECRETARY OF DEFENSE (PROGRAM 

INTEGRATION), DEPARTMENT OF DEFENSE; JAMES C. 

REARDON, CHIEF INFORMATION OFFICER FOR MILITARY 

HEALTH SYSTEM, DEPARTMENT OF DEFENSE; AND MAJ. 

GEN. KENNETH L. FARMER, JR., DEPUTY SURGEON GENERAL, U.S. ARMY 

STATEMENT OF FRANCES M. MURPHY 

Dr. MURPHY. I am pleased to appear before the Subcommittee to 

discuss the progress being made by the Department of Defense and 

the Department of Veterans Affairs to share health information 

and to develop a veteran-centric, seamless electronic health record. 

I’m accompanied this morning by Mr. Ed Meagher, Deputy Assistant Secretary of VA’s Office of Information and Technology. With 

your permission, I’d like to enter my entire testimony into the 
12

record, but I will summarize briefly this morning, and then Mr. 

Meagher and I will be prepared to respond to your questions. 

Mr. BUYER. Your written testimony shall be entered. 

Dr. MURPHY. One of the most important lessons learned from the 

previous wars is the need for interagency collaboration on deployment health issues. VA needs information that may be relevant to 

recently deployed servicemembers’ or veterans’ immediate health 

care needs, to clinical and administrative data to establish combat 

theatre veterans’ status, and to evaluate and meet long-term 

health care needs of America’s veterans. 

The ‘‘President’s Task Force to Improve Health Care Delivery 

For Our Nation’s Veterans,’’ the PTF, focused upon the importance 

of providing for a seamless transition from military to veteran status, and included in that focus the coordination and sharing of electronic health information between VA and DOD. Furthermore, the 

record shows that in the past decade alone, almost a dozen expert 

panels have provided valuable advice on the content of the seamless, life-long record system for these purposes. 

Through the VA-DOD Health Executive Council and the Joint 

Executive Council, VA is working with DOD in other venues to 

keep up the focus on this critical goal of information sharing. It’s 

important to recognize the importance and significant first steps 

that have already been taken by VA and DOD in these areas. We 

have developed a joint business case for electronic health record exchange through the Federal Health Information Exchange, and 

have substantially implemented the records exchange. 

As a result, VA clinical staff now have access to information that 

was collected in DOD’s Composite Health Care System on veterans 

who have been discharged since that system was implemented in 

1989. 

Progress towards development of electronic medical records that 

are interoperable, bidirectional, and standards-based by the end of 

2005 is also taking place. It’s important to note that VA’s health 

data repository is projected to be available in 2005, and that the 

Joint VA-DOD Interoperable Electronic Health Record Plan, which 

has also been known as Healthy People Federal, further commits 

the two departments to implementing compatible IT enterprise architectures and adopting common standards by 2005. 

This will be a significant step towards reaching our goal of 

achieving a lifelong health record for veterans. That health record 

starts with the Recruit Assessment Program (RAP) and continues 

throughout the remainder of the life of the veteran. 

Mr. Chairman, as discussed during the full Committee hearing 

on October 16, VA’s Seamless Transition Task Force has led to development of a number of new initiatives to assure VA is providing 

world-class service to those returning from Operation Iraqi Freedom and also to the Afghanistan Enduring Freedom Veterans. 

This task force continues to monitor services being provided to 

these veterans and to develop further system improvements to support attainment of these goals. 

VA has successfully adapted many existing programs and created 

new programs, as necessary, that have improved outreach, improved clinical care through practice guidelines and educational ef-
13

forts, and improved VA’s health care providers’ access to medical 

records. 

We’re actively working with DOD to attain the maximum level 

of sharing of information on injured combat veterans and recently 

discharged veterans. My statement provides a report on our Joint 

Interoperable Health Records Plan, and the progress to date, as 

well as other efforts that are underway to expand VA and DOD information and information technology systems sharing. 

This concludes my statement, and my colleagues and I will be 

happy to answer your questions. 

[The prepared statement of Dr. Murphy appears on p. 60.] 

Mr. BUYER. Thank you, Dr. Murphy. Major General Farmer, 

you’re now recognized. 

Ms. FITES. Let me start out. I’m Jeanne Fites, the Deputy Under 

Secretary for Program Integration——

Mr. BUYER. Is not General Farmer representing the Secretary of 

Health; are you not? You are. All right. You’re recognized. 

STATEMENT OF JEANNE FITES 

Ms. FITES. I’m really pleased that we have the Under Secretary 

for Personnel and Readiness to appear before this Committee, Mr. 

Chairman and Members, to talk about the initiatives that we are 

trying to take to expedite the sharing of personnel and health information with the Veterans’ Administration. 

We have been working on this since the last Gulf War, and we 

are committed to making it work. What I would like to do is introduce my colleagues who have more of the substantive part of the 

statement, then I’ll come back and answer the explicit questions I 

can answer for you. 

I’d like to introduce Mr. Jim Reardon, who’s the Chief Information Officer for the Military Health System, and Major General 

Kenneth Farmer, who’s the Deputy Surgeon General of the U.S. 

Army. 

Mr. BUYER. Are you testifying? 

Ms. FITES. Yes, but since I’m testifying on the Defense Integrated 

Military Human Resources System Personnel Pay Questions, and 

the DD–214’s, I thought that you wanted to hear first from them 

on the bigger systems. 

[The prepared statement of Ms. Fites, with attachments, appears 

on p. 71.] 

Mr. BUYER. All right. Go ahead. 

STATEMENT OF JAMES C. REARDON 

Mr. REARDON. Okay. Mr. Chairman, thank you very much. Distinguished members of the Committee, thank you very much for 

providing the opportunity to appear before you today. With your 

permission, I would like to submit my written testimony for the 

record and provide the Committee with a brief summary. 

Mr. BUYER. No objections. Your statement shall be entered in the 

record. 

Mr. REARDON. Thank you, Mr. Chairman. I want to assure you 

that our highest priority is to maintain the health of our military 

members with a continuum of medical care. This care begins with 
14

entry into military service and ends with separation or retirement 

and transition to the VA health care system. 

The ability to transfer electronic health information is a significant factor for improving the continuity of care for those who have 

so loyally served our country. 

Over the past two years, the Department has made unprecedented strides toward a level of partnership, launching a new era 

of collaboration between DOD and VA. This partnership has fostered several initiatives between the departments. 

There is still much to be done, but a number of these initiatives 

address clinical data interoperability that will benefit 

servicemembers as they transition to veteran status. 

The Federal Health Information Exchange, which has been discussed earlier, supports the secure transfer of electronic health information from DOD to VA at the time a servicemember separates 

or retires from active duty. 

To date, DOD has transmitted electronic medical information to 

the VA on more than 1.7 million retired or discharged 

servicemembers. This number continues to grow as health information on recently separated and retired servicemembers is packaged 

and electronically transmitted to the Veterans’ Administration. 

VA providers and benefits administrators within the VA nationwide are utilizing this information for the delivery of health care, 

as well as the adjudication of disability claims. The departments 

are working on interoperability between DOD’s clinical data repository and the VA’s health data repository. This initiative will provide a more robust capability and institute a two-way exchange of 

information responding to the needs of DOD and VA providers. It 

will also meet the recommendations of the President’s Task Force 

to Improve Health Care Delivery for Our Nation’s Veterans and address the interoperable electronic medical records objectives in the 

VA-DOD Joint Strategic Plan. 

Indicative of the senior leadership’s support for this initiative is 

that at that September 2002 DOD-VA Health Executive Committee 

Meeting, the Assistant Secretary of Defense for Health Affairs and 

the Veterans’ Affairs Under Secretary for Health co-signed an executive decision memorandum defining the goals of the Joint DOD 

Electronic Health Records Plan. A DOD-VA team is now in place, 

led by senior clinical managers and information technologists from 

both departments, managing the plan’s execution. 

A prototype test supporting bidirectional exchange of pharmacy 

and drug allergy information will begin in 2004. One of the cornerstones of this initiative is DOD’s clinical data repository, developed 

for the Composite Health Care System II, which is DOD’s electronic health record. 

CHCS II was created by providers for providers, allowing care 

givers at all military hospitals, clinics, and dental facilities worldwide, immediate, and secure access to beneficiary health records 

day or night. 

DOD’s clinical data repository is operational today, supporting 

more than 17,000 patient encounters per week. It is maintaining 

a master patient index of all DOD beneficiaries and the clinical 

data records of more than 400,000 individual patients are online at 

that repository. 
15

Having successfully completed the limited production phase of 

this program, full fielding of CHCS II will begin in January. The 

initiatives highlighted today and in my written testimony directly 

support sharing of DOD-VA medical information and development 

of seamless interoperable medical records. Mr. Chairman and distinguished members of the Committee, the Department of Defense 

and the Department of Veterans Affairs have joined forces to improve the sharing of medical information in accordance with the 

Health Insurance Portability and Accountability Act of 1996 and 

the Privacy Act of 1994. Our efforts are focused on continually enhancing the continuity of health care to active servicemembers and 

our veterans. 

Thank you for the opportunity to testify before your Committee 

today on this important issue, and I will be pleased to take your 

questions. Thank you, sir and madam. 

[The prepared statement of Mr. Reardon appears on p. 88.] 

Mr. BUYER. All right. Major General Farmer. 

STATEMENT OF MAJ. GEN. KENNETH L. FARMER, JR. 

General FARMER. Mr. Chairman and members of Committee, I’m 

Major General Ken Farmer, the Deputy Surgeon General of the 

Army, and I thank you for this opportunity to represent General 

Peak, our Surgeon General, and to appear before your Committee 

today and discuss our ongoing efforts to electronically share medical information with the Department of Veterans Affairs. 

I will submit testimony for the record, Mr. Chairman, as you requested earlier this morning. And we’d like to provide this oral 

statement. 

As you heard from Mr. Reardon, we are collectively involved in 

the development and implementation of multiple information management and information technology programs to improve our ability to electronically share patient information between the Department of Defense and the VA. 

The implementation and next generation of the Composite 

Health Care Systems, CHCS II, across the military health care system represents the heart of our effort to create a seamless, longitudinal electronic medical record that captures patient care from the 

first medical visit at the medical entrance station to the last visit 

as a solider, including all care provided from fox hole to medical 

center. 

The first step in this complex effort is the development of outpatient care functionality, found in CHCS II block one, which the 

senior military medical advisory committee recently approved for a 

30-month accelerated fielding beginning in January of 2004. Using 

spiral development processes that are closely to evolving medical 

requirements, additional CHCS II functionality blocks are under 

development and testing and will collectively represent all patient 

care provided across the entire health care continuum. 

The military health system patient care data will be deposited 

into the clinical data repository, and, because of joint DOD-VA effort, will be available for two-way interface with the VA health 

data repository in 2005, thus establishing the seamless electronic 

record envisioned by all. 
16

I’d like to focus the remainder of my remarks on specific Army 

Medical Department initiatives to reengineer clinical and business 

practices that underpin the successful deployment of CHCS II and 

other electronic patient care systems. 

I’ll discuss also interim electronic solutions and the Army participation on DOD and VA joint demonstration projects. 

Establishing close partnerships with the VA such that clinical 

and business requirements are understood represents an important 

first step. Over the past two years, the Army and VA have developed a process to provide a single separation physical examination 

at all but one Army medical treatment facility, and that one will 

come on line before the end of the year that meets both DOD and 

VA requirements, establishing the identification of requirements 

that can be developed into a data lexicon and mapped both DOD’s 

clinical data repository and the VA’s health data repository. 

Force health protection and the associated pre- and post deployment health assessments represent another area of joint focus by 

DOD and VA. In September of 2002, the Army Medical Department 

launched an initiative to improve the process of pre- and post-deployment health assessments by automating the collection, distribution, and archiving of the data. 

The goal is to streamline the data entry process, standardize the 

data fields, and eliminate the need for copying, mailing, and scanning paper forms. These paper forms, which included a four-page 

questionnaire filled out by the servicemember, was a labor-intensive manual process, leading to inevitable lost records, erroneous 

data entries, and delays in getting the data scanned into the Central Army Medical Surveillance Activity database. 

An Internet version of automated pre- and post-deployment 

health assessment forms was activated in the Army’s Medical Operations System website on April 1st of 2003. A hand-held computer version, with the automated forms, was successfully integrated into the system on the 23rd of July of 2003 and was sent 

for use by the Coalition Forces Land Component Commander in the 

Middle East and to the European Theater in August of 2003. 

Over the past five months, about a fifth of the worldwide collections of the post-deployment surveys have been collected using 

these various electronic tools, and this percentage is increasing. 

Recently, the Army used a hand-held device at Fort Lewis, 

Washington, to support the automated collection and archival of 

pre-deployment health assessments for 98 percent of the 4,400 

troops deploying. 

Today, military providers can access the completed electronic 

pre- and post-deployment forms at the Army’s Medical Surveillance 

Activity Database through Tracker Online, which provides the 

encrypted HIPAA-compliant portal for accessing protected patient 

information, and efforts are underway to provide the same kind of 

access to VA providers. 

We have a number of Army medical treatment facilities in which 

a VA clinic is embedded. At Tripler Army Medical Center, VA physicians have access to the CHCS host server. Pharmacy orders 

placed in CHCS, to be filled at a VA pharmacy, are sent electronically to the Veterans Health Information System and Technology 

Architecture, called VISTA, and the laboratory orders placed by VA 
17

physicians in VISTA, to be completed at the Tripler Laboratory, are 

sent electronically to CHCS, and the results are sent back to 

VISTA so that they are visible in both systems. 

DOD providers will soon have access to the VA computerized patient records system and VISTA through a web-interfaced Army Interim Patient Record System, the ICDB. 

This effort provides practical experience in our effort to create 

the seamless transfer of electronic information. William Beaumont 

Army Medical Center in El Paso, Texas, is another Army location 

where the transfer of CHCS laboratory data to the VA VISTA host 

server occurs. In fact, William Beaumont, where CHCS II has already been fielded as one of two Army limited deployment sites, is 

also one of eight DOD medical demonstrations sites selected to participate in joint demonstrations with VA medical facilities, as mandated by the FY 2003 National Defense Authorization Act. 

A second Army medical information system demo site is between 

Madigan Army Medical Center in Tacoma, Washington, and the 

Puget Sound VA Health Care System. And that demo site will provide read-only access to both the Army’s Interim Health Forces Integrated Clinical Database and the VA’s computerized patient 

record system and will provide visibility of clinical information at 

the point of care in either health care system. 

The Army Medical Department is committed to improving the delivery of health care to all its military beneficiaries through the 

seamless exchange of electronic medical information with the VA. 

This effort requires not just the implementation of technical solutions, but also reengineering of clinical and business processes supported by these information management tools. 

Collectively, the DOD initiatives described by Mr. Reardon and 

the examples of reengineering efforts underway in the Army Medical Department represent the critical steps to realizing the seamless electronic medical record that captures and shares patient care 

information, beginning with the first encounter at the entrance station through the provision of military care over the 

servicemember’s career, followed by the care rendered in the VA facilities. 

In closing, I would like to thank the Committee for your continued commitment and support to provide quality care for our soldiers and for our veterans, and I will be happy to take questions 

with the panel. Thank you. 

[The prepared statement of General Farmer appears on p. 99.] 

Mr. BUYER. I’d like to know how you are going to address HIPAA 

concerns as we move forward. 

General FARMER. Mr. Chairman, I will respond, and my colleagues may have also some information on that. But, as you know, 

the HIPAA law does have a——

Mr. BUYER. This question, though, General Farmer, is not just 

to you. It’s also to the VA, because this data and information is 

going to be going both directions, and the VA may end up with information for which DOD doesn’t have and for whatever reason 

may be shipped back. 

General FARMER. Yes, sir, the exemption in the law that allows 

us to pass information to the Veterans’ Affairs for determination of 

benefits and for the provision of health care is an important vehicle 
18

that allows us, at the point of separation or retirement, to pass 

that information to the VA. 

Mr. BUYER. I just didn’t know if you have to create a document 

with guidelines or that the law in and of itself is sufficient. 

Dr. MURPHY. No, the HIPAA regulations themselves have a provision—— Mr. BUYER. Good. 

Dr. MURPHY. That allows us already, with the existing HIPAA 

regulations, to pass this information back and forth. No special 

agreements or new provisions are necessary. 

Mr. BUYER. Thank you. Dr. Murphy, with regard to these discussions about measurable milestone objectives, would you like to comment on them, please? 

Dr. MURPHY. I would like to comment on that because, in fact, 

the VA Health Data Repository is expected to be ready by 2005, 

and the scheduling ready by 2006. As with any development process, depending on whether unrecognized difficulties are encountered along the way, the timeline might slip. 

However, we do have a system of accountability that allows us 

to adjust and actually recover from those situations. In addition, 

we have instituted a better project planning process through the 

Department CIO that we believe will improve the performance in 

the future. And I’d like to ask Mr. Meagher to add anything that 

he’d like to about that process. 

Mr. MEAGHER. Thank you. First of all, I have to decline the honorific. It’s not doctor. It’s mister. But we have, in fact, established 

a standardized program management system throughout the Department, and we have, in fact, submitted all our A-300s to OMB 

this year, with a certified level three program manager. And we are 

tracking these projects now by cost, performance across the Department on a real-time basis or actually it’s now once a week, but it 

will soon be real-time. 

Mr. BUYER. Dr. Murphy, is the VA, are they getting any of the 

DOD’s pre- and post-deployment screening data in any format? 

Dr. MURPHY. At this time, I’m not aware that we have access to 

the pre- and post-deployment screening; however, we are working 

on getting that capability in the very near future. The records are 

available in a database and can be transferred to VA as soon as 

DOD makes a policy decision to do so. 

Mr. BUYER. Well, I think it’s pretty exciting, General Farmer, 

that you went out, and you obtained this technology and did it 

paperless. It saves a lot of time. But somehow, it’s got to get to 

where it needs to be. 

General FARMER. Yes, Mr. Chairman, if I may. Right now, 

whether we do those surveys electronically or in paper, we are putting a copy of those surveys and reports into the paper record. So, 

one of the ways now, in the interim, that that information is available to the VA upon separation is that upon separation the appropriate medical or health record of the soldier is made available to 

the VA, and it will have that screening form in it. 

Now, as I said, we are working toward being able to provide that 

electronically to them. That is a work in progress. 

Mr. BUYER. Dr. Murphy, by 2005, are you going to be able to access DEERS in real-time? 
19

Dr. MURPHY. I don’t believe that we will be able to access 

DEERS. By 2005, we will have access to the available electronic 

medical records. However, we do have access to personnel information at this point, and I ask Ms. Fites to respond in more detail 

to the issue of DEERS. 

Ms. FITES. We are working together with the VA to share the 

DEERS information base. We have not worked out how we’re going 

to do it all the way. We do give them nightly feeds, the personnel 

parts of the information. But we are committed to working together 

to have it shared. 

Mr. BUYER. So any rumors that we hear on the Hill that that initiative has been derailed or stopped is strictly a rumor? 

Ms. FITES. As far as I know. 

Mr. BUYER. Okay. I accept your testimony. 

Dr. MURPHY. Mr. Chairman? Mr. Chairman? 

Mr. BUYER. Yes. 

Dr. MURPHY. Could I offer—part of the confusion may be that we 

expected to adopt DEERS as the VA enrollment system and therefore to be able to share the DOD information contained within 

DEERS. However, at this time there has been no decision made by 

VA to move forward with adoption of DEERS as our enrollment 

system. That may be where you’re hearing rumors that we’ve taken 

a step back in the planning process, and we’re back at stage one 

looking at the content and requirements in DEERS. And I’m sure 

Mr. Meagher would be happy to expand on that for you. 

Mr. MEAGHER. Yes, sir, I think there’s no question on our part 

that DEERS data is the most relevant data, and we currently are 

looking at standardizing that. Currently, we receive 31 data feeds 

from DEERS, and we give them 11. And I think one of the problems has been some inconsistency. So, we have not changed at all 

in our commitment to working with DOD and using the DEERS 

data. We’ve simply put a step in front that says we need to understand this data just a little bit better, and we need to understand 

our own requirement. It’s a very short-term step, and I think it’s 

the most prudent thing we can do. But it does not or should not 

reflect in any way a lack of commitment or a change in direction. 

Ms. FITES. And the Department of Defense is committed to providing the data. It’s a matter of we’re working together to figure 

out——

Mr. BUYER. In real time? 

Ms. FITES. The best way to do it. Yes. 

Mr. BUYER. In real time. 

Ms. FITES. Yes. 

Mr. BUYER. Thank you. To my colleagues, we have the right people sitting at the table here, and I have no objections at all for taking up the five minute rule so you can develop your questions even 

further. I yield to Ms. Hooley. 

Ms. HOOLEY. Thank you, Mr. Chair. First, I would like to acknowledge a group of students here from Washington, DC, participating in the Close Up Program, and welcome. This is a committee 

where we’re talking about issues that are very current right now 

with the VA Veterans Affairs and DOD, Department of Defense, 

talking about how they share information for medical records, because they really are interwoven. And so we’re asking questions 
20

about whether they’re doing this and how the process is working. 

Welcome. Dr. Murphy, you indicated in your testimony that VA 

needs certain information regarding servicemembers returning 

from overseas and locations like Iraq and Afghanistan. You note 

that they received an initial list of 17,000 veterans from DOD and 

that some had sought health care from VA. When did you receive 

that list—first list, and when was the next list due? And what information should be included in the member record? In your statement, you suggested a number of service indicators. Is the record 

complete and timely? 

Dr. MURPHY. We’re working closely with DOD to obtain a complete roster of individuals who have served in Operations Iraqi 

Freedom and Enduring Freedom. So far, we’ve received one list in 

the past couple of months of 17,000 individuals who have been discharged and served in that theater of operations. 

We believe that a complete roster is necessary for us to understand the full impact on the health of veterans, and we’re working 

closely to obtain that roster. So far, the information has been helpful to us in understanding which individuals have accessed the VA 

health care system and what kinds of complaints and diagnoses 

they have presented with. 

A you know, the issue of creation of lifelong health records system for servicemembers and veterans has been explored very well 

over the past decade. A number of very distinguished groups and 

expert panels have given us advice on what kind of information is 

important to providing quality health care to veterans. 

Those groups recommended that we need a complete roster of all 

deployed individuals for every combat theatre; that we have baseline information on recruits. In response, VA has asked for a complete roster card and we’ve worked together with DOD to pilot a 

recruit assessment program. 

In addition, we do need outpatient and inpatient records. We 

need access to in-theatre medical records. We need the pre- and 

post-deployment health screens. We need obviously the personnel 

information and the DD–214 in order to be able to determine eligibility, and we need to be able to connect all of that with the veteran’s health care record in the Department of Veterans Affairs. 

These are the basic components of a lifelong health record for veterans. 

It would be nice to be able to have that all collected in a veterancentric record rather than in disparate databases. However, that is 

a challenge for both Departments at this time. Furthermore, we 

need to create real-time interoperability of our record and IT systems in the future. 

The challenges are even more difficult to solve as they relate to 

National Guard and Reservists, and in accessing records on active 

duty members who have been treated in TRICARE. 

Ms. HOOLEY. I was going to ask you a question on Guards and 

Reservists. How do you get their records? 

Dr. MURPHY. The paper medical records on Reservists are located 

at the individual local unit. We’ll also be able to, through the Army 

Reserve, be able to get copies of their pre- and post-deployment 

screening as they are put into the electronic data system that the 

Army is providing. 
21

Ms. HOOLEY. For the Reserves and National Guard, are those— is that information taken on some way to transfer that information 

other than on a piece of paper? Is that taken electronically, the information? Any one of you. Major Farmer. 

General FARMER. Ma’am, are you talking about the pre- and 

post-deployment surveys, specifically? 

Ms. HOOLEY. Right that the Guards will have to take. 

General FARMER. My comments on the use of the electronic systems for capturing that apply to all components. As I said, we are 

using that for some of the collections. Most of the post-deployment 

surveys that are being done in the deployed theater of operations 

are now being done electronically, irregardless of whether they are 

active reserve or guard. And some of those being done here in the 

deployment and redeployment are being done electronically. 

Ms. HOOLEY. Are all of those—is all of that information taken 

with hand-held devices—I mean where you can take the—where 

you can take all the information, and it’s on a hand-held device? 

General FARMER. Ma’am, as I mentioned, we have both a handheld device, a portable hand-held device module, as well as an 

Internet web module, in order to do that. And so it depends on the 

setting. In the deployed theater of operations, for example, we’re 

largely using the hand-held. For those that are being done in our 

treatment facilities, many of those are being done, for example, 

using the web module. 

Ms. HOOLEY. Is there any reason that you can’t get to the Veterans’ Department, is there any reason that you can’t get the list 

of all of the people that are currently serving overseas. I mean, 

you’ve got a list of 17,000. There’s something like, I don’t know, 

200,000 troops. Is there any reason they can’t get that list to them? 

Ms. FITES. We’re in the process of developing the list. We’re not 

confident yet that what we have is accurate. So, we’re working 

back and forth with the Veterans’ Administration as we clean up 

the information. 

Ms. HOOLEY. When do you think that will be accurate? 

Ms. FITES. I’ll have to provide that for the record. I’m not sure. 

(See p. 142.) 

Ms. HOOLEY. Is there a technical reason why they’re not accurate? I mean what’s? 

Ms. FITES. Yes. It’s database information inaccuracies that we’re 

cleaning up, and I just don’t have the timelines for when that will 

be completed. But we are working on it. We know it’s important. 

Ms. HOOLEY. Okay. Thank you. 

Dr. MURPHY. We have had good cooperation from the DMDC in 

working out the data issues. But, you know, so far we’ve not been 

able to get a completed roster. 

Mr. BUYER. Mr. Evans? 

Mr. EVANS. Thank you, Mr. Chairman. Mr. Reardon, in your 

statement you discuss HHS standards adopted in March 2003 for 

electronic health data transfer. Are these standards enmeshed with 

the private sector’s standards, and are we leading the charge or retreating? 

Mr. REARDON. Sir, excuse me. Thank you. These are the standards that are being developed through the HHS-led Consolidated 

Health Care Informatics Project. And it is primarily a Federal 
22

membership on these standards. However, as the standards are 

being developed, they do ask for comment from the public and private sectors on those standards. 

Once the standards are adopted, they are adopted for use in Federal systems as new systems are developed. And they’re continuing, 

at this point, to develop more of those standards. They have somewhere around six to seven standards adopted now, and the objective I believe is approximately 15 standards. So there is input from 

the private sector, sir, but it is primarily a Federal group that is 

selecting those standards. 

Mr. BUYER. Mr. Udall. 

Mr. UDALL. Thank you, Mr. Chairman. From hearing you describe it, you talk about the seamless interoperable system, where 

individuals move from the military to the veterans system, and 

you’re able to move these records back and forth. I mean, is that 

basically what we’re talking about in this system that we’re trying 

to develop? 

Dr. MURPHY. That’s basically it. We’d like to have completely 

interoperable records so that we can provide the highest quality 

health care and benefits to veterans. And in order to do that, we 

need a lifelong, seamless medical record. Not only a medical clinical 

care record, but a health record that connects a lot of other kinds 

of information that are important for us in analyzing the potential 

health impacts of service in the military. An example is environmental and occupational exposure information for military 

servicemembers interoperational. 

I would say that VA and DOD are actually leading the 

interoperabling effort. If you look at what the capabilities are in 

the private sector for doing this, they’re extremely limited. And 

they’re really only a few sites in the country who would have any 

capability to be able to have an interoperable electronic health 

record. The national health infrastructure at this point is very limited, and I think that in the most positive context, it’s actually important to recognize that if it wasn’t for VA and DOD, we would 

not have, we would not likely have any ability at all to transfer 

electronic health records, because electronic health records in the 

private sector are not available. 

Mr. UDALL. To what extent today do we have this seamless, 

interoperable system working for numbers of veterans, percentages, 

what you all have been working on this I guess about seven years; 

right? Or more? 

Dr. MURPHY. In terms of percentage, you know, there are approximately 25 million living veterans in this country, and we’ve 

said that we have records on 1.7 million in the data repository at 

this point. It’s a small portion of the veteran population, but an important first step. The effort will allow us to have access to the 

electronic health records that DOD has at this point. And by 2005, 

we will have the first interoperable records system available. 

Mr. UDALL. Of the 1.7 million that we developed the system, are 

these recent veterans leaving the military and going into veterans 

health care, or are they—is it an older set? 

Dr. MURPHY. As I understand it, it’s all of the available records 

in CHCS first instituted since 1989. So all discharged individuals 

with an electronic record will be included in the records exchange. 
23

Mr. UDALL. All discharged individuals with an electronic record 

since 1989? Okay. And what is the—has Congress or have you been 

given instructions to try to include all 25 million. I mean, are you 

attempting to get there. Is there some timetable for that? 

Dr. MURPHY. It won’t be possible to get electronic records on all 

25 million veterans. Many of them served in the military prior to 

1989, and would not have electronic records available. We’ll still be 

relying on the St. Louis records center and their paper records for 

those who served prior to 1989. 

Mr. UDALL. And you’re in—you don’t put those—there isn’t going 

to be an attempt to put those in an electronic format? 

Dr. MURPHY. At this point, we’re working prospectively. 

Mr. UDALL. Prospectively. So your intent is to include everybody 

in the future that comes out in this same situation. 

Dr. MURPHY. That is correct. 

Mr. UDALL. Not to necessarily go back? And to not go back, I 

mean, is that—you’re nodding, but the record doesn’t pick that up. 

Mr. REARDON. Sir, starting at the time at which the Department 

of Defense started collecting the information electronically, which 

was, as Dr. Murphy said, in the late 1980s, we’ve gone in, and 

we’ve pulled out the information on all our separated and retired 

servicemembers since that point; and our intent is to continue to 

do that. As members separate or retire, we get a notification. We 

in the medical community, General Farmer and I, get a notification 

from the personnel community, and it says, Jim Reardon has separated. And that information comes to us. We go out, pull the information out of our electronic health records systems, package it, and 

send it to the VA. So it’s very prospective in nature. And we’re 

doing roughly 17,000 to 20,000 notifications every month on separations that we pull the information, and we provide it to the Veterans’ Administration. 

Mr. UDALL. And think you will be able to do all the future people, include them in this system? 

Mr. REARDON. Yes, sir, we’re doing that now, and we are actually, as we move forward, increasing the types of information. We 

started out with demographics and laboratory and pharmacy, and 

we’re moving to consults and retail pharmacy. So the amount of information that we’re providing is continuing to grow. 

Mr. UDALL. And you’re putting adequate, in the budget request, 

you’re putting adequate resources in there in order to make sure 

you’re able to carry this out? 

Mr. REARDON. Yes, sir. We are. It’s a funded program. 

Mr. UDALL. Okay. Mr. Chairman, I noticed the light’s red, but 

can I continue for a minute or two here? 

Mr. BUYER. Yes. No objections. 

Mr. UDALL. Just to—thank you. And I’d like the DOD and the 

VA to comment on this. When you have a database like this, laden 

with protected privacy-related information and it’s shared among 

agencies, that information is only as secure as the weakest link 

among shared systems. Is this an issue for you? Is it perceived as 

an issue among DOD and VA? 

Mr. REARDON. Information security is a significant issue and a 

significant point of focus for the Department of Defense and for the 

Veterans’ Administration. The information, when it comes to us 
24

and when we transmit the information, we’re transmitting it in an 

encrypted fashion. So when we’re moving the information out of 

our local records systems and packaging it up and sending it to the 

VA, it is encrypted. It’s also secure in those facilities that the databases themselves reside on, in that they are either on military installations or in secure facilities in the Veterans’ Administration—

I think in Austin, Texas, right now. So information security is an 

issue that is higher on our radar screen. 

Mr. UDALL. Yes. Okay. 

Mr. MEAGHER. I’d just add that as the previous CIO has testified 

before this committee that security—IT security is the number one 

priority for information technology at the VA is to improve that security, and we take that very seriously. 

Mr. UDALL. Okay. Thank you for that answer. Let me return just 

one more time to the seamless, interoperable system that you’re 

trying to put in place. Many of the veterans in my state of New 

Mexico, a very rural state, more rural than others, and there’s been 

a real attempt by the Veterans’ Administration to reach out to veterans where they live and provide health care. And so we have the 

Veterans’ Administration entering into contracts with community 

health care providers. And many of our veterans are getting their 

primary health care, obviously not specialty health care, but primary health care right in their communities where they live, rather than having to travel 200, 300, or 400 miles to a Veterans Hospital. 

Is this system you’re putting together a doctor in one of these 

community health care clinics would be able to access these kinds 

of records in order to give the veteran the very best medical care? 

Dr. MURPHY. In our contracted community-based outpatient clinics, the providers often use the VA records system. For those who 

have a fee basis arrangement for care, an individual doctor with an 

individual veteran, we often have to rely on paper records. But we 

do have the ability to image those records and include them as a 

image file in their overall health record. 

Mr. UDALL. But the system you’re talking about could be very, 

very effective for veterans; couldn’t it, to alert doctors of problems 

and things if they could get all this information at their fingertips 

through this electronic means. Is that correct? 

Dr. MURPHY. Absolutely. And, as I said, we are providing access 

to the VA records system for our community-based outpatient clinics, where we have a contract with private providers to provide 

health care to a large number of veterans. And our vision is that 

hopefully the rest of the country in a short period of time will adopt 

electronic records. 

And one of the reasons that the CHIE initiative, the data standards initiative, is so important for the Federal Government to lead 

is that only by having data standards in place will we get interoperable commercially developed records systems that will be able 

to communicate with the VA and the DOD records. Hopefully in 

the future we’ll have a national health information infrastructure 

that we’ll be able to share privacy—protected information much 

more broadly than just between the VA+DOD systems, but will include the private providers also. 
25

Mr. UDALL. Great. Thank you very much. And, Mr. Chairman, 

thank you for allowing me to go on a little longer there. 

Mr. BUYER. You’re quite welcome. We’ll have another round of 

questions. Dr. Murphy, you also state that the VA can now access 

DOD’s—the Composite Health Care System for veteran information 

such as lab results, x ray reports, outpatient pharmacy prescription 

information, admission disposition transfer records, discharge summaries, and near future information will occur for allergies, consult 

reports, and summary outpatient appointments information. 

You further state that the Veterans Benefit Administration used 

this information to ‘‘fulfill the evidentiary requirements for processing disability compensation claims, as well as determine the eligibility for other benefits.’’ My question is what about the entrance 

and separation physicals? What about the inpatient hospitalizations? What about the pre- and post-deployment assessments? 

Aren’t all of these pieces of information absolutely necessary to adjudicate a compensation and pension claim? 

Dr. MURPHY. I’m going to ask Mr. Reardon to expand on my comments related to that question. 

The information that’s currently available is being taken out of 

CHCS1, which includes hospital discharge information. When we 

get to the fully interoperable health record exchange, it will involve 

information being exchanged between health data repositories in 

VA and DOD, including outpatient records that are now being piloted in CHCS II. You know, in order to be able to provide full access to a full record, we need to get to the fully interoperable 

health record exchange. And for the details of whether——

Mr. BUYER. But, Dr. Murphy, as of right now, you’ve got a great 

program with DOD and VA to make sure that that individual, 

upon discharge, has a physical. It’s all about the baseline. When 

will that physical be included in the repository? 

Dr. MURPHY. If it’s being done at one of the places where we do 

a single discharge physical, that is already available in our records 

system in VA and DOD. 

At the sites who are not participating in those programs and pilots, that is not yet available, to my knowledge. I’d ask Mr. 

Reardon to tell us exactly what’s available in CHCS1, and what the 

timeline is for the remainder of those records being available. 

Mr. BUYER. All right. Thank you, Dr. Murphy. Mr. Reardon. 

Mr. REARDON. Sir, we’re providing the VA discharge summaries, 

so there is some inpatient information-inpatient history, diagnosis, 

and procedures. In February, we will be beginning to provide more 

ambulatory data, which will be the appointments that a particular 

individual has had, what the appointment type was, the date that 

it was made. So that information will come across. 

To the extent of getting to your question about the information 

on the physical, which occurs in a military hospital, and the information that is being entered into the CHCS system at that hospital, sir, then that information would be packaged up and come 

across in the area of the labs, the RADS, and the diagnostic codes 

that would come across. But I don’t know to what degree the exit 

physical for our military members are being put into the CHCS 

system. Maybe General Farmer might be able to answer that. 
26

General FARMER. I think Dr. Murphy said it correctly, sir, that 

in those sites where we have an agreement for a single separation 

physical that meets the requirements of DOD and the VA, whether 

it is done in one of our facilities or, in many cases, in one of their 

facilities, either way, that data is then populated into both systems; 

and so it is electronically available in both of our systems. 

Mr. BUYER. I think I’m challenged. When you—and help with 

this scenario. There are no perfect analogies, but these are very 

real-life scenarios. 

You have a soldier on the battlefield that is wounded or injured. 

He’s seen at a combat support hospital. He’s then medevac’d to 

Landstuhl. From Landstuhl, he comes to Walter Reed. After Walter 

Reed recovery, rehabilitation, perhaps it was time for his separation from the military. They’re now being seen at a VA. That doctor 

at the VA, of whom receives the soldier, the veteran now, comes in 

and complaining about maybe it’s his back, when, in fact, maybe 

the back now—he has muscular, because now he has to walk a little different. That doctor at the VA ought to be able to trace back 

and see the records from the combat support hospital to Landstuhl 

to Walter Reed. Would you concur, Dr. Murphy? 

Dr. MURPHY. Yes, that would be the optimal situation. 

Mr. BUYER. But today, Dr. Murphy, can that doctor at a VA access those records? How do they—there’s no electronic medical 

record in order to do that; correct? 

Dr. MURPHY. That is correct. At this point, we do not have realtime electronic interoperability in the two systems. However, the 

scenario you’re talking about is exactly the one that we’ve tried to 

address with the seamless transition task force. And I have to compliment General Peak and the Army, because they have been exceedingly collaborative and great partners in this process. 

We’ve set up a system so that we make sure that before someone 

is discharged from Walter Reed today, that they’ve been seen by a 

VA social worker, who has made a contact to the local hospital that 

the patient will be transferred to or nearest to his home. And those 

records can be provided, not necessarily always electronically at 

this point, but a coordinator at the local medical center is responsible for making contact with that individual and ensuring that 

there is a direct handoff between VA and DOD. 

That was not present in the very recent past. And we had some 

very unfortunate occurrences of people who may not have had that 

seamless transition and didn’t receive immediate access to the—either care at the VA medical center or have their records available. 

For that particular instance, we believe we’ve put a system in 

place that, while not fool proof, does give us what we believe is the 

best handoff between VA and the Army at this point. 

Mr. BUYER. So presently in this world, let’s take the record 

lists—strike that. Digital—well, no. Radiology. Digital radiology. So 

the VA is doing it. DOD is doing it. But then the two can’t even—

you can’t even talk to each other. So, for example, that VA doctor, 

of whom wants to access then the images that may have been 

taken at Landstuhl, they cannot—they’ve got two systems that are 

not interoperable; correct? 

Dr. MURPHY. At this point, our imaging systems are not interoperable. 
27

Mr. BUYER. That’s crazy. I recall being at Tripler in Hawaii, and 

Tripler and the VA they have done an excellent job with their 

interoperability. And that was the first time that I had seen two 

fantastic systems—you can make a paper airplane and hit the VA 

from Tripler. But they can’t talk to each other with regard to that 

digital record? Ouch. That really—that smarts. 

Now, let me—help me so if I can understand where we’re trying 

to go. And, Dr. Farmer, please jump in to correct me. 

You envision what we are hope—where we’re trying to go is our 

soldiers when they go on the battlefield will have a dog tag. And 

on that dog tag, we’ll have their—medical information will be on 

the dog tag. 

When they are injured, maybe the soldier is found on the battlefield and is unconscious, so there’s a lot of things we don’t know 

about them. They’re taking to the combat support hospital. That information can be taken off the dog tag, put into the system, and 

they’re going to know everything about their present health, 

whether they have allergies, whether they—their blood types. You 

name it. It will be on there. Now that we’re in that digital world, 

things that occurred at the combat support hospital then can be 

linked through a satellite so when the patient arrives at a military 

medical treatment facility, the doctors of whom are waiting to receive that patient, they know in real-time what the situation is and 

are in contact with the patient in flight when they arrive and then 

as they transfer back to the states. And this is not occurring just 

with the Army. We want this to occur with the Air Force, with the 

Marine Corps, and Navy. 

And then that life that is accompanied by a real-time medical 

record then finds its way to the VA. And, in the end, when we are 

treating this human being and are providing timely adjudication of 

claims, that all of this can be done quicker. Now is this where we’re 

trying—this is where we’re trying to move to? Dr. Murphy and 

General Farmer, isn’t that where we’re trying to move to? 

Dr. MURPHY. I think you’ve presented a wonderful vision of 

where, (hopefully), the technology will take us in the future. 

VA+DOD need to be able to coordinate our activities so that an individual servicemember and veteran gets seamless care. And in 

order to get that seamless care, we need to have our digital information be interoperable. 

General FARMER. Yes, sir, I think you have described a vision of 

that ideal future that we’re trying to move toward. We have a number of pilots, of incremental initiatives toward that future. For example, the Striker Brigade that is just deploying now out of Fort 

Lewis, Washington, that I mentioned in my opening statement, 

4,400 troops. 

Not only did we mention that we did their pre-surveys electronically, but we also loaded onto an electronic information carrier with 

each of those troops a record from Madigan, from their local health 

clinic their medical information in an electronic information carrier 

that they will have with them. And we will do some incremental 

utilization and testing of that ability to access that and then transfer that from the theater during the deployment. 

Secondly, in response to your question a moment ago, in Afghanistan today, we do have in our Army health facilities over there 
28

CHCS1 capability, and so the labs and the x rays and pharmacy 

data, for example, that is given in our facilities over there will be 

in CHCS1; and, therefore, does become under the Federal Health 

Information Exchange part of that transfer of information that we 

were talking about earlier. 

So I think that this is a work in progress, but we have a number 

of good steps to get us toward that future that you outlined. 

Mr. BUYER. Well, I can’t speak for my colleagues, but from the 

perspective of looking out for the taxpayer and giving oversight of 

where you’re trying to go, I think it’s a noble cause. And the purpose of this hearing is for us, we’re challenged. I think our challenge is we look out there. 

We deal with corporations and the private sector and companies 

and other countries, and we see things happening, but we don’t understand why DOD and VA don’t—can’t talk to each other when 

it’s—when we can talk with our own staff and our own states. And 

I know you have different procurement routes that you do, but 

what I do find unacceptable as we move into this world of being 

seamless is to have—gosh—state of the art systems that cannot 

talk. I just find that dumbfounding. 

Let me ask this—let me ask this, and I’ll yield to my colleagues. 

Mr. Reardon, earlier when the Secretary—Secretary Principi was 

going to take on these IT issues and removing the stove pipes within the VA, and the question that we asked of his IT czar was 

whether or not he was going to have the authority, the actual authority, to do his job. So I did take a look at your resume, as I do 

all witnesses, and I know that you have 28 years in the IT systems, 

but what I missed is I don’t know how long you’ve worked in your 

present job or for the Government. Can you tell me that? 

Mr. REARDON. Yes, sir. I’ve been in the present job for five years. 

Mr. BUYER. For five years. 

Mr. REARDON. Yes, sir. 

Mr. BUYER. And you are working at OSD level? 

Mr. REARDON. I work in the TRICARE management activities, 

sir. So it’s one level below OSD. I’m not actually in the Office of 

the Secretary. 

Mr. BUYER. Okay. So you are outside of the line on budget authorities. In other words, you got to turn to somebody to implement 

that which you want to do; right? 

Mr. REARDON. That’s correct, sir. 

Mr. BUYER. So you don’t have any control over the dollar? 

Mr. REARDON. Well, sir, we do prepare a budget request and forward that up through health affair, the Office of the Assistant Secretary, Health Affairs, which forwards it as part of the Defense 

Health Program budget or program objective memorandum. So we 

would lay the programs on the table, sir. We would estimate the 

cost over a five——

Mr. BUYER. This is an issue I brought up earlier, and I need to 

address right now, because I know that different agencies, whether 

it’s in Agriculture and in the Government agency, and the real 

question is should Congress accept this new world that we’re in 

and give some real authority to an individual who is an MIS Director or the individual who’s the Director of the Information Technology—if you have to turn to others, you’re begging. And when we 
29

find ourselves in a time of war, sometimes if you’re not banging 

loud enough, you’re not able to achieve particular timelines. I don’t 

know if you have the specific authority to do the job for which you 

are asked to do. 

Mr. REARDON. I believe I do, sir. I receive very strong support 

from the OSD staff. We have a Board of Directors that oversees 

what we do, and it’s General Farmer and the other Deputy Surgeons, and also the Deputy Director of Medical Readiness on the 

Joint Staff, Major General Porr right now. They help us prepare 

what the requirements are. We package up our requirements and 

our funding requirements that go along with those, as many other 

components in the Defense Health Program do. And those are forwarded up for approval at the assistant secretary level, and other 

budgets come in through the services for the Defense Health Program. 

Mr. BUYER. Right. I understand how to be a good listener, but 

here’s evidence: evidence of that inability is you can’t even give an 

electronic DD2-14 to the VA. If you can’t even do a personnel action, what makes us satisfied that we can take on these bigger 

causes? That’s what I’m really challenged. Those are very challenging—oh, my gosh, I’m about to yield, because I’m going to go 

nuts. Would you please——

Ms. FITES. That’s a fair statement. We cannot give an electronic 

DD–214 to the VA, because we do not have electronic DD–214s. 

Mr. BUYER. Why can’t you make electronic—— Ms. FITES. The defense—we are going to. That is part of the Defense Integrated Human Resources System that we are building 

right now. It’s integral to the system. It will be one-time data 

entry, all components, all services. It will eliminate all the errors 

that we have from multiple data entries everywhere. Right now, 

the DD–214 is paper. It’s done in thousands of places around the 

world. It is not transmitted electronically. It does not have standard data elements that are the same. That is one thing we are trying to correct with the Defense Integrated Human Resources System. 

Mr. BUYER. You know, Dr. Murphy, I sit here and look out, and 

I see you, and I think it’s Ground Hog Day. You and I have been 

here at this Committee for 11 years, and I hear things like this— and, it is—it’s the movie Ground Hog Day, because we’ve asked 

this—this particular question has even come up in the past. And 

that’s the kind of answer we’ve even gotten. Let me just—let me 

yield. Ms. Hooley will be recognized. 

Dr. MURPHY. If I could——

Ms. HOOLEY. Thank you, Mr. Chair. I haven’t been here since 

Groundhog Day. I’ll give her a chance to answer. I haven’t been 

here over and over and over again, but let me give you just a couple of incidences and maybe they don’t even apply here. But several 

years ago, and I served for six years on a major hospital board, a 

series of hospitals went to electronic records. It was difficult. I 

mean, it took time, but I was there from beginning to end. Nurses 

went in and hand-held devices when they went and visited the patient. Everything was done electronically. 

So I think it can be done. And then when you look at a lot of 

other businesses who are compiling huge amounts of records for 
30

millions of people and they deal with privacy and deal with a lot 

of other things in that process. I guess knowing that this is 21 

years old, I’m frustrated by it just like everybody else is. And why 

it takes so long to happen. Why you only have 17,000 names on 

your record from the people that are currently have been deployed, 

when we’re talking about 200,000, 300,000 people. You got 17,000? 

And that’s due to data error. 

It is just frustrating, and I have a hard time understanding why 

something like this, where two agencies who care very much about 

the same person haven’t been able to make this move forward a little faster. I mean, and I would feel better if you said, well, the 

technology is not there. I think it is, but I would feel better about 

that. I mean, I just understand why this has taken so long, and 

I share our Chair’s vision of what this should be. 

Every single member in Congress also knows the frustration of 

veterans who can’t get information—that it’s not shared. I mean, 

here is a fabulous opportunity, and I guess I would just like your 

comment on why, from Dr. Fites or Dr. Murphy on why we only 

have 17,000, and then whatever else you were going to say to the 

Chair that I interrupted you on. 

Ms. FITES. First, I’d like to say for the interim, until we have our 

new system, we have developed with the Veterans’ Administration 

a Defense Personnel Records Image Retrieval System that gets not 

only the 214s, but other personnel records that the VA needs. 

It’s taking the paper records. It’s making them electronic, and 

the VA is getting them in the average now of 60 days. And it’s not 

overnight, which is what we want. But it is working very well, and 

2,380 Veterans Benefit Administration users are submitting a 

thousand—1,500 requests a month against that system. 

So, we’re pleased we’ve been able to put in that interim, and that 

is helping. 

Dr. MURPHY. And what I’d like to reiterate is that there has been 

progress made. The Federal Health Information Exchange is an important first step forward. Jeanne Fites and I have been working 

together since the early ’90s. And I think that both of us have seen 

the changes in the exchange of information that have occurred over 

that decade. 

We all recognize that we’re nowhere near the optimal system or 

nowhere near meeting the vision that you’ve set out and the Chairman has set out. But I think we now have a roadmap towards the 

Joint Interoperable Electronic Health Record. 

The technology is there to support that, and we have the planning process in place to get us there within the timelines that have 

been set out by VA and DOD. The leadership of both departments 

have set up a joint management structure through the Joint Executive Council and are closely tracking those items that have been 

agreed to within the Joint Strategic Plan. 

So I think we can be hopeful that this time we will move through 

that list of items that have been identified as being important to 

be included in the lifelong health record that should be produced 

for veterans. And I hope that I don’t come back here in the next 

decade saying we still haven’t completed it, but in fact, say, in a 

very short period of time, in 2005, that we’ve been able to deliver 

on the promises we made today. 
31

Mr. BUYER. Mr. Udall. 

Mr. UDALL. Thank you, Mr. Chairman. The Indian Health Service, is it a part of this system? I mean, how does it interface with 

a soldier that moves through, that starts let’s say before they enlist 

or are taken care of by the Indian Health Service and then goes 

through the system; discharged by the military and then comes 

back, and is near an Indian Health Service Hospital. Is the—are 

they included in the Federal Health Information Exchange. I mean, 

what is the—— Dr. MURPHY. At this point, the Federal Health Information Exchange is an initiative between VA and DOD. Part of my responsibilities as the Deputy Under Secretary for Health for Health Policy Coordination is to interface with HHS organizations, including 

the Indian Health Service. VA signed a memorandum of understanding with IHS in February of 2003, and, over the past year, 

have worked on several national initiatives to try to create the 

most accessible, highest quality health care for Native American 

veterans. Part of that now consists of a national initiative in health 

information technology. Our CIO’s office in VHA has been working 

on a program to bring the VISTA-CPRS electronic health record 

system, in its current version, to the Indian Health Service. 

That is a program that has been funded through the HHS budget 

this year and hopefully will move forward to full implementation 

in the future. So there is the opportunity if VA and IHS use identical health records systems and to include IHS in a Federal 

Health Information Exchange, or this real-time interoperable medical records system. 

Mr. UDALL. Do they have the same system? 

Dr. MURPHY. At this point, they have a system that they call 

RPMS, which is similar to our records system in VA but is about 

three versions older. IHS has recognized the need to upgrade it and 

include a more integrated package of IT services through their 

health records system and will adopt, hopefully in the future, the 

same system that VA is using. 

Mr. UDALL. Thank you. Thank you, Mr. Chairman. 

Mr. BUYER. That was a great question. I got an area I wanted 

to cover. Ms. Fites, your testimony indicates that it takes 60 days 

to get an image of the DD–214 to DPRIS, the Defense Personnel 

Records Image System; is that correct? Sixty days? 

Ms. FITES. That’s about the average. 

Mr. BUYER. We don’t know if any VA claims are delayed because 

of 60 days, do we, Dr. Murphy? It’s kind of hard to tell, isn’t it? 

Dr. MURPHY. I don’t know. We can certainly provide an answer 

for the record. 

Mr. BUYER. That’s all right. I’m just——

Dr. MURPHY. Most veterans know that they need to hand carry 

their paper, DD–214. 

Mr. BUYER. You were an officer in the military, were you not? 

Dr. MURPHY. Yes, sir. 

Mr. BUYER. Ma’am, do you know the number of monthly requests 

the VA submits to DPRIS? And if you have it, can it be broken 

down by services? For the record? 

Ms. FITES. Yes. 

(See p. 137.) 
32

Mr. BUYER. Do you know what the service turnaround times are 

for the VA when they make these requests to the personnel system? 

Ms. FITES. No, I do not. But we can provide that—— Mr. BUYER. Can anybody help me out here? 

Dr. MURPHY. We have somebody here from VBA. Yesterday, 

when I asked the same question, we were told that for individual 

records we sometimes get an immediate response. For batched 

records, the DD–214s are sent within 48 hours. 

Mr. BUYER. Ma’am, can you answer this? What is your name? 

Ms. ST. CLAIR. My name is Norma St. Clair. I work for Ms. Fites. 

Mr. BUYER. Oh. Why don’t you tell Ms. Fites, and Ms. Fites will 

testify. 

Ms. FITES. Before the Defense Personnel Records Imaging System, it would take months to get the DD–214s to VA. Now, that 

it’s in the system, it takes on the average to get it in the system 

the 60 days, but then it’s either real-time or 48-hours in batch. 

Mr. BUYER. Well, I’m going to stop beating you up on that. I 

guess where I’m left is, you know, Mr. Udall, my experience in 

dealing with DOD is that sometimes the only way you can get 

them to do things is you find out what their toys are, and you take 

them away. And it’s called power on power. 

I mean, it’s really ridiculous, but it’s something that—it happens 

sometimes. Maybe what we do, I’m just speaking out loud, what we 

ought to do is this Committee, coordinating with the Armed Services Committee, say, and we’ll be prospective here, and we put a 

limiting amendment on an appropriations bill that says something 

to the effect that no monies shall be spent for future information 

technology systems, medical IT that is not interoperable between 

DOD, VA, or subsidiary health agencies. So we stop. We stop. 

We actually stop the Army or the Navy or the Air Force buying 

medical IT systems that are not compatible or interoperable with 

the VA; and, at the same time, we tell the VA you can’t go out 

there and buy this new flash bang item that somebody wants to 

sell you unless it can talk to DOD. You know, that’s probably 

where I am, that we’re going to have to actually do something like 

that. 

Now, that will cause tremendous heartache. That, in fact, could 

cause tremendous problems, as you’re trying to move toward ‘‘that 

vision.’’ But that’s about where I am. So, I’ll give you an opportunity right now to tell me what your thoughts are if Congress 

were actually to do that in the Omnibus Bill that’s going to happen 

here in two days. What do I do to you if we do that? 

Ms. FITES. I think you hurt the people you very much want to 

help. 

Mr. BUYER. Who, you? 

Ms. FITES. No, you don’t want to help me. 

Mr. BUYER. That’s right. 

Ms. FITES. You want to help the servicemember and the veteran, 

and any delays in getting these programs more interoperable, and 

such language would cause delays, because the departments 

wouldn’t know what to do. 

Mr. BUYER. Wouldn’t know what to do. Wouldn’t the departments—let me turn to General Farmer. 
33

General FARMER. Yes, sir, I believe that could hurt us very much 

and serve to undermine the vision that you have outlined. And let 

me tell you one of the ways is that in the Army, our medical information systems really have to do two things. We have to be interoperable with DOD, the Air Force and the Navy and ultimately the 

VA, but we also have to be interoperable with the rest of the Army 

on the battlefield in the many of the connections that we have— logistics and operations and other areas with the Army. 

Many of those IM—IT systems that we put into Army medicine 

do not need to be both. So, we are running—— Mr. BUYER. So, General Farmer, if we give you a bridge, right? 

Because you’ve got a lot of systems out there, and we bridge it and 

say that no monies shall be spent after 2005. I’m just throwing 

something out here that I think it’s a waste of money to allow the 

VA and DOD to continue to buy these medical technology systems, 

and you continue to purchase them through your own procurement 

routes knowing, knowing that while you’re trying to move to seamless, you’re buying systems that you know are not. So, General 

Farmer, help me out here? How do I—do I have to break—how do 

you break the culture. Generally, what we’ve found here on Capitol 

Hill is you break the culture through the dollar. 

General FARMER. Sir, I believe that the leadership in the Department and in our service and our Army Medical Department is very 

dedicated to what you are after. The Health Executive Committee 

has been referenced a couple of times here this morning. It includes the Under Secretary of Health from the VA, Assistant Secretary of Defense for Health Affairs, and the Surgeons General, 

and our CIOs. And we are very dedicated toward getting to the future that you envision. 

I would—I think we’ve talked about some of the future and some 

of the interim things that we’re doing, demonstration projects and 

so forth, to get there. I would hope that we would not have barriers 

toward getting there, and I’m afraid that if you were to put into 

statute an absolute that precluded any systems that were not interoperable that it might backfire, sir. 

Dr. MURPHY. From a VA standpoint, putting the restrictions on 

future IT purchases that you’ve proposed, I think would be counterproductive. We’ve come forward with a very good plan for creating 

interoperable records by 2005. There’s already exchange of health 

records between VA and DOD. And I would ask that you monitor 

what we’re doing. 

I agree that putting an overall restriction on any IT spending 

could have a whole host of domino effects that could potentially affect the quality of health care for both active duty military members and for veterans. And I know that you don’t want to do that, 

Mr. Chairman. 

I think that there are other ways to accomplish what we all believe needs to be done. And we’ve committed today that we will 

complete the Joint Interoperable Electronic Health Record. And I 

can tell you that Dr. Roswell and Secretary Principi will keep the 

pressure on to keep this progress going. And there are other ways 

to encourage interdepartmental, inter-agency cooperation. 

Mr. BUYER. Dr. Murphy, we do have the ability to be artful and 

clever on how to draft specific measures that are not harmful, yet 
34

achieve what we desire. I’ll tell you—here’s where I think the Committee will be pretty upset—is we go out and we visit a facility 

next fall. And in that facility, we find out that the VA has just purchased a particular system, and I’ll use the example of digital radiology, again, and it may be at a particular facility. Maybe it’s 

Nellis. I don’t know. Just pick one. And I see two brand new systems, just purchased, and they can’t even talk to each other. I just 

want you to know—I just want to lay down the signal. 

Mr. Udall, do you have anything on this panel? Last thing: I 

know you continue to meet. Will you bring up this discussion that 

we just had today? I want you to bring up the discussion because— well, have the discussion. And then I’ll talk with you in the future. 

This panel is now excused. Thank you for your testimony today. 

Sorry for taking so long. We now recognize Mr. Kem Clawson, 

Director of Advanced Solutions for EMC Corporation. You are now 

recognized. I thank you for your patience. Not that you haven’t 

seen these types of things in the corporate world, but we are interested in your testimony. If you have a written statement, it will be 

submitted for the record. No objections, it shall be submitted, and 

your oral testimony, please proceed. 

STATEMENT OF KEM CLAWSON, DIRECTOR OF ADVANCED 

TECHNOLOGY SOLUTIONS, EMC CORPORATION, McLEAN, VA 

Mr. CLAWSON. Thank you, Chairman Buyer and distinguished 

members of the Oversight and Investigations Subcommittee. I am 

Kem Clawson, Director of Advanced Technology Solutions at EMC. 

It is an honor to be here today. 

I welcome the opportunity to offer an industry perspective on the 

benefits and technological feasibility of developing a seamless, electronic record and sharing medical information between the DOD 

and the VA. 

EMC has a deep understanding of the information storage and 

management challenges at the heart of health care today. Over 90 

percent of the world’s largest health care organizations depend 

upon EMC to store and manage their data. 

Historically, the health care industry has been slow to adopt information technologies that provide dramatic increases in efficiency 

and reductions in cost. From our experience in the private sector, 

it requires active, forceful, senior executive direction from within 

an organization. Evidence of growing collaboration between the VA 

and DOD in the delivery of health care is a positive indicator that 

these agencies are firmly committed to overcoming institutional 

and cultural resistance to change often inherent in large organizations. 

As the members of this Subcommittee know, the challenge of 

squeezing inefficiencies out of the health care system while improving the care that patients receive is considerable. 

One obvious impediment is that our health care system remains 

a stubbornly paper-intensive and minimally automated environment. It has not fully embraced the productivity enhancing benefits 

of an electronic health care information capability. 

The good news, Mr. Chairman, is that the impetus for change exists. It’s a Patient Information Lifecycle Management Strategy. In 

simple terms, this refers to providing medical caregivers, regard-
35

less of time, distance, or geography, with an electronic patient 

record, a comprehensive unified digital record that encompasses a 

patient’s medical information from birth to death. By pursuing this 

approach, DOD and VA can provide medical professionals with 

vital information that can be managed and shared. In other words, 

it can be seamless. 

So how do we make progress today? Here are four steps in the 

right direction. 

First, acknowledge a fundamental inconsistency of health care: it 

is one of the world’s most information-intensive yet one of the 

world’s least electronically-enabled industries. 

Second, we must fully digitize and automate the collection, movement, and management of information throughout the health care 

environment. Electronic records can improve both our public and 

governmental health systems’ ability to share medical information. 

Third, take inspiration from medical organizations making the 

transition to electronic health records. In central Alabama, the 

name Baptist Health Montgomery is synonymous with high-quality 

health care. Baptist Health Montgomery has implemented an integrated health information system that ties together administrative, 

financial, imaging, and patient care applications. 

From a business perspective, the system provides Baptist Health 

Montgomery with a business continuity capability that virtually 

eliminates downtime. It also enables clinicians and administrative 

personnel to better manage and share vital patient data for faster 

patient diagnosis; supports HIPAA requirements and state regulations more effectively; and facilitates a highly effective business decision making process. 

Fourth, recognize that if we do not take full advantage of today’s 

information technology, health care costs are going to continue to 

devour a larger and larger share of the annual budgets of both the 

DOD and VA. Moreover, critical patient information will remain 

fragmented, and, in many cases, unavailable when needed. 

In closing, Mr. Chairman, please allow me to make one final observation. While the technology exists to establish a seamless medical record between the DOD and the VA, the complexity of these 

health care systems create enormous challenges. These challenges 

can be and will be overcome. Success, however, will not be achieved 

over night. Nor will it be attained without the continued and forceful involvement of each department’s executive leadership, as well 

as Congress’ commitment to provide each department with the resources it needs, in people and dollars, to execute on this vision. 

At the end of the day, even the world’s best technology is only an 

enabler. What’s needed is the determined resolve to build bridges 

between the DOD, VA, and Congress to get the job done. Thank 

you. 

[The prepared statement of Mr. Clawson appears on p. 105.] 

Mr. BUYER. Thank you very much. In terms of resources, metric 

is the word you’ve just used. Can you make a recommendation to 

the Committee regarding what metric should be used to determine 

the amount of money that we’re to provide to the VA and DOD to 

make this initiative a reality? 

Mr. CLAWSON. I’d be delighted, sir. Many projects are obviously 

underway. At this time, we don’t have sufficient detail on those 
36

projects to assess how far along they are. We believe that there are 

some metrics in the private sector that we could use as a benchmark—— Mr. BUYER. Okay. 

Mr. CLAWSON. And what I’d like to suggest is that we get back 

to the Committee for the record with an answer in a very short 

time period as we look at some private sector benchmarks and compare it to knowledge we will hopefully be receiving from both departments. 

Mr. BUYER. I think that would be extremely helpful to us. I appreciate—— Mr. CLAWSON. We’d be delighted. 

Mr. BUYER. Your willingness to do so. There are instances where 

Congress, we’ve thrown a lot of money at these major IT systems, 

and, as you could tell from the last panel, that we’re pretty challenged at the amount of money that we spend and continue to see 

cultures that they’re moving incrementally together, but not at a 

speed at which we’re satisfied. Well, actually this is—this question 

really shouldn’t even go to you. I guess my mind is still back on 

the last panel. I apologize. 

Mr. CLAWSON. That’s quite all right, sir. 

Mr. BUYER. Would you have a comment with regard to the 

timelines, since EMC—you do contracting, obviously with DOD, 

and do you have contracts with VA? 

Mr. CLAWSON. Yes, sir. 

Mr. BUYER. EMC. You do? Do you have the ability to comment 

on the reality of these timelines as they’ve been discussed in the 

last panel? Do you have the competency to testify to that? 

Mr. CLAWSON. Mr. Chairman, we’re not currently involved in any 

of the data sharing projects directly. We do have other contracts 

with both sides. On the surface, it sounds like a long time. 

I think the March agreement to standardize on the emerging 

health standards is very positive. I’d like to see what the plans are 

in terms of execution against that agreement. 

Standards are now considerably in place. We didn’t have those 

five or ten years ago. There have been many enhancements to computer technology that have come out of the Internet world. We 

need to employ those. 

There’s an emerging standard, XML, which is extensible markup language. It’s a way of facilitating data interchange between 

disparate systems. So, my answer is a bit long winded. I apologize. 

I think on the surface, it sounds like a conservative plan. We don’t 

have the insight to what challenges may be coming upon them that 

we haven’t seen. 

Mr. BUYER. But let me use your term disparate systems. If we 

here in Congress permit these two agencies, of which we’re trying 

to be more seamless, to continue to purchase disparate systems 

with varying capabilities, does that not then become an impediment to what we’re trying to achieve? 

Mr. CLAWSON. Mr. Chairman, it appears that way on the surface, 

certainly. 

Certainly any enhancements that they’re making should be made 

in view of data interchange compatibility being a requirement. 

Mr. BUYER. All right. Mr. Udall? 
37

Mr. UDALL. Thank you, Mr. Chairman. Mr. Clawson, on page 5 

of our testimony you discuss HIPAA and how the new system supports privacy-related issues. As the size of the shared system gains 

access points, does it become more or less secure? 

Mr. CLAWSON. Congressman, with best practices employed, current available technology does not increase the exposure. Electronic-based records, when we’re employing our current best practices for security and privacy, are more secure and private than the 

paper-based records. The key imperative there is: are we employing 

current best practices? I believe that that technology is available. 

I believe the practice are established and proven; we just need to 

ensure that we’re employing them. 

Mr. UDALL. What are some of those best practices that would assure that privacy. 

Mr. CLAWSON. I think there’s several layers, and, please, I hope 

I’m not going to get too technical. I believe one is access control. 

It says we look at who has access to our networks. We have capability for authentication to ensure that only authorized people are 

accessing networks. We have technology to then control—so that 

gets them into the network to some servers. We then have capability to ensure that only the proper servers have access to the certain databases. So we can control internally. 

Security experts tell me that the challenge of security is, in many 

cases, larger within an organization than from the outside. But we 

need to be sure to look at both sides of that. So, again, I believe 

network access control standards, and there’s a wealth of technology there available; then at the server and data level, we have 

additional levels. 

It reminds me of my home security. I have a door knob with a 

lock and a deadbolt. I want multiple layers there. And so I think 

that technology is well known and in existence and should be employed. 

Mr. UDALL. Thank you. And thank you, Mr. Chairman. 

Mr. BUYER. Based on experience in the private sector, can you 

tell us with regard to any risk or threat potential that there has 

been with regard to a digitized medical record that you should 

warn us about? 

Mr. CLAWSON. Mr. Chairman, I’m not aware of any particular 

threat. Again, I think we need to employ all of our current best 

practices for security and HIPAA compliance. I think that body of 

knowledge is well known and documented. There are professionals 

with that expertise. We need to ensure that it’s put to use. 

Mr. BUYER. All right. So obviously the great fear is what happens—the computer goes down. You have a system outage. A system has been corrupted. Viruses. I mean, that’s the reason I asked 

that particular question. So, yeah, we’re moving to this digital 

world. It gives us benefits, but we also know that there are also 

some threats out there. That was the purpose of—I should have defined my question a little bit better, and now let me throw it back 

to you. 

Mr. CLAWSON. Thank you, Mr. Chairman, for the clarification. 

You know, I pretty much live my life with my Palm Pilot. And I 

remember the first one I bought people said to me, oh, yeah, that’s 

great. What happens when you lose it or it breaks? Aren’t you 
38

going to be in trouble? And, of course, the person that was asking 

me that had the proverbial little black book, with all their phone 

numbers and addresses, which had been lost before. And I said, 

well, you know, this is backed up. It’s synchronized with my lap 

top, which is backed up to my file server, which is every other 

night backed up to magnetic tape and stored off site. So, I said, I 

feel like we have the capability, and we certainly espouse in those 

best practices of replicating key information such that it’s done in 

a non-invasive fashion and multiple copies are available should one 

become lost or corrupted. 

So to your point, there are best practices today that will ensure 

the ongoing availability of those accurate records. 

Mr. BUYER. Well, with regard to the vision on where we’re trying 

to take DOD and VA as a provider of storage, you guys got to be 

happy. Who else is out there in the industry with regard to storage? EMC and who else? I don’t know who all’s in the storage business. 

Mr. CLAWSON. Mr. Chairman, all of the major computer server 

vendors also have storage. So, of course, IBM, Sun, Hewlett-Packard. Storage Technology is another firm, and then there are a number of smaller firms. But those—— Mr. BUYER. How many do government contracting? 

Mr. CLAWSON. Pardon me? 

Mr. BUYER. How many are in the business of government contracting with regard to server storage? 

Mr. CLAWSON. I believe all of them are. 

Mr. BUYER. And with regard to major systems? 

Mr. CLAWSON. Mm hmm. 

Mr. BUYER. Okay. The contracts that you have with DOD right 

now and VA, were those competitively bid or were they sole source 

contracts. 

Mr. CLAWSON. I believe those were competitively bid, to the best 

of my knowledge. 

Mr. BUYER. All right. Okay. Mr. Udall, do you have any followup? Mr. Clawson, I want to thank you for your patience, and I also 

want to thank you for the extra project that you’re taking on for 

us with regard to the financial matrix. I think that will be helpful 

to us. And I appreciate you working with DOD and VA on these 

larger issues. 

Dr. Murphy, I want to thank you for sticking around, and if I 

could see you immediately after the hearing, I would appreciate it. 

This hearing is now concluded. Thank you very much. 

[Whereupon, at 1:00 p.m., the subcommittee was adjourned.] 
39

A P P E N D I X 
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WRITTEN COMMITTEE QUESTIONS AND THEIR RESPONSES 

CHAIRMAN BUYER TO GENERAL ACCOUNTING OFFICE
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CHAIRMAN BUYER TO DEPARTMENT OF VETERANS AFFAIRS
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CHAIRMAN BUYER TO DEPARTMENT OF DEFENSE
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Æ