79–006 

115TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 115–691 

VETERANS’ ELECTRONIC HEALTH RECORD 

MODERNIZATION OVERSIGHT ACT OF 2017 

MAY 21, 2018.—Committed to the Committee of the Whole House on the State of 

the Union and ordered to be printed 

Mr. ROE of Tennessee, from the Committee on Veterans’ Affairs, 

submitted the following 

R E P O R T 

[To accompany H.R. 4245] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Veterans’ Affairs, to whom was referred the 

bill (H.R. 4245) to direct the Secretary of Veterans Affairs to submit to Congress certain documents relating to the Electronic 

Health Record Modernization Program of the Department of Veterans Affairs, having considered the same, report favorably thereon 

without amendment and recommend that the bill do pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 2 

Background and Need for Legislation .................................................................... 2 

Hearings ................................................................................................................... 3 

Subcommittee Consideration .................................................................................. 3 

Committee Consideration ........................................................................................ 3 

Committee Votes ...................................................................................................... 3 

Committee Oversight Findings ............................................................................... 3 

Statement of General Performance Goals and Objectives .................................... 4 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 4 

Earmarks and Tax and Tariff Benefits .................................................................. 4 

Committee Cost Estimate ....................................................................................... 4 

Congressional Budget Office Estimate ................................................................... 4 

Federal Mandates Statement ................................................................................. 5 

Advisory Committee Statement .............................................................................. 5 

Constitutional Authority Statement ...................................................................... 5 

Applicability to Legislative Branch ........................................................................ 5 

Statement on Duplication of Federal Programs .................................................... 5 

Disclosure of Directed Rulemaking ........................................................................ 6 

Section-by-Section Analysis of the Legislation ...................................................... 6 

Changes in Existing Law Made by the Bill as Reported ...................................... 6 

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PURPOSE AND SUMMARY

H.R. 4245, the ‘Veterans’ Electronic Health Record Modernization Oversight Act of 2017, would: direct the Department of Veterans Affairs (VA) to provide Congress with the key planning and 

implementation documents related to its Electronic Health Record 

Modernization (EHRM) program, in addition to copies of its underlying contracts, to indicate the effort’s progress and how money is 

being spent. This bill would also require VA to notify Congress in 

the event of any significant cost increase, schedule delay, loss of 

veteran health data, or breach of privacy. Representative Tim 

Walz, the Ranking Member of the Committee on Veterans’ Affairs, 

introduced H.R. 4245 on November 3, 2017. 

BACKGROUND AND NEED FOR LEGISLATION

In July 2015, the Department of Defense (DoD) commenced its 

electronic health record (EHR) modernization effort, called MHS 

GENESIS, by awarding a contract to the Leidos Partnership for 

Defense Health. The objective of MHS GENESIS is to implement 

the Cerner Corporation’s Millennium EHR and Henry Schein, Inc.’s 

Dentrix Enterprise software, with Leidos serving as the prime integrator, to replace the Armed Forces Health Longitudinal Technology Application and the Composite Health Care System in 

waves consisting of groups of military treatment facilities through 

2022. 

In June 2017, then-Secretary of Veterans Affairs David Shulkin 

signed a determination and findings document utilizing the public 

interest exception of the Federal Acquisition Regulation to authorize issuance of a sole-source contract solicitation to Cerner to purchase and implement its Millennium EHR to replace the Veterans 

Health Information Systems and Technology Architecture in VA. 

The overarching goal of VA’s EHRM program is to implement a 

common EHR throughout VA and the DoD Military Health System 

capable of seamless interoperability to facilitate transition of active 

duty military members into VA, improve their timely access to 

care, and enable a single, accurate, lifetime health record. VA’s implementation is similarly structured as a series of waves consisting 

of groups of medical centers, closely corresponding to the MHS 

GENESIS waves, through 2027. 

In February, July, September, and October 2017, MHS GENESIS 

completed implementations at the Fairchild Air Force Base clinic, 

Naval Hospital Oak Harbor, Naval Hospital Bremerton, and Madigan Army Medical Center, respectively. Early reports from these 

facilities indicate several issues of concern for the Committee with 

respect to VA’s forthcoming EHRM implementation. As of this report’s filing, VA has not yet awarded the EHRM contract to Cerner. 

VA tasked the MITRE Corporation to conduct a review of the intended contract’s interoperability requirements, from which a report was issued in January 2018. Additional reviews of the intended contract have continued. In April 2018, Acting Secretary of 

Veterans Affairs Robert Wilkie announced his near-term priority to 

finalize a decision on EHRM. 

Given the high cost, length, level of risk, and transformational 

importance of the EHRM program, it is necessary for the Committee to devote to it rigorous oversight. This entails monitoring 

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the program’s strategic conception, organizational construction, 

contractual activity, technical soundness, and actual progress. 

These factors are established and recorded in key programmatic 

and contractual documents. 

HEARINGS

On March 7, 2018, the Subcommittee on Oversight and Investigations held a legislative hearing that included a discussion of 

H.R. 4245. 

The following witnesses testified: 

The Honorable Cathy McMorris Rodgers, U.S. House of Representatives, 5th District, Washington; Fred Mingo, Director of 

Program Control, Program Executive Office, Electronic Health 

Record Modernization Program, U.S. Department of Veterans 

Affairs, accompanied by Ricky Lemmon, Acting Deputy Chief 

Procurement Officer, Veterans Health Administration, U.S. Department of Veterans Affairs, John Adams, Director of Corporate Travel, Office of Management, U.S. Department of Veterans Affairs, and Katrina Tuisamatatele, Health Portfolio Director, Office of Information and Technology, U.S. Department 

of Veterans Affairs; Louis Celli, Jr., Director, Veterans Affairs 

& Rehabilitation Division, The American Legion; and Scott 

Denniston, Executive Director National Veterans Small Business Coalition. 

Statements for the record were provided by: 

The Honorable Cathy McMorris Rodgers, U.S. House of Representatives, 5th District, Washington; and Veterans of Foreign Wars. 

SUBCOMMITTEE CONSIDERATION

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

COMMITTEE CONSIDERATION

On May 8, 2018, the full Committee met in open markup session, 

a quorum being present, and ordered H.R. 4245 favorably reported 

to the House of Representatives by voice vote. A motion by Representative Tim Walz of Minnesota to report H.R. 4245 favorably 

to the House of Representatives was adopted by voice vote. 

COMMITTEE VOTES

In compliance with clause 3(b) of rule XIII of the Rules of the 

House of Representatives, there were no recorded votes taken on 

amendments or in connection with ordering H.R. 4245 reported to 

the House. A motion by Representative Tim Walz of Minnesota to 

report H.R. 4245 favorably to the House of Representatives was 

adopted by voice vote. 

COMMITTEE OVERSIGHT FINDINGS

In compliance with clause 3(c)(1) of rule XIII and clause (2)(b)(1) 

of rule X of the Rules of the House of Representatives, the Committee’s oversight findings and recommendations are reflected in the 

descriptive portions of this report. 

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STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

In accordance with clause 3(c)(4) of rule XIII of the Rules of the 

House of Representatives, the Committee’s performance goals and 

objectives are to ensure VA provides the Committee with the appropriate information and documentation to conduct rigorous oversight over the EHRM program. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee adopts as its own the estimate of new budget authority, entitlement authority, or tax expenditures or revenues contained in the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974. 

EARMARKS AND TAX AND TARIFF BENEFITS

H.R. 4245 does not contain any Congressional earmarks, limited 

tax benefits, or limited tariff benefits as defined in clause 9 of rule 

XXI of the Rules of the House of Representatives. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate on H.R. 4245 

prepared by the Director of the Congressional Budget Office pursuant to section 402 of the Congressional Budget Act of 1974. 

CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House 

of Representatives, the following is the cost estimate for H.R. 4245 

provided by the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974: 

U.S. CONGRESS, CONGRESSSIONAL BUDGET OFFICE, Washington, DC, May 9, 2018. 

Hon. PHIL ROE, M.D., 

Chairman, Committee on Veterans’ Affairs, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 4245, the Veterans’ Electronic Health Record Modernization Oversight Act of 2017. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Ann E. Futrell. 

Sincerely, 

KEITH HALL, 

Director. 

Enclosure. 

H.R. 4245—Veterans’ Electronic Health Record Modernization Oversight Act of 2017 

Within a month of enactment, H.R. 4245 would require the Department of Veterans Affairs (VA) to submit to the Congress documents related to managing the Electronic Health Record ModVerDate Sep 11 2014 09:22 May 23, 2018 Jkt 079006 PO 00000 Frm 00004 Fmt 6659 Sfmt 6602 E:\HR\OC\HR691.XXX HR691
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ernization (EHRM) program. The bill also would require VA to provide the Congress with quarterly reports on the program and information regarding related contractual agreements. Under the 

EHRM program, VA plans on adopting the electronic health 

records used by the Department of Defense. 

The documents that the bill would require VA to submit will already be prepared in conjunction with the EHRM Program. As a 

result, CBO estimates that implementing the bill would cost less 

than $500,000 over the 2019–2023 period to compile and submit 

the necessary program documents to the Congress. That spending 

would be subject to the availability of appropriated funds. 

Enacting H.R. 4245 would not affect direct spending or revenues; 

therefore, pay-as-you-go procedures do not apply. 

CBO estimates that enacting H.R. 4245 would not increase net 

direct spending or on-budget deficits in any of the four consecutive 

10-year periods beginning in 2029. 

H.R. 4245 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act. 

The CBO staff contact for this estimate is Ann E. Futrell. The 

estimate was reviewed by Leo Lex, Deputy Assistant Director for 

Budget Analysis. 

FEDERAL MANDATES STATEMENT

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

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act would be created by H.R. 4245. 

STATEMENT OF CONSTITUTIONAL AUTHORITY

Pursuant to Article I, section 8 of the United States Constitution, 

H.R. 4245 is authorized by Congress’ power to ‘‘provide for the common Defense and general Welfare of the United States.’’ 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that H.R. 4245 does not relate to the terms 

and conditions of employment or access to public services or accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act. 

STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS

Pursuant to clause 3(c)(5) of rule XIII of the Rules of the House 

of Representatives, the Committee finds that no provision of H.R. 

4245 establishes or reauthorizes a program of the Federal Government known to be duplicative of another Federal program, a program that was included in any report from the Government Accountability Office to Congress pursuant to section 21 of Public 

Law 111–139, or a program related to a program identified in the 

most recent Catalog of Federal Domestic Assistance. 

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DISCLOSURE OF DIRECTED RULEMAKING

Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017), the 

Committee estimates that H.R. 4245 contains no directed rulemaking that would require the Secretary to prescribe regulations. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title 

Section 1 of the bill would establish the short title as the ‘‘Veterans’ Electronic Health Record Modernization Oversight Act of 

2017.’’ 

Section 2. Oversight of Electronic Health Record Modernization program 

Section 2(a) of the bill would require that, not later than 30 days 

after enactment, the Secretary of Veterans Affairs shall submit to 

the Committees on Veterans’ Affairs and Appropriations of the 

House and Senate copies of 15 documents produced in the EHRM 

program. 

Section 2(b) of the bill would require that, not later than 30 days 

after the end of each fiscal quarter, the Secretary shall provide 

quarterly updates of six of the documents required in section 2(a). 

Section 2(c) of the bill would require the Secretary to provide to 

the Committees copies of all contracts, orders, agreements, or modifications thereto, not later than five days after their award. 

Section 2(d) of the bill would require the Secretary to provide notification to the Committees not later than 10 days after the occurrence of any delay of any milestone or deliverable exceeding 30 

days, request for equitable adjustment by the contractor or change 

order exceeding $1 million, submission of any protest, claim, dispute, and resolution of the same, loss of clinical or other data, or 

breach of patient privacy. 

Section 2(e) of the bill would provide relevant definitions. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

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

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