II 

118TH CONGRESS 

1ST SESSION S. 1125 

To authorize an electronic health record modernization program of the Department of Veterans Affairs and increase oversight and accountability 

of the program to better serve veterans, medical professionals of the 

Department, and taxpayers, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MARCH 30, 2023 

Mr. TESTER (for himself, Mrs. MURRAY, and Mr. BROWN) introduced the following bill; which was read twice and referred to the Committee on Veterans’ Affairs 

A BILL 

To authorize an electronic health record modernization program of the Department of Veterans Affairs and increase 

oversight and accountability of the program to better 

serve veterans, medical professionals of the Department, 

and taxpayers, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Electronic Health Record Program Restructure, En6 hance, Strengthen, and Empower Technology Act of 

7 2023’’ or the ‘‘EHR Program RESET Act of 2023’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents for 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Definitions. 

TITLE I—PROGRAM ESTABLISHMENT, STRUCTURE, 

MANAGEMENT, AND OBJECTIVES 

Sec. 101. Establishment of electronic health record and health information 

technology modernization program and program office of Department of Veterans Affairs. 

Sec. 102. Establishment of Department of Veterans Affairs advisory subcommittee on electronic health record and health information 

technology modernization. 

TITLE II—DEPLOYMENT CRITERIA AND THRESHOLDS TO 

ADVANCE 

Sec. 201. Requirement to exceed or meet certain health care performance baseline or national metrics for continuation of electronic health 

record modernization program of Department of Veterans Affairs. 

Sec. 202. Requirements before continued deployment of new electronic health 

record by Department of Veterans Affairs at additional locations and facilities. 

Sec. 203. Sense of Congress on training and change management activities for 

deployment of new electronic health record. 

TITLE III—ENHANCED SUPPORT FOR HEALTH CARE AND OTHER 

FACILITIES DEPLOYING NEW ELECTRONIC HEALTH RECORD 

Sec. 301. Report on support to facilities for new electronic health record deployment by Department of Veterans Affairs. 

Sec. 302. Modification of quarterly report to include information on system stability, satisfaction, morale, retention of staff, training, and 

change management with respect to new electronic health 

record of Department of Veterans Affairs. 

TITLE IV—CONTRACTING AND ACQUISITION OVERSIGHT AND 

REFORM 

Sec. 401. Termination of contract with Oracle Cerner for training and change 

management. 

Sec. 402. Strengthening contract negotiation by Department of Veterans Affairs with respect to new electronic health record and designation of lead contract negotiator. 

Sec. 403. Independent verification and validation of certain major modernization efforts of Department of Veterans Affairs. 

Sec. 404. Annual report on efforts to maintain VistA electronic health record 

system. 

Sec. 405. Report on alternatives to current electronic health record technology 

and contract for Department of Veterans Affairs. 

Sec. 406. Report on leadership, acquisition, and contracting oversight lessons 

learned. 


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Sec. 407. Report on contract savings, services provided at no cost to the Department, and contract cost incurred with respect to OracleCerner product. 

TITLE V—COORDINATION WITH DEPARTMENT OF DEFENSE 

Sec. 501. Quarterly reports on system uptime, modernization, and coordination 

activities for information technology systems and policies of 

Department of Defense affecting operations of Department of 

Veterans Affairs. 

Sec. 502. Coordination with Department of Defense regarding information 

technology programs, systems, and services. 

TITLE VI—OTHER MATTERS 

Sec. 601. Report on legislative action required. 

Sec. 602. Report on current and future State interoperability with legacy electronic health record, new electronic health record, and future 

potential electronic health record and other health information 

technology and exchanges. 

1 SEC. 2. DEFINITIONS. 

2 Except as otherwise provided, in this Act: 

3 (1) APPROPRIATE COMMITTEES OF CON4 GRESS.—The term ‘‘appropriate committees of Con5 gress’’ means— 

6 (A) the Committee on Veterans’ Affairs 

7 and the Committee on Appropriations of the 

8 Senate; and 

9 (B) the Committee on Veterans’ Affairs 

10 and the Committee on Appropriations of the 

11 House of Representatives. 

12 (2) DEPARTMENT.—The term ‘‘Department’’ 

13 means the Department of Veterans Affairs. 

14 (3) DEPUTY SECRETARY.—The term ‘‘Deputy 

15 Secretary’’ means the Deputy Secretary of Veterans 

16 Affairs. 


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1 (4) FOURTH MISSION.—The term ‘‘Fourth Mis2 sion’’ means the mission of the Department to im3 prove the preparedness of the United States for re4 sponse to war, terrorism, national emergency, and 

5 natural disaster. 

6 (5) MODERNIZATION; MODERNIZE.—The terms 

7 ‘‘modernization’’ and ‘‘modernize’’, with respect to 

8 the electronic health record and other relevant 

9 health information technology systems of the De10 partment, means to replace, in whole or in part, 

11 overhaul, or upgrade such record or other system in 

12 a manner that gives such record or other system lon13 gevity and ability to constantly be updated to meet 

14 the needs of veterans, employees of the Department, 

15 and the Department. 

16 (6) NEW ELECTRONIC HEALTH RECORD.—The 

17 term ‘‘new electronic health record’’ means any elec18 tronic health record provided for the Department on 

19 or after the date of the enactment of this Act, in20 cluding pursuant to a contract entered into by the 

21 Department. 

22 (7) ORACLE-CERNER PRODUCT.—The term 

23 ‘‘Oracle-Cerner product’’ means the product pro24 vided under the contract entered into by the Depart25 ment with Cerner pursuant to the electronic health 


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1 record modernization program of the Department 

2 before the date of the enactment of this Act. 

3 (8) SECRETARY.—The term ‘‘Secretary’’ means 

4 the Secretary of Veterans Affairs. 

5 (9) UNDER SECRETARY.—The term ‘‘Under 

6 Secretary’’ means the Under Secretary for Health of 

7 the Department of Veterans Affairs. 

8 TITLE I—PROGRAM ESTABLISH9 MENT, STRUCTURE, MANAGE10 MENT, AND OBJECTIVES 

11 SEC. 101. ESTABLISHMENT OF ELECTRONIC HEALTH 

12 RECORD AND HEALTH INFORMATION TECH13 NOLOGY MODERNIZATION PROGRAM AND 

14 PROGRAM OFFICE OF DEPARTMENT OF VET15 ERANS AFFAIRS. 

16 (a) ESTABLISHMENT OF PROGRAM.— 

17 (1) ESTABLISHMENT.—There is established 

18 within the Veterans Health Administration a pro19 gram to modernize the electronic health record and 

20 other relevant health information technology systems 

21 of the Department (in this section referred to as the 

22 ‘‘Program’’). 

23 (2) PURPOSE AND GOALS.—The purpose and 

24 goals of the Program are as follows: 


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1 (A) To deliver an electronic health record, 

2 platform, and related systems that allow the 

3 Department to deliver, as measured by quantifi4 able industry and Department-specific metrics, 

5 improved standardized workflows and con6 sistent, quality health care to veterans through 

7 a modern, user-friendly, electronic health record 

8 and related systems that allow medical profes9 sionals of the Department to deliver health care 

10 to veterans safely. 

11 (B) To increase the productivity, effi12 ciency, retention, satisfaction, and experience of 

13 such medical professionals. 

14 (C) To improve veteran experience and 

15 health outcomes. 

16 (D) To improve quality and coordination of 

17 care, reduce unnecessary variation, and improve 

18 data management. 

19 (E) To maintain, strengthen, and expand 

20 the research and development activities of the 

21 Department to include those activities required 

22 under title 38, United States Code. 

23 (F) To maintain and strengthen the ability 

24 of the Department to carry out Fourth Mission 


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1 requirements, to include the requirements under 

2 title 38, United States Code. 

3 (G) To protect the health and other per4 sonal identifying information of veterans from 

5 being monetized, sold, or otherwise misused by 

6 any internal or external entity conducting work 

7 for, with, or on behalf of the Department. 

8 (H) To protect the health and other per9 sonal identifying information of veterans or 

10 other users of the electronic health record or 

11 other programs or services of the Department 

12 from cyber attacks, identity theft, and other 

13 cyber and security threats. 

14 (I) To deliver— 

15 (i) operational value to the Depart16 ment from the use of the electronic health 

17 record and related systems; 

18 (ii) business value and return on in19 vestment to the Department from improve20 ment to the electronic health record and 

21 related systems across all relevant do22 mains, to include cyber and other security, 

23 business, and financial operations; and 

24 (iii) an evolving level of advanced 

25 interoperability of the electronic health 


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1 record with the greatest number of elec2 tronic health record systems, platforms, 

3 services, and related interfaces in the Fed4 eral, private, nonprofit, and other relevant 

5 health sectors. 

6 (J) To develop health information tech7 nology modernization strategies and implemen8 tation plans that provide the Department with 

9 the most flexibility to continuously modernize 

10 the health information technology systems of 

11 the Department in an agile manner, not com12 mitted to any one particular vendor or vendors 

13 or technology solution or solutions, commonly 

14 known as ‘‘vendor lock’’, and respond to new 

15 trends in the health information technology in16 dustry in real time, allowing for relevant and 

17 appropriate integration with other health infor18 mation technology platforms and services. 

19 (K) To aggressively manage and monitor 

20 the implementation of all contracts and services 

21 procured by the Department related to such 

22 electronic health record and related services to 

23 control cost, ensure best value, monitor, and 

24 evaluate delivery of the services procured in line 

25 with program goals and desired outcomes. 


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1 (L) To carry out the purposes and goals 

2 described in subparagraphs (A) through (K) at 

3 the most effective short-, medium-, and long4 term cost to the Federal Government using in5 dustry and government best practices so as to 

6 protect taxpayers. 

7 (M) Such other purposes or goals as deter8 mined— 

9 (i) pursuant to the report submitted 

10 under subsection (b)(6); or 

11 (ii) by the Secretary, the Deputy Sec12 retary, or the Under Secretary pursuant to 

13 a report submitted to the appropriate com14 mittees of Congress describing any new 

15 purpose or goal for the Program not later 

16 than 90 days after adding such purpose or 

17 goal to the Program. 

18 (b) ESTABLISHMENT OF PROGRAM MANAGEMENT

19 OFFICE.— 

20 (1) IN GENERAL.—There is established within 

21 the Veterans Health Administration the Electronic 

22 Health Record and Health Information Technology 

23 Modernization Program Management Office (re24 ferred to in this section as the ‘‘Office’’). The Sec25 retary or the Deputy Secretary may rename the OfVerDate Sep 11 2014 22:10 Apr 11, 2023 Jkt 039200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1125.IS S1125

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1 fice and upon renaming such office shall notify Con2 gress not later than 60 days after such renaming. 

3 (2) ORGANIZATIONAL LOCATION OF OFFICE.— 

4 (A) IN GENERAL.—The Under Secretary 

5 shall determine the appropriate organizational 

6 location within the Veterans Health Adminis7 tration for the Office so as to align responsibil8 ities within existing or newly formed clinical, 

9 patient safety, health informatics, finance, and 

10 other business operations of the Veterans 

11 Health Administration. 

12 (B) REORGANIZATION OF OFFICE.—The 

13 Secretary, the Deputy Secretary, and the Under 

14 Secretary may move or reorganize the organiza15 tional location of the Office only after notifying 

16 the appropriate committees of Congress not 

17 later than 90 days before such move or reorga18 nization. 

19 (3) LEADERSHIP AND STAFF.— 

20 (A) EXECUTIVE DIRECTOR.—The Under 

21 Secretary shall establish a leader to be respon22 sible for the Office, to be known as the ‘‘Execu23 tive Director of the Electronic Health Record 

24 and Health Information Technology Moderniza25 tion Program Management Office’’. 


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1 (B) PROGRAM FUNCTIONAL CHAMPION.— 

2 (i) IN GENERAL.—The Under Sec3 retary shall establish a Functional Cham4 pion of the Program who will serve with 

5 the Executive Director of the Office. 

6 (ii) DUTIES.—The duties of the Func7 tional Champion are— 

8 (I) to be the lead clinical execu9 tive to guide and address functional 

10 initiatives to support medical per11 sonnel of the Department in the de12 ployment of a new electronic health 

13 record and other health information 

14 technology products; and 

15 (II) to carry out such additional 

16 duties as the Under Secretary and the 

17 Executive Director of the Office may 

18 prescribe. 

19 (C) OTHER OFFICES AND POSITIONS.— 

20 (i) IN GENERAL.—The Under Sec21 retary shall direct the establishment of var22 ious other relevant sub-offices and posi23 tions for the Office as the Under Secretary 

24 considers necessary drawing upon best 

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1 partment of Defense, and other govern2 ment, private sector, and nonprofit models 

3 and develop an organizational model tai4 lored to the Department for business and 

5 management effectiveness. 

6 (ii) TYPES OF SUB-OFFICES.—At a 

7 minimum, within the Office there shall be 

8 offices dedicated to— 

9 (I) training; 

10 (II) change management; 

11 (III) communications; 

12 (IV) field support; 

13 (V) contract task order develop14 ment, monitoring, and oversight; 

15 (VI) metrics, performance, and 

16 value; and 

17 (VII) quality and safety. 

18 (iii) SENSE OF CONGRESS.—It is the 

19 sense of Congress that— 

20 (I) the Department should de21 velop a model under clause (i) that is 

22 driven by best practices from govern23 ment and industry but not replicate 

24 for the sake of replication structures 

25 used by the Department of Defense or 


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1 elsewhere that do not factor in the pa2 tient population, unique mission, 

3 Fourth Mission requirements, and re4 search requirements of the Depart5 ment, and other relevant factors; and 

6 (II) the structure of such model 

7 should be driven by the objectives of 

8 the Office and the desired end state to 

9 improve value and quality of care and 

10 health outcomes for veterans while im11 proving provider efficiency and pro12 ductivity and operations of the De13 partment. 

14 (4) FUNCTION AND DUTIES.— 

15 (A) FUNCTION.—The function of the Of16 fice shall be, with respect to all aspects of the 

17 modernization or replacement of the electronic 

18 health record and other key health information 

19 technology and services of the Department— 

20 (i) to develop and execute strategy in 

21 coordination with relevant offices and enti22 ties of the Department; and 

23 (ii) to perform management, over24 sight, and accountability, including over all 


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1 contracts, coordination, planning, manage2 ment, and implementation. 

3 (B) DUTIES.—The duties of the Office 

4 shall include the following: 

5 (i) Ensuring the Program delivers the 

6 tools medical professionals of the Depart7 ment need to safely deliver care to veterans 

8 while increasing productivity, satisfaction, 

9 and efficiency as measured by metrics. 

10 (ii) Organizing all of the relevant 

11 health, business, informatics, and related 

12 offices of the Veterans Health Administra13 tion to ensure a coordinated strategy re14 garding the new electronic health record 

15 and other current and future key health 

16 information technology and services of the 

17 Department. 

18 (iii) Coordinating with other offices 

19 and entities of the Department with key 

20 dependencies and responsibilities in the 

21 success of the Program or operational 

22 needs for the services of the Program, in23 cluding the Office of Information and 

24 Technology, the Veterans Benefits Admin25 istration, and other relevant offices. 


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1 (iv) Ensuring the stability and secu2 rity of the new electronic health record and 

3 other current and future key health infor4 mation technology and services of the De5 partment. 

6 (v) Oversight of work performed by 

7 contractors regarding such record, tech8 nology, and services. 

9 (vi) Developing a health information 

10 technology strategy of the Department— 

11 (I) to increase quality of care, 

12 health outcomes, and experience of 

13 care received by veterans; 

14 (II) to increase value to business 

15 and health operations of the Depart16 ment; 

17 (III) to enable the further re18 cruitment and retention of medical 

19 professionals; and 

20 (IV) to coherently define how dis21 parate health information technology 

22 efforts of the Department can be 

23 aligned to deliver on that strategy 

24 with concrete goals, metrics, and out25 comes. 


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1 (vii) Developing goals, key perform2 ance indicators, and metrics to evaluate 

3 such record, technology, and services, in4 cluding with respect to financial perform5 ance, provider productivity, and health per6 formance. 

7 (viii) Monitoring such goals, perform8 ance indicators, and metrics to develop ac9 tions for when such goals, performance in10 dicators, and metrics have not been met. 

11 (ix) Improvement of business oper12 ations of the Department relating to such 

13 record, technology, and services. 

14 (x) Such other matters as the Sec15 retary, the Deputy Secretary, or the Under 

16 Secretary consider appropriate. 

17 (5) REPORT ON ESTABLISHMENT OF OFFICE.— 

18 (A) IN GENERAL.—Not later than 90 days 

19 after the date of the enactment of this Act, the 

20 Deputy Secretary, the Under Secretary, and the 

21 Chief Information Officer of the Department 

22 shall submit to the appropriate committees of 

23 Congress a single report outlining the establish24 ment of the Office and its current strengths 

25 and weaknesses. 


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1 (B) ELEMENTS.—The report required 

2 under subparagraph (A) shall include— 

3 (i) a clear articulation of the objective 

4 of the Program and how that objective is 

5 tied to the broader health information 

6 technology modernization strategy and 

7 health care mission of the Department, 

8 which shall include functional and tech9 nical quality standards to define success of 

10 the Program based on clear demonstration 

11 of improved health and business oper12 ational metrics; 

13 (ii) a strategy describing how tech14 nology procured by the Department shall 

15 be part of a comprehensive approach for 

16 using health information technology, mod17 els of care delivery, and research conducted 

18 by the Department to strengthen services 

19 for veterans and veteran engagement; 

20 (iii) concrete steps for how the De21 partment will use internal and external re22 sources to operationalize the strategy 

23 under clause (ii) through technical and 

24 functional engineering expertise to stream25 line the organization and governance of the 


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1 Office of Information and Technology, the 

2 Veterans Health Administration, and other 

3 relevant offices or entities of the Depart4 ment to enact that strategy; 

5 (iv) an assessment of the current and 

6 desired future state, with timelines to 

7 achieve such future state, of enterprise 

8 business and technical architecture, infor9 mation technology product consolidation 

10 and management, information technology 

11 governance, business and clinical process 

12 standardization and quality control of the 

13 Department and the steps that are or will 

14 be taken in response to that assessment, 

15 including a timeline for execution of those 

16 reforms; and 

17 (v) a description, as of the date of the 

18 report, of the current status of the objec19 tives of the Office, whether those objectives 

20 are being met, and if they are not being 

21 met the steps the Department will take, in22 cluding a timeline, to achieve those objec23 tives. 


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1 (c) DEPUTY CHIEF INFORMATION OFFICER FOR

2 ELECTRONIC HEALTH RECORD AND HEALTH INFORMA3 TION TECHNOLOGY.— 

4 (1) ESTABLISHMENT.—There is established 

5 within the Office of Information and Technology of 

6 the Department a Deputy Chief Information Officer 

7 for Electronic Health Record and Health Informa8 tion Technology who shall be accountable for all 

9 technical implementation of the modernization of the 

10 electronic health record and health information tech11 nology, in coordination with the Program and the 

12 Office. 

13 (2) RENAMING.—The Chief Information Officer 

14 of the Department may rename the position estab15 lished under paragraph (1) and upon renaming such 

16 position shall notify Congress not later than 90 days 

17 after such renaming. 

18 (3) CHAIN OF COMMAND.—The Deputy Chief 

19 Information Officer for Electronic Health Record 

20 and Health Information Technology of the Depart21 ment shall report to the Chief Information Officer 

22 and the Assistant Secretary for Information and 

23 Technology of the Department. 

24 (4) DUTIES.—The Deputy Chief Information 

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1 formation Technology of the Department shall be re2 sponsible for organizing all functions of the Office of 

3 Information and Technology of the Department to 

4 support the modernization of the electronic health 

5 record and health information technology of the De6 partment, including cyber security, system stability 

7 and uptime, system performance, and integration 

8 with relevant platforms, systems, and services, in9 cluding those of the Department of Defense and 

10 other Federal agencies. 

11 (5) ADDITIONAL GUIDANCE.—The Chief Infor12 mation Officer of the Department may provide addi13 tional or modified guidance for the role of Deputy 

14 Chief Information Officer for Electronic Health 

15 Record and Health Information Technology of the 

16 Department. 

17 (d) ADMINISTRATIVE MATTERS.— 

18 (1) ACCOUNTABILITY AND OVERSIGHT FOR

19 PROGRAM.—The Deputy Secretary shall be the ac20 countable official for the Program, oversee the Pro21 gram, and may direct resources, subject to appro22 priations, throughout the Department, particularly 

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1 ment, to facilitate successful planning, management, 

2 oversight, and execution of the Program. 

3 (2) RESPONSIBILITY FOR PROGRAM AND OF4 FICE.—The Under Secretary shall be the responsible 

5 official for the Program and the Office, working to6 gether with the Executive Director of the Office. 

7 The Under Secretary and the Executive Director of 

8 the Office shall be directly responsible and in charge 

9 of the daily work of the Program and the Office. 

10 (3) TRACKING AND REPORTING OF FUNDS.— 

11 Any funds directed by the Deputy Secretary to other 

12 entities of the Department to support the Program 

13 or the Office shall be tracked and reported as falling 

14 under the Program regardless of the office that 

15 manages and executes those particular funds. 

16 SEC. 102. ESTABLISHMENT OF DEPARTMENT OF VETERANS 

17 AFFAIRS ADVISORY SUBCOMMITTEE ON 

18 ELECTRONIC HEALTH RECORD AND HEALTH 

19 INFORMATION TECHNOLOGY MODERNIZA20 TION. 

21 (a) IN GENERAL.—Not later than 60 days after the 

22 date of the enactment of this Act, the Secretary, acting 

23 in coordination with and through the Under Secretary, 

24 shall establish a permanent subcommittee of the special 

25 medical advisory group established under section 7312 of 


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1 title 38, United States Code, focused on electronic health 

2 record and health information technology modernization 

3 of the Department, to be known as the Subcommittee on 

4 Electronic Health Record and Health Information Tech5 nology Modernization (in this section referred to as the 

6 ‘‘Subcommittee’’). 

7 (b) COMPOSITION OF SUBCOMMITTEE.— 

8 (1) IN GENERAL.—The Subcommittee shall be 

9 composed of not fewer than 5 and not more than 10 

10 individuals selected by the Under Secretary who 

11 have a current or previous documented and relevant 

12 deep professional background within a leading health 

13 care organization or organizations of the United 

14 States in the private or nonprofit health sector, in15 cluding— 

16 (A) experience with health systems; 

17 (B) experience as a health executive, chief 

18 health information or informatics officer, chief 

19 medical information officer, clinician, or nurse 

20 with deep experience implementing or over21 seeing medium- or large-scale health informa22 tion technology transformation, including elec23 tronic health record deployments and business 

24 modernizations; 


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1 (C) experience improving health care out2 comes; 

3 (D) experience managing change; or 

4 (E) experience in developing and imple5 menting electronic health record training. 

6 (2) NURSE OR NURSE EXECUTIVE.—At least 

7 one member of the Subcommittee shall be a nurse 

8 or nurse executive. 

9 (3) MEMBER OF VETERANS SERVICE ORGANIZA10 TION.—At least one member of the Subcommittee 

11 shall be a representative of a Federally chartered, 

12 membership-based veterans service organization. 

13 (4) LIMITATION.—An individual is not eligible 

14 to be a member of the Subcommittee if the indi15 vidual— 

16 (A) is from the information technology 

17 vendor or technology development sector; or 

18 (B) had a role in the Oracle or Cerner pro19 curement by the Department or related con20 tracts for program management services for the 

21 electronic health record modernization program 

22 of the Department. 

23 (c) DUTIES.—The Subcommittee shall produce peri24 odic reports and recommendations as directed or re25 quested by the Secretary or the Under Secretary on plans 


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1 and opportunities for the Department to improve its strat2 egy, goals, and implementation for and deployment of elec3 tronic health records and health information technology 

4 to better improve quality of care, patient outcomes, oper5 ational efficiency and productivity, provider productivity 

6 and engagement, and related matters based on national 

7 best practices that are relevant to the Department. 

8 (d) ADMINISTRATION.—Administration of the Sub9 committee, including terms of service and replacement of 

10 members, shall be guided by the rules and charter of the 

11 special medical advisory group established under section 

12 7312 of title 38, United States Code. 

13 (e) TERMINATION.—This section shall terminate on 

14 the date on which the Secretary determines that a mod15 ernized electronic health record has been deployed to every 

16 medical center and other relevant medical facility of the 

17 Department. 


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1 TITLE II—DEPLOYMENT CRI2 TERIA AND THRESHOLDS TO 

3 ADVANCE 

4 SEC. 201. REQUIREMENT TO EXCEED OR MEET CERTAIN 

5 HEALTH CARE PERFORMANCE BASELINE OR 

6 NATIONAL METRICS FOR CONTINUATION OF 

7 ELECTRONIC HEALTH RECORD MODERNIZA8 TION PROGRAM OF DEPARTMENT OF VET9 ERANS AFFAIRS. 

10 (a) IN GENERAL.—The Secretary may not initiate a 

11 new go-live deployment of the electronic health record 

12 modernization program until the quality, access, produc13 tivity, and all other health and operational performance 

14 metrics data of the Veterans Health Administration and 

15 the Office of Information and Technology of the Depart16 ment at each facility of the Department (including any 

17 subsidiary facilities, such as community-based outpatient 

18 clinics) that is using the Oracle-Cerner product under such 

19 program as of January 31, 2023, has either— 

20 (1) exceeded the health and information tech21 nology operational levels of the facility before deploy22 ing such product; or 

23 (2) met national standards set forth by the Vet24 erans Health Administration for quality, safety, effi25 ciency, and financial performance as established by 


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1 the Program established under section 101(a) and 

2 the Under Secretary. 

3 (b) ESTABLISHMENT OF NATIONAL STANDARDS.— 

4 (1) IN GENERAL.—The Under Secretary and 

5 the Program established under section 101(a) shall 

6 establish national standards required under sub7 section (a)(2) to create a common health perform8 ance standard of the Veterans Health Administra9 tion under which all medical facilities of the Depart10 ment may be evaluated under that subsection that 

11 takes into account relevant differences in size, com12 plexity, and market of each facility. 

13 (2) COMMON METRIC AND STANDARD.—In es14 tablishing standards under paragraph (1), the Under 

15 Secretary and the Program established under section 

16 101(a) shall establish a common data driven metric 

17 and service delivery standard for care for veterans 

18 by which medical facilities of the Department can be 

19 evaluated. 

20 (3) REPORTS.— 

21 (A) INITIAL REPORT.—Not later than 60 

22 days after the establishment of standards under 

23 paragraph (1), the Program established under 

24 section 101(a) shall submit to the appropriate 


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1 committees of Congress a report on such stand2 ards. 

3 (B) MODIFICATION TO STANDARDS.—Not 

4 later than 30 days before the modification to 

5 any standards established under paragraph (1), 

6 the Program established under section 101(a) 

7 shall submit to the appropriate committees of 

8 Congress a report on such modification. 

9 (c) TERMINATION OR CONTINUATION OF USE.— 

10 (1) IN GENERAL.—If, by the date that is 180 

11 days after the date of the enactment of this Act, the 

12 data from the first five facilities of the Department 

13 as well as any relevant remote sites, consolidated pa14 tient account centers, subsidiary facilities, such as 

15 community-based outpatient clinics that deployed the 

16 Oracle-Cerner product, have not reached the require17 ments under subsection (a)— 

18 (A) not later than 13 months after such 

19 date of enactment, the Secretary, in consulta20 tion with the Deputy Secretary, the Under Sec21 retary for Health, the Chief Information Offi22 cer, and the Executive Director of the Office, 

23 shall— 

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1 partment will meet the requirements under 

2 such subsection either through the existing 

3 technology strategy of the Department, a 

4 new procurement, or some other combina5 tion or approach; and 

6 (ii) publicly announce a replacement 

7 technology solution or solutions or contract 

8 or contracts, including a new timeline and 

9 strategy to implement such solution or so10 lutions; and 

11 (B) not later than 180 days after com12 pleting the requirements under subparagraph 

13 (A), the Secretary shall— 

14 (i) terminate, cancel, or modify the 

15 contract for the Oracle-Cerner product; 

16 and 

17 (ii) develop appropriate coordination 

18 and transition plans for the transition of 

19 use of technology from the Oracle-Cerner 

20 product back to VistA or from the Oracle21 Cerner product to an alternate electronic 

22 health record technology. 

23 (2) LIMITATION ON CANCELLATION OF EXIST24 ING CONTRACT.—In carrying out paragraph (1), to 

25 ensure a smooth transition and reduce operational 


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1 and care delivery disturbance, the Secretary may not 

2 terminate any existing electronic health record con3 tract until a replacement contract and strategy for 

4 such electronic health record are in place or near 

5 award and commencement. 

6 (3) EXTENSION OF TIME.— 

7 (A) IN GENERAL.—Not later than 120 

8 days after the date of the enactment of this 

9 Act, the Secretary may, for one time only, tem10 porarily delay each of the requirements of para11 graph (1) for a period not to exceed 180 days 

12 if the Secretary determines such delay is nec13 essary due to mission critical, national emer14 gency, national security, patient safety, quality 

15 and access to care, protection of taxpayer in16 vestments, or other unforeseen reasons. 

17 (B) JUSTIFICATION FOR EXTENSION.—If 

18 the Secretary determines that a delay under 

19 subparagraph (A) is necessary, not later than 

20 105 days after the date of the enactment of this 

21 Act, the Secretary shall submit to the appro22 priate committees of Congress a report setting 

23 forth the justification of the Secretary for such 

24 delay. 


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1 SEC. 202. REQUIREMENTS BEFORE CONTINUED DEPLOY2 MENT OF NEW ELECTRONIC HEALTH 

3 RECORD BY DEPARTMENT OF VETERANS AF4 FAIRS AT ADDITIONAL LOCATIONS AND FA5 CILITIES. 

6 (a) REPORT ON METRICS TO DETERMINE CONTIN7 UED DEPLOYMENT.— 

8 (1) IN GENERAL.—Not later than 30 days after 

9 the date of the enactment of this Act, the Deputy 

10 Secretary shall submit to the appropriate committees 

11 of Congress a report containing the metrics, readi12 ness criteria, and governance decision process that 

13 the Department will use to determine whether con14 tinued deployment of the electronic health record 

15 technology of the Department is appropriate in June 

16 2023, or whether a further pause in such deploy17 ment is warranted to address system issues, patient 

18 safety, technology features, provider efficiency, and 

19 related matters. 

20 (2) METRICS.—The metrics included in the re21 port submitted under paragraph (1) shall— 

22 (A) be data driven based on industry 

23 standards, metrics of the Department, and the 

24 unique health care delivery needs of the Depart25 ment to serve veterans, perform research, and 

26 support Fourth Mission requirements; 


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1 (B) ensure patient safety, quality of and 

2 access to care, system stability, cyber security, 

3 and sound financial and business administra4 tion activities are successfully evaluated as sta5 ble and functional at desired performance levels 

6 and in place to proceed; 

7 (C) ensure completion of relevant training 

8 and change management activities; and 

9 (D) include any other specific readiness 

10 criteria that each location of the Department is 

11 required to meet before moving forward with 

12 continued deployment of the electronic health 

13 record technology of the Department, as deter14 mined by the Department. 

15 (3) OTHER ELEMENTS.—The report submitted 

16 under paragraph (1) shall— 

17 (A) indicate how the metrics required 

18 under the report are or will be adjusted to in19 corporate the research function and health com20 plexity levels of facilities of the Department and 

21 whether additional or different metrics are or 

22 will be added based on more or less complex fa23 cilities or facilities with a greater research func24 tion; 


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1 (B) explain how the metrics and readiness 

2 criteria under the report incorporate appro3 priate input and findings of the National Cen4 ter for Patient Safety, the Clinical Episode Re5 view Team, or the Office of the Assistant Under 

6 Secretary for Health for Quality and Patient 

7 Safety of the Veterans Health Administration, 

8 or any successor office, and resolve any issues 

9 raised by those offices to the satisfaction of 

10 those offices through information technology 

11 changes, functionality, training, and other 

12 areas, including regarding patient record flags, 

13 behavioral health and suicide risks, configura14 tion of roles and responsibilities, referrals, am15 bulatory care, pharmacy, identity, orders, medi16 cation administration, and other areas, which 

17 shall include a specific description of how each 

18 issue identified in the March 2023 report of the 

19 Department entitled, ‘‘EHRM Sprint Report’’ 

20 has been resolved or mitigated; and 

21 (C) provide a clear process description re22 flecting— 

23 (i) the repeatable method for how de24 cisions relating to deployment of electronic 

25 health record technology are made within 


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1 the Department from the field level up to 

2 the Secretary; and 

3 (ii) the input received from each rel4 evant element of the Department before 

5 such a decision is made, to include input 

6 from the National Center for Patient Safe7 ty. 

8 (4) CERTIFICATION.—In submitting metrics 

9 under paragraph (1), the Deputy Secretary shall 

10 certify that the metrics have been approved by the 

11 Under Secretary, the Executive Director of the Of12 fice, and the Chief Information Officer of the De13 partment. 

14 SEC. 203. SENSE OF CONGRESS ON TRAINING AND CHANGE 

15 MANAGEMENT ACTIVITIES FOR DEPLOYMENT 

16 OF NEW ELECTRONIC HEALTH RECORD. 

17 It is the sense of Congress that— 

18 (1) training and change management with re19 spect to any new electronic health record shall be led 

20 by the Department and employees of the Depart21 ment who are uniquely positioned to understand the 

22 legacy VistA system of the Department, the existing 

23 and future standardized workflow of the Depart24 ment, and the history, culture, and mission of the 

25 Department; and 


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1 (2) any contractors of the Department involved 

2 in the implementation of any new electronic health 

3 record should serve in a support function to the De4 partment rather than lead and conduct all training 

5 and change management activities. 

6 TITLE III—ENHANCED SUPPORT 

7 FOR HEALTH CARE AND 

8 OTHER FACILITIES DEPLOY9 ING NEW ELECTRONIC 

10 HEALTH RECORD 

11 SEC. 301. REPORT ON SUPPORT TO FACILITIES FOR NEW 

12 ELECTRONIC HEALTH RECORD DEPLOYMENT 

13 BY DEPARTMENT OF VETERANS AFFAIRS. 

14 (a) IN GENERAL.—Not later than 90 days after the 

15 date of the enactment of this Act, the Deputy Secretary 

16 shall submit to the appropriate committees of Congress 

17 a report summarizing the standard support services that 

18 the Department does or intends to provide to each facility 

19 in preparation for potential future deployment of the new 

20 electronic health record of the Department at such facility 

21 and in the period after such deployment. 

22 (b) SUPPORT TO BE PROVIDED.—The support re23 quired to be provided to a facility by the Department and 

24 included in the report under subsection (a) shall include, 

25 at a minimum, the following: 


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1 (1) Budgetary resources and support to address 

2 the need for increased staffing at the facility, re3 duced productivity and collections, increased use of 

4 community care networks, and other issues identi5 fied in the report of the Institute for Defense Anal6 yses dated October 2022, entitled ‘‘Independent Cost 

7 Estimate for Veterans Affairs Electronic Health 

8 Record Modernization Program’’. 

9 (2) Increased staffing level surge at the facility, 

10 including temporary and permanent staff. 

11 (3) Steps to be taken by the Department to re12 duce burnout and turnover. 

13 (4) Enhanced training to include government or 

14 vendor supplied trainers to maintain a presence until 

15 dismissed by the director or other relevant leader of 

16 the facility after deployment of the new electronic 

17 health record. 

18 (5) A description of any additional legislative 

19 action requested to improve the level of support serv20 ices required at each such facility for such deploy21 ment. 

22 (6) Such other support as the Deputy Secretary 

23 determines necessary in consultation with the Under 

24 Secretary, the Executive Director of the Electronic 

25 Health Record and Health Information Technology 


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1 Modernization Program Management Office, and the 

2 Chief Information Officer. 

3 SEC. 302. MODIFICATION OF QUARTERLY REPORT TO IN4 CLUDE INFORMATION ON SYSTEM STABILITY, 

5 SATISFACTION, MORALE, RETENTION OF 

6 STAFF, TRAINING, AND CHANGE MANAGE7 MENT WITH RESPECT TO NEW ELECTRONIC 

8 HEALTH RECORD OF DEPARTMENT OF VET9 ERANS AFFAIRS. 

10 Section 503(b) of the Veterans Benefits and Transi11 tion Act of 2018 (Public Law 115–407; 38 U.S.C. 5701 

12 note prec.) is amended— 

13 (1) by redesignating paragraphs (1) through 

14 (6) as subparagraphs (A) through (F), respectively, 

15 and moving those subparagraphs, as so redesig16 nated, two ems to the right; 

17 (2) in the matter preceding subparagraph (A), 

18 as designated by paragraph (1), by striking ‘‘Not 

19 later than 30 days’’ and inserting the following: 

20 ‘‘(1) IN GENERAL.—Not later than 30 days’’; 

21 and 

22 (3) by adding at the end the following new 

23 paragraph: 

24 ‘‘(2) ADDITIONAL MATTERS TO BE IN25 CLUDED.— 


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1 ‘‘(A) IN GENERAL.—The Secretary shall 

2 include with any update submitted under para3 graph (1) on or after the date of the enactment 

4 of the Electronic Health Record Program Re5 structure, Enhance, Strengthen, and Empower 

6 Technology Act of 2023, with respect to the 

7 quarter covered by the report, the following: 

8 ‘‘(i) Data on employee satisfaction 

9 with the new electronic health record of the 

10 Department of Veterans Affairs using 

11 credible, industry standard surveys and 

12 data analysis. 

13 ‘‘(ii) Data on retention, morale, and 

14 turnover at sites using such new record. 

15 ‘‘(iii) Data on satisfaction with train16 ing and change management activities pro17 vided to employees and facilities of the De18 partment regarding such record. 

19 ‘‘(iv) Data on ticket resolution and 

20 closure. 

21 ‘‘(v) The specific system enhance22 ments to include configuration changes 

23 and new service requests that have been 

24 tested and put into production for elec25 tronic health record system users and a list 


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1 and description of remaining configuration 

2 changes and new service requests under 

3 development or in requirements develop4 ment and the estimated date for such im5 provements to be tested and put into pro6 duction for electronic health record system 

7 users. 

8 ‘‘(vi) The system performance statis9 tics for such record, to include— 

10 ‘‘(I) cause, length, and source of 

11 or responsible entity for performance 

12 issues; and 

13 ‘‘(II) corrective steps taken to 

14 rectify outages, performance degrada15 tions, incomplete functionality, and 

16 loss of redundancy. 

17 ‘‘(vii) The health operations, produc18 tivity, and quality metrics of each facility 

19 using such new record as of the end of the 

20 quarter covered by the report compared to 

21 the health operations, productivity, and 

22 quality metrics of that facility before de23 ployment of the new record while using the 

24 legacy VistA and related systems and com25 pared to the national quality and access 


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1 standards established by the Veterans 

2 Health Administration to evaluate per3 formances of medical facilities under sec4 tion 201(b) of the Electronic Health 

5 Record Program Restructure, Enhance, 

6 Strengthen, and Empower Technology Act 

7 of 2023. 

8 ‘‘(viii) Revenue, collections, and all 

9 other financial data at facilities using such 

10 new record, including an assessment of 

11 planned versus actual revenue and collec12 tions and steps taken to remediate per13 formance challenges as well as a compari14 son to revenue, collections, and all other fi15 nancial data collected before the new 

16 record was in use. 

17 ‘‘(ix) A description of the number of 

18 cure notices, letters of concern, and other 

19 relevant corrective contracting actions 

20 taken by the Department, the responses to 

21 those actions by relevant contractor or con22 tractors and any credits, reimbursements, 

23 or other relevant repayment or corrective 

24 action agreed upon or issued and the 

25 dates, purposes, and reasons for issuance 


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1 of such cure notices, letters of concern, 

2 and other relevant requests for corrective 

3 actions and the status or resolution of 

4 those matters. 

5 ‘‘(B) COMPILATION OF INFORMATION.— 

6 The information provided under subparagraph 

7 (A) shall be— 

8 ‘‘(i) compiled in a manner that shows 

9 the information over time, at the facility 

10 level and aggregated for all facilities; 

11 ‘‘(ii) compiled using industry-based 

12 questions, standards, and metrics; and 

13 ‘‘(iii) informed by the unique veteran 

14 care delivery services and functions of the 

15 Department.’’. 

16 TITLE IV—CONTRACTING AND 

17 ACQUISITION OVERSIGHT 

18 AND REFORM 

19 SEC. 401. TERMINATION OF CONTRACT WITH ORACLE 

20 CERNER FOR TRAINING AND CHANGE MAN21 AGEMENT. 

22 (a) IN GENERAL.—Not later than 275 days after the 

23 date of the enactment of this Act, the Secretary shall— 

24 (1) terminate all contracts of the Department 

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1 ment related to electronic health record moderniza2 tion; and 

3 (2) cease to issue task orders for training and 

4 change management activities from Oracle Cerner or 

5 subcontractors of Oracle Cerner. 

6 (b) REPLACEMENT OF SERVICES.—Before termi7 nating all contracts of the Department with Oracle Cerner 

8 as required under subsection (a)(1), the Secretary, as the 

9 Secretary determines necessary and consistent with sec10 tion 203 of this Act, shall put plans in place to replace 

11 the services provided under those contracts with a new 

12 contract or contracts, competitively procured, with compa13 nies with a proven track-record in delivering electronic 

14 health record and health information technology training 

15 and change management in medium or large health sys16 tems in the United States. 

17 (c) REPORT.—Not later than 200 days after the date 

18 of the enactment of this Act, the Secretary shall submit 

19 to the appropriate committees of Congress a report on the 

20 implementation of this section. 


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1 SEC. 402. STRENGTHENING CONTRACT NEGOTIATION BY 

2 DEPARTMENT OF VETERANS AFFAIRS WITH 

3 RESPECT TO NEW ELECTRONIC HEALTH 

4 RECORD AND DESIGNATION OF LEAD CON5 TRACT NEGOTIATOR. 

6 (a) DESIGNATION OF LEAD NEGOTIATOR FOR NEW

7 ELECTRONIC HEALTH RECORD.— 

8 (1) IN GENERAL.—The Secretary shall des9 ignate one senior career official of the Department, 

10 at grade GS–15 of the General Schedule or an 

11 equivalent or higher grade, as the lead negotiator for 

12 the Department on all current and future contracts 

13 relating to the new electronic health record of the 

14 Department (in this section referred to as the ‘‘Ne15 gotiator’’). 

16 (2) ORGANIZATION.—The Negotiator shall re17 side within the Office of Acquisition, Logistics, and 

18 Construction of the Department and report to the 

19 Chief Acquisition Officer of the Department. 

20 (3) NOTIFICATION.—Not later than 15 days 

21 after designating the Negotiator under paragraph 

22 (1), the Secretary shall notify the appropriate com23 mittees of Congress of such designation. 

24 (b) OBJECTIVE OF NEGOTIATIONS.—The goal of con25 tract negotiations and activities conducted by the Nego26 tiator with respect to contracts relating to the new elecVerDate Sep 11 2014 22:10 Apr 11, 2023 Jkt 039200 PO 00000 Frm 00042 Fmt 6652 Sfmt 6201 E:\BILLS\S1125.IS S1125

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1 tronic health record of the Department are, at a min2 imum— 

3 (1) to ensure that any future contracts or task 

4 orders for such a record, including modifications of 

5 existing contracts or new awards, shall— 

6 (A) seek to protect the interest of tax7 payers to the greatest extent practicable; and 

8 (B) recover, by whatever means available, 

9 direct and indirect costs that the Department 

10 and veterans have already incurred due to pa11 tient harm, poor performance, inadequate train12 ing, insufficient ticket resolution, system crash13 es, inefficient processes driven by new tech14 nology, extra Department personnel hours, and 

15 other factors relating to the use of the Oracle16 Cerner product; 

17 (2) to consider options to descope existing con18 tracts and secure discounted rates on future work 

19 and sustainment work; 

20 (3) to achieve aggressive industry standard 

21 service-level agreements and significant financial 

22 penalties for failure to meet those standards; 

23 (4) to contractually codify the services, tech24 nology features, and other elements that have been 


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1 verbally offered to the Department at no cost by a 

2 contractor or contractors related to such new record; 

3 (5) to develop an organized and properly 

4 phased contract cancellation, transition, and replace5 ment strategy should the negotiations not result in 

6 best value terms for the taxpayer, veterans, and 

7 medical personnel of the Department; and 

8 (6) to address issues of conflicting or duplica9 tive contracting requirements to include those be10 tween contractors deploying various aspects of such 

11 new record and the program management office con12 tract, including potential conflicts of interest and 

13 perverse incentives for one set of contractors to in14 hibit or slow the work of other contractors for poten15 tial financial gain and leverage for current and fu16 ture work for the Department. 

17 (c) COORDINATION OF ACTIVITIES.—The Negotiator 

18 shall closely coordinate with individuals in the Program 

19 and the Office established under section 101 who have 

20 day-to-day responsibility for existing contract oversight 

21 with respect to health record contracts and relevant health 

22 information technology contracts. 

23 (d) CONSULTATION.—The Negotiator shall leverage 

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1 retary, the Office of General Counsel, the Under Sec2 retary, and the Chief Information Officer and the Assist3 ant Secretary for Information and Technology of the De4 partment, in conducting negotiations relating to the elec5 tronic health record of the Department. 

6 (e) ASSISTANCE.— 

7 (1) OTHER FEDERAL AGENCIES.—In con8 ducting negotiations relating to the new electronic 

9 health record of the Department, the Negotiator or 

10 the Secretary may request assistance from the other 

11 Federal agencies that have experienced contract ne12 gotiators, legal counsel, litigators, and other relevant 

13 personnel, particularly those with specialties and ex14 perience in health information technology acquisi15 tions, contracts, negotiations, and litigation. 

16 (2) OUTSIDE ENTITIES.— 

17 (A) IN GENERAL.—In conducting negotia18 tions, the Negotiator or the Secretary may en19 gage non-Federal, private sector, or nonprofit 

20 entities to perform independent contract and 

21 legal advisory services for the Department so as 

22 to advise the Department on options and strate23 gies to achieve a revised, modified, or new con24 tract for a new electronic health record that is 

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1 essary for appropriate cancellation terms and 

2 transition planning. 

3 (B) TYPES OF ENTITIES.—In procuring 

4 services under subparagraph (A), the Nego5 tiator and the Secretary— 

6 (i) shall only engage with entities that 

7 have a proven, long-term experience in de8 livering value and resolution to entities 

9 through high-dollar contracts, agreements, 

10 settlements, or litigation structured to de11 liver performance, accountability, and 

12 value to taxpayers, governments, or clients, 

13 as the case may be; and 

14 (ii) shall not engage with a company 

15 that works for Oracle, Oracle Cerner, or 

16 any subcontractor of either such company. 

17 (f) TERMS RELATING TO PROTECTION OF DATA.— 

18 Any contract of the Department related to electronic 

19 health records entered into on or after January 1, 2018, 

20 shall include a clause or clauses, or be modified to include 

21 such clause or clauses, protecting the health and other 

22 personal identifying data of veterans to include a total pro23 hibition on that data being monetized, sold, controlled, or 

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1 ducting work for, with, or on behalf of the Department, 

2 including data that has gone through anonymization. 

3 SEC. 403. INDEPENDENT VERIFICATION AND VALIDATION 

4 OF CERTAIN MAJOR MODERNIZATION EF5 FORTS OF DEPARTMENT OF VETERANS AF6 FAIRS. 

7 (a) CONTRACTING AUTHORITY.—Not later than 90 

8 days after the date of the enactment of this Act, the Chief 

9 Acquisition Officer of the Department of Veterans Affairs 

10 established pursuant to section 1702 of title 41, United 

11 States Code, shall enter into a contract with an eligible 

12 entity under subsection (b) to carry out the oversight func13 tions described in subsection (c). 

14 (b) ELIGIBILITY.—An entity is eligible under this 

15 subsection if the Chief Acquisition Officer of the Depart16 ment determines that, with respect to the solicitation by 

17 the Department for a contract under subsection (a), the 

18 entity— 

19 (1) is currently performing or has performed, 

20 during the three-year period preceding the date of 

21 the issuance of such solicitation, not fewer than 

22 three prime contracts for the independent 

23 verification and validation, or equivalent technical 

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1 tems, in accordance with guidance of the Depart2 ment of Defense relating to such acquisition pro3 grams or such business systems; and 

4 (2) is not currently performing and has not per5 formed, for at least the five-year period preceding 

6 the date of the issuance of such solicitation, any con7 tract or subcontract for the Department of Veterans 

8 Affairs (including such a contract or subcontract re9 lating to a covered program). 

10 (c) FUNCTIONS.—The oversight functions described 

11 in this subsection are the following: 

12 (1) Conducting an initial assessment of each 

13 covered program and submitting to the Secretary a 

14 report containing the findings of such assessment. 

15 (2) On an annual basis, conducting an overall 

16 assessment of each covered program and submitting 

17 to the Secretary a report containing the findings of 

18 each such assessment. 

19 (3) Conducting continuous oversight of the ac20 tivities carried out under, and the systems associated 

21 with, each covered program, including oversight of 

22 the status, compliance, performance, and implemen23 tation of recommendations with respect to, for each 

24 covered program, the following: 


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1 (A) Management, including governance, 

2 costs, and implementation milestones and 

3 timelines. 

4 (B) Contracts for implementation, includ5 ing financial metrics and performance bench6 marks for contractors. 

7 (C) Effect on the functions, business oper8 ations, or clinical organizational structure of 

9 the health care system of the Department. 

10 (D) Supply chain risk management, con11 trols, and compliance. 

12 (E) Data management. 

13 (F) With respect to associated systems, the 

14 following: 

15 (i) Technical architectural design, de16 velopment, and stability of the systems. 

17 (ii) System interoperability and inte18 gration with related information technology 

19 systems. 

20 (iii) System testing. 

21 (iv) Functional system training pro22 vided to users. 

23 (v) System adoption and use. 

24 (d) SUBMISSION TO CONGRESS.—Not later than 30 

25 days after the date on which the Secretary receives any 


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1 annual report under subsection (c)(2), the Secretary shall 

2 submit to the Committee on Veterans’ Affairs of the Sen3 ate and the Committee on Veterans’ Affairs of the House 

4 of Representatives such report. 

5 (e) AWARDED AMOUNTS.—Not later than 90 days 

6 after the date on which the Chief Acquisition Officer of 

7 the Department enters into the contract under subsection 

8 (a), the Chief Financial Officer of the Department, in co9 ordination with the heads of such office of the Department 

10 responsible for the management of a covered program, 

11 shall ensure that amounts awarded to an eligible entity 

12 under such contract are derived, in proportionate 

13 amounts, from amounts otherwise authorized to be appro14 priated for each such office of the Department, respec15 tively. 

16 (f) DEFINITIONS.—In this section: 

17 (1) COVERED PROGRAM.—The term ‘‘covered 

18 program’’ means the following: 

19 (A) The electronic health record mod20 ernization program (or any successor program). 

21 (B) The Financial Management and Busi22 ness Transformation Program (or any successor 

23 program). 

24 (C) Any program of the Department relat25 ing to supply chain modernization. 


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1 (D) Any program of the Department relat2 ing to the modernization of information tech3 nology systems associated with human re4 sources. 

5 (E) Any program of the Department relat6 ing to the Veterans Benefits Management Sys7 tem. 

8 (2) PRIORITY DEFENSE BUSINESS SYSTEM.— 

9 The term ‘‘priority defense business system’’ has the 

10 meaning given such term in section 2222(i) of title 

11 10, United States Code. 

12 (3) MAJOR DEFENSE ACQUISITION PROGRAM.— 

13 The term ‘‘major defense acquisition program’’ has 

14 the meaning given such term in section 4201 of title 

15 10, United States Code. 

16 SEC. 404. ANNUAL REPORT ON EFFORTS TO MAINTAIN 

17 VISTA ELECTRONIC HEALTH RECORD SYS18 TEM. 

19 (a) IN GENERAL.—Not later than 60 days after the 

20 date of the enactment of this Act, and not later than 90 

21 days after the beginning of each fiscal year thereafter, the 

22 Secretary shall submit to the appropriate committees of 

23 Congress a report on the VistA system used by the De24 partment. 


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1 (b) ELEMENTS.—The report required by subsection 

2 (a) shall include the following: 

3 (1) The cost to maintain and strengthen the 

4 VistA system for each of fiscal years 2018 through 

5 2022, for funding relating to both development and 

6 operations and maintenance. 

7 (2) The projected cost to maintain and 

8 strengthen such system for fiscal year 2023, for 

9 funding relating to both development and operations 

10 and maintenance. 

11 (3) The projected cost to maintain and 

12 strengthen such system for each of fiscal years 2024 

13 through 2033, for funding relating to both develop14 ment and operations and maintenance. 

15 (4) The planned enhancements underway to 

16 strengthen and secure the VistA system until its fea17 tures and modules are no longer needed by the De18 partment through such system, or have been sub19 sumed or replaced by other programs and informa20 tion technology services and systems, including cyber 

21 security enhancements, movement to the cloud, and 

22 new features and services. 

23 (5) A list of modules or features of the VistA 

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1 tronic health record or other health information 

2 technology and are planned to reside in a remnant 

3 VistA system, or successor remnant system. 

4 (c) INITIAL REPORT.—The first report required by 

5 subsection (a) shall include a description of any enhance6 ments to the VistA system that have occurred during the 

7 one-year period preceding the date of the report and those 

8 planned for the fiscal year in which the report is sub9 mitted. 

10 (d) SUBSEQUENT REPORTS.—Each report after the 

11 first report required by subsection (a) shall include a de12 scription of any enhancements to the VistA system that 

13 have occurred during fiscal year immediately preceding 

14 the date of the report, those planned, but not implemented 

15 and an explanation for such lack of implementation and 

16 those planned for the fiscal year in which the report is 

17 submitted. 

18 (e) TERMINATION.—This section shall terminate on 

19 the date that is 15 years after the date of the enactment 

20 of this Act. 


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1 SEC. 405. REPORT ON ALTERNATIVES TO CURRENT ELEC2 TRONIC HEALTH RECORD TECHNOLOGY AND 

3 CONTRACT FOR DEPARTMENT OF VETERANS 

4 AFFAIRS. 

5 (a) IN GENERAL.—Not later than 60 days after the 

6 date of the enactment of this Act, the Secretary shall sub7 mit to the appropriate committees of Congress a report 

8 on paths the Department and Congress should consider 

9 to achieve a modernized electronic health record as an al10 ternative to the Oracle-Cerner product. 

11 (b) ELEMENTS.—The report required under sub12 section (a) shall include the following with respect to an 

13 alternative path or paths to be considered by the Depart14 ment and Congress: 

15 (1) Considerations for and against such alter16 native path or paths. 

17 (2) Accurate reinvestment analysis of expendi18 tures, developed consistent with cost estimation and 

19 other relevant guidance issued by the Comptroller 

20 General of the United States, already made on the 

21 modernized electronic health record as of the date of 

22 the report, including an assessment of which of 

23 those expenditures would have to be made again and 

24 which would not based on an alternative technology 

25 and contract path chosen and the ability to repur26 pose investments. 


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1 (3) The capabilities and weaknesses of other 

2 technology solutions the Department could pursue, 

3 including an assessment of long-term value and re4 turn on investment from a health delivery, health 

5 quality, and operational perspective, and the acquisi6 tion process that could be used to procure such solu7 tions. 

8 (4) An analysis of electronic health record and 

9 health information technology market trends, capa10 bilities, and market leaders to include user satisfac11 tion and health outcome statistics to the extent they 

12 are relevant to the goals and strategy of the Depart13 ment. 

14 (5) An analysis of whether the Department 

15 choosing an alternative path or paths would, and to 

16 what extent, or would not impact necessary align17 ment with the electronic health record modernization 

18 conducted by the Department of Defense commonly 

19 known as MHS GENESIS. 

20 (6) An analysis of whether the ability to share 

21 and exchange records in an interoperable manner, 

22 and with what level of interoperability, with the De23 partment of Defense would be negatively impacted 

24 or positively enhanced, or neither, by an alternative 

25 technology path or contract. 


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1 (7) An analysis of whether the ability share and 

2 exchange records in an interoperable manner, and 

3 with what level of interoperability, with non-Federal 

4 health entities would be negatively impacted or posi5 tively enhanced, or neither, by an alternative tech6 nology path or contract. 

7 (8) An estimated timeline to restart deployment 

8 of a new electronic health record of the Department 

9 with a different vendor based on an alternative tech10 nology path or contract. 

11 (9) An assessment of options that may in12 clude— 

13 (A) a narrow or descoped contract supple14 mented by other contracts to strengthen areas 

15 in which the Oracle-Cerner product performs in 

16 a substandard fashion or is inadequate to the 

17 health delivery and operational needs of the De18 partment; or 

19 (B) any other combination of possibilities. 

20 (10) An analysis of the strengths and weak21 nesses of the alternative path or paths towards the 

22 Department meeting or exceeding the highest indus23 try interoperability standards. 

24 (11) An analysis of whether the interoperability 

25 of the Oracle-Cerner product with the private sector, 


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1 the community care networks of the Department, 

2 academic hospitals, Federal health entities, and 

3 other relevant health providers, systems, and net4 works is demonstrably superior to other electronic 

5 health records in the health technology industry. 

6 (12) A description of which path or paths the 

7 Secretary has selected to take or not take, the rea8 son for such selection, and the key milestones to 

9 achieve any new course of action described, including 

10 any new Departmental structures, estimated life 

11 cycle costs, and timelines. 

12 (13) Such other matters as the Secretary con13 siders appropriate. 

14 SEC. 406. REPORT ON LEADERSHIP, ACQUISITION, AND 

15 CONTRACTING OVERSIGHT LESSONS 

16 LEARNED. 

17 (a) IN GENERAL.—Not later than 180 days after the 

18 date of the enactment of this Act, the Secretary, through 

19 the Chief Acquisition Officer, the Under Secretary for 

20 Health, and the Executive Director of the Electronic 

21 Health Record and Health Information Technology Mod22 ernization Program Management Office, shall submit to 

23 the appropriate committees of Congress a report detailing 

24 the structural controls, programs, and processes the De25 partment has or will put in to place to prevent current 


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1 or future failures with respect to leadership engagement 

2 and management, strategic planning, contracting and con3 tract oversight, and program management in— 

4 (1) the implementation of the electronic health 

5 record modernization program of the Department 

6 from 2017 to the date of the report; and 

7 (2) any large acquisitions and major moderniza8 tions conducted, including those that are ongoing or 

9 planned by the Department after the date of the re10 port. 

11 (b) ELEMENTS.—The report required under sub12 section (a) shall include— 

13 (1) steps to improve the composition of and 

14 management of task orders placed on the current 

15 and any future electronic health record contract or 

16 other major acquisition or modernization, including 

17 covered programs (as defined in section 403(f)); 

18 (2) a timeline to achieve the reforms described 

19 in the report or the date upon which reforms already 

20 put in place were finalized and implemented; 

21 (3) a description of lessons learned regarding 

22 the need for stable consistent leadership, strategy, 

23 and management of large modernization programs 

24 and how to prevent such challenges as experienced 

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1 ated in 2017 from occurring again in any major pro2 gram of the Department; and 

3 (4) a description of the number of acting or 

4 Senate-confirmed Deputy Secretaries of the Depart5 ment and the number of leaders of the program 

6 management office of the electronic health record 

7 modernization program of the Department from 

8 2017 to the date of the report. 

9 (c) LEGISLATIVE OR ADMINISTRATIVE ACTION.—The 

10 report required by subsection (a) shall include a descrip11 tion of any legislative or administrative action necessary 

12 to achieve the structural controls described in such sub13 section. 

14 SEC. 407. REPORT ON CONTRACT SAVINGS, SERVICES PRO15 VIDED AT NO COST TO THE DEPARTMENT, 

16 AND CONTRACT COST INCURRED WITH RE17 SPECT TO ORACLE-CERNER PRODUCT. 

18 Not later than 90 days after the date of the enact19 ment of this Act, the Deputy Secretary shall submit to 

20 the appropriate committees of Congress a report that con21 tains the following: 

22 (1) A detailed list of the services, functions, or 

23 other matters that Oracle-Cerner provided to the 

24 Department without compensation since assuming 

25 ownership of Cerner in June 2022. 


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1 (2) A list of specific credits or reimbursements, 

2 to include dollar amounts and an indication of the 

3 specific failure for which those credits or reimburse4 ments are provided, Cerner or Oracle-Cerner has 

5 provided to the Department across all domains for 

6 contract failure, service-level agreement failure, per7 formance failure, training and change management 

8 failure, ticket system failure, and related issues dur9 ing the period beginning on the award of the con10 tract to Cerner on May 17, 2018, and ending on the 

11 date of the report. 

12 (3) The estimated and known costs, both direct 

13 and indirect, incurred by all facilities using the Ora14 cle-Cerner product as of the date of the report due 

15 to— 

16 (A) increased staffing; 

17 (B) lost productivity; 

18 (C) increased referrals to community care; 

19 (D) copayment and debt management ac20 tions; 

21 (E) staff turnover; 

22 (F) reduced collections; and 

23 (G) other factors as determined by the 

24 Secretary. 


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1 TITLE V—COORDINATION WITH 

2 DEPARTMENT OF DEFENSE 

3 SEC. 501. QUARTERLY REPORTS ON SYSTEM UPTIME, MOD4 ERNIZATION, AND COORDINATION ACTIVI5 TIES FOR INFORMATION TECHNOLOGY SYS6 TEMS AND POLICIES OF DEPARTMENT OF DE7 FENSE AFFECTING OPERATIONS OF DEPART8 MENT OF VETERANS AFFAIRS. 

9 (a) IN GENERAL.—Not later than 90 days after the 

10 date of the enactment of this Act, and not less frequently 

11 than quarterly thereafter, the Secretary of Defense shall 

12 submit to the appropriate committees of Congress a report 

13 on the system uptime, modernization, and coordination ac14 tivities for information technology systems of the Depart15 ment of Defense that are relied upon by the Department 

16 of Veterans Affairs to deliver health care, compensation, 

17 memorial benefits, and other services required to be pro18 vided under the laws administered by the Secretary of Vet19 erans Affairs. 

20 (b) ELEMENTS.—Each report required by subsection 

21 (a)— 

22 (1) shall identify steps taken by the Secretary 

23 of Defense to improve governance, coordination, and 

24 policy decisions conducted with the Secretary of Vet25 erans Affairs related to information technology of 


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1 the Department of Defense and related systems 

2 upon which the Department of Veterans Affairs has 

3 an operational dependency; 

4 (2) shall include a schedule for the moderniza5 tion or replacement of key information technology 

6 and related systems of the Department of Defense 

7 upon which the Department of Veterans Affairs has 

8 an operational dependency, including the Defense 

9 Enrollment Eligibility Reporting System, or suc10 cessor system; 

11 (3) shall include a schedule for the movement 

12 by the Department of Defense of the MHS GEN13 ESIS software and related systems to the cloud; 

14 (4) shall include information regarding goals 

15 for and actual uptime and stability of all information 

16 technology and related systems of the Department of 

17 Defense— 

18 (A) that the Department of Veterans Af19 fairs relies on to operate, manage, or administer 

20 the current or any future electronic health 

21 record of the Department of Veterans Affairs; 

22 (B) on which the Department of Veterans 

23 Affairs has an operational dependency; or 

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1 fairs for the delivery of health care, compensa2 tion, memorial benefits, or other services; 

3 (5) shall identify— 

4 (A) any system or systems, infrastructure, 

5 or related entities of the Department of Defense 

6 that are critical to operations of the Depart7 ment of Veterans Affairs; 

8 (B) any performance issues with respect to 

9 those systems, infrastructure, or related enti10 ties; 

11 (C) steps taken by the Secretary of De12 fense to remediate any such issues in the short, 

13 medium, and long term and timelines for such 

14 remediation; 

15 (D) the accountable offices within the De16 partment of Defense for the maintenance, re17 placement, and stability of those systems, infra18 structure, or related entities; and 

19 (E) policies and governance structures re20 garding collaboration and coordination with the 

21 Department of Veterans Affairs with respect to 

22 changes to those systems, infrastructure, or re23 lated entities; 

24 (6) shall include a description of the definitions, 

25 monitoring, and reporting of service level agreements 


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1 between the Department of Defense and the Depart2 ment of Veterans Affairs, including specific critical 

3 infrastructure availability targets, incident reporting 

4 mean time to resolution, and related matters; 

5 (7) shall include a description of the service re6 liability measurements in use and the previous quar7 ter’s actual reliability data by the Department of 

8 Defense as it relates to services relied upon by the 

9 Department of Veterans Affairs measured as experi10 enced by the Department of Veterans Affairs, inclu11 sive of any Department of Defense network, identity, 

12 and security services dependencies; 

13 (8) shall include a complete list of incident re14 porting, root cause analyses, after action reporting, 

15 and preventive measures for each event in which a 

16 Department of Defense system or service’s degraded 

17 performance or outage caused operational harm to 

18 the Department of Veterans Affairs inclusive of net19 work and security services degradations, outages, 

20 and related matters; and 

21 (9) may include an identification of legislative 

22 or administrative action required to accomplish the 

23 goals in the report. 

24 (c) INITIAL REPORT.—The first report required 

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1 cluding current system uptime and goals and targets with 

2 respect to system uptime, and steps the Department of 

3 Defense is taking to better meet standards, goals, and tar4 gets with respect to system uptime. 

5 (d) SUBSEQUENT REPORTS.—Each report after the 

6 first report required under subsection (a) shall, for the 

7 quarter covered by the report— 

8 (1) discuss updates on the information provided 

9 in previous reports, including system uptime per10 formance; 

11 (2) indicate the performance of the Department 

12 of Defense in meeting the goals established in pre13 vious reports; 

14 (3) indicate the steps the Department of De15 fense is taking to address the areas in which the De16 partment is not meeting those goals; and 

17 (4) indicate improvements to and work in 

18 progress toward strengthening policies and govern19 ance structures regarding collaboration and coordi20 nation with the Department of Veterans Affairs with 

21 respect to changes to the systems, infrastructure, or 

22 related entities with respect to which the Depart23 ment of Veterans Affairs has an operational depend24 ency. 


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1 (e) TERMINATION.—This section shall terminate on 

2 the date that is 10 years after the date of the enactment 

3 of this Act. 

4 (f) APPROPRIATE COMMITTEES OF CONGRESS DE5 FINED.—In this section, the term ‘‘appropriate commit6 tees of Congress’’ means— 

7 (1) the Committee on Armed Services and the 

8 Committee on Veterans’ Affairs of the Senate; and 

9 (2) the Committee on Armed Services and the 

10 Committee on Veterans’ Affairs of the House of 

11 Representatives. 

12 SEC. 502. COORDINATION WITH DEPARTMENT OF DEFENSE 

13 REGARDING INFORMATION TECHNOLOGY 

14 PROGRAMS, SYSTEMS, AND SERVICES. 

15 (a) IN GENERAL.—Not later than 45 days after the 

16 date of the enactment of this Act, the Deputy Secretary 

17 shall submit to the appropriate committees of Congress, 

18 the Committee on Armed Services of the Senate, and the 

19 Committee on Armed Services of the House of Represent20 atives a report indicating the additional support needed 

21 by the Department from the Department of Defense to 

22 make the current and future delivery of health, benefits, 

23 memorial affairs and other services of the Department sta24 ble and successful, including through reliable availability 

25 of data and services of the information technology systems 


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1 and programs of the Department of Defense, including the 

2 legacy VistA and new electronic health record of the De3 partment. 

4 (b) ELEMENTS.—The report required under sub5 section (a) shall include a description of support, collabo6 ration, and coordination, needed by the Department from 

7 the Department of Defense relating to— 

8 (1) governance between the Department of De9 fense and the Department of Veterans Affairs re10 lated to information technology, systems, services, 

11 networks, and related infrastructure; 

12 (2) coordination and policy between the Depart13 ment of Defense and the Department of Veterans 

14 Affairs related to information technology, systems, 

15 services, networks, and related infrastructure; 

16 (3) system availability, stability, and uptime 

17 standards of critical information technology systems, 

18 systems, services, networks, and related infrastruc19 ture; 

20 (4) definition, monitoring, and reporting of 

21 service level agreements between the Department of 

22 Defense and the Department of Veterans Affairs re23 lated to information technology, systems, services, 

24 networks, and related infrastructure; 


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1 (5) service reliability measurements as experi2 enced by the Department of Veterans Affairs, in3 cluding any network, identity, and security service 

4 dependencies with the Department of Defense; 

5 (6) the current state and desired future state 

6 transparency in incident reporting, root cause, after 

7 action reporting, and preventative measures for in8 formation technology, systems, services, networks, 

9 and related infrastructure events of the Department 

10 of Defense in which the Department of Veterans Af11 fairs has an operational dependency; 

12 (7) the current state and desired future state of 

13 network and security services of the Department of 

14 Defense on which the Department of Veterans Af15 fairs has an operational dependency or that signifi16 cantly impact the Department of Veterans Affairs; 

17 (8) a description of the key systems of the De18 partment of Defense that the Department of Vet19 erans Affairs believes need modernization or replace20 ment so as to improve delivery of services to vet21 erans and operations of the Department of Veterans 

22 Affairs; and 

23 (9) Such other related matters as the Deputy 

24 Secretary may choose to include. 


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1 TITLE VI—OTHER MATTERS 

2 SEC. 601. REPORT ON LEGISLATIVE ACTION REQUIRED. 

3 Not later than 180 days after the date of the enact4 ment of this Act, and periodically thereafter as the Sec5 retary considers appropriate, the Secretary shall submit 

6 to the appropriate committees of Congress a report re7 garding any legislative action, including resources, re8 quired to carry out this Act or implement a modernized 

9 electronic health record and related health information 

10 technology systems. 

11 SEC. 602. REPORT ON CURRENT AND FUTURE STATE 

12 INTEROPERABILITY WITH LEGACY ELEC13 TRONIC HEALTH RECORD, NEW ELECTRONIC 

14 HEALTH RECORD, AND FUTURE POTENTIAL 

15 ELECTRONIC HEALTH RECORD AND OTHER 

16 HEALTH INFORMATION TECHNOLOGY AND 

17 EXCHANGES. 

18 (a) REPORT REQUIRED.—Not later than 180 days 

19 after the date of the enactment of this Act, the Secretary 

20 shall, acting through the Under Secretary for Health, sub21 mit to the appropriate committees of Congress a report 

22 on the current state of interoperability, including the level 

23 of interoperability, with the Department’s legacy VistA 

24 electronic health record and legacy applications, including 

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1 Cerner product in use at five facilities of the Department 

2 between such systems, applications, and records and the 

3 Department of Defense, the private sector, the community 

4 care networks of the Department, academic hospitals, 

5 other Federal health entities, and other relevant non-Fed6 eral health providers and systems. 

7 (b) CONTENTS.—The report submitted under sub8 section (a) shall include a description of the following: 

9 (1) The level of interoperability that existed be10 fore the contract with Cerner entered into on May 

11 17, 2018, between the Department and the Depart12 ment of Defense, the private sector, the community 

13 care networks of the Department, academic hos14 pitals, other Federal health entities, and other rel15 evant non-Federal health providers and systems, in16 cluding strengths and limitations, and a description 

17 of the applications and exchanges in use by the De18 partment to facilitate such interoperability. 

19 (2) The level of interoperability that exists as of 

20 the date of the report between the Department and 

21 the Department of Defense, the private sector, the 

22 community care networks of the Department, aca23 demic hospitals, other Federal health entities, and 

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1 scription of the applications and exchanges in use by 

2 the Department to facilitate such interoperability 

3 that are not those procured as part of the contract 

4 with Cerner entered into on May 17, 2018. 

5 (3) The level of interoperability that exists as of 

6 the date of the report between the Department and 

7 the Department of Defense, the private sector, the 

8 community care networks of the Department, aca9 demic hospitals, other Federal health entities, and 

10 other relevant non-Federal health providers and sys11 tems, including strengths and limitations, and a de12 scription of the applications and exchanges in use by 

13 the Department to facilitate such interoperability 

14 that are solely those procured as part of the contract 

15 with Cerner entered into on May 17, 2018, and that 

16 are in use at each facility of the Department (includ17 ing any subsidiary facilities, such as community18 based outpatient clinics) that is using the Oracle19 Cerner product under such program as of the date 

20 of the report. 

21 (4) A discussion of the limitation of the Depart22 ment’s interoperability with whom and of what na23 ture, if any, described in paragraphs (2) and (3) and 

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1 tinued deployment of the Oracle-Cerner product, a 

2 procurement of another electronic health record, 

3 other health information exchanges, networks, appli4 cations or solutions. 

5 (5) A comprehensive interoperability roadmap 

6 and strategy for the next five fiscal years, including 

7 goals, interoperability levels, partners, timelines, reg8 ulatory and legal limitations and challenges, and re9 quired resources and authorities to achieve such 

10 goals. 

11 (6) A description of the role interoperable data 

12 exchange plays in improving health care outcomes 

13 and care coordination for veterans who are eligible 

14 to receive health care through programs and services 

15 of the Department and whether interoperability 

16 alone improves health care outcomes, access, and 

17 quality or whether it must be part of a larger func18 tioning electronic health record that can facilitate, 

19 among other actions, the delivery of physician or20 ders, referrals, dispense prescriptions, schedule ap21 pointments, and other such foundational and routine 

22 elements of modern health care delivery. 

23 (7) Such other such matters as the Secretary 

24 considers appropriate, including recommendations 


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1 for legislative action to achieve the goals set forth in 

2 the report. 

3 (c) DISCUSSION.—The discussion included under 

4 subsection (b)(4) shall include the following: 

5 (1) A clear indication of what entities the De6 partment experiences the greatest level of interoper7 ability limitations in current state such as the De8 partment of Defense, community care networks of 

9 the Department, academic hospitals and the Depart10 ment’s solution or solutions for remedying those lim11 itations. 

12 (2) A description of what current health care 

13 referral patterns, patient volumes, and networks it 

14 currently experiences the greatest volume of care re15 ferral, data exchange and interoperability trans16 actions and how such patterns and volumes are pro17 jected to evolve and change over the next one, five, 

18 and ten fiscal years. 

19 (3) In providing the description required by 

20 paragraph (2), an indication of whether the volume 

21 of care coordination, record exchange, and related 

22 matters is expected to be greater with the Depart23 ment of Defense in the next one, five, and ten fiscal 

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1 partment, academic hospitals, and other Federal and 

2 non-Federal health entities. 

Æ 


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