EHR Program RESET Act of 2023

Subjects: Armed Forces and National Security


<html><body><pre>[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1125 Introduced in Senate (IS)]

&lt;DOC&gt;






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.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Electronic Health 
Record Program Restructure, Enhance, Strengthen, and Empower Technology 
Act of 2023'' or the ``EHR Program RESET Act of 2023''.
    (b) Table of Contents.--The table of contents for 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.
Sec. 407. Report on contract savings, services provided at no cost to 
                            the Department, and contract cost incurred 
                            with respect to Oracle-Cerner 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.

SEC. 2. DEFINITIONS.

    Except as otherwise provided, in this Act:
            (1) Appropriate committees of congress.--The term 
        ``appropriate committees of Congress'' means--
                    (A) the Committee on Veterans' Affairs and the 
                Committee on Appropriations of the Senate; and
                    (B) the Committee on Veterans' Affairs and the 
                Committee on Appropriations of the House of 
                Representatives.
            (2) Department.--The term ``Department'' means the 
        Department of Veterans Affairs.
            (3) Deputy secretary.--The term ``Deputy Secretary'' means 
        the Deputy Secretary of Veterans Affairs.
            (4) Fourth mission.--The term ``Fourth Mission'' means the 
        mission of the Department to improve the preparedness of the 
        United States for response to war, terrorism, national 
        emergency, and natural disaster.
            (5) Modernization; modernize.--The terms ``modernization'' 
        and ``modernize'', with respect to the electronic health record 
        and other relevant health information technology systems of the 
        Department, means to replace, in whole or in part, overhaul, or 
        upgrade such record or other system in a manner that gives such 
        record or other system longevity and ability to constantly be 
        updated to meet the needs of veterans, employees of the 
        Department, and the Department.
            (6) New electronic health record.--The term ``new 
        electronic health record'' means any electronic health record 
        provided for the Department on or after the date of the 
        enactment of this Act, including pursuant to a contract entered 
        into by the Department.
            (7) Oracle-cerner product.--The term ``Oracle-Cerner 
        product'' means the product provided under the contract entered 
        into by the Department with Cerner pursuant to the electronic 
        health record modernization program of the Department before 
        the date of the enactment of this Act.
            (8) Secretary.--The term ``Secretary'' means the Secretary 
        of Veterans Affairs.
            (9) Under secretary.--The term ``Under Secretary'' means 
        the Under Secretary for Health of the Department of Veterans 
        Affairs.

 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.

    (a) Establishment of Program.--
            (1) Establishment.--There is established within the 
        Veterans Health Administration a program to modernize the 
        electronic health record and other relevant health information 
        technology systems of the Department (in this section referred 
        to as the ``Program'').
            (2) Purpose and goals.--The purpose and goals of the 
        Program are as follows:
                    (A) To deliver an electronic health record, 
                platform, and related systems that allow the Department 
                to deliver, as measured by quantifiable industry and 
                Department-specific metrics, improved standardized 
                workflows and consistent, quality health care to 
                veterans through a modern, user-friendly, electronic 
                health record and related systems that allow medical 
                professionals of the Department to deliver health care 
                to veterans safely.
                    (B) To increase the productivity, efficiency, 
                retention, satisfaction, and experience of such medical 
                professionals.
                    (C) To improve veteran experience and health 
                outcomes.
                    (D) To improve quality and coordination of care, 
                reduce unnecessary variation, and improve data 
                management.
                    (E) To maintain, strengthen, and expand the 
                research and development activities of the Department 
                to include those activities required under title 38, 
                United States Code.
                    (F) To maintain and strengthen the ability of the 
                Department to carry out Fourth Mission requirements, to 
                include the requirements under title 38, United States 
                Code.
                    (G) To protect the health and other personal 
                identifying information of veterans from being 
                monetized, sold, or otherwise misused by any internal 
                or external entity conducting work for, with, or on 
                behalf of the Department.
                    (H) To protect the health and other personal 
                identifying information of veterans or other users of 
                the electronic health record or other programs or 
                services of the Department from cyber attacks, identity 
                theft, and other cyber and security threats.
                    (I) To deliver--
                            (i) operational value to the Department 
                        from the use of the electronic health record 
                        and related systems;
                            (ii) business value and return on 
                        investment to the Department from improvement 
                        to the electronic health record and related 
                        systems across all relevant domains, to include 
                        cyber and other security, business, and 
                        financial operations; and
                            (iii) an evolving level of advanced 
                        interoperability of the electronic health 
                        record with the greatest number of electronic 
                        health record systems, platforms, services, and 
                        related interfaces in the Federal, private, 
                        nonprofit, and other relevant health sectors.
                    (J) To develop health information technology 
                modernization strategies and implementation plans that 
                provide the Department with the most flexibility to 
                continuously modernize the health information 
                technology systems of the Department in an agile 
                manner, not committed to any one particular vendor or 
                vendors or technology solution or solutions, commonly 
                known as ``vendor lock'', and respond to new trends in 
                the health information technology industry in real 
                time, allowing for relevant and appropriate integration 
                with other health information technology platforms and 
                services.
                    (K) To aggressively manage and monitor the 
                implementation of all contracts and services procured 
                by the Department related to such electronic health 
                record and related services to control cost, ensure 
                best value, monitor, and evaluate delivery of the 
                services procured in line with program goals and 
                desired outcomes.
                    (L) To carry out the purposes and goals described 
                in subparagraphs (A) through (K) at the most effective 
                short-, medium-, and long-term cost to the Federal 
                Government using industry and government best practices 
                so as to protect taxpayers.
                    (M) Such other purposes or goals as determined--
                            (i) pursuant to the report submitted under 
                        subsection (b)(6); or
                            (ii) by the Secretary, the Deputy 
                        Secretary, or the Under Secretary pursuant to a 
                        report submitted to the appropriate committees 
                        of Congress describing any new purpose or goal 
                        for the Program not later than 90 days after 
                        adding such purpose or goal to the Program.
    (b) Establishment of Program Management Office.--
            (1) In general.--There is established within the Veterans 
        Health Administration the Electronic Health Record and Health 
        Information Technology Modernization Program Management Office 
        (referred to in this section as the ``Office''). The Secretary 
        or the Deputy Secretary may rename the Office and upon renaming 
        such office shall notify Congress not later than 60 days after 
        such renaming.
            (2) Organizational location of office.--
                    (A) In general.--The Under Secretary shall 
                determine the appropriate organizational location 
                within the Veterans Health Administration for the 
                Office so as to align responsibilities within existing 
                or newly formed clinical, patient safety, health 
                informatics, finance, and other business operations of 
                the Veterans Health Administration.
                    (B) Reorganization of office.--The Secretary, the 
                Deputy Secretary, and the Under Secretary may move or 
                reorganize the organizational location of the Office 
                only after notifying the appropriate committees of 
                Congress not later than 90 days before such move or 
                reorganization.
            (3) Leadership and staff.--
                    (A) Executive director.--The Under Secretary shall 
                establish a leader to be responsible for the Office, to 
                be known as the ``Executive Director of the Electronic 
                Health Record and Health Information Technology 
                Modernization Program Management Office''.
                    (B) Program functional champion.--
                            (i) In general.--The Under Secretary shall 
                        establish a Functional Champion of the Program 
                        who will serve with the Executive Director of 
                        the Office.
                            (ii) Duties.--The duties of the Functional 
                        Champion are--
                                    (I) to be the lead clinical 
                                executive to guide and address 
                                functional initiatives to support 
                                medical personnel of the Department in 
                                the deployment of a new electronic 
                                health record and other health 
                                information technology products; and
                                    (II) to carry out such additional 
                                duties as the Under Secretary and the 
                                Executive Director of the Office may 
                                prescribe.
                    (C) Other offices and positions.--
                            (i) In general.--The Under Secretary shall 
                        direct the establishment of various other 
                        relevant sub-offices and positions for the 
                        Office as the Under Secretary considers 
                        necessary drawing upon best practices from the 
                        Department, the Department of Defense, and 
                        other government, private sector, and nonprofit 
                        models and develop an organizational model 
                        tailored to the Department for business and 
                        management effectiveness.
                            (ii) Types of sub-offices.--At a minimum, 
                        within the Office there shall be offices 
                        dedicated to--
                                    (I) training;
                                    (II) change management;
                                    (III) communications;
                                    (IV) field support;
                                    (V) contract task order 
                                development, monitoring, and oversight;
                                    (VI) metrics, performance, and 
                                value; and
                                    (VII) quality and safety.
                            (iii) Sense of congress.--It is the sense 
                        of Congress that--
                                    (I) the Department should develop a 
                                model under clause (i) that is driven 
                                by best practices from government and 
                                industry but not replicate for the sake 
                                of replication structures used by the 
                                Department of Defense or elsewhere that 
                                do not factor in the patient 
                                population, unique mission, Fourth 
                                Mission requirements, and research 
                                requirements of the Department, and 
                                other relevant factors; and
                                    (II) the structure of such model 
                                should be driven by the objectives of 
                                the Office and the desired end state to 
                                improve value and quality of care and 
                                health outcomes for veterans while 
                                improving provider efficiency and 
                                productivity and operations of the 
                                Department.
            (4) Function and duties.--
                    (A) Function.--The function of the Office shall be, 
                with respect to all aspects of the modernization or 
                replacement of the electronic health record and other 
                key health information technology and services of the 
                Department--
                            (i) to develop and execute strategy in 
                        coordination with relevant offices and entities 
                        of the Department; and
                            (ii) to perform management, oversight, and 
                        accountability, including over all contracts, 
                        coordination, planning, management, and 
                        implementation.
                    (B) Duties.--The duties of the Office shall include 
                the following:
                            (i) Ensuring the Program delivers the tools 
                        medical professionals of the Department need to 
                        safely deliver care to veterans while 
                        increasing productivity, satisfaction, and 
                        efficiency as measured by metrics.
                            (ii) Organizing all of the relevant health, 
                        business, informatics, and related offices of 
                        the Veterans Health Administration to ensure a 
                        coordinated strategy regarding the new 
                        electronic health record and other current and 
                        future key health information technology and 
                        services of the Department.
                            (iii) Coordinating with other offices and 
                        entities of the Department with key 
                        dependencies and responsibilities in the 
                        success of the Program or operational needs for 
                        the services of the Program, including the 
                        Office of Information and Technology, the 
                        Veterans Benefits Administration, and other 
                        relevant offices.
                            (iv) Ensuring the stability and security of 
                        the new electronic health record and other 
                        current and future key health information 
                        technology and services of the Department.
                            (v) Oversight of work performed by 
                        contractors regarding such record, technology, 
                        and services.
                            (vi) Developing a health information 
                        technology strategy of the Department--
                                    (I) to increase quality of care, 
                                health outcomes, and experience of care 
                                received by veterans;
                                    (II) to increase value to business 
                                and health operations of the 
                                Department;
                                    (III) to enable the further 
                                recruitment and retention of medical 
                                professionals; and
                                    (IV) to coherently define how 
                                disparate health information technology 
                                efforts of the Department can be 
                                aligned to deliver on that strategy 
                                with concrete goals, metrics, and 
                                outcomes.
                            (vii) Developing goals, key performance 
                        indicators, and metrics to evaluate such 
                        record, technology, and services, including 
                        with respect to financial performance, provider 
                        productivity, and health performance.
                            (viii) Monitoring such goals, performance 
                        indicators, and metrics to develop actions for 
                        when such goals, performance indicators, and 
                        metrics have not been met.
                            (ix) Improvement of business operations of 
                        the Department relating to such record, 
                        technology, and services.
                            (x) Such other matters as the Secretary, 
                        the Deputy Secretary, or the Under Secretary 
                        consider appropriate.
            (5) Report on establishment of office.--
                    (A) In general.--Not later than 90 days after the 
                date of the enactment of this Act, the Deputy 
                Secretary, the Under Secretary, and the Chief 
                Information Officer of the Department shall submit to 
                the appropriate committees of Congress a single report 
                outlining the establishment of the Office and its 
                current strengths and weaknesses.
                    (B) Elements.--The report required under 
                subparagraph (A) shall include--
                            (i) a clear articulation of the objective 
                        of the Program and how that objective is tied 
                        to the broader health information technology 
                        modernization strategy and health care mission 
                        of the Department, which shall include 
                        functional and technical quality standards to 
                        define success of the Program based on clear 
                        demonstration of improved health and business 
                        operational metrics;
                            (ii) a strategy describing how technology 
                        procured by the Department shall be part of a 
                        comprehensive approach for using health 
                        information technology, models of care 
                        delivery, and research conducted by the 
                        Department to strengthen services for veterans 
                        and veteran engagement;
                            (iii) concrete steps for how the Department 
                        will use internal and external resources to 
                        operationalize the strategy under clause (ii) 
                        through technical and functional engineering 
                        expertise to streamline the organization and 
                        governance of the Office of Information and 
                        Technology, the Veterans Health Administration, 
                        and other relevant offices or entities of the 
                        Department to enact that strategy;
                            (iv) an assessment of the current and 
                        desired future state, with timelines to achieve 
                        such future state, of enterprise business and 
                        technical architecture, information technology 
                        product consolidation and management, 
                        information technology governance, business and 
                        clinical process standardization and quality 
                        control of the Department and the steps that 
                        are or will be taken in response to that 
                        assessment, including a timeline for execution 
                        of those reforms; and
                            (v) a description, as of the date of the 
                        report, of the current status of the objectives 
                        of the Office, whether those objectives are 
                        being met, and if they are not being met the 
                        steps the Department will take, including a 
                        timeline, to achieve those objectives.
    (c) Deputy Chief Information Officer for Electronic Health Record 
and Health Information Technology.--
            (1) Establishment.--There is established within the Office 
        of Information and Technology of the Department a Deputy Chief 
        Information Officer for Electronic Health Record and Health 
        Information Technology who shall be accountable for all 
        technical implementation of the modernization of the electronic 
        health record and health information technology, in 
        coordination with the Program and the Office.
            (2) Renaming.--The Chief Information Officer of the 
        Department may rename the position established under paragraph 
        (1) and upon renaming such position shall notify Congress not 
        later than 90 days after such renaming.
            (3) Chain of command.--The Deputy Chief Information Officer 
        for Electronic Health Record and Health Information Technology 
        of the Department shall report to the Chief Information Officer 
        and the Assistant Secretary for Information and Technology of 
        the Department.
            (4) Duties.--The Deputy Chief Information Officer for 
        Electronic Health Record and Health Information Technology of 
        the Department shall be responsible for organizing all 
        functions of the Office of Information and Technology of the 
        Department to support the modernization of the electronic 
        health record and health information technology of the 
        Department, including cyber security, system stability and 
        uptime, system performance, and integration with relevant 
        platforms, systems, and services, including those of the 
        Department of Defense and other Federal agencies.
            (5) Additional guidance.--The Chief Information Officer of 
        the Department may provide additional or modified guidance for 
        the role of Deputy Chief Information Officer for Electronic 
        Health Record and Health Information Technology of the 
        Department.
    (d) Administrative Matters.--
            (1) Accountability and oversight for program.--The Deputy 
        Secretary shall be the accountable official for the Program, 
        oversee the Program, and may direct resources, subject to 
        appropriations, throughout the Department, particularly to the 
        Veterans Health Administration and the Office of Information 
        and Technology of the Department, to facilitate successful 
        planning, management, oversight, and execution of the Program.
            (2) Responsibility for program and office.--The Under 
        Secretary shall be the responsible official for the Program and 
        the Office, working together with the Executive Director of the 
        Office. The Under Secretary and the Executive Director of the 
        Office shall be directly responsible and in charge of the daily 
        work of the Program and the Office.
            (3) Tracking and reporting of funds.--Any funds directed by 
        the Deputy Secretary to other entities of the Department to 
        support the Program or the Office shall be tracked and reported 
        as falling under the Program regardless of the office that 
        manages and executes those particular funds.

SEC. 102. ESTABLISHMENT OF DEPARTMENT OF VETERANS AFFAIRS ADVISORY 
              SUBCOMMITTEE ON ELECTRONIC HEALTH RECORD AND HEALTH 
              INFORMATION TECHNOLOGY MODERNIZATION.

    (a) In General.--Not later than 60 days after the date of the 
enactment of this Act, the Secretary, acting in coordination with and 
through the Under Secretary, shall establish a permanent subcommittee 
of the special medical advisory group established under section 7312 of 
title 38, United States Code, focused on electronic health record and 
health information technology modernization of the Department, to be 
known as the Subcommittee on Electronic Health Record and Health 
Information Technology Modernization (in this section referred to as 
the ``Subcommittee'').
    (b) Composition of Subcommittee.--
            (1) In general.--The Subcommittee shall be composed of not 
        fewer than 5 and not more than 10 individuals selected by the 
        Under Secretary who have a current or previous documented and 
        relevant deep professional background within a leading health 
        care organization or organizations of the United States in the 
        private or nonprofit health sector, including--
                    (A) experience with health systems;
                    (B) experience as a health executive, chief health 
                information or informatics officer, chief medical 
                information officer, clinician, or nurse with deep 
                experience implementing or overseeing medium- or large-
                scale health information technology transformation, 
                including electronic health record deployments and 
                business modernizations;
                    (C) experience improving health care outcomes;
                    (D) experience managing change; or
                    (E) experience in developing and implementing 
                electronic health record training.
            (2) Nurse or nurse executive.--At least one member of the 
        Subcommittee shall be a nurse or nurse executive.
            (3) Member of veterans service organization.--At least one 
        member of the Subcommittee shall be a representative of a 
        Federally chartered, membership-based veterans service 
        organization.
            (4) Limitation.--An individual is not eligible to be a 
        member of the Subcommittee if the individual--
                    (A) is from the information technology vendor or 
                technology development sector; or
                    (B) had a role in the Oracle or Cerner procurement 
                by the Department or related contracts for program 
                management services for the electronic health record 
                modernization program of the Department.
    (c) Duties.--The Subcommittee shall produce periodic reports and 
recommendations as directed or requested by the Secretary or the Under 
Secretary on plans and opportunities for the Department to improve its 
strategy, goals, and implementation for and deployment of electronic 
health records and health information technology to better improve 
quality of care, patient outcomes, operational efficiency and 
productivity, provider productivity and engagement, and related matters 
based on national best practices that are relevant to the Department.
    (d) Administration.--Administration of the Subcommittee, including 
terms of service and replacement of members, shall be guided by the 
rules and charter of the special medical advisory group established 
under section 7312 of title 38, United States Code.
    (e) Termination.--This section shall terminate on the date on which 
the Secretary determines that a modernized electronic health record has 
been deployed to every medical center and other relevant medical 
facility of the Department.

        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.

    (a) In General.--The Secretary may not initiate a new go-live 
deployment of the electronic health record modernization program until 
the quality, access, productivity, and all other health and operational 
performance metrics data of the Veterans Health Administration and the 
Office of Information and Technology of the Department at each facility 
of the Department (including any subsidiary facilities, such as 
community-based outpatient clinics) that is using the Oracle-Cerner 
product under such program as of January 31, 2023, has either--
            (1) exceeded the health and information technology 
        operational levels of the facility before deploying such 
        product; or
            (2) met national standards set forth by the Veterans Health 
        Administration for quality, safety, efficiency, and financial 
        performance as established by the Program established under 
        section 101(a) and the Under Secretary.
    (b) Establishment of National Standards.--
            (1) In general.--The Under Secretary and the Program 
        established under section 101(a) shall establish national 
        standards required under subsection (a)(2) to create a common 
        health performance standard of the Veterans Health 
        Administration under which all medical facilities of the 
        Department may be evaluated under that subsection that takes 
        into account relevant differences in size, complexity, and 
        market of each facility.
            (2) Common metric and standard.--In establishing standards 
        under paragraph (1), the Under Secretary and the Program 
        established under section 101(a) shall establish a common data 
        driven metric and service delivery standard for care for 
        veterans by which medical facilities of the Department can be 
        evaluated.
            (3) Reports.--
                    (A) Initial report.--Not later than 60 days after 
                the establishment of standards under paragraph (1), the 
                Program established under section 101(a) shall submit 
                to the appropriate committees of Congress a report on 
                such standards.
                    (B) Modification to standards.--Not later than 30 
                days before the modification to any standards 
                established under paragraph (1), the Program 
                established under section 101(a) shall submit to the 
                appropriate committees of Congress a report on such 
                modification.
    (c) Termination or Continuation of Use.--
            (1) In general.--If, by the date that is 180 days after the 
        date of the enactment of this Act, the data from the first five 
        facilities of the Department as well as any relevant remote 
        sites, consolidated patient account centers, subsidiary 
        facilities, such as community-based outpatient clinics that 
        deployed the Oracle-Cerner product, have not reached the 
        requirements under subsection (a)--
                    (A) not later than 13 months after such date of 
                enactment, the Secretary, in consultation with the 
                Deputy Secretary, the Under Secretary for Health, the 
                Chief Information Officer, and the Executive Director 
                of the Office, shall--
                            (i) submit to the appropriate committees of 
                        Congress a plan on how the Department will meet 
                        the requirements under such subsection either 
                        through the existing technology strategy of the 
                        Department, a new procurement, or some other 
                        combination or approach; and
                            (ii) publicly announce a replacement 
                        technology solution or solutions or contract or 
                        contracts, including a new timeline and 
                        strategy to implement such solution or 
                        solutions; and
                    (B) not later than 180 days after completing the 
                requirements under subparagraph (A), the Secretary 
                shall--
                            (i) terminate, cancel, or modify the 
                        contract for the Oracle-Cerner product; and
                            (ii) develop appropriate coordination and 
                        transition plans for the transition of use of 
                        technology from the Oracle-Cerner product back 
                        to VistA or from the Oracle-Cerner product to 
                        an alternate electronic health record 
                        technology.
            (2) Limitation on cancellation of existing contract.--In 
        carrying out paragraph (1), to ensure a smooth transition and 
        reduce operational and care delivery disturbance, the Secretary 
        may not terminate any existing electronic health record 
        contract until a replacement contract and strategy for such 
        electronic health record are in place or near award and 
        commencement.
            (3) Extension of time.--
                    (A) In general.--Not later than 120 days after the 
                date of the enactment of this Act, the Secretary may, 
                for one time only, temporarily delay each of the 
                requirements of paragraph (1) for a period not to 
                exceed 180 days if the Secretary determines such delay 
                is necessary due to mission critical, national 
                emergency, national security, patient safety, quality 
                and access to care, protection of taxpayer investments, 
                or other unforeseen reasons.
                    (B) Justification for extension.--If the Secretary 
                determines that a delay under subparagraph (A) is 
                necessary, not later than 105 days after the date of 
                the enactment of this Act, the Secretary shall submit 
                to the appropriate committees of Congress a report 
                setting forth the justification of the Secretary for 
                such delay.

SEC. 202. REQUIREMENTS BEFORE CONTINUED DEPLOYMENT OF NEW ELECTRONIC 
              HEALTH RECORD BY DEPARTMENT OF VETERANS AFFAIRS AT 
              ADDITIONAL LOCATIONS AND FACILITIES.

    (a) Report on Metrics To Determine Continued Deployment.--
            (1) In general.--Not later than 30 days after the date of 
        the enactment of this Act, the Deputy Secretary shall submit to 
        the appropriate committees of Congress a report containing the 
        metrics, readiness criteria, and governance decision process 
        that the Department will use to determine whether continued 
        deployment of the electronic health record technology of the 
        Department is appropriate in June 2023, or whether a further 
        pause in such deployment is warranted to address system issues, 
        patient safety, technology features, provider efficiency, and 
        related matters.
            (2) Metrics.--The metrics included in the report submitted 
        under paragraph (1) shall--
                    (A) be data driven based on industry standards, 
                metrics of the Department, and the unique health care 
                delivery needs of the Department to serve veterans, 
                perform research, and support Fourth Mission 
                requirements;
                    (B) ensure patient safety, quality of and access to 
                care, system stability, cyber security, and sound 
                financial and business administration activities are 
                successfully evaluated as stable and functional at 
                desired performance levels and in place to proceed;
                    (C) ensure completion of relevant training and 
                change management activities; and
                    (D) include any other specific readiness criteria 
                that each location of the Department is required to 
                meet before moving forward with continued deployment of 
                the electronic health record technology of the 
                Department, as determined by the Department.
            (3) Other elements.--The report submitted under paragraph 
        (1) shall--
                    (A) indicate how the metrics required under the 
                report are or will be adjusted to incorporate the 
                research function and health complexity levels of 
                facilities of the Department and whether additional or 
                different metrics are or will be added based on more or 
                less complex facilities or facilities with a greater 
                research function;
                    (B) explain how the metrics and readiness criteria 
                under the report incorporate appropriate input and 
                findings of the National Center for Patient Safety, the 
                Clinical Episode Review Team, or the Office of the 
                Assistant Under Secretary for Health for Quality and 
                Patient Safety of the Veterans Health Administration, 
                or any successor office, and resolve any issues raised 
                by those offices to the satisfaction of those offices 
                through information technology changes, functionality, 
                training, and other areas, including regarding patient 
                record flags, behavioral health and suicide risks, 
                configuration of roles and responsibilities, referrals, 
                ambulatory care, pharmacy, identity, orders, medication 
                administration, and other areas, which shall include a 
                specific description of how each issue identified in 
                the March 2023 report of the Department entitled, 
                ``EHRM Sprint Report'' has been resolved or mitigated; 
                and
                    (C) provide a clear process description 
                reflecting--
                            (i) the repeatable method for how decisions 
                        relating to deployment of electronic health 
                        record technology are made within the 
                        Department from the field level up to the 
                        Secretary; and
                            (ii) the input received from each relevant 
                        element of the Department before such a 
                        decision is made, to include input from the 
                        National Center for Patient Safety.
            (4) Certification.--In submitting metrics under paragraph 
        (1), the Deputy Secretary shall certify that the metrics have 
        been approved by the Under Secretary, the Executive Director of 
        the Office, and the Chief Information Officer of the 
        Department.

SEC. 203. SENSE OF CONGRESS ON TRAINING AND CHANGE MANAGEMENT 
              ACTIVITIES FOR DEPLOYMENT OF NEW ELECTRONIC HEALTH 
              RECORD.

    It is the sense of Congress that--
            (1) training and change management with respect to any new 
        electronic health record shall be led by the Department and 
        employees of the Department who are uniquely positioned to 
        understand the legacy VistA system of the Department, the 
        existing and future standardized workflow of the Department, 
        and the history, culture, and mission of the Department; and
            (2) any contractors of the Department involved in the 
        implementation of any new electronic health record should serve 
        in a support function to the Department rather than lead and 
        conduct all training and change management activities.

   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.

    (a) In General.--Not later than 90 days after the date of the 
enactment of this Act, the Deputy Secretary shall submit to the 
appropriate committees of Congress a report summarizing the standard 
support services that the Department does or intends to provide to each 
facility in preparation for potential future deployment of the new 
electronic health record of the Department at such facility and in the 
period after such deployment.
    (b) Support To Be Provided.--The support required to be provided to 
a facility by the Department and included in the report under 
subsection (a) shall include, at a minimum, the following:
            (1) Budgetary resources and support to address the need for 
        increased staffing at the facility, reduced productivity and 
        collections, increased use of community care networks, and 
        other issues identified in the report of the Institute for 
        Defense Analyses dated October 2022, entitled ``Independent 
        Cost Estimate for Veterans Affairs Electronic Health Record 
        Modernization Program''.
            (2) Increased staffing level surge at the facility, 
        including temporary and permanent staff.
            (3) Steps to be taken by the Department to reduce burnout 
        and turnover.
            (4) Enhanced training to include government or vendor 
        supplied trainers to maintain a presence until dismissed by the 
        director or other relevant leader of the facility after 
        deployment of the new electronic health record.
            (5) A description of any additional legislative action 
        requested to improve the level of support services required at 
        each such facility for such deployment.
            (6) Such other support as the Deputy Secretary determines 
        necessary in consultation with the Under Secretary, the 
        Executive Director of the Electronic Health Record and Health 
        Information Technology Modernization Program Management Office, 
        and the Chief Information Officer.

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.

    Section 503(b) of the Veterans Benefits and Transition Act of 2018 
(Public Law 115-407; 38 U.S.C. 5701 note prec.) is amended--
            (1) by redesignating paragraphs (1) through (6) as 
        subparagraphs (A) through (F), respectively, and moving those 
        subparagraphs, as so redesignated, two ems to the right;
            (2) in the matter preceding subparagraph (A), as designated 
        by paragraph (1), by striking ``Not later than 30 days'' and 
        inserting the following:
            ``(1) In general.--Not later than 30 days''; and
            (3) by adding at the end the following new paragraph:
            ``(2) Additional matters to be included.--
                    ``(A) In general.--The Secretary shall include with 
                any update submitted under paragraph (1) on or after 
                the date of the enactment of the Electronic Health 
                Record Program Restructure, Enhance, Strengthen, and 
                Empower Technology Act of 2023, with respect to the 
                quarter covered by the report, the following:
                            ``(i) Data on employee satisfaction with 
                        the new electronic health record of the 
                        Department of Veterans Affairs using credible, 
                        industry standard surveys and data analysis.
                            ``(ii) Data on retention, morale, and 
                        turnover at sites using such new record.
                            ``(iii) Data on satisfaction with training 
                        and change management activities provided to 
                        employees and facilities of the Department 
                        regarding such record.
                            ``(iv) Data on ticket resolution and 
                        closure.
                            ``(v) The specific system enhancements to 
                        include configuration changes and new service 
                        requests that have been tested and put into 
                        production for electronic health record system 
                        users and a list and description of remaining 
                        configuration changes and new service requests 
                        under development or in requirements 
                        development and the estimated date for such 
                        improvements to be tested and put into 
                        production for electronic health record system 
                        users.
                            ``(vi) The system performance statistics 
                        for such record, to include--
                                    ``(I) cause, length, and source of 
                                or responsible entity for performance 
                                issues; and
                                    ``(II) corrective steps taken to 
                                rectify outages, performance 
                                degradations, incomplete functionality, 
                                and loss of redundancy.
                            ``(vii) The health operations, 
                        productivity, and quality metrics of each 
                        facility using such new record as of the end of 
                        the quarter covered by the report compared to 
                        the health operations, productivity, and 
                        quality metrics of that facility before 
                        deployment of the new record while using the 
                        legacy VistA and related systems and compared 
                        to the national quality and access standards 
                        established by the Veterans Health 
                        Administration to evaluate performances of 
                        medical facilities under section 201(b) of the 
                        Electronic Health Record Program Restructure, 
                        Enhance, Strengthen, and Empower Technology Act 
                        of 2023.
                            ``(viii) Revenue, collections, and all 
                        other financial data at facilities using such 
                        new record, including an assessment of planned 
                        versus actual revenue and collections and steps 
                        taken to remediate performance challenges as 
                        well as a comparison to revenue, collections, 
                        and all other financial data collected before 
                        the new record was in use.
                            ``(ix) A description of the number of cure 
                        notices, letters of concern, and other relevant 
                        corrective contracting actions taken by the 
                        Department, the responses to those actions by 
                        relevant contractor or contractors and any 
                        credits, reimbursements, or other relevant 
                        repayment or corrective action agreed upon or 
                        issued and the dates, purposes, and reasons for 
                        issuance of such cure notices, letters of 
                        concern, and other relevant requests for 
                        corrective actions and the status or resolution 
                        of those matters.
                    ``(B) Compilation of information.--The information 
                provided under subparagraph (A) shall be--
                            ``(i) compiled in a manner that shows the 
                        information over time, at the facility level 
                        and aggregated for all facilities;
                            ``(ii) compiled using industry-based 
                        questions, standards, and metrics; and
                            ``(iii) informed by the unique veteran care 
                        delivery services and functions of the 
                        Department.''.

       TITLE IV--CONTRACTING AND ACQUISITION OVERSIGHT AND REFORM

SEC. 401. TERMINATION OF CONTRACT WITH ORACLE CERNER FOR TRAINING AND 
              CHANGE MANAGEMENT.

    (a) In General.--Not later than 275 days after the date of the 
enactment of this Act, the Secretary shall--
            (1) terminate all contracts of the Department with Oracle 
        Cerner for training and change management related to electronic 
        health record modernization; and
            (2) cease to issue task orders for training and change 
        management activities from Oracle Cerner or subcontractors of 
        Oracle Cerner.
    (b) Replacement of Services.--Before terminating all contracts of 
the Department with Oracle Cerner as required under subsection (a)(1), 
the Secretary, as the Secretary determines necessary and consistent 
with section 203 of this Act, shall put plans in place to replace the 
services provided under those contracts with a new contract or 
contracts, competitively procured, with companies with a proven track-
record in delivering electronic health record and health information 
technology training and change management in medium or large health 
systems in the United States.
    (c) Report.--Not later than 200 days after the date of the 
enactment of this Act, the Secretary shall submit to the appropriate 
committees of Congress a report on the implementation of this section.

SEC. 402. STRENGTHENING CONTRACT NEGOTIATION BY DEPARTMENT OF VETERANS 
              AFFAIRS WITH RESPECT TO NEW ELECTRONIC HEALTH RECORD AND 
              DESIGNATION OF LEAD CONTRACT NEGOTIATOR.

    (a) Designation of Lead Negotiator for New Electronic Health 
Record.--
            (1) In general.--The Secretary shall designate one senior 
        career official of the Department, at grade GS-15 of the 
        General Schedule or an equivalent or higher grade, as the lead 
        negotiator for the Department on all current and future 
        contracts relating to the new electronic health record of the 
        Department (in this section referred to as the ``Negotiator'').
            (2) Organization.--The Negotiator shall reside within the 
        Office of Acquisition, Logistics, and Construction of the 
        Department and report to the Chief Acquisition Officer of the 
        Department.
            (3) Notification.--Not later than 15 days after designating 
        the Negotiator under paragraph (1), the Secretary shall notify 
        the appropriate committees of Congress of such designation.
    (b) Objective of Negotiations.--The goal of contract negotiations 
and activities conducted by the Negotiator with respect to contracts 
relating to the new electronic health record of the Department are, at 
a minimum--
            (1) to ensure that any future contracts or task orders for 
        such a record, including modifications of existing contracts or 
        new awards, shall--
                    (A) seek to protect the interest of taxpayers to 
                the greatest extent practicable; and
                    (B) recover, by whatever means available, direct 
                and indirect costs that the Department and veterans 
                have already incurred due to patient harm, poor 
                performance, inadequate training, insufficient ticket 
                resolution, system crashes, inefficient processes 
                driven by new technology, extra Department personnel 
                hours, and other factors relating to the use of the 
                Oracle-Cerner product;
            (2) to consider options to descope existing contracts and 
        secure discounted rates on future work and sustainment work;
            (3) to achieve aggressive industry standard service-level 
        agreements and significant financial penalties for failure to 
        meet those standards;
            (4) to contractually codify the services, technology 
        features, and other elements that have been verbally offered to 
        the Department at no cost by a contractor or contractors 
        related to such new record;
            (5) to develop an organized and properly phased contract 
        cancellation, transition, and replacement strategy should the 
        negotiations not result in best value terms for the taxpayer, 
        veterans, and medical personnel of the Department; and
            (6) to address issues of conflicting or duplicative 
        contracting requirements to include those between contractors 
        deploying various aspects of such new record and the program 
        management office contract, including potential conflicts of 
        interest and perverse incentives for one set of contractors to 
        inhibit or slow the work of other contractors for potential 
        financial gain and leverage for current and future work for the 
        Department.
    (c) Coordination of Activities.--The Negotiator shall closely 
coordinate with individuals in the Program and the Office established 
under section 101 who have day-to-day responsibility for existing 
contract oversight with respect to health record contracts and relevant 
health information technology contracts.
    (d) Consultation.--The Negotiator shall leverage and consult with 
all relevant stakeholders of the Department, but at a minimum the 
Secretary, the Deputy Secretary, the Office of General Counsel, the 
Under Secretary, and the Chief Information Officer and the Assistant 
Secretary for Information and Technology of the Department, in 
conducting negotiations relating to the electronic health record of the 
Department.
    (e) Assistance.--
            (1) Other federal agencies.--In conducting negotiations 
        relating to the new electronic health record of the Department, 
        the Negotiator or the Secretary may request assistance from the 
        other Federal agencies that have experienced contract 
        negotiators, legal counsel, litigators, and other relevant 
        personnel, particularly those with specialties and experience 
        in health information technology acquisitions, contracts, 
        negotiations, and litigation.
            (2) Outside entities.--
                    (A) In general.--In conducting negotiations, the 
                Negotiator or the Secretary may engage non-Federal, 
                private sector, or nonprofit entities to perform 
                independent contract and legal advisory services for 
                the Department so as to advise the Department on 
                options and strategies to achieve a revised, modified, 
                or new contract for a new electronic health record that 
                is of better value to the taxpayer or where necessary 
                for appropriate cancellation terms and transition 
                planning.
                    (B) Types of entities.--In procuring services under 
                subparagraph (A), the Negotiator and the Secretary--
                            (i) shall only engage with entities that 
                        have a proven, long-term experience in 
                        delivering value and resolution to entities 
                        through high-dollar contracts, agreements, 
                        settlements, or litigation structured to 
                        deliver performance, accountability, and value 
                        to taxpayers, governments, or clients, as the 
                        case may be; and
                            (ii) shall not engage with a company that 
                        works for Oracle, Oracle Cerner, or any 
                        subcontractor of either such company.
    (f) Terms Relating to Protection of Data.--Any contract of the 
Department related to electronic health records entered into on or 
after January 1, 2018, shall include a clause or clauses, or be 
modified to include such clause or clauses, protecting the health and 
other personal identifying data of veterans to include a total 
prohibition on that data being monetized, sold, controlled, or 
otherwise misused by any internal or external entity conducting work 
for, with, or on behalf of the Department, including data that has gone 
through anonymization.

SEC. 403. INDEPENDENT VERIFICATION AND VALIDATION OF CERTAIN MAJOR 
              MODERNIZATION EFFORTS OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) Contracting Authority.--Not later than 90 days after the date 
of the enactment of this Act, the Chief Acquisition Officer of the 
Department of Veterans Affairs established pursuant to section 1702 of 
title 41, United States Code, shall enter into a contract with an 
eligible entity under subsection (b) to carry out the oversight 
functions described in subsection (c).
    (b) Eligibility.--An entity is eligible under this subsection if 
the Chief Acquisition Officer of the Department determines that, with 
respect to the solicitation by the Department for a contract under 
subsection (a), the entity--
            (1) is currently performing or has performed, during the 
        three-year period preceding the date of the issuance of such 
        solicitation, not fewer than three prime contracts for the 
        independent verification and validation, or equivalent 
        technical and program oversight support, of major defense 
        acquisition programs or priority defense business systems, in 
        accordance with guidance of the Department of Defense relating 
        to such acquisition programs or such business systems; and
            (2) is not currently performing and has not performed, for 
        at least the five-year period preceding the date of the 
        issuance of such solicitation, any contract or subcontract for 
        the Department of Veterans Affairs (including such a contract 
        or subcontract relating to a covered program).
    (c) Functions.--The oversight functions described in this 
subsection are the following:
            (1) Conducting an initial assessment of each covered 
        program and submitting to the Secretary a report containing the 
        findings of such assessment.
            (2) On an annual basis, conducting an overall assessment of 
        each covered program and submitting to the Secretary a report 
        containing the findings of each such assessment.
            (3) Conducting continuous oversight of the activities 
        carried out under, and the systems associated with, each 
        covered program, including oversight of the status, compliance, 
        performance, and implementation of recommendations with respect 
        to, for each covered program, the following:
                    (A) Management, including governance, costs, and 
                implementation milestones and timelines.
                    (B) Contracts for implementation, including 
                financial metrics and performance benchmarks for 
                contractors.
                    (C) Effect on the functions, business operations, 
                or clinical organizational structure of the health care 
                system of the Department.
                    (D) Supply chain risk management, controls, and 
                compliance.
                    (E) Data management.
                    (F) With respect to associated systems, the 
                following:
                            (i) Technical architectural design, 
                        development, and stability of the systems.
                            (ii) System interoperability and 
                        integration with related information technology 
                        systems.
                            (iii) System testing.
                            (iv) Functional system training provided to 
                        users.
                            (v) System adoption and use.
    (d) Submission to Congress.--Not later than 30 days after the date 
on which the Secretary receives any annual report under subsection 
(c)(2), the Secretary shall submit to the Committee on Veterans' 
Affairs of the Senate and the Committee on Veterans' Affairs of the 
House of Representatives such report.
    (e) Awarded Amounts.--Not later than 90 days after the date on 
which the Chief Acquisition Officer of the Department enters into the 
contract under subsection (a), the Chief Financial Officer of the 
Department, in coordination with the heads of such office of the 
Department responsible for the management of a covered program, shall 
ensure that amounts awarded to an eligible entity under such contract 
are derived, in proportionate amounts, from amounts otherwise 
authorized to be appropriated for each such office of the Department, 
respectively.
    (f) Definitions.--In this section:
            (1) Covered program.--The term ``covered program'' means 
        the following:
                    (A) The electronic health record modernization 
                program (or any successor program).
                    (B) The Financial Management and Business 
                Transformation Program (or any successor program).
                    (C) Any program of the Department relating to 
                supply chain modernization.
                    (D) Any program of the Department relating to the 
                modernization of information technology systems 
                associated with human resources.
                    (E) Any program of the Department relating to the 
                Veterans Benefits Management System.
            (2) Priority defense business system.--The term ``priority 
        defense business system'' has the meaning given such term in 
        section 2222(i) of title 10, United States Code.
            (3) Major defense acquisition program.--The term ``major 
        defense acquisition program'' has the meaning given such term 
        in section 4201 of title 10, United States Code.

SEC. 404. ANNUAL REPORT ON EFFORTS TO MAINTAIN VISTA ELECTRONIC HEALTH 
              RECORD SYSTEM.

    (a) In General.--Not later than 60 days after the date of the 
enactment of this Act, and not later than 90 days after the beginning 
of each fiscal year thereafter, the Secretary shall submit to the 
appropriate committees of Congress a report on the VistA system used by 
the Department.
    (b) Elements.--The report required by subsection (a) shall include 
the following:
            (1) The cost to maintain and strengthen the VistA system 
        for each of fiscal years 2018 through 2022, for funding 
        relating to both development and operations and maintenance.
            (2) The projected cost to maintain and strengthen such 
        system for fiscal year 2023, for funding relating to both 
        development and operations and maintenance.
            (3) The projected cost to maintain and strengthen such 
        system for each of fiscal years 2024 through 2033, for funding 
        relating to both development and operations and maintenance.
            (4) The planned enhancements underway to strengthen and 
        secure the VistA system until its features and modules are no 
        longer needed by the Department through such system, or have 
        been subsumed or replaced by other programs and information 
        technology services and systems, including cyber security 
        enhancements, movement to the cloud, and new features and 
        services.
            (5) A list of modules or features of the VistA system that 
        are not planned to be replaced, subsumed, or otherwise 
        incorporated into a new electronic health record or other 
        health information technology and are planned to reside in a 
        remnant VistA system, or successor remnant system.
    (c) Initial Report.--The first report required by subsection (a) 
shall include a description of any enhancements to the VistA system 
that have occurred during the one-year period preceding the date of the 
report and those planned for the fiscal year in which the report is 
submitted.
    (d) Subsequent Reports.--Each report after the first report 
required by subsection (a) shall include a description of any 
enhancements to the VistA system that have occurred during fiscal year 
immediately preceding the date of the report, those planned, but not 
implemented and an explanation for such lack of implementation and 
those planned for the fiscal year in which the report is submitted.
    (e) Termination.--This section shall terminate on the date that is 
15 years after the date of the enactment of this Act.

SEC. 405. REPORT ON ALTERNATIVES TO CURRENT ELECTRONIC HEALTH RECORD 
              TECHNOLOGY AND CONTRACT FOR DEPARTMENT OF VETERANS 
              AFFAIRS.

    (a) In General.--Not later than 60 days after the date of the 
enactment of this Act, the Secretary shall submit to the appropriate 
committees of Congress a report on paths the Department and Congress 
should consider to achieve a modernized electronic health record as an 
alternative to the Oracle-Cerner product.
    (b) Elements.--The report required under subsection (a) shall 
include the following with respect to an alternative path or paths to 
be considered by the Department and Congress:
            (1) Considerations for and against such alternative path or 
        paths.
            (2) Accurate reinvestment analysis of expenditures, 
        developed consistent with cost estimation and other relevant 
        guidance issued by the Comptroller General of the United 
        States, already made on the modernized electronic health record 
        as of the date of the report, including an assessment of which 
        of those expenditures would have to be made again and which 
        would not based on an alternative technology and contract path 
        chosen and the ability to repurpose investments.
            (3) The capabilities and weaknesses of other technology 
        solutions the Department could pursue, including an assessment 
        of long-term value and return on investment from a health 
        delivery, health quality, and operational perspective, and the 
        acquisition process that could be used to procure such 
        solutions.
            (4) An analysis of electronic health record and health 
        information technology market trends, capabilities, and market 
        leaders to include user satisfaction and health outcome 
        statistics to the extent they are relevant to the goals and 
        strategy of the Department.
            (5) An analysis of whether the Department choosing an 
        alternative path or paths would, and to what extent, or would 
        not impact necessary alignment with the electronic health 
        record modernization conducted by the Department of Defense 
        commonly known as MHS GENESIS.
            (6) An analysis of whether the ability to share and 
        exchange records in an interoperable manner, and with what 
        level of interoperability, with the Department of Defense would 
        be negatively impacted or positively enhanced, or neither, by 
        an alternative technology path or contract.
            (7) An analysis of whether the ability share and exchange 
        records in an interoperable manner, and with what level of 
        interoperability, with non-Federal health entities would be 
        negatively impacted or positively enhanced, or neither, by an 
        alternative technology path or contract.
            (8) An estimated timeline to restart deployment of a new 
        electronic health record of the Department with a different 
        vendor based on an alternative technology path or contract.
            (9) An assessment of options that may include--
                    (A) a narrow or descoped contract supplemented by 
                other contracts to strengthen areas in which the 
                Oracle-Cerner product performs in a substandard fashion 
                or is inadequate to the health delivery and operational 
                needs of the Department; or
                    (B) any other combination of possibilities.
            (10) An analysis of the strengths and weaknesses of the 
        alternative path or paths towards the Department meeting or 
        exceeding the highest industry interoperability standards.
            (11) An analysis of whether the interoperability of the 
        Oracle-Cerner product with the private sector, the community 
        care networks of the Department, academic hospitals, Federal 
        health entities, and other relevant health providers, systems, 
        and networks is demonstrably superior to other electronic 
        health records in the health technology industry.
            (12) A description of which path or paths the Secretary has 
        selected to take or not take, the reason for such selection, 
        and the key milestones to achieve any new course of action 
        described, including any new Departmental structures, estimated 
        life cycle costs, and timelines.
            (13) Such other matters as the Secretary considers 
        appropriate.

SEC. 406. REPORT ON LEADERSHIP, ACQUISITION, AND CONTRACTING OVERSIGHT 
              LESSONS LEARNED.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary, through the Chief Acquisition 
Officer, the Under Secretary for Health, and the Executive Director of 
the Electronic Health Record and Health Information Technology 
Modernization Program Management Office, shall submit to the 
appropriate committees of Congress a report detailing the structural 
controls, programs, and processes the Department has or will put in to 
place to prevent current or future failures with respect to leadership 
engagement and management, strategic planning, contracting and contract 
oversight, and program management in--
            (1) the implementation of the electronic health record 
        modernization program of the Department from 2017 to the date 
        of the report; and
            (2) any large acquisitions and major modernizations 
        conducted, including those that are ongoing or planned by the 
        Department after the date of the report.
    (b) Elements.--The report required under subsection (a) shall 
include--
            (1) steps to improve the composition of and management of 
        task orders placed on the current and any future electronic 
        health record contract or other major acquisition or 
        modernization, including covered programs (as defined in 
        section 403(f));
            (2) a timeline to achieve the reforms described in the 
        report or the date upon which reforms already put in place were 
        finalized and implemented;
            (3) a description of lessons learned regarding the need for 
        stable consistent leadership, strategy, and management of large 
        modernization programs and how to prevent such challenges as 
        experienced with the electronic health record modernization 
        initiated in 2017 from occurring again in any major program of 
        the Department; and
            (4) a description of the number of acting or Senate-
        confirmed Deputy Secretaries of the Department and the number 
        of leaders of the program management office of the electronic 
        health record modernization program of the Department from 2017 
        to the date of the report.
    (c) Legislative or Administrative Action.--The report required by 
subsection (a) shall include a description of any legislative or 
administrative action necessary to achieve the structural controls 
described in such subsection.

SEC. 407. REPORT ON CONTRACT SAVINGS, SERVICES PROVIDED AT NO COST TO 
              THE DEPARTMENT, AND CONTRACT COST INCURRED WITH RESPECT 
              TO ORACLE-CERNER PRODUCT.

    Not later than 90 days after the date of the enactment of this Act, 
the Deputy Secretary shall submit to the appropriate committees of 
Congress a report that contains the following:
            (1) A detailed list of the services, functions, or other 
        matters that Oracle-Cerner provided to the Department without 
        compensation since assuming ownership of Cerner in June 2022.
            (2) A list of specific credits or reimbursements, to 
        include dollar amounts and an indication of the specific 
        failure for which those credits or reimbursements are provided, 
        Cerner or Oracle-Cerner has provided to the Department across 
        all domains for contract failure, service-level agreement 
        failure, performance failure, training and change management 
        failure, ticket system failure, and related issues during the 
        period beginning on the award of the contract to Cerner on May 
        17, 2018, and ending on the date of the report.
            (3) The estimated and known costs, both direct and 
        indirect, incurred by all facilities using the Oracle-Cerner 
        product as of the date of the report due to--
                    (A) increased staffing;
                    (B) lost productivity;
                    (C) increased referrals to community care;
                    (D) copayment and debt management actions;
                    (E) staff turnover;
                    (F) reduced collections; and
                    (G) other factors as determined by the Secretary.

            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.

    (a) In General.--Not later than 90 days after the date of the 
enactment of this Act, and not less frequently than quarterly 
thereafter, the Secretary of Defense shall submit to the appropriate 
committees of Congress a report on the system uptime, modernization, 
and coordination activities for information technology systems of the 
Department of Defense that are relied upon by the Department of 
Veterans Affairs to deliver health care, compensation, memorial 
benefits, and other services required to be provided under the laws 
administered by the Secretary of Veterans Affairs.
    (b) Elements.--Each report required by subsection (a)--
            (1) shall identify steps taken by the Secretary of Defense 
        to improve governance, coordination, and policy decisions 
        conducted with the Secretary of Veterans Affairs related to 
        information technology of the Department of Defense and related 
        systems upon which the Department of Veterans Affairs has an 
        operational dependency;
            (2) shall include a schedule for the modernization or 
        replacement of key information technology and related systems 
        of the Department of Defense upon which the Department of 
        Veterans Affairs has an operational dependency, including the 
        Defense Enrollment Eligibility Reporting System, or successor 
        system;
            (3) shall include a schedule for the movement by the 
        Department of Defense of the MHS GENESIS software and related 
        systems to the cloud;
            (4) shall include information regarding goals for and 
        actual uptime and stability of all information technology and 
        related systems of the Department of Defense--
                    (A) that the Department of Veterans Affairs relies 
                on to operate, manage, or administer the current or any 
                future electronic health record of the Department of 
                Veterans Affairs;
                    (B) on which the Department of Veterans Affairs has 
                an operational dependency; or
                    (C) that is a critical system or service relied 
                upon by the Department of Veterans Affairs for the 
                delivery of health care, compensation, memorial 
                benefits, or other services;
            (5) shall identify--
                    (A) any system or systems, infrastructure, or 
                related entities of the Department of Defense that are 
                critical to operations of the Department of Veterans 
                Affairs;
                    (B) any performance issues with respect to those 
                systems, infrastructure, or related entities;
                    (C) steps taken by the Secretary of Defense to 
                remediate any such issues in the short, medium, and 
                long term and timelines for such remediation;
                    (D) the accountable offices within the Department 
                of Defense for the maintenance, replacement, and 
                stability of those systems, infrastructure, or related 
                entities; and
                    (E) policies and governance structures regarding 
                collaboration and coordination with the Department of 
                Veterans Affairs with respect to changes to those 
                systems, infrastructure, or related entities;
            (6) shall include a description of the definitions, 
        monitoring, and reporting of service level agreements between 
        the Department of Defense and the Department of Veterans 
        Affairs, including specific critical infrastructure 
        availability targets, incident reporting mean time to 
        resolution, and related matters;
            (7) shall include a description of the service reliability 
        measurements in use and the previous quarter's actual 
        reliability data by the Department of Defense as it relates to 
        services relied upon by the Department of Veterans Affairs 
        measured as experienced by the Department of Veterans Affairs, 
        inclusive of any Department of Defense network, identity, and 
        security services dependencies;
            (8) shall include a complete list of incident reporting, 
        root cause analyses, after action reporting, and preventive 
        measures for each event in which a Department of Defense system 
        or service's degraded performance or outage caused operational 
        harm to the Department of Veterans Affairs inclusive of network 
        and security services degradations, outages, and related 
        matters; and
            (9) may include an identification of legislative or 
        administrative action required to accomplish the goals in the 
        report.
    (c) Initial Report.--The first report required under subsection (a) 
shall include baseline information, including current system uptime and 
goals and targets with respect to system uptime, and steps the 
Department of Defense is taking to better meet standards, goals, and 
targets with respect to system uptime.
    (d) Subsequent Reports.--Each report after the first report 
required under subsection (a) shall, for the quarter covered by the 
report--
            (1) discuss updates on the information provided in previous 
        reports, including system uptime performance;
            (2) indicate the performance of the Department of Defense 
        in meeting the goals established in previous reports;
            (3) indicate the steps the Department of Defense is taking 
        to address the areas in which the Department is not meeting 
        those goals; and
            (4) indicate improvements to and work in progress toward 
        strengthening policies and governance structures regarding 
        collaboration and coordination with the Department of Veterans 
        Affairs with respect to changes to the systems, infrastructure, 
        or related entities with respect to which the Department of 
        Veterans Affairs has an operational dependency.
    (e) Termination.--This section shall terminate on the date that is 
10 years after the date of the enactment of this Act.
    (f) Appropriate Committees of Congress Defined.--In this section, 
the term ``appropriate committees of Congress'' means--
            (1) the Committee on Armed Services and the Committee on 
        Veterans' Affairs of the Senate; and
            (2) the Committee on Armed Services and the Committee on 
        Veterans' Affairs of the House of Representatives.

SEC. 502. COORDINATION WITH DEPARTMENT OF DEFENSE REGARDING INFORMATION 
              TECHNOLOGY PROGRAMS, SYSTEMS, AND SERVICES.

    (a) In General.--Not later than 45 days after the date of the 
enactment of this Act, the Deputy Secretary shall submit to the 
appropriate committees of Congress, the Committee on Armed Services of 
the Senate, and the Committee on Armed Services of the House of 
Representatives a report indicating the additional support needed by 
the Department from the Department of Defense to make the current and 
future delivery of health, benefits, memorial affairs and other 
services of the Department stable and successful, including through 
reliable availability of data and services of the information 
technology systems and programs of the Department of Defense, including 
the legacy VistA and new electronic health record of the Department.
    (b) Elements.--The report required under subsection (a) shall 
include a description of support, collaboration, and coordination, 
needed by the Department from the Department of Defense relating to--
            (1) governance between the Department of Defense and the 
        Department of Veterans Affairs related to information 
        technology, systems, services, networks, and related 
        infrastructure;
            (2) coordination and policy between the Department of 
        Defense and the Department of Veterans Affairs related to 
        information technology, systems, services, networks, and 
        related infrastructure;
            (3) system availability, stability, and uptime standards of 
        critical information technology systems, systems, services, 
        networks, and related infrastructure;
            (4) definition, monitoring, and reporting of service level 
        agreements between the Department of Defense and the Department 
        of Veterans Affairs related to information technology, systems, 
        services, networks, and related infrastructure;
            (5) service reliability measurements as experienced by the 
        Department of Veterans Affairs, including any network, 
        identity, and security service dependencies with the Department 
        of Defense;
            (6) the current state and desired future state transparency 
        in incident reporting, root cause, after action reporting, and 
        preventative measures for information technology, systems, 
        services, networks, and related infrastructure events of the 
        Department of Defense in which the Department of Veterans 
        Affairs has an operational dependency;
            (7) the current state and desired future state of network 
        and security services of the Department of Defense on which the 
        Department of Veterans Affairs has an operational dependency or 
        that significantly impact the Department of Veterans Affairs;
            (8) a description of the key systems of the Department of 
        Defense that the Department of Veterans Affairs believes need 
        modernization or replacement so as to improve delivery of 
        services to veterans and operations of the Department of 
        Veterans Affairs; and
            (9) Such other related matters as the Deputy Secretary may 
        choose to include.

                        TITLE VI--OTHER MATTERS

SEC. 601. REPORT ON LEGISLATIVE ACTION REQUIRED.

    Not later than 180 days after the date of the enactment of this 
Act, and periodically thereafter as the Secretary considers 
appropriate, the Secretary shall submit to the appropriate committees 
of Congress a report regarding any legislative action, including 
resources, required to carry out this Act or implement a modernized 
electronic health record and related health information technology 
systems.

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.

    (a) Report Required.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary shall, acting through the Under 
Secretary for Health, submit to the appropriate committees of Congress 
a report on the current state of interoperability, including the level 
of interoperability, with the Department's legacy VistA electronic 
health record and legacy applications, including the Joint Longitudinal 
Viewer, as well as with the Oracle-Cerner product in use at five 
facilities of the Department between such systems, applications, and 
records and the Department of Defense, the private sector, the 
community care networks of the Department, academic hospitals, other 
Federal health entities, and other relevant non-Federal health 
providers and systems.
    (b) Contents.--The report submitted under subsection (a) shall 
include a description of the following:
            (1) The level of interoperability that existed before the 
        contract with Cerner entered into on May 17, 2018, between the 
        Department and the Department of Defense, the private sector, 
        the community care networks of the Department, academic 
        hospitals, other Federal health entities, and other relevant 
        non-Federal health providers and systems, including strengths 
        and limitations, and a description of the applications and 
        exchanges in use by the Department to facilitate such 
        interoperability.
            (2) The level of interoperability that exists as of the 
        date of the report between the Department and the Department of 
        Defense, the private sector, the community care networks of the 
        Department, academic hospitals, other Federal health entities, 
        and other relevant non-Federal health providers and systems, 
        including strengths and limitations, and a description of the 
        applications and exchanges in use by the Department to 
        facilitate such interoperability that are not those procured as 
        part of the contract with Cerner entered into on May 17, 2018.
            (3) The level of interoperability that exists as of the 
        date of the report between the Department and the Department of 
        Defense, the private sector, the community care networks of the 
        Department, academic hospitals, other Federal health entities, 
        and other relevant non-Federal health providers and systems, 
        including strengths and limitations, and a description of the 
        applications and exchanges in use by the Department to 
        facilitate such interoperability that are solely those procured 
        as part of the contract with Cerner entered into on May 17, 
        2018, and that are in use at each facility of the Department 
        (including any subsidiary facilities, such as community-based 
        outpatient clinics) that is using the Oracle-Cerner product 
        under such program as of the date of the report.
            (4) A discussion of the limitation of the Department's 
        interoperability with whom and of what nature, if any, 
        described in paragraphs (2) and (3) and how the Secretary 
        foresees such limitations being resolved in whole, in part, or 
        in no way through a continued deployment of the Oracle-Cerner 
        product, a procurement of another electronic health record, 
        other health information exchanges, networks, applications or 
        solutions.
            (5) A comprehensive interoperability roadmap and strategy 
        for the next five fiscal years, including goals, 
        interoperability levels, partners, timelines, regulatory and 
        legal limitations and challenges, and required resources and 
        authorities to achieve such goals.
            (6) A description of the role interoperable data exchange 
        plays in improving health care outcomes and care coordination 
        for veterans who are eligible to receive health care through 
        programs and services of the Department and whether 
        interoperability alone improves health care outcomes, access, 
        and quality or whether it must be part of a larger functioning 
        electronic health record that can facilitate, among other 
        actions, the delivery of physician orders, referrals, dispense 
        prescriptions, schedule appointments, and other such 
        foundational and routine elements of modern health care 
        delivery.
            (7) Such other such matters as the Secretary considers 
        appropriate, including recommendations for legislative action 
        to achieve the goals set forth in the report.
    (c) Discussion.--The discussion included under subsection (b)(4) 
shall include the following:
            (1) A clear indication of what entities the Department 
        experiences the greatest level of interoperability limitations 
        in current state such as the Department of Defense, community 
        care networks of the Department, academic hospitals and the 
        Department's solution or solutions for remedying those 
        limitations.
            (2) A description of what current health care referral 
        patterns, patient volumes, and networks it currently 
        experiences the greatest volume of care referral, data exchange 
        and interoperability transactions and how such patterns and 
        volumes are projected to evolve and change over the next one, 
        five, and ten fiscal years.
            (3) In providing the description required by paragraph (2), 
        an indication of whether the volume of care coordination, 
        record exchange, and related matters is expected to be greater 
        with the Department of Defense in the next one, five, and ten 
        fiscal years or with community care networks of the Department, 
        academic hospitals, and other Federal and non-Federal health 
        entities.
                                 &lt;all&gt;
</pre></body></html>