priations, throughout the Department, particularly 
to the Veterans Health Administration and the Of-
fice of Information and Technology of the Depart-
ment, to facilitate successful planning, management, 
oversight, and execution of the Program. 
(2) RESPONSIBILITY
FOR
PROGRAM
AND
OF-
FICE.—The Under Secretary shall be the responsible 
official for the Program and the Office, working to-
gether 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 
MODERNIZA-
TION. 
(a) IN GENERAL.—Not later than 60 days after the 
date of the enactment of this Act, the Secretary, acting 
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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 Tech-
nology 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, in-
cluding— 
(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 over-
seeing medium- or large-scale health informa-
tion technology transformation, including elec-
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tronic health record deployments and business 
modernizations; 
(C) experience improving health care out-
comes; 
(D) experience managing change; or 
(E) experience in developing and imple-
menting 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 ORGANIZA-
TION.—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 indi-
vidual— 
(A) is from the information technology 
vendor or technology development sector; or 
(B) had a role in the Oracle or Cerner pro-
curement by the Department or related con-
tracts for program management services for the 
electronic health record modernization program 
of the Department. 
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(c) DUTIES.—The Subcommittee shall produce peri-
odic reports and recommendations as directed or re-
quested by the Secretary or the Under Secretary on plans 
and opportunities for the Department to improve its strat-
egy, goals, and implementation for and deployment of elec-
tronic health records and health information technology 
to better improve quality of care, patient outcomes, oper-
ational 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 Sub-
committee, 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 mod-
ernized electronic health record has been deployed to every 
medical center and other relevant medical facility of the 
Department. 
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TITLE 
II—DEPLOYMENT 
CRI-
TERIA 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 MODERNIZA-
TION PROGRAM OF DEPARTMENT OF VET-
ERANS 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, produc-
tivity, and all other health and operational performance 
metrics data of the Veterans Health Administration and 
the Office of Information and Technology of the Depart-
ment 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 tech-
nology operational levels of the facility before deploy-
ing such product; or 
(2) met national standards set forth by the Vet-
erans Health Administration for quality, safety, effi-
ciency, and financial performance as established by 
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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 sub-
section (a)(2) to create a common health perform-
ance standard of the Veterans Health Administra-
tion under which all medical facilities of the Depart-
ment may be evaluated under that subsection that 
takes into account relevant differences in size, com-
plexity, and market of each facility. 
(2) COMMON METRIC AND STANDARD.—In es-
tablishing 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 
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committees of Congress a report on such stand-
ards. 
(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 pa-
tient account centers, subsidiary facilities, such as 
community-based outpatient clinics that deployed the 
Oracle-Cerner product, have not reached the require-
ments under subsection (a)— 
(A) not later than 13 months after such 
date of enactment, the Secretary, in consulta-
tion with the Deputy Secretary, the Under Sec-
retary for Health, the Chief Information Offi-
cer, and the Executive Director of the Office, 
shall— 
(i) submit to the appropriate commit-
tees of Congress a plan on how the De-
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partment will meet the requirements under 
such subsection either through the existing 
technology strategy of the Department, a 
new procurement, or some other combina-
tion 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 so-
lutions; 
(B) not later than 180 days after com-
pleting 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 EXIST-
ING CONTRACT.—In carrying out paragraph (1), to 
ensure a smooth transition and reduce operational 
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and care delivery disturbance, the Secretary may not 
terminate any existing electronic health record con-
tract 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, tem-
porarily delay each of the requirements of para-
graph (1) for a period not to exceed 180 days 
if the Secretary determines such delay is nec-
essary due to mission critical, national emer-
gency, national security, patient safety, quality 
and access to care, protection of taxpayer in-
vestments, 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 appro-
priate committees of Congress a report setting 
forth the justification of the Secretary for such 
delay. 
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SEC. 202. REQUIREMENTS BEFORE CONTINUED DEPLOY-
MENT 
OF 
NEW 
ELECTRONIC 
HEALTH 
RECORD BY DEPARTMENT OF VETERANS AF-
FAIRS AT ADDITIONAL LOCATIONS AND FA-
CILITIES. 
(a) REPORT ON METRICS TO DETERMINE CONTIN-
UED 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, readi-
ness criteria, and governance decision process that 
the Department will use to determine whether con-
tinued deployment of the electronic health record 
technology of the Department is appropriate in June 
2023, or whether a further pause in such deploy-
ment is warranted to address system issues, patient 
safety, technology features, provider efficiency, and 
related matters. 
(2) METRICS.—The metrics included in the re-
port 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 Depart-
ment to serve veterans, perform research, and 
support Fourth Mission requirements; 
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(B) ensure patient safety, quality of and 
access to care, system stability, cyber security, 
and sound financial and business administra-
tion activities are successfully evaluated as sta-
ble 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 deter-
mined 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 in-
corporate the research function and health com-
plexity levels of facilities of the Department and 
whether additional or different metrics are or 
will be added based on more or less complex fa-
cilities or facilities with a greater research func-
tion; 
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(B) explain how the metrics and readiness 
criteria under the report incorporate appro-
priate input and findings of the National Cen-
ter for Patient Safety, the Clinical Episode Re-
view 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, configura-
tion of roles and responsibilities, referrals, am-
bulatory care, pharmacy, identity, orders, medi-
cation 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 re-
flecting— 
(i) the repeatable method for how de-
cisions relating to deployment of electronic 
health record technology are made within 
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the Department from the field level up to 
the Secretary; and 
(ii) the input received from each rel-
evant element of the Department before 
such a decision is made, to include input 
from the National Center for Patient Safe-
ty. 
(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 Of-
fice, and the Chief Information Officer of the De-
partment. 
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 re-
spect to any new electronic health record shall be led 
by the Department and employees of the Depart-
ment who are uniquely positioned to understand the 
legacy VistA system of the Department, the existing 
and future standardized workflow of the Depart-
ment, and the history, culture, and mission of the 
Department; and 
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(2) any contractors of the Department involved 
in the implementation of any new electronic health 
record should serve in a support function to the De-
partment rather than lead and conduct all training 
and change management activities. 
TITLE III—ENHANCED SUPPORT 
FOR 
HEALTH 
CARE 
AND 
OTHER FACILITIES DEPLOY-
ING 
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 re-
quired to be provided to a facility by the Department and 
included in the report under subsection (a) shall include, 
at a minimum, the following: 
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(1) Budgetary resources and support to address 
the need for increased staffing at the facility, re-
duced productivity and collections, increased use of 
community care networks, and other issues identi-
fied in the report of the Institute for Defense Anal-
yses 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 re-
duce 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 serv-
ices required at each such facility for such deploy-
ment. 
(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 
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Modernization Program Management Office, and the 
Chief Information Officer. 
SEC. 302. MODIFICATION OF QUARTERLY REPORT TO IN-
CLUDE INFORMATION ON SYSTEM STABILITY, 
SATISFACTION, 
MORALE, 
RETENTION 
OF 
STAFF, TRAINING, AND CHANGE MANAGE-
MENT WITH RESPECT TO NEW ELECTRONIC 
HEALTH RECORD OF DEPARTMENT OF VET-
ERANS AFFAIRS. 
Section 503(b) of the Veterans Benefits and Transi-
tion 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 redesig-
nated, 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
IN-
CLUDED.— 
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‘‘(A) IN
GENERAL.—The Secretary shall 
include with any update submitted under para-
graph (1) on or after the date of the enactment 
of the Electronic Health Record Program Re-
structure, 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 train-
ing and change management activities pro-
vided to employees and facilities of the De-
partment regarding such record. 
‘‘(iv) Data on ticket resolution and 
closure. 
‘‘(v) The specific system enhance-
ments to include configuration changes 
and new service requests that have been 
tested and put into production for elec-
tronic health record system users and a list 
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and description of remaining configuration 
changes and new service requests under 
development or in requirements develop-
ment and the estimated date for such im-
provements to be tested and put into pro-
duction for electronic health record system 
users. 
‘‘(vi) The system performance statis-
tics 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 degrada-
tions, incomplete functionality, and 
loss of redundancy. 
‘‘(vii) The health operations, produc-
tivity, 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 de-
ployment of the new record while using the 
legacy VistA and related systems and com-
pared to the national quality and access 
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standards established by the Veterans 
Health Administration to evaluate per-
formances of medical facilities under sec-
tion 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 collec-
tions and steps taken to remediate per-
formance challenges as well as a compari-
son to revenue, collections, and all other fi-
nancial 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 con-
tractors and any credits, reimbursements, 
or other relevant repayment or corrective 
action agreed upon or issued and the 
dates, purposes, and reasons for issuance 
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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 MAN-
AGEMENT. 
(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 manage-
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ment related to electronic health record moderniza-
tion; 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 termi-
nating all contracts of the Department with Oracle Cerner 
as required under subsection (a)(1), the Secretary, as the 
Secretary determines necessary and consistent with sec-
tion 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 compa-
nies with a proven track-record in delivering electronic 
health record and health information technology training 
and change management in medium or large health sys-
tems 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. 
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SEC. 402. STRENGTHENING CONTRACT NEGOTIATION BY 
DEPARTMENT OF VETERANS AFFAIRS WITH 
RESPECT 
TO 
NEW 
ELECTRONIC 
HEALTH 
RECORD AND DESIGNATION OF LEAD CON-
TRACT NEGOTIATOR. 
(a) DESIGNATION OF LEAD NEGOTIATOR FOR NEW 
ELECTRONIC HEALTH RECORD.— 
(1) IN
GENERAL.—The Secretary shall des-
ignate 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 ‘‘Ne-
gotiator’’). 
(2) ORGANIZATION.—The Negotiator shall re-
side 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 com-
mittees of Congress of such designation. 
(b) OBJECTIVE OF NEGOTIATIONS.—The goal of con-
tract negotiations and activities conducted by the Nego-
tiator with respect to contracts relating to the new elec-
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tronic health record of the Department are, at a min-
imum— 
(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 tax-
payers 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 pa-
tient harm, poor performance, inadequate train-
ing, insufficient ticket resolution, system crash-
es, inefficient processes driven by new tech-
nology, extra Department personnel hours, and 
other factors relating to the use of the Oracle- 
Cerner product; 
(2) to consider options to descope existing con-
tracts 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, tech-
nology features, and other elements that have been 
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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 replace-
ment 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 duplica-
tive contracting requirements to include those be-
tween contractors deploying various aspects of such 
new record and the program management office con-
tract, including potential conflicts of interest and 
perverse incentives for one set of contractors to in-
hibit or slow the work of other contractors for poten-
tial financial gain and leverage for current and fu-
ture 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 Depart-
ment, but at a minimum the Secretary, the Deputy Sec-
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retary, the Office of General Counsel, the Under Sec-
retary, and the Chief Information Officer and the Assist-
ant Secretary for Information and Technology of the De-
partment, in conducting negotiations relating to the elec-
tronic health record of the Department. 
(e) ASSISTANCE.— 
(1) OTHER
FEDERAL
AGENCIES.—In con-
ducting 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 ne-
gotiators, legal counsel, litigators, and other relevant 
personnel, particularly those with specialties and ex-
perience in health information technology acquisi-
tions, contracts, negotiations, and litigation. 
(2) OUTSIDE ENTITIES.— 
(A) IN GENERAL.—In conducting negotia-
tions, the Negotiator or the Secretary may en-
gage 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 strate-
gies to achieve a revised, modified, or new con-
tract for a new electronic health record that is 
of better value to the taxpayer or where nec-
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essary for appropriate cancellation terms and 
transition planning. 
(B) TYPES
OF
ENTITIES.—In procuring 
services under subparagraph (A), the Nego-
tiator and the Secretary— 
(i) shall only engage with entities that 
have a proven, long-term experience in de-
livering value and resolution to entities 
through high-dollar contracts, agreements, 
settlements, or litigation structured to de-
liver 
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 pro-
hibition on that data being monetized, sold, controlled, or 
otherwise misused by any internal or external entity con-
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ducting 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 EF-
FORTS OF DEPARTMENT OF VETERANS AF-
FAIRS. 
(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 func-
tions described in subsection (c). 
(b) ELIGIBILITY.—An entity is eligible under this 
subsection if the Chief Acquisition Officer of the Depart-
ment 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 ac-
quisition programs or priority defense business sys-
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tems, in accordance with guidance of the Depart-
ment of Defense relating to such acquisition pro-
grams or such business systems; and 
(2) is not currently performing and has not per-
formed, for at least the five-year period preceding 
the date of the issuance of such solicitation, any con-
tract or subcontract for the Department of Veterans 
Affairs (including such a contract or subcontract re-
lating 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 ac-
tivities carried out under, and the systems associated 
with, each covered program, including oversight of 
the status, compliance, performance, and implemen-
tation of recommendations with respect to, for each 
covered program, the following: 
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(A) Management, including governance, 
costs, and implementation milestones and 
timelines. 
(B) Contracts for implementation, includ-
ing financial metrics and performance bench-
marks for contractors. 
(C) Effect on the functions, business oper-
ations, or clinical organizational structure of 
the health care system of the Department. 
(D) Supply chain risk management, con-
trols, and compliance. 
(E) Data management. 
(F) With respect to associated systems, the 
following: 
(i) Technical architectural design, de-
velopment, and stability of the systems. 
(ii) System interoperability and inte-
gration with related information technology 
systems. 
(iii) System testing. 
(iv) Functional system training pro-
vided 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 
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annual report under subsection (c)(2), the Secretary shall 
submit to the Committee on Veterans’ Affairs of the Sen-
ate 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 co-
ordination 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 appro-
priated for each such office of the Department, respec-
tively. 
(f) DEFINITIONS.—In this section: 
(1) COVERED
PROGRAM.—The term ‘‘covered 
program’’ means the following: 
(A) The electronic health record mod-
ernization program (or any successor program). 
(B) The Financial Management and Busi-
ness Transformation Program (or any successor 
program). 
(C) Any program of the Department relat-
ing to supply chain modernization. 
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(D) Any program of the Department relat-
ing to the modernization of information tech-
nology systems associated with human re-
sources. 
(E) Any program of the Department relat-
ing to the Veterans Benefits Management Sys-
tem. 
(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 SYS-
TEM. 
(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 De-
partment. 
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(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 develop-
ment and operations and maintenance. 
(4) The planned enhancements underway to 
strengthen and secure the VistA system until its fea-
tures and modules are no longer needed by the De-
partment through such system, or have been sub-
sumed or replaced by other programs and informa-
tion 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, sub-
sumed, or otherwise incorporated into a new elec-
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tronic 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 enhance-
ments 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 sub-
mitted. 
(d) SUBSEQUENT REPORTS.—Each report after the 
first report required by subsection (a) shall include a de-
scription 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. 
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SEC. 405. REPORT ON ALTERNATIVES TO CURRENT ELEC-
TRONIC 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 sub-
mit 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 al-
ternative to the Oracle-Cerner product. 
(b) ELEMENTS.—The report required under sub-
section (a) shall include the following with respect to an 
alternative path or paths to be considered by the Depart-
ment and Congress: 
(1) Considerations for and against such alter-
native path or paths. 
(2) Accurate reinvestment analysis of expendi-
tures, 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 repur-
pose investments. 
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(3) The capabilities and weaknesses of other 
technology solutions the Department could pursue, 
including an assessment of long-term value and re-
turn on investment from a health delivery, health 
quality, and operational perspective, and the acquisi-
tion process that could be used to procure such solu-
tions. 
(4) An analysis of electronic health record and 
health information technology market trends, capa-
bilities, and market leaders to include user satisfac-
tion and health outcome statistics to the extent they 
are relevant to the goals and strategy of the Depart-
ment. 
(5) An analysis of whether the Department 
choosing an alternative path or paths would, and to 
what extent, or would not impact necessary align-
ment 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 De-
partment of Defense would be negatively impacted 
or positively enhanced, or neither, by an alternative 
technology path or contract. 
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(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 posi-
tively enhanced, or neither, by an alternative tech-
nology 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 tech-
nology path or contract. 
(9) An assessment of options that may in-
clude— 
(A) a narrow or descoped contract supple-
mented 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 De-
partment; or 
(B) any other combination of possibilities. 
(10) An analysis of the strengths and weak-
nesses of the alternative path or paths towards the 
Department meeting or exceeding the highest indus-
try interoperability standards. 
(11) An analysis of whether the interoperability 
of the Oracle-Cerner product with the private sector, 
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the community care networks of the Department, 
academic hospitals, Federal health entities, and 
other relevant health providers, systems, and net-
works 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 rea-
son 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 con-
siders 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 Mod-
ernization Program Management Office, shall submit to 
the appropriate committees of Congress a report detailing 
the structural controls, programs, and processes the De-
partment has or will put in to place to prevent current 
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or future failures with respect to leadership engagement 
and management, strategic planning, contracting and con-
tract 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 moderniza-
tions conducted, including those that are ongoing or 
planned by the Department after the date of the re-
port. 
(b) ELEMENTS.—The report required under sub-
section (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 initi-
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ated in 2017 from occurring again in any major pro-
gram of the Department; and 
(4) a description of the number of acting or 
Senate-confirmed Deputy Secretaries of the Depart-
ment 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 descrip-
tion of any legislative or administrative action necessary 
to achieve the structural controls described in such sub-
section. 
SEC. 407. REPORT ON CONTRACT SAVINGS, SERVICES PRO-
VIDED AT NO COST TO THE DEPARTMENT, 
AND CONTRACT COST INCURRED WITH RE-
SPECT TO ORACLE-CERNER PRODUCT. 
Not later than 90 days after the date of the enact-
ment of this Act, the Deputy Secretary shall submit to 
the appropriate committees of Congress a report that con-
tains 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. 
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(2) A list of specific credits or reimbursements, 
to include dollar amounts and an indication of the 
specific failure for which those credits or reimburse-
ments are provided, Cerner or Oracle-Cerner has 
provided to the Department across all domains for 
contract failure, service-level agreement failure, per-
formance failure, training and change management 
failure, ticket system failure, and related issues dur-
ing the period beginning on the award of the con-
tract 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 Ora-
cle-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 ac-
tions; 
(E) staff turnover; 
(F) reduced collections; and 
(G) other factors as determined by the 
Secretary. 
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TITLE V—COORDINATION WITH 
DEPARTMENT OF DEFENSE 
SEC. 501. QUARTERLY REPORTS ON SYSTEM UPTIME, MOD-
ERNIZATION, AND COORDINATION ACTIVI-
TIES FOR INFORMATION TECHNOLOGY SYS-
TEMS AND POLICIES OF DEPARTMENT OF DE-
FENSE AFFECTING OPERATIONS OF DEPART-
MENT 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 ac-
tivities for information technology systems of the Depart-
ment 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 pro-
vided under the laws administered by the Secretary of Vet-
erans 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 Vet-
erans Affairs related to information technology of 
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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 moderniza-
tion 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 suc-
cessor system; 
(3) shall include a schedule for the movement 
by the Department of Defense of the MHS GEN-
ESIS 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 Af-
fairs 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 re-
lied upon by the Department of Veterans Af-
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fairs for the delivery of health care, compensa-
tion, 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 Depart-
ment of Veterans Affairs; 
(B) any performance issues with respect to 
those systems, infrastructure, or related enti-
ties; 
(C) steps taken by the Secretary of De-
fense to remediate any such issues in the short, 
medium, and long term and timelines for such 
remediation; 
(D) the accountable offices within the De-
partment of Defense for the maintenance, re-
placement, and stability of those systems, infra-
structure, or related entities; and 
(E) policies and governance structures re-
garding collaboration and coordination with the 
Department of Veterans Affairs with respect to 
changes to those systems, infrastructure, or re-
lated entities; 
(6) shall include a description of the definitions, 
monitoring, and reporting of service level agreements 
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between the Department of Defense and the Depart-
ment 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 re-
liability measurements in use and the previous quar-
ter’s actual reliability data by the Department of 
Defense as it relates to services relied upon by the 
Department of Veterans Affairs measured as experi-
enced by the Department of Veterans Affairs, inclu-
sive of any Department of Defense network, identity, 
and security services dependencies; 
(8) shall include a complete list of incident re-
porting, 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 net-
work 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, in-
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cluding 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 tar-
gets 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 per-
formance; 
(2) indicate the performance of the Department 
of Defense in meeting the goals established in pre-
vious reports; 
(3) indicate the steps the Department of De-
fense is taking to address the areas in which the De-
partment is not meeting those goals; and 
(4) indicate improvements to and work in 
progress toward strengthening policies and govern-
ance structures regarding collaboration and coordi-
nation with the Department of Veterans Affairs with 
respect to changes to the systems, infrastructure, or 
related entities with respect to which the Depart-
ment of Veterans Affairs has an operational depend-
ency. 
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(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 DE-
FINED.—In this section, the term ‘‘appropriate commit-
tees 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 Represent-
atives 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 sta-
ble and successful, including through reliable availability 
of data and services of the information technology systems 
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and programs of the Department of Defense, including the 
legacy VistA and new electronic health record of the De-
partment. 
(b) ELEMENTS.—The report required under sub-
section (a) shall include a description of support, collabo-
ration, and coordination, needed by the Department from 
the Department of Defense relating to— 
(1) governance between the Department of De-
fense and the Department of Veterans Affairs re-
lated to information technology, systems, services, 
networks, and related infrastructure; 
(2) coordination and policy between the Depart-
ment 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 infrastruc-
ture; 
(4) definition, monitoring, and reporting of 
service level agreements between the Department of 
Defense and the Department of Veterans Affairs re-
lated to information technology, systems, services, 
networks, and related infrastructure; 
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(5) service reliability measurements as experi-
enced by the Department of Veterans Affairs, in-
cluding 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 in-
formation technology, systems, services, networks, 
and related infrastructure events of the Department 
of Defense in which the Department of Veterans Af-
fairs 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 Af-
fairs has an operational dependency or that signifi-
cantly impact the Department of Veterans Affairs; 
(8) a description of the key systems of the De-
partment of Defense that the Department of Vet-
erans Affairs believes need modernization or replace-
ment so as to improve delivery of services to vet-
erans and operations of the Department of Veterans 
Affairs; and 
(9) Such other related matters as the Deputy 
Secretary may choose to include. 
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TITLE VI—OTHER MATTERS 
SEC. 601. REPORT ON LEGISLATIVE ACTION REQUIRED. 
Not later than 180 days after the date of the enact-
ment of this Act, and periodically thereafter as the Sec-
retary considers appropriate, the Secretary shall submit 
to the appropriate committees of Congress a report re-
garding any legislative action, including resources, re-
quired 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 
ELEC-
TRONIC 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, sub-
mit 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- 
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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-Fed-
eral health providers and systems. 
(b) CONTENTS.—The report submitted under sub-
section (a) shall include a description of the following: 
(1) The level of interoperability that existed be-
fore the contract with Cerner entered into on May 
17, 2018, between the Department and the Depart-
ment of Defense, the private sector, the community 
care networks of the Department, academic hos-
pitals, other Federal health entities, and other rel-
evant non-Federal health providers and systems, in-
cluding strengths and limitations, and a description 
of the applications and exchanges in use by the De-
partment 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, aca-
demic hospitals, other Federal health entities, and 
other relevant non-Federal health providers and sys-
tems, including strengths and limitations, and a de-
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scription 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, aca-
demic hospitals, other Federal health entities, and 
other relevant non-Federal health providers and sys-
tems, including strengths and limitations, and a de-
scription 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 (includ-
ing 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 Depart-
ment’s interoperability with whom and of what na-
ture, if any, described in paragraphs (2) and (3) and 
how the Secretary foresees such limitations being re-
solved in whole, in part, or in no way through a con-
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tinued deployment of the Oracle-Cerner product, a 
procurement of another electronic health record, 
other health information exchanges, networks, appli-
cations or solutions. 
(5) A comprehensive interoperability roadmap 
and strategy for the next five fiscal years, including 
goals, interoperability levels, partners, timelines, reg-
ulatory and legal limitations and challenges, and re-
quired 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 func-
tioning electronic health record that can facilitate, 
among other actions, the delivery of physician or-
ders, referrals, dispense prescriptions, schedule ap-
pointments, and other such foundational and routine 
elements of modern health care delivery. 
(7) Other such matters as the Secretary con-
siders appropriate, including recommendations for 
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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 De-
partment experiences the greatest level of interoper-
ability limitations in current state such as the De-
partment of Defense, community care networks of 
the Department, academic hospitals and the Depart-
ment’s solution or solutions for remedying those lim-
itations. 
(2) A description of what current health care 
referral patterns, patient volumes, and networks it 
currently experiences the greatest volume of care re-
ferral, data exchange and interoperability trans-
actions and how such patterns and volumes are pro-
jected 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 Depart-
ment of Defense in the next one, five, and ten fiscal 
years or with community care networks of the De-
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partment, academic hospitals, and other Federal and 
non-Federal health entities. 
Æ 
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