[House Hearing, 115 Congress] [From the U.S. Government Publishing Office] OVERSIGHT OF IT AND CYBERSECURITY AT THE DEPARTMENT OF VETERANS AFFAIRS ======================================================================= HEARING BEFORE THE SUBCOMMITTEE ON INFORMATION TECHNOLOGY OF THE COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM HOUSE OF REPRESENTATIVES ONE HUNDRED FIFTEENTH CONGRESS FIRST SESSION __________ DECEMBER 7, 2017 __________ Serial No. 115-59 __________ Printed for the use of the Committee on Oversight and Government Reform [GRAPHIC NOT AVAILABLE IN TIFF FORMAT] Available via the World Wide Web: http://www.fdsys.gov http://oversight.house.gov __________ U.S. GOVERNMENT PUBLISHING OFFICE 30-246 PDF WASHINGTON : 2018 ---------------------------------------------------------------------------------------- For sale by the Superintendent of Documents, U.S. Government Publishing Office, http://bookstore.gpo.gov. For more information, contact the GPO Customer Contact Center, U.S. Government Publishing Office. Phone 202-512-1800, or 866-512-1800 (toll-free). E-mail, [email protected]. Committee on Oversight and Government Reform Trey Gowdy, South Carolina, Chairman John J. Duncan, Jr., Tennessee Elijah E. Cummings, Maryland, Darrell E. Issa, California Ranking Minority Member Jim Jordan, Ohio Carolyn B. Maloney, New York Mark Sanford, South Carolina Eleanor Holmes Norton, District of Justin Amash, Michigan Columbia Paul A. Gosar, Arizona Wm. Lacy Clay, Missouri Scott DesJarlais, Tennessee Stephen F. Lynch, Massachusetts Blake Farenthold, Texas Jim Cooper, Tennessee Virginia Foxx, North Carolina Gerald E. Connolly, Virginia Thomas Massie, Kentucky Robin L. Kelly, Illinois Mark Meadows, North Carolina Brenda L. Lawrence, Michigan Ron DeSantis, Florida Bonnie Watson Coleman, New Jersey Dennis A. Ross, Florida Stacey E. Plaskett, Virgin Islands Mark Walker, North Carolina Val Butler Demings, Florida Rod Blum, Iowa Raja Krishnamoorthi, Illinois Jody B. Hice, Georgia Jamie Raskin, Maryland Steve Russell, Oklahoma Peter Welch, Vermont Glenn Grothman, Wisconsin Matt Cartwright, Pennsylvania Will Hurd, Texas Mark DeSaulnier, California Gary J. Palmer, Alabama Jimmy Gomez,California James Comer, Kentucky Paul Mitchell, Michigan Greg Gianforte, Montana Sheria Clarke, Staff Director Robert Borden, Deputy Staff Director William McKenna General Counsel Sean Brebbia, Senior Counsel Kiley Bidelman, Clerk David Rapallo, Minority Staff Director ------ Subcommittee on Information Technology Will Hurd, Texas, Chairman Paul Mitchell, Michigan, Vice Chair Robin L. Kelly, Illinois, Ranking Darrell E. Issa, California Minority Member Justin Amash, Michigan Jamie Raskin, Maryland Blake Farenthold, Texas Stephen F. Lynch, Massachusetts Steve Russell, Oklahoma Gerald E. Connolly, Virginia Raja Krishnamoorthi, Illinois C O N T E N T S ---------- Page Hearing held on December 7, 2017................................. 1 WITNESSES Mr. David A. Powner, Director, IT Management Issues, U.S. Government Accountability Office Oral Statement............................................... 4 Written Statement............................................ 6 Mr. Scott Blackburn, Acting Chief Information Officer, Department of Veterans Affairs Oral Statement............................................... 39 Written Statement............................................ 41 Mr. Bill James, Deputy Assistant Secretary for the Enterprise Program Management Office, U.S. Department of Veterans Affairs Oral Statement............................................... 58 Mr. John Windom, Program Executive for Electronic Health Records Modernization, U.S. Department of Veterans Affairs Oral Statement............................................... 58 Mr. Dominic Cussatt, Chief Information Security Officer, Department of Veterans Affairs Oral Statement............................................... 74 APPENDIX Ranking Member Kelly Opening Statement........................... 78 Mr. Connolly Opening Statement................................... 80 GAO Chart submitted by Chairman Hurd............................. 82 OVERSIGHT OF IT AND CYBERSECURITY AT THE DEPARTMENT OF VETERANS AFFAIRS ---------- Thursday, December 7, 2017 House of Representatives, Subcommittee on Information Technology, Committee on Oversight and Government Reform, Washington, D.C. The subcommittee met, pursuant to call, at 2:38 p.m., in Room 2154, Rayburn House Office Building, Hon. Will Hurd [chairman of the subcommittee] presiding. Present: Representatives Hurd, Amash, Gianforte, Kelly, Lynch, Connolly, and Krishnamoorthi. Mr. Hurd. The Subcommittee on Information Technology will come to order. And without objection, the chair is authorized to declare a recess at any time. Good afternoon. Thank you for being here today. Seventy-six years ago to the day, Japan launched a sneak attack on the U.S. naval base at Pearl Harbor. By the time the sun had set on that infamous day, 2,335 U.S. servicemen had been killed and 1,143 had been wounded. The next day, the United States of America declared war on Japan. Three days later, the world was at war. Over 16 million Americans eventually served in that war, the so-called war to end all wars. There are only around 624,000 World War II veterans left. Most are in their 90s. I want to take this opportunity today to thank all of them for their service and their courage. Sadly, that war did not end all wars. In 2016, Gulf War veterans became the largest group of veterans at over 7 million. The total number of veterans enrolled in VA's healthcare system rose from 7.9 million to almost 9 million for fiscal year 2006 through fiscal year 2016. The total veteran population currently stands at 20 million people, 20 million of our fellow citizens who are willing to put their lives on the line for this country and for the rest of us. And for that sacrifice, we should honor our promise to provide them with world-class health care. But the modernization of the VA's legacy technology has been a persistent concern that is affecting millions of veterans. A veteran should be able to go from active duty on base to the VA to a private-sector provider seamlessly. The health records should be available and up-to-date no matter where the veteran chooses to get health care. A fully functional modernized healthcare information system is the goal, and today, we are going to talk about some of the specifics on how the VA will modernize and upgrade its information systems and how we can learn from past mistakes so that this time it is going to be a success. But let's be honest. There is not a track record of successes here. As a result of a GAO review requested by this committee back in May of 2016, we have learned that during fiscal years 2011 to 2016, VA obligated about $1 billion for previous VistA modernization contracts. Seven hundred and forty million went to 15 key contractors. Without objection, I would like to enter into the record a chart from GAO that lists the 15 contractors and the amount they received to work on VistA modernization and interoperable electronic health records. So moved. Mr. Hurd. On that list of 15 contractors is the Cerner Corporation, which was recently chosen by the VA to provide an electronic health record that will be interoperable with the Department of Defense and then ultimately be interoperable with the private sector. Also on the list are the Mitre Corporation and Booz Allen Hamilton. According to the GAO, these companies have been awarded program management contracts to develop planning and support for the electronic health record modernization effort. Given the amount of money spent on VistA modernization, the lack of return on that investment, we have concerns about this rollout. It needs to succeed. The whole country is rooting for the VA to succeed. Previous initiatives to modernize VistA and to develop and interoperable electronic health record with the Department of Defense have been full of missed deadlines, cost overruns, and failures to produce. According to the GAO, from 2011 to 2016, the VA spent about $1 billion for contractors' activities on their health information technology systems. Additionally, veterans have had difficulties with scheduling appointments for far too long. The VA has been trying and failing to develop a scheduling system that is compatible with VistA since 2000. That is 17 years spent working on developing a scheduling system. It is a whole lot of money, a whole lot of time, and very little to show for it. VA Secretary Shulkin has said that the VA, and I quote, ``should focus on the things veterans need us to focus on and work with companies who know how to do this better than we do,'' end of quote. The Secretary is absolutely right. The technology and tools to improve the VA's technology and cybersecurity exist. What is required is strong leadership at the VA to make the tough decisions about pursuing that technology. Our veterans deserve a state-of-the-art scheduling system, they deserve an interoperable and longitudinal electronic health record, and they deserve good quality information technology at the agency that exists to serve the ones who served. I am looking forward to our hearing today. I am looking forward to hearing from our witnesses about the future of modernization, improvement, and technology at the VA. Mr. Hurd. And now, as always, it is my pleasure to recognize my friend Robin Kelly for her opening statement. Ms. Kelly. Thank you, Mr. Chairman. Information technology is critical to improving the service and performance of the Federal Government. This is especially true at the Department of Veterans Affairs, which is one of the largest integrated healthcare systems in the United States, serving millions of veterans and their families. The VA's goal for modernizing its healthcare IT is full of interoperability, which would allow seamless sharing of health information between the VA and the Department of Defense, as well as private healthcare providers. The VA is now in its fourth attempt since 2001 to modernize its healthcare IT system. The record has not been good. The VA abandoned two earlier attempts at spending billions of dollars. This summer, the VA announced that it would scrap its third attempt in favor of acquiring the same healthcare IT system as the DOD. I do not know what we should make of that since the VA previously abandoned the same approach four years ago. Chairman Hurd and I requested that GAO examine the VA's modernization efforts because of these red flags. We discovered that, right now, the VA is relying on 138 contractors to help it modernize. Some of them are the very same contractors VA had hired and fired after their previous attempts had failed. In fact, 34 through 38 repeat contractors make up about $793 million of the $1.1 billion of the contractual obligations related to modernization between fiscal years 2011 through 2016. This raises serious concerns. Every change in strategy delays actually modernizing and makes it harder on veterans who rely on the agency for health care. We need to understand whether these changes are justified. I want to hear today what the agency is doing to hold this army of contractors accountable. I also want to hear about the progress made toward its interoperability and improving the ability to track patient outcomes. Getting these efforts right and improving VA operations and information security are essential to regaining the trust and confidence of the American public that the VA is taking care of our nation's veterans. Thank you so much. Thank you for being here, and thank you, Mr. Chair. Mr. Hurd. The gentlelady yields back. And I now am pleased to introduce our witnesses: Mr. Scott Blackburn, acting chief information officer at the VA; Mr. Dominic Cussatt, is that correct, sir? He is the CISO at the Department of Veterans Affairs, the chief information security officer; Mr. Bill James, the deputy assistant secretary for the Enterprise Program Management Office at the Department of Veterans Affairs; and Mr. John Windom, program executive for Electronic Health Records Modernization at the Department of Veterans Affairs; and the person that wins the award for most times testifying in front of OGR, Mr. David Powner, director of IT Management Issues at the U.S. Government Accountability Office. Welcome to you all. And pursuant to committee rules, all witnesses will be sworn in before you testify, so please rise and raise your right hand. [Witnesses sworn.] Mr. Hurd. Thank you. Please let the record reflect that all witnesses answered in the affirmative. And in order to allow time for discussion, please limit your testimony to five minutes. I recognize there are only can be two statements. And your entire written statement is going to be made part of the record. As a reminder, the clock in front of you shows your remaining time. The light will turn yellow when you have 30 seconds left, and the red when your time is up. Please also remember to press the button to turn your microphone on before speaking. We are going to actually start with Mr. Powner. Mr. Powner, it is always a pleasure to have you here, sir. No-shave November is over, just for the record. And you are now recognized for five minutes, sir. WITNESS STATEMENTS STATEMENT OF DAVID A. POWNER Mr. Powner. Chairman Hurd, Ranking Member Kelly, and members of the subcommittee, thank you for inviting GAO to testify on VA's FITARA progress and their efforts to modernize their aging electronic health records system. Technology can help make improvements so that ultimately our veterans will face shorter wait times to schedule care, receive higher-quality care, and have claims processed quicker and more accurately. The Department will spend over $4 billion on IT this year. That makes them the fifth-highest IT spender in the government. Of the $4 billion, only about $360 million goes towards developing or acquiring new systems. The remaining goes towards operational systems and payroll. Many of these operational systems are old, inefficient, and difficult to maintain. In addition to its 30-plus-year-old medical information system known as VistA, VA has an accounting system and a claims processing system that are both more than 50 years old. In 2015, GAO added two new areas to our high-risk list: managing VA health care and managing IT acquisitions and operations, which both highlight concerns with VA's IT management, including past failures where hundreds of millions of dollars were wasted. Turning to VA's FITARA progress, VA has historically done a good job planning for incremental development and continues to do so. Also to their credit they are only one of seven agencies to have a complete software license inventory. The area that needs the most work is data center optimization. VA has closed about 40 of its 415 centers, saved just over $20 million, and reports meeting one of OMB's five optimization metrics. Their closure savings and optimization metrics all fall short of OMB's goals. VA needs to consider more comprehensive data center optimization strategy that coincides with their new approach of reducing the 130 instances of VistA. Now turning to the EHR modernization initiative, I will briefly summarize the work we did for you looking at contractors involved in previous VA EHR efforts, current plans for the new approach, and suggestions for success moving forward. My written statement provides details on specific contractors and the amounts obligated to VA's EHR efforts over the previous six years. Here are the highlights: VA obligated approximately $1.1 billion to 138 contractors between 2011 and 2016. About $740 million or almost 70 percent of this went to 15 contractors. Clearly, we did not get the return needed to modernize electronic health records with these previous efforts, but that's water over the dam. What's important now is how can we improve contractor oversight, performance, and delivery with the new effort. The decision by Secretary Shulkin in June to go with the same commercial electronic health records system as DOD is a good one. Contract award is expected this month. Plans are to follow within 90 days, and we understand that initial deployment is expected within 18 months with subsequent deployments to occur over the next 10 years. This is a massive undertaking, and I'd like to mention five keys to success. One, continuity of leadership and Executive Office of the President involvement. This continuity includes the Secretary, CIO, and others. Of particular concern is VA's CIO tenure, which is less than two years. They have had nine CIOs since 2004. Since leadership change is inevitable, having White House involvement could help mitigate setbacks associated with this. The current administration has several EOP offices whose involvement can help with this important acquisition. This includes the Office of Innovation and the American Tech Council. We also think that the Federal CIO's involvement is important. Number two, governance in building a robust Program Management Office. We understand that both interagency governance is planned, as is governance run by VA's Deputy Secretary. In addition, it is important that the PMO ensure better collaboration between the Veterans Health Administration and the CIO shop than has occurred historically. Also, this PMO needs to have a strong focus on contract management to ensure that contractors have high levels of productivity, quality, and delivery. Number three, business change management. A major issue with Federal agencies adopting commercial products is their unwillingness to change their business processes. This is definitely a high-risk area for VA. Number four, leveraging lessons from DOD. Since DOD is ahead of VA, learning from their experience is essential. And lastly, number five, building in appropriate cyber security measures. VA's FISMA audit shows several cyber areas that need strengthening. Many of these are extremely important to the new EHR acquisition, including controls associated with network security and controls for monitoring systems hosted by contractors. Mr. Chairman, this concludes my statement. I look forward to your questions. [Prepared statement of Mr. Powner follows:] [GRAPHICS NOT AVAILABLE IN TIFF FORMAT] Mr. Hurd. Thank you, sir. Mr. Blackburn, I have been advised you are going to speak for the entire VA team. You are now recognized for five minutes. Welcome. STATEMENT OF SCOTT BLACKBURN Mr. Blackburn. Will do. Chairman Hurd, Ranking Member Kelly, members of the subcommittee, thank you very much for the opportunity to discuss OIT transformation with an emphasis on IT modernization, cybersecurity, FISMA and FITARA compliance, and the electronic health record management initiative. I'm accompanied by Mr. James, Mr. Cussatt, and Mr. Windom, and then also available to answer questions behind me as Mr. John Short, executive director of Information Technology Systems Modernization. Also, thank you all for the opportunity to meet with you one-on-one. The feedback we received was very positive, very constructive, and we really appreciate that. We especially appreciate your interest to help ensure we get the electronic health record modernization effort off on the right foot, along with other pressing VA matters. VA is in the midst of a turnaround. Trust was broken in 2014, and helping re-earn that trust is why I left the private sector to join the VA in November of 2014. This is personal to me as a disabled veteran and as one of five siblings who are all either veterans or still serving today in uniform. Our first quarterly survey to measure veteran trust two years ago revealed that only 47 percent of veterans said that they trusted the VA to fulfill our country's commitment to veterans. Today, that number is 69 percent with an uptick in each of the last seven quarters. OIT has played a major role in that improvement. And while 69 percent is great compared to where we started, that still means that 31 percent of veterans do not trust VA, which means we still have a long way to go, and OIT will play an even more important role closing that gap. We have a comprehensive IT modernization plan, which is the foundation for reducing reliance on the VA legacy systems. We will leverage modern technology such as telehealth, cloud, robotics, machine learning, mobile, digital services, and blockchain. We will stop or migrate 240 of our 299 current projects and leverage a buy-first strategy, getting us out of the software development business and ensuring we are positioned to manage the influx of new technologies and innovations. I'd like to highlight four areas which align with the Secretary's priorities. Number one, the selection of the new electronic health record is a major step for VA. A veteran will have one single longitudinal lifetime medical record. That means a single common system from the time of enlistment or commission throughout their service and the remainder of their life as a veteran. We realize implementing Cerner Millennium across the country's largest integrated healthcare system will not be easy, but we strongly believe it is the right thing to do. Our new electronic health records system will enable VA to keep pace with the improvements in health IT and cybersecurity, which the current system VistA is unable to do. Continuing to maintain VistA is costly. Transition solutions for nearly all VistA modules have been identified with the majority to be replaced by the Cerner solution. Number two, modernizing our scheduling systems is something I am extremely passionate about as a veteran who's received treatment at the Washington, D.C., VA Medical Center. This is an area where we have made improvements, but much more must be done. Number three, another OIT commitment is modernizing the legacy COBOL-based financial management system to standardize and improve accounting and acquisition services. And number four involves our benefits delivery network, BDN, and modernizing BDN will ensure that VBA-wide--that's our benefits administration--wide monthly payment and processing of 4 million checks remains feasible and that veterans receive benefits quickly. Additionally, VA cybersecurity program enables data protection in the face of threats and is committed to safeguarding veteran information. We have recently achieved various program capability and policy milestones to advance cybersecurity to include just a few hours ago receiving from the Federal CIO this memo closing 11 open cyber stat activities with OMB. VA received a B-plus grade from your FITARA scorecard, and while we are proud of that score, we acknowledge that our data center consolidation, as Mr. Powner noted, is nowhere near where it needs to be, and we are working to fix it. The establishment of an OIT-based strategic sourcing division will ensure FITARA compliance for all IT acquisitions. Thank you again, Chairman and Ranking Member, for the opportunity to discuss OIT's transformation efforts. As a note, if there are any questions that are acquisitions-sensitive to our EHR efforts, we will not be able to discuss those in a public session, but we can provide those--that information to you in a closed session at a later date. Ensuring a safe and secure environment for veteran information and improving their experiences our goal. I look forward to your questions. [Prepared statement of Mr. Blackburn follows:] [GRAPHICS NOT AVAILABLE IN TIFF FORMAT] Mr. Hurd. Thank you, Mr. Blackburn. And before we turn to Mr. Gianforte for the first round of questions, Mr. Cussatt, we know what a CISO does. Mr. James and Mr. Windom, can I get you all to explain to the committee what your exact role is, who you report to directly? Just take 30 seconds. Mr. James. Yes, Chairman, thank you. The Enterprise Program Management Office inside the CIO's organization at the VA, we're the control tower for all of the projects, the ongoing projects with the exception of the EHR project, which has its own BEO. So we track all the project's costs, schedule performance that are ongoing today in the IT organization. Mr. Hurd. And who is your direct supervisor? Mr. James. Scott Blackburn, sir. Mr. Hurd. Got you. Mr. Windom? Mr. Windom. Sir, recently retired, Captain John Windom, 33 years United States Navy. I was a program manager that oversaw the DOD successful acquisition of the Cerner Millennium product. I was brought over in uniform about six months ago at the request of Secretary Shulkin from Secretary Mattis to kick off if you will the DNF activities and negotiations with Cerner. I've been leading that and now in a retired capacity as a--as the executive overseeing the entire electronic health record modernization, direct report to the Deputy Secretary, and so he is who I consider my boss. Mr. Hurd. Well, welcome. It is good to have you here. Mr. Windom. Thank you. Mr. Hurd. It is a mess, and we are glad we have you on board to work on this project. Mr. Windom. Great to be here, sir. Mr. Hurd. The distinguished gentleman from Montana is now recognized for five minutes. Mr. Gianforte. Okay. Thank you, Mr. Chairman. I want to thank each of you for being here. This is a critically important topic for us to be discussing. In Montana, we are the second-largest per capita of citizens that have served in the military. And as I travel the State, the number-one issue I hear is health care from the VA in every single meeting, so I appreciate you being here. And in a rural State like Montana, it can take hours to drive to a VA hospital or clinic, so scheduling becomes extremely important, particularly advanced notice. It could take three days to go to an appointment and come back again. So, as we have heard, clearly we can do better, and I appreciate your efforts in that regard. I come from a software background. I have done literally thousands of enterprise-class deployments. One particular one was for the Air Force Personnel Center. It was their entire records systems for processing all the stuff, so have some experience. And that handled all active-duty and all retired Air Force personnel, so it was of some scale. You have shared that this new Cerner system, Mr. Blackburn, will be $10 billion and 10 years to complete. Is that correct? Mr. Blackburn. That's correct, sir. Mr. Gianforte. Okay. I haven't been through a lot of sales cycles on the software side. If I had walked into a boardroom and asked for $10 billion and 10 years before we could get a system deployed, honestly, I would have gotten laughed out of the boardroom. It is difficult to fathom it could take that long. And comparing my own experience with the Air Force system that we deployed, granted, the entire VA is larger, but what you are proposing is not 10 times more expensive, it is not 100 times more expensive, it is 1,000 times more expensive, three orders of magnitude, which provides some level of sticker shock. Where I want to focus my questioning, Mr. Blackburn, is just on what steps you are taking to minimize the cost and get functionality in the field so that we can retire this VistA system and move on. So the first area I want to speak about is just customization of applications. When large enterprise-class applications are customized, they tend to become brittle. Integrations don't work as well. What percentage--and one measure of that is how much of the total fee is going into customization versus licenses versus operation and maintenance. Can you share with me a little bit of how that $10 billion breaks out between license and customization? Mr. Blackburn. Well, first of all, thank you for the one- on-one time. That was very productive, and I really appreciate it. This is going to be the largest implementation of a healthcare system, EHR, ever, and it's going to be a really big undertaking. The key difference between previous efforts is we're going to be buying the commercial off-the-shelf solution and absolutely minimizing the customization. I'll ask Mr. Windom to kind of get into some of the specifics there. Mr. Windom. Sir, I appreciate your question, appreciate the opportunity. The--I need to make sure there are some facts brought to the table. Number one is the VA is three times larger than DOD. We awarded the contract for DOD at $4.33 billion, and so the complexity is deemed about four times larger in that we have well over 100 interfaces. DOD had approximately 25 to 27 interfaces. The $10 billion is not what's needed at contract award. The $10 billion is for the duration of the contract. And I'm really not at liberty to talk about specifics of the price negotiation. We'll gladly come brief you in whatever detail you'd like personally and give you a complete breakdown of the pricing structure. Mr. Gianforte. So just in the initial acquisition, what percentage is professional services versus license? Mr. Windom. The--sir, that would be crossing me over to Procurement Integrity Act because I would be giving you contract values. Again, sir, prepared to give you that granularity in a private session outside ---- Mr. Gianforte. Okay. Mr. Windom.--the public forum, so I apologize. I guess ---- Mr. Gianforte. I think with a number that large we are just asking to understand. Mr. Windom. Well ---- Mr. Gianforte. And, Mr. Blackburn then, if we--one of the recommendations from the GAO here was item 3 to redesign business process to conform with commercial off-the-shelf software as a way to bring costs down and reliability. What business process redesign efforts are you undertaking inside VA to conform with best practices and maybe leave behind some of those 30-year-old processes and pick up new ones that are available to us? Mr. Blackburn. Well, one of the big issues that we have is we have different processes at each one of our 168 medical centers, and so we're not standardized right now across our own medical system. What this will force us to do is standardize across our medical system and then also in line with the workflows of DOD in order to implement this off-the-shelf solution. Mr. Gianforte. And, Mr. James, is that a primary focus of the PMO in doing business process redesign to bring conformity across the ---- Mr. James. Congressman, that would be better addressed by the PEO Mr. Windom. Mr. Windom. Sir, my primary responsibility is program management oversight, as you alluded to. You get what you inspect, not expect. I have led to a number of multibillion- dollar programs and understanding that though we have selected a phenomenal partner in Cerner or will award a contract, we've got to have the mechanisms in place to oversee their efforts to protect the taxpayers' interest and obviously the interest of our veterans. So our Program Management Office is going to consist of what I believe is you need physics, physicists to grade physics homework. So we're going to have the full breadth of clinical capabilities and technological capabilities at our disposal to oversee the implementation, sir. Mr. Gianforte. Okay. Well, I would encourage you that as much standardization would be ---- Mr. Windom. Yes, sir. Mr. Gianforte.--helpful in keeping the cost down. The last point I just want to ask Mr. Blackburn is we have heard before this committee a number of other agencies testify about the cost savings increase in reliability and speed to deployment when solutions are in the cloud. What percentage of the Cerner system will be native in-the-cloud technology? Mr. Blackburn. The--Mr. Windom will probably have the best information for that, but it's the majority. Mr. Windom. Sir, so we're involving with technology. As you know, there are a number of inhibitors associated with the movement of PII data into the cloud. I can assure you we're working ---- Mr. Gianforte. So is there a percentage? Mr. Windom. Sir, I don't have a percentage, but we're going to be on premise and in the cloud simultaneously in delivering that support. What the ---- Mr. Gianforte. We have had other agencies testify that there are 100 percent in the cloud now. Mr. Windom. That's not the case, sir. Mr. Gianforte. Okay. Well ---- Mr. Windom. That would not be the case for us. Mr. Gianforte.--I just want to--I will just finish up. I have run past my time. Thank you, Mr. Chairman. It is just the work you are doing is critically important for our veterans. They are not--we all know they are not being served well today. Let's work together to make this happen. Mr. Blackburn. Absolutely. Absolutely, sir. Mr. Gianforte. I yield back. Mr. Hurd. The gentleman yields back. Now, I recognize the ranking member for her first five minutes of questions. Ms. Kelly. Thank you, Mr. Chair. The number-one mission of the VA is to care for our veterans, and a central part of that mission in delivering quality healthcare generally is tracking outcomes. The ability to track outcomes help both prevention and treatment. Mr. Blackburn, the VA cannot properly care for our veterans and track outcomes without the ability to communicate with DOD and share information. Can DOD and the VA currently exchange patient health data between one another? Mr. Blackburn. Thank you, Ranking Member Kelly, and thank you also for our one-on-one session. The--yes. The answer is yes, that we currently can. My doctor in the Orange Clinic of the Washington VAMC, we have something called Joint Legacy Viewer in--which allows clinicians within DOD and VA to be able to see each other's medical records. It's not perfect. It's read-only. It's as good as it could possibly get it. I think we have roughly almost 8 million or so medical records that have been viewed on Joint Legacy Viewer. Ms. Kelly. Thank you. Do all users have access to interoperable electronic health records, the system? Mr. Blackburn. The--I think most. John Short, is that all? All. Ms. Kelly. All? Okay, great. Mr. Blackburn. Yes. Ms. Kelly. VistA evolution showed progress in achieving the ability to share data between DOD and VA. In June of this year, however, the Secretary announced that the VA would now acquire the same health system as the DOD. This is a rather remarkable shift since it was previously planned that DOD and VA would have the same healthcare system and that efforts were abandoned. Why is the VA going back to this plan that it previously abandoned, and why does it believe this is the best course of action at this time? Mr. Blackburn. The--maintaining our current VistA system is not an option. It will be incredibly costly. Matter of fact, we had a third-party estimate that took a look at it and estimated it would be roughly up to $19 billion to maintain and to upgrade our current VistA system. And that would not get us the seamless interoperability of--that we're looking for with veterans. With--by moving to the same exact product, the same exact instance that DOD has, it will all be one record. It will be DOD doctors and VA doctors going into the exact same record, which will make that seamless. Currently, as a veteran, most of my records as a soldier were on paper. Those were lost when my parents' basement was flooded, so my VA doctor does not have that information. That will not be the case for my kids when they go to serve. Ms. Kelly. Okay. And, Mr. Blackburn, will the transition away from the health management platform that was the key part of the VistA evolution affect the interoperability with the Department of Defense? Mr. Blackburn. Please repeat the question. Ms. Kelly. Will the transition away from the health management platform that was a key part of VistA ---- Mr. Blackburn. Yes. Ms. Kelly.--evolution, will that affect the interoperability with the Department of Defense? Mr. Blackburn. We will maintain that ability on Cerner to be able to view those records within the Joint Legacy Viewer, so we will not lose that data. That will be a key part of our implementation. Ms. Kelly. And what is your timeline? Mr. Blackburn. The timeline overall for implementation of Cerner is roughly 10 years ---- Ms. Kelly. And ---- Mr. Blackburn.--for the entire thing. Ms. Kelly. And what are you doing to achieve interoperability with healthcare providers outside of the VA and DOD? Mr. Blackburn. That's a great question, and that's actually something that we're working with the Office of American Innovation and the White House on. The Cerner solution, that will give us interoperability within the VA, first of all. Second, it will give us interoperability with the DOD because it's the same record. And then thirdly, the--Cerner has a CommonWell solution in which they have their network of private hospitals that that will--but it won't give us 100 percent. No solution right now will give us 100 percent with the private sector. That solution does not exist right now, but I think that would be a longer-term goal for our country so that it would be completely seamless. And that's actually a problem that we're working with the White House on. Ms. Kelly. Okay. Thank you. In previous testimony before this committee GAO has stated that agencies need, and I quote, ``To define what they aim to accomplish through these efforts and identify meaningful outcome-oriented goals and metrics.'' DOD and VA, do you agree with GAO's assessment that outcome- oriented goals would help measure progress toward interoperability and hold your departments accountable for their progress? Mr. Blackburn. Absolutely. Absolutely agree. Ms. Kelly. And what do--well, what does your respective agency aim to achieve regarding improved health outcomes and delivery from your interoperability efforts? Mr. Blackburn. Ask Mr. Windom for specifics there. Mr. Windom. The metrics--the right metrics, ma'am, I would offer are our primary concerns, so KPPs, SLRs, SLAs, things that we can use to clearly identify that we are achieving our quality goals on behalf of our beneficiaries. We've got what's called a quality assurance surveillance plan as part of the contract. Those contracting officer representatives, quality assurance representatives will be overseeing the delivery of those metrics as the product is being rolled out to ensure that we're in fact getting what we paid for. So there's a myriad of metrics that add value that are not only aligned with the commercial standards that kind of reduce that customized problem that we often have when implemented business systems but also to leverage what's important within the VA with regards to value metrics. So a combination of the two, ma'am, and we use the quality assurance surveillance plan as that tool to oversee those metrics. Ms. Kelly. Can I just ask one more question? When I asked about how you are working with outside ---- Mr. Blackburn. Yes. Ms. Kelly.--entities, now in the State of Illinois I believe they passed legislation where a veteran could go to another hospital or at least they were working on it. Mr. Blackburn. Yes. Ms. Kelly. How many States is it, do you know, that ---- Mr. Blackburn. The whole ---- Ms. Kelly.--can do that? The whole ---- Mr. Blackburn. The whole country. That's the Veterans Choice Program, which has not been perfect. I know in Montana it has not been good. It's been terrible. But that's something that we're working on, and actually, there's draft proposals of bills in place to improve that program right now. Ms. Kelly. Okay. Is this--like where I live in the suburbs or the south suburbs of Chicago and where the VA hospitals are ---- Mr. Blackburn. Yes. Ms. Kelly.--downtown and west, so it is an effort to get there, not like Montana but ---- Mr. Blackburn. Yes. So, ma'am, I'm actually a good example. I get my primary care at the Washington VAMC, but I get physical therapy through the Veterans Choice Program in Bethesda closer to where I live. The--and it makes a big difference. Ms. Kelly. Okay. Thank you. Mr. Blackburn. Yes. Mr. Hurd. All right. I recognize myself ---- Mr. Connolly. I am sorry, Mr. Chairman. Did I just hear Maryland, not Virginia? Mr. Blackburn. That is correct, Mr. Connolly. Mr. Connolly. Oh, my Lord. All right. Mr. Hurd. Bad move, Mr. Blackburn. I recognize myself for five minutes, and I yield to the gentleman from Montana. Mr. Gianforte. Okay. Thank you, Mr. Chairman. I just want to continue the conversation a little bit. And, Mr. Blackburn, you testified again this Cerner implementation, $10 billion, 10 years, and I understand the VistA system then has to stay in place for that entire period of time. And as I understand the cost to--annual cost currently for the system is between 800 and $900 million a year. Is that correct? Mr. Blackburn. Roughly. Roughly. It's multiple hundreds of millions of dollars, way too expensive. Mr. Gianforte. And aspects of that system are pretty long in the tooth, is that correct? It has been around a long time? Mr. Blackburn. Oh, it's been around for about 40 years. Mr. Gianforte. And it is not working that well? Mr. Blackburn. It has worked for 40 years, but it's not sustainable. It can't go forward into the future. Mr. Gianforte. It has lost its luster at a minimum ---- Mr. Blackburn. It has. Mr. Gianforte.--the 40 years. So here is my--one strategy I have seen used in the private sector when you have these massive boil-the-ocean kind of projects like the one we are undertaking that is 10 years and $10 billion is to use on an interim basis best-of-breed technologies to pick off high-value components that may be excessively costly or of high value in terms of functionality. You mentioned scheduling. Mr. Blackburn. Yes. Mr. Gianforte. It happens that I had served on a board of directors of a medical scheduling company. I am not here to advocate for them, but we did scheduling for tens of thousands of doctors across the United States completely in the cloud. If you were able to spend a small amount of money to do something and then throw it away when utopia arrives in 10 years, have you considered strategies like this to use best-of-breed technology on an interim basis to deliver more value to our vets in the short term and save operation and maintenance costs out of this $8-900 million a year you are spending on VistA? Mr. Blackburn. We have. And scheduling's been a massive issue for us. As a matter of fact, we have a board, a visual that shows what our previous scheduling system looked like, right? This is what doctors had to go and use. What we're currently doing right now in 151 out of our 158 facilities is we've moved under Mr. James, who has lead this program, to what we're calling VSE, VistA--it's an upgraded VistA GUI system on top of that. That is a shorter-term bridge as one of the efforts we've done on there. There are also a couple of other efforts that we have. One is an online scheduling application, again, a homegrown system, so ---- Mr. Gianforte. Okay. Mr. Blackburn.--the VSE system is homegrown. Mr. Gianforte. To what extent have you looked at commercial off-the-shelf ---- Mr. Blackburn. Yes. Mr. Gianforte.--best-of-breed applications to pick off either high-cost or high-value components of VistA just on an interim--I mean, because 10 years is a long time. I am not sure any of us are going to be sitting here in 10 years, but we are going to have veterans looking for services. To what extent have you implemented that sort of strategy? Mr. Blackburn. Yes. Mr. James, do you want to talk a little bit about that? Mr. James. Sure. We've looked at that over and over again, and we can apply, for example, with the VSE, VistA scheduling enhancement outlook like GUIDANCE, that type of best-of-breed at the top layer, but the problem comes when you have to interface it to the 130 different versions of VistA across the country, each one of which has 140 to 150 old ---- Mr. Gianforte. Does that ---- Mr. James.--applications. Mr. Gianforte. That VistA GUI, does that work on mobile devices? Mr. Blackburn. Yes. Yes, sir. Mr. Gianforte. And it works on a web browser? Mr. James. Yes, sir. Mr. Gianforte. So a veteran can access it from anywhere? Mr. James. Yes, sir. Mr. Gianforte. And is that deployed in Montana? Mr. James. I believe it is. I'd have to confirm ---- Mr. Blackburn. It's currently deployed in 110 of our sites. We'll have to check and make sure Fort Harris ---- Mr. Gianforte. I am more interested--I ask more from the perspective of a rural State ---- Mr. Blackburn. Yes. Mr. Gianforte.--that has a lot of veterans. So I would just encourage you to do that. And just in our conversation, to summarize, I think--and you have mentioned these things. I would just encourage you, minimize customization. Mr. Blackburn. Yes. Mr. Gianforte. Change business practices to standardize them so you are not doing the customization. Get to the cloud. That is where the puck is going to be. Mr. Blackburn. Yes. Mr. Gianforte. We need to skate there. And then I would highly encourage you to look at best-of-breed commercial off- the-shelf apps as gap-fillers between now and utopia that is going to show up in 10 years from now. Mr. Blackburn. Absolutely. I appreciate that feedback. Mr. Gianforte. And, Mr. Chairman, I yield back. Mr. Hurd. Reclaiming my time. Mr. Powner, there is a lot of conversations going on, a lot of topics hit. Do you have any opinion on the comments so far? Mr. Powner. Yes. I think clearly the word minimize is-- that's a scary word, okay, because we've heard minimize customization with a lot of commercial products in the Federal Government, and that's--minimize means a range of activities. I think you want to really try to almost eliminate customization. You're going to change your business processes anyway significantly, so go full bore and eliminate. Mr. Hurd. Thank you, Mr. Powner. Now, it is a pleasure to recognize my friend from the Commonwealth of Virginia, Mr. Connolly, for your round of questions. Mr. Connolly. I thank my friend from Texas, Mr. Chairman. Thank you. And welcome. And Mr. Blackburn was also--you made the rounds, and good for you. Mr. Blackburn. Thank you. Mr. Connolly. Mr. Powner, let's begin by--can you summarize what kind of performance did we see in the FITARA scorecard for VA this time? Mr. Powner. Well, on the FITARA scorecard overall B-plus. They've consistently scored well on incremental development to their credit. Software licensing, they were one of seven agencies to have that inventory and do something with it, so those areas are very strong. The one area that everyone acknowledges that they have a lot of work to do is on data center optimization. They fall far short of OMB's goals on closures, savings, and also with the optimization metrics. Mr. Connolly. And, by the way, just putting that in context, if I am correct, GAO reported that, as of August 2017, we have identified a total of 12,062 data centers. That is 2,000 more than a year ago. Mr. Powner. Yes, we've been back and forth on the total number here. A lot of that's attributed to Treasury where you've ---- Mr. Connolly. Those people ---- Mr. Powner. They had a number in the inventory, off the inventory. They're back in the inventory, so now we are up to about 12,000. The good news government-wide is we've closed almost half of those, close to 6,000, so that's the good news. Mr. Connolly. Right. Okay. And let me see. And, Mr. Blackburn, if I understand your inventory, you have got 415 data centers, correct? Mr. Blackburn. Roughly. I think we started with 386, but it's an awful lot, way too many. Mr. Connolly. And you have closed only 39 as of August? Mr. Blackburn. I had 24 but the--roughly correct. Mr. Connolly. Mr. Powner, do you want to comment on that? Mr. Powner. My numbers are close to about 40 of the 415 -- -- Mr. Connolly. Right. Mr. Powner.--as of August. Mr. Connolly. I mean, I am kind of following his numbers, but ---- Mr. Powner. Sure. Mr. Connolly.--if your performance is even less stellar -- -- Mr. Powner. I have even less closures. Mr. Connolly. All right. Now, in our conversation you set a metric for yourself, and do you want to share that with us? So let's call the number somewhere around 400 data centers. Mr. Blackburn. Yes. Mr. Connolly. What do you want to get it down to and in what time frame? Mr. Blackburn. We would like to get down to 14 core data centers by the end of 2020. In addition to that, we would have 42 special-purpose data centers. These are things like for our mail-order pharmacy and things of that nature, but even that to me feels it might be a little high, so I would like to go and kind of scrub those with my team. But that would be our goal by the end of 2020. Mr. Connolly. That is a pretty strong stretch goal to go from 400-plus to 20. Mr. Powner, realistic goal? Mr. Powner. I believe--here's what's--that makes it realistic. When you look at the 130 instances of VistA and a lot of the data centers are co-located at these facilities, I think the data center consolidation really needs to go hand-in- hand with this migration to the commercial Cerner product. That's where there's a real opportunity to save a lot of money in the data center area. We're spending a lot of money, but we can get a huge return from a data center point of view. Mr. Connolly. What is the estimated savings if Mr. Blackburn achieves this goal in three years for the data center consolidation? Any estimate? Mr. Powner. I don't have a good estimate on that. Mr. Connolly. Are you operating on any kind of assumption it will save us X? Mr. Blackburn. I haven't been able to get an estimate yet. I think that's one of the reasons why we have such a low grade on FITARA. Mr. Connolly. Yes, I think that is really important both for ---- Mr. Blackburn. Yes. Mr. Connolly.--incentivization and maybe more important now that MGT, the bill we have been working on collectively here, hopefully will be law soon. Mr. Blackburn. By Tuesday. Mr. Connolly. By Tuesday. And that obviously allows you to be reinvesting in yourself with the savings effectuated pursuant to FITARA. So we--among other things, but I mean I would hope that is an incentive for people. Mr. Blackburn. Absolutely. We're very excited about that, and I think the more positive incentives like MGT that can put in place where we can reinvest those savings, we're extremely excited, and that will really help us. Mr. Connolly. Mr. James, I see you affirming that. You are welcome to comment. Mr. James. Yes, Congressman. I'm from your district so I can dig Scott out of ---- Mr. Connolly. Excuse me. Mr. James.--his Maryland hole. Mr. Connolly. This man is only deputy assistant. He needs a promotion. Mr. James. Congressman, the reason I share the excitement in that act is that our Secretary has challenged us to go find--ask industry for some innovative ideas, share-in-savings types of ideas where we put in some seed money, they find savings, and then we share the benefits. We win, they win. And the seed money could come from that particular act, and so we're--we have a runway in front of us that, with that act, I think we can make some headway. Mr. Connolly. And you have raised the Secretary, and that is good to hear, too. Can you talk a little bit, both you and Mr. Blackburn, anyone else who wants to as well, but one of the things Mr. Hurd, Ms. Kelly, and Mr. Meadows and I are concerned about frankly is the organization chart. Who reports to whom? How high up in the hierarchy is the CIO? Because we feel that if you don't have the ear of the boss, it is all fascinating but no guarantee anyone is going to pay the kind of qualitative attention we demand, we want. We think that the CIO has just got to be an empowered person and everyone needs to know it. So comment a little bit about what is the relationship with the Secretary? Mr. Blackburn. Yes. Mr. Connolly. Let's stipulate the Secretary is wonderful and walks on water. We will stipulate that, but what is the working relationship and what does it look like on the organization chart so the somebody like us, it would leap out right away or it wouldn't? Mr. Blackburn. So on the organizational chart the CIO reports directly to the Deputy Secretary at the VA. The ---- Mr. Connolly. Which is Mr. James? Mr. Blackburn. Which is Mr. Tom Bowman is the Deputy Secretary. Mr. Connolly. Okay. Mr. Blackburn. The ---- Mr. Connolly. Oh, I'm sorry, you said Deputy Secretary. Mr. Blackburn. Yes. Mr. Connolly. Right. Mr. Blackburn. Yes. Yes. So CIO reports to--I report to Tom Bowman. The--Secretary Shulkin is incredibly hands-on involved. He and I have a great relationship. I was the interim deputy secretary until Mr. Bowman came on board. He has been very, very hands-on and active. He is the one that personally made the decision to go to the commercial off-the-shelf solution with Cerner. He is very comfortable with technology and a big proponent of what we're doing. Mr. Connolly. Sure. And you concur, Mr. James? Mr. James. Yes. Yes, Congressman. Mr. Connolly. All right. Anyone else want to comment? So, Mr. Powner, we are going to be back here in a year or so hopefully with a different grade that is an improved grade because of data center consolidation. Do you agree? Mr. Powner. Let's hope so. Mr. Connolly. All righty. Thank you all so much for being here. I do hope--I want to underscore Mr. Hurd, my presence here, and Ms. Kelly and Mr. Meadows--who couldn't join us today--I don't mean to leave you out. I am just talking about the ranking member and the chair. We are committed on a bipartisan basis to make this happen, so we have got your back, but we will also--we are more than willing to create pressure and stress where it is needed to improve performance because we are very serious about FITARA and the other related bills. So thank you for being here and thanks for your commitment, which I think is robust, and I like that in government, so thank you. Mr. Blackburn. Thank you, sir. Mr. Hurd. I now recognize myself again for five minutes of questions. And to follow up on what my friend from Virginia was talking about, about the question on coordinating data centers with the Cerner rollout, and everybody was shaking their head as if this is a good idea. And my question is are we coordinating the closure of data centers with the Cerner rollout? Mr. Blackburn, maybe that goes to you. Mr. Blackburn. We are, and I'll yield to Mr. Windom to talk about the Cerner rollout. Mr. Windom. Yes, sir. Mr. Chairman, the Cerner solution has a platform called Healthy Intent. That's its primary data management hosting element that we intend to move our data into obviously in a controlled and properly risk-mitigated fashion such that we don't compromise that care being delivered. We are going to make sure that we--that data is where we want it to be and usable before we shut anything down. That's why I believe that our data consolidation plan is feasible because we are moving that data very similar to the DOD solution into the Healthy Intent platform that gives us again that seamless movement of data across DOD and VA environments. Mr. Hurd. So how long will VistA and the new electronic health records system coexist? Mr. Windom. Sir, let me--so you have a relative--the DOD-- when we awarded the DOD contract, it's a seven-year rollout for about a third of the size of the VA population, 1,600 facilities on VA side, about 600-plus including ships and expeditionary platforms on the DOD side. In addition, we have 318,000 users relative to about 112,000 users on the DOD side. So the answer to your question is is that the plan is going to be to roll this out, VistA has to run simultaneously with the new solution. That's part of the acquisition curve and that we have to keep that solution delivering today. Mr. Hurd. Mr. Windom ---- Mr. Windom. Yes, sir. Mr. Hurd.--I understand, and your job is hard. Mr. Windom. Yes, sir. Mr. Hurd. Nobody questions that. Nobody questions that. But the difficulty you are going to have is what I would call the incompetence of previous activity, right? And so you are the new man, and you have the right credentials to do this, but this is the frustration when you see this has been going on for a long time because we are solving the problem. So the first-- if the veteran leaves DOD in, let's say, 2019 and they transition to the VA, he or she will be moving to the VistA system, is that correct? Mr. Windom. Potentially. And I say that because one of the reasons for our deployment schedule is we're--we intended to align as much as possible to the deployment schedule of DOD -- -- Mr. Hurd. Yes. Mr. Windom.--because we want to demonstrate interoperability to you immediately. Mr. Hurd. So ---- Mr. Windom. So it depends would be the answer. Mr. Hurd. And let's get to interoperability. We are going to be here for a while. The JLV is not interoperability. Has anybody at this panel set with doctors in a facility and had them walk you through the JLV? Mr. Windom? Mr. Windom. Yes, sir. I was DOD when we only were moving 50 records. Mr. Hurd. Yes. Mr. Windom. Now, we're moving tens of thousands if not hundreds of thousands ---- Mr. Hurd. So ---- Mr. Windom.--so yes, sir, the answer is yes, sir. Mr. Hurd. So you understand the problem. And so we talk about JLV like we have already achieved interoperability. We haven't. It is the equivalent of using microfiche, and so the fact that, yes, it is the right decision to go to one system, but that one--so the people that are going to benefit are potentially--we are seven years away from that. And yes, Healthy Intent is the data platform that you're going to be using on Cerner, but what VA and DOD have not proven they can do is to integrate that data in one view. And so my concern is this is still a problem of data interoperability because we have to take all the data that has been gathered from VistA and make sure it is viewable through Cerner. And there is nothing to date that makes me feel comfortable that we know we can do that. And we are sitting here saying, yes, it is a big--the largest software sale ever in the history of the planet, right? Like I get how big of a deal it is, but, number one, why the hell are there 130 versions of VistA? Now, Mr. Windom, I know that is not your problem. That is not your problem. But, Mr. Blackburn, can you give me some--like how has that been allowed to continue? I don't even know what that means. How would you have 130 versions of the same program operating in one organization? Mr. Blackburn. So my understanding of that--and VistA started around the time I was born, so this decision dates back to me being a toddler--was--the idea at the time was local innovation. VistA was built by doctors, for doctors. Still to this day it actually rates as a--doctors rate it as the most user-friendly electronic health record. Mr. Hurd. It was groundbreaking ---- Mr. Blackburn. Yes. Mr. Hurd.--when it started. Mr. Blackburn. Yes. Mr. Hurd. Yes. I would agree with that. Mr. Blackburn. And they ---- Mr. Hurd. But 130 versions later is pretty crummy. Mr. Blackburn. You're exactly correct, and that means, you know, if I go--if I'm getting seen in--right now in Washington, they can't--it's difficult if I go to another instance for that data to flow seamlessly. Mr. Hurd. So what processes were in place or not in place that allowed that behavior to continue? Because if we don't first identify why that behavior was allowed to happen, we are not going to be able to prevent it in the future. Mr. Blackburn. The philosophy at the time was we're going to push the power of how to run the hospital to the electronic health record and their workflow to the local hospitals. Mr. Hurd. Sure. Mr. Blackburn. So there's the joke if you've seen one VA, you've seen one VA. They run completely differently, and then they map their health record to how they were run. What we are--what we are going to do is standardize workflows and not allow that to happen. And matter of fact, DOD and VA will have the exact same workflows. Mr. Hurd. Now, it is pretty clear from the limited time we have in with Mr. Windom that he is high speed, low drag, and my question, Mr. Windom, when will we be able to demonstrate for one record that we can get the data from a VistA EHR and view it through a Cerner application? When will we be able to demonstrate the ability to do that for one? Mr. Windom. Sir, the timeline for what we call initial operating capability, which we anticipate for Pacific Northwest is less than 18 months. So we expect to be able to demonstrate interoperability. Obviously, we will be doing it in a laboratory environment where will be able to demonstrate a record, but we want to show you in a real-time environment. And so prior to full deployment, we will have achieved IOC at these various sites, sir. Mr. Hurd. The last time we had this conversation with your predecessors, my question was, at its core, this is not a hard challenge. You map one data element to another data element. L name maps to last name, full name maps to F name. Have we done that mapping? Mr. Windom. Sir, that alignment--we've got a comprehensive data management strategy. You know, your points are right on point if you will in that we are not going to put JLV data into the Healthy Intent platform. That data is being reconciled such that we have transactional capability to move data ---- Mr. Hurd. Sure. Mr. Windom.--to process data between DOD and VA, so it's not just--we know--JLV was a--was an interim fix. JLV access will exist as we transition because we don't want to destroy that existing continuity of data. But the Healthy Intent, it's just not going to be load JLV into Healthy Intent. It's going to have manipulatable data, transactional data that supports the movement of information across the DOD and the VA enterprise, sir. Mr. Hurd. So is the data architecture of VistA version 1 different from VistA version 130? So are you working with 130 different data sets? Mr. Windom. Yes, sir. That would be accurate. Mr. Hurd. That is crazy. I would like to now recognize Mr. Connolly. Mr. Connolly. Thank you, Mr. Chairman. Just to humanize what you are talking about, Mr. Chairman, Mr. Blackburn, I think you shared with me your own personal experience in terms of health records. Could you remind me, so you come from Massachusetts, God's country, right ---- Mr. Blackburn. Right. Mr. Connolly.--except for Virginia. Mr. Blackburn. Yes. Mr. Connolly. And your files were in ---- Mr. Blackburn. Partners Health Care, so Mass General Hospital ---- Mr. Connolly. Right. Okay. Mr. Blackburn.--Beth Israel. Mr. Connolly. And you need to have someone here look at them, right? Mr. Blackburn. Yes, so I--and I lived in Cleveland for 10 years, so I have medical information in the Cleveland Clinic. Obviously, I was a soldier in the Army. I get my care at the VA. I get some of my care at NovaCare. The--last summer, I broke my arm and got rushed to the hospital at a Johns Hopkins Hospital, so all my data, my healthcare data is spread out over all these different healthcare systems that do not necessarily talk to each other. Mr. Connolly. So how did that affect in any material way the quality of care you were given? Mr. Blackburn. Oh, it affects it drastically. The--you know, when I came here and enrolled in the Washington VAMC, I actually brought a large paper file from the Cleveland Clinic that I printed out to my doctor, and he was very appreciative of that. The--it's very difficult for them to tell me--to be able to see things like x-rays from when I broke my arm, what shots I've had. You have to fill out paperwork over and over again. Mr. Connolly. Which an electronic record-keeping system ought to obviate? Mr. Blackburn. As long as they talk to each other. Mr. Connolly. But they have got to be compatible, which it goes to interoperability, right, Mr. Windom? Mr. Windom. Yes, sir. Mr. Connolly. Well, as we heard, it is not just a nice thing to do, and it is not even just that it saves money. It also affects quality of care of the veterans we serve ---- Mr. Blackburn. Yes. Mr. Connolly.--so there is a real imperative here. I thank you. Thank you, Mr. Chairman. Mr. Hurd. The distinguished gentleman from Montana is recognized. Mr. Gianforte. Thank you, Mr. Chairman. Mr. Blackburn, you had said that scheduling is a particular area of focus ---- Mr. Blackburn. Yes. Mr. Gianforte.--for you, so a very simple question. Does the VA currently have a commercial off-the-shelf scheduling pilot in production? Mr. Blackburn. We have two. So we have one as mandated by the Faster Care for Veterans Act. We actually--it's in test mode right now. I believe it just went live just a few days ago in three VA hospitals: Minneapolis; Salt Lake City; and Bedford, Massachusetts. We also have a pilot going on in Columbus, Ohio, with a solution called MASS, which is an Epic- based, resource-based scheduling system. Mr. Gianforte. Okay. So Epic is really a competitor with Cerner? Mr. Blackburn. They are. Mr. Gianforte. Yes, so you are deploying Epic as well as Cerner? Mr. Blackburn. The Epic is in pilot mode in Columbus. We-- that was actually--that was put in place before the Secretary made the Cerner decision. Mr. Gianforte. Okay. So that will be phased out and converted to Cerner? Mr. Blackburn. Depending on how the pilot--we haven't made that final decision yet, but we will be making that in the spring. Mr. Gianforte. Okay. So we have VistA that is 30 years old. We are rolling out a $10 billion Cerner project. We are also rolling out a competitor in the Epic system. I thought I was going to ask about scheduling, but this gives me more concern. Why wouldn't you just shut that project down now that you have made the decision to go with Cerner? Mr. Blackburn. That was one of the options. Mr. Gianforte. Is this ---- Mr. Blackburn. We just haven't made the final decision. Mr. Gianforte. Is this taxpayer dollars being well spent on a project that is going to get--I, honestly--frankly, I just don't understand that decision. On the scheduling, you say you have just been live a short period of time. Do you have any initial analysis of the functionality of this OPSS system that is piloted versus the lipstick that was put on the pig on VistA? Mr. Blackburn. Mr. James? Mr. James. Yes, Congressman. The Faster Care for Veterans Act specifies seven capabilities that must be provided by the OPSS system, and today, our PM tells me that the OPSS system meets those seven requirements. The other part of the Faster Care for Veterans Act requires a Mitre in the IVNV mode to assess other similar types of scheduling, homebrewed systems if you will into VA, and that one is far. And that also has those seven capabilities. Mr. Gianforte. Okay. So you're just getting started with that pilot. What is your first review period of the pilot? Is it in 90 days or so? Mr. James. Sir, the Secretary must certify according to the law that it provides those seven capabilities by December 31 at those three sites, and we believe that it is operating today, but that's just today. We have some time. Then, subsequent to that certification, we have to have an independent validation verification of those seven capabilities. That's also in the law by an FFRDC. In this case, that's Mitre. So that'll happen after the Secretary certifies on--by December 31. Mr. Gianforte. Okay. Well, Mr. Chairman, I would just suggest that maybe we ask for some feedback on this pilot. We have been advocating--earlier, I advocated for commercial off- the-shelf scheduling applications. This OPSS didn't come up in that earlier discussion. It sounds like we are live in a number of cities. We ought to know in 90 days if it is working or not and is it better than the lipstick we are putting on VistA that is costing us so much money. So I thank you for sharing that additional information. I yield back. Mr. Hurd. I recognize myself for five minutes. Mr. James, MGT, what do you need to do in order to ensure that you have a working capital fund, an MGT working capital fund to take advantage of the savings that Mr. Blackburn and Mr. Windom are going to realize through their efforts? Mr. James. Thank you. Thank you, Mr. Chairman. I'm not the finance guy in OINT. I believe we do have today some working capital fund mechanisms in place that we already use. My expectation is that MGT would either complement those or augment those or be part of those. I can come back with additional information. Mr. Hurd. Who would be the person that would set that up so Mr. Blackburn has his MGT working capital fund? Mr. James. Chairman, they're--inside our CIO organization we have a finance organization that's dedicated to managing our appropriation every year, so that is our--internally, we call that ITRM. That's our CFO if you will for our CIO organization. He would have that responsibility. Mr. Hurd. Well, will you please deliver a message to him that this committee is interested in ensuring that Mr. Blackburn has a--or Mr. Blackburn's replacement has a working capital fund from MGT because there is going to be a whole lot of modernization going on in the VA. There is going to be savings that are being realized, and because it is such a massive enterprise, that will be able to help Mr. Windom hopefully beat that 10-year clock ---- Mr. James. Sure. Mr. Hurd.--of getting this implemented. Mr. Cussatt, we haven't even gotten to you because there are so many questions about the actual deployment. How are you ensuring when this deployment is being done, that all the appropriate cybersecurity tools and functions are activated and live to ultimately protect the health data of our veterans? Mr. Cussatt. Thank you, Chairman. So it's--I see it as my job as the CISO for the VA to ensure that cybersecurity is not a barrier to interoperability and information-sharing but instead it's an enabler of it. So I came from DOD. I was there for 12 years in the CIO's office, and we rewrote all the DOD policy to better employ the NIST standards. And in the year-and-a-half I've been at VA, we've done the same at VA. So we are ---- Mr. Hurd. So, Mr. Cussatt, are we going to have a written policy on application security for the Cerner implementation? Mr. Cussatt. I believe the Cerner application will benefit from the policy we have writ large for VA that applies to all the systems. We're trying not to build a one--a single instant solution for it. We want to build something that's going to benefit us across the Department and be interoperable with DOD. Mr. Hurd. So, gentlemen, there are so many questions here. Mr. Powner, before I close, do you have any further insights on the rest of the conversations that have been going on today? Mr. Powner. Just a comment about the scheduling situation. I mean, you have VSE, we have pilots going on, we clearly have a module with Cerner. What needs to occur in the scheduling area is direction forward. What's the plan? There needs to be a clear plan because right now, it's duplicative. There's no other way--it's duplicative. And it's okay to pilot and do things and test all this, but we ultimately need a plan going forward that's a solid plan with the right solution. Mr. Hurd. Good copy, Mr. Powner. One of the things that I feel good about is that I love that many of the folks intimately involved in this are veterans. You understand the type of sacrifices your compatriots have made. You understand the interest that this service is to many of our veterans. But I would say you all are actually doing something that can be life-altering for a lot of folks. A $10 billion project to integrate 130 different data sets and achieving true interoperability, this will be the model. If we are able to integrate DOD in VA, the two largest healthcare providers in the world, then we are going to be able to integrate to every other system. And so the VA is going to be back in setting the curve and being on the cutting edge because you all have achieved the ability to do a true longitudinal record so everybody is going to be able to have better health outcomes because every doctor they go to, they are going to be able to see every other time they went to the doctor. We are going to be able to do virtualized research cohorts based on this information because it is in the cloud and we are going to be able to access it. Mr. Cussatt is going to make sure it is protected and anonymized, and then we are going to be able to bring drugs, lifesaving drugs to market faster. And so this is the opportunity that we have here, and if we can't do it in 10 years with $10 billion, then it is never going to get done. And so I think you all recognize and understand this issue. This committee is going to continue to provide oversight and continue to get into the weeds. It is great having the talent of folks like my friend from Montana and the gentleman from the Commonwealth of Virginia. We are not going to stop. So thank you all for being here. Mr. Powner, it is always great having you here. This is an important issue, and I know many of my friends around the country are hoping you all succeed. And we are going to continue to make sure we are doing our part to make sure you have the tools to be successful. So I thank you all for appearing before us today. The hearing record will remain open for two weeks for any member to submit a written opening statement or questions for the record. And if there is no further business, without objection, the subcommittee stands adjourned. [Whereupon, at 3:50 p.m., the subcommittee was adjourned.] APPENDIX ---------- Material Submitted for the Hearing Record [GRAPHICS NOT AVAILABLE IN TIFF FORMAT] [all]