Beyond Go-Live: VA Electronic Health Record Modernization Status Update

Problem I have all day. This is probably no problem.

Committee will come to order. Without objection the chair ma- uh c- may declare a recess at any time. I wanna make uh I wanna thank the members for being here. This morning we have one item of committee business to address before we begin our today's hearing a resolution to assign representative Maggie Goodlander, uh, of New Hampshire to the subcommittee on House Committee on Veterans Affairs. And I know I now call up a resolution offered by Ranking Member Tucano. Court Show Report.

A resolution offered by Mister Tucano, be it resolved by the Committee of Veteran Affairs, that the democratic membership of the subcommittees

Resolution was circulated in advance pursuant to committee rules, and without objection the first reading is dispensed with. The resolution is open to amendment at any point. I now recognize ranking member Takano for statement on his resolution.

Thank you, Mr. Chairman. Uh, Representative Maggie Goodlander of New Hampshire uh will be an outstanding addition to our committee. As a former intelligence officer who served eleven years in the Navy Reserve, Representative Goodlander brings firsthand experience and a deep understanding of the challenges service members and veterans face. She also has firsthand experience and an understanding of working within and across all three branches of government. Before coming to Congress in twenty twenty five, she held several positions as an aide in both chambers on Capitol Hill. She also spent time clerking in the US Court of Appeals and the US Supreme Court, and later served as a Deputy Assistant Attorney General within the Department of Justice. In addition, just before she was elected to Congress, Representative Goodlander served as a senior advisor in the White House, where she focused on addressing opioid epidemic op- uh the opioid epidemic, improving access to mental health care, holding big tech companies accountable, meeting our obligations uh to our veterans and ending cancer. Representative Goodlander, we are fortunate uh to be gaining your expertise, perspective and commitment to public service on our committee. I can think of no better subcommittee assignments

Gentlemen yields back,

Jim.

I now recognize myself in support of the resolution. The resolution will appoint Representative Goodlander, a newly a- appointed member of our committee, as a member on the health and technology modernization subcommittees. Representative Goodlander, welcome to the committee. Uh, this marine won't hold it against you that you're from the Navy, but we always need the right. So, um, uh, I'm and I hope we'll be - we will be able to work well together. And understand this, we may disagree on certain things, but I believe all - everybody on this committee were working towards the best that we feel that we can do for our veterans and I - we look forward to having you here. With that, does any other member wish to comment? Mister Luttrell.

Well, I've - I've enjoyed working with you these past, um, few years and you've done a great job on the House Armed Services Committee, and I tell you, these - these two committees partner very well with themselves and Being a veteran, you you completely understand that, and I look forward to working with you on Tech Mod, um, and on the main committee. Congratulations.

Anyone else? No member uh n- no amen Go ahead, I'm sorry, Dr. Miller makes. Um, sidebar. No amendments were filed. Does any member wish to offer an amendment to the resolution? Hearing none, I now recognize ranking member of Takano for a motion.

Mr. Chairman, I move that the committee adopt this resolution.

All those in favor say aye.

Aye.

Those opposed, no. In the opinion of the chair of the ayes, have it that its resolution is agreed to and representative of Goodlander is appointed to the subcommittees on health and technology ma- uh modernization we will now take a brief recess to bring our witnesses forward to start the full committee.

So these people are the job.

And the business meeting is adjourned, by the way.

Do you want these letters?

Yes, please. He doesn't care. First he wants to know what the actual value of that. So what was that? Committee will come to order. Without objection, the chair may declare recess at any time. Good morning. Thank you to our witnesses for being here as we conduct a st- a status check on VA's EHRM program. Last year, the subcommittee on technology modernization held several hearings uh, to review how VA plans to execute its strategy for twenty twenty-six. As of today, the EHRM platform has been deployed across eleven sites under the accelerated market-based rollout. We are here today to ask how well that strategy has worked. We need to understand that VA has learned what VA has learned before the next wave of developments for in two twenty twenty seven. It is well known that I have been skeptical of the deployment of this system for very from the very beginning. Past deployments were filled with cost overruns and patient safety issues. And to be clear, I still have concerns, but I also recognize the progress that has been made to modernize and improve the VA health record system. I'm glad to see the VA leadership t- uh taking these problems seriously. But that does not mean our oversight will stop. This is a multi-billion dollar, years-long effort. Congress needs transparency. Veterans deserve accountability. I understand we are not done with the twenty-twenty-six deployment yet. Cleveland and Alaska are still scheduled to go live in October. As VA prepares for the next sites, our goal today is simple. We need to clear a clear picture of where this program stands. We need to know what it will cost going forward. We need to know if the VA is ready for what comes next in twenty twenty-seven. VA recently extended its contracts with Oracle because the or uh the original price tag was not enough to complete the rollout. We have seen this story before. Time after time, this committee has learned that VA first pr- First price tag is rarely the last one. For years we've been asking legitimate questions about the full life cycle cost of this program and have still not received those answers. Before Congress funds additional work, veterans and taxpayers deserve to know why costs are rising faster than planned. We can talk about all the IT systems, contracts, and technical terms, but at the end of the day, This is about the veterans sitting in an exam room. And it's about making sure the medical professionals caring for our veterans have the best tools they need to provide the best health care in the world. With that, I again welcome our witnesses and I look forward to the testimony. I now recognize ranking member Takano for his opening comments.

Well, thank you, uh, Chairman Bost. Uh, the subject of this hearing could not be more timely. Unfortunately, sir, this hearing as structured falls far short of this committee's Article one responsibilities. VA's electronic health record modernization program is potentially the largest modernization effort in the history of VA, but this hearing, I'm afraid, does not meet the moment. You know, and I've shared, you and I have both shared uh a skepticism um about the progress and about uh uh uh about the uh effort to implement this system. Now, I'm gonna say, sir, if you were serious about oversight, um you would have invited all key stakeholders, and instead you invited the Deputy Secretary of VA to come and claim success on behalf of the Trump administration. I had to ask you for the prime contractor, Oracle Health, to be invited so that they could explain why uh we're hearing from the news. not VA or Oracle, we didn't hear about uh from the VA itself or Oracle, that the current contract has tripled to twenty-seven billion dollars. Let me say that again, twenty-seven billion dollars. The original EHRM contract was for ten billion dollars. That's a staggering increase. Now, Oracle originally accepted the invitation to be here. but then later decided they didn't want to come, uh citing timing constraints. Mister Chairman, you chose nothing, you chose to do nothing about it. And it seems that you thought it was acceptable to let Oracle skip what is probably the most consequential conversation to date about the project. Uh, you thought it was acceptable to let Oracle off the hook when it comes to accountability and when the dollar value of their contract is tripled. I have to, I have, I beg to disagree. There's nothing acceptable about this situation, this scenario. And as of today, Mister Chairman, you have not shown that you are willing to compel Oracle to show up. You did not invite any independent watchdog to testify. I mean, VA is uh gonna be able to grade its own work before us today. No other independent voices that, you know, are are gonna be able to advise us, you know, about the claims he's gonna make in his uh statement and our questions that uh the and the quest- and the answers to the questions we asked. Instead, I had to request that the Government Accountability Office be here to provide information about the many ongoing problems with this program. Now, Mister Chairman, I've done everything in my power in the minority to make this hearing reflect serious oversight of this massive modernization effort. I'm gonna show you that on August twentieth, your own staff sent an invitation to Oracle Health at my request. Um, on August twenty fifth, I sent you a letter sharing my concerns about the lack of key witnesses not being invited to this hearing and uh a and I thought those witnesses should include Accenture the Inspector General and the GAO. I have not received a response to the letter I sent you on August twenty fifth. On August twenty sixth, Oracle emailed that it accepted the invitation to testify. So they accepted. I mean, they should be here to explain this seventeen billion dollar augmentation. Uh, in the same email chain on August twenty seventh, they reneged on that acceptance citing quote "time constraints and the two panel structure" end quote. On August twenty eighth, I sent a letter to Oracle telling them that their refusal to appear was not acceptable. And finally on August thirty-first, Oracle responded in a letter reiterating their refusal to appear. Mr. Chairman, I ask unanimous consent to enter all these documents into the committee's record.

Without rejection.

Now, behind me, um, you know, I think you and I have always, w- as you say, we share the skepticism. Uh, uh, you know, the original the original contract with Cerner was ten billion dollars. Um, I was skeptical that that contract ceiling would hold, especially given the impacts of COVID and the multiple pauses that have happened. However, a seventeen billion dollar increase is unreasonable. A seventeen billion dollar increase with no advance notice to the authorizing committee is a huge problem for me. Uh, here we have on this document a copy of the justification for Oracle's amended contract. And look at all these redactions. Guess what those redactions are? Those redactions are how much the taxpayer will be shouldering in order to shore up Oracle's bottom line. I have a problem with this. And in fact, the VA trying to hide this increase, the VA, it indicates to me that the department, person sitting at that table, knows. that this is a problem. We shouldn't be surprised, though this is the least transparent administration I've dealt with in my time in Congress. They're even less transparent than the first Trump administration, which is saying, which is really saying something. Committee Democrats have dozens of requests for information that the department has been sitting on for months, just been indifferent to our requests. Uh, when we get, we do get responses from the department, they rarely address the questions Additionally, the administration has created a culture of fear, which has prevented VA employees from talking to Congress, which is a federal employee statutory right, and some would say if their if if their employee of the federal government, it's their duty to tell Congress when something's up. Now, under the guise of taking care of veterans, Secretary Collins and Deputy Secretary Lawrence have leveled one attack after another on the federal workforce many of whom are veterans themselves. This administration has stripped employees of their collective bargaining rights, forced people out of positions, and overwhelmed the department with political appointees to the point that career employees, people for whom taking care of veterans is their life's work, have had to leave VA. None of this is acceptable. Now the Deputy Secretary would have you believe that everything is wonderful, that the EHRM deployments are going smoothly, that this administration has fixed everything. This ignores the fact that VA has had to spend the last three years working to right the ship. It ignores the fact that most of the issues with this program were caused by the first Trump administration's desire to rush into a sole source contract, a sole source contract with Cerner, without doing any of the critical pre-work that would have prevented all of these issues. Now, we're in this mess because of the Trump And we're going to go deeper into a twenty-seven billion dollar hole because of the Trump administration. Now proper requirements development before Go-Lives would have prevented years' worth of pauses and it would have prevented so much pain and frustration on the part of veterans and VA employees. Instead, improper political pressure forced the department into a program that it wasn't ready for. Now they're doing it again. After three years and reset, VA resumed and accelerated deployments without completing the independent operational assessment GAO recommended, so that VA could verify that the system is suitable and effective in VA's actual clinical environment. VA and Oracle can point to improved uptime, better ticket management, and eleven deployments this year, but system-wide uptime is not the same as clinical usability, safe workflows, restored productivity, or successful veteran patient outcomes. Without testing, without testing to verify that all of the issues have been addressed, this leadership team has introduced a schedule that will require more than sixty goal lives in the next two years. And we're hearing rumors that they want to add even more. I'm concerned that this pace is unsustainable. And I'm not convinced that there are enough qualified people to support an effort of this magnitude, and from what we're hearing from a few brave VA employees, it's already not going well. Employees in Michigan, Southern Ohio, and Indiana are telling us that the, that many of the issues identified by the first six sites still have not been fixed. They also share that they and their colleagues are struggling with a system that they weren't sufficiently trained to use, struggling to teach themselves how to use a system that wasn't designed to support their work, and uh don't feel like they have enough support or resources to make sure veterans receive the care they deserve. Now we're also hearing a very a very concerning things about missing referrals in the EHR in the Michigan Ohio and Indiana facilities. Missing referrals means the risk of delayed care for veterans. Is this the next iteration of the unknown cue? I think many of us remember the issue of the unknown cue. Whether it's the technology or leadership, this program is currently not working for VA or veterans, especially for veterans with accessibility issues. There was at least one lawsuit against VA and Oracle citing the fact that the system is not accessible for blind and low vision employees. Visually impaired VA employees, many of whom are veterans, are being prevented from doing their jobs by a technology that does not support them doing the work. And instead of VA and Oracle attempting to fix that? VA is ad- is hiring additional people to operate the computer for the employee. After more than eight years, VA and Oracle still haven't managed to make EHRM a system that meets the needs of VA employees and veterans. Now, Oracle is not, has not proven it is capable of being the vendor for this contract. It is time for VA to evaluate whether a new vendor is needed to lead the EHRM. uh program. Today, the Deputy Secretary must explain the nearly seventeen billion dollar ceiling increase, produce the cost and schedule information Congress has repeatedly requested, and tell us when an independent assessment will verify VA's claims. I will not allow the Deputy Secretary to grade his own work. An oracle must appear publicly before this committee to answer for its performance. and how the additional billions of dollars it will receive will benefit veterans. Now, um, here's this other poster here, and uh, now I I wanna I want you to pay attention. This is a a testimony or a statement by Michael D. Cecilia, the CEO of Oracle Health. And um, you know, something is wrong here. Uh, what he says here is um, well, Congress needs to act and s- and needs to start by asking questions both of both VA and Oracle about this program when Oracle testified before this committee in June of twenty twenty two its chief executive officer told us something different than what we're hearing or seeing now. As you can see in this excerpt uh he said that if there were cost overruns, Oracle was quote " prepared" to bear those costs. Oracle was prepared to bear those costs if there were cost overruns. What has changed? Why does Oracle need seventeen billion dollars more to get the job done, when this program has already dragged on for eight years? These things do not add up. We need answers and not excuses. I yield back, Mr. Chairman.

Thank you, ranking member. You know, the committee has been and has n- or has not been passive in oversight of this program. We've been conducting oversight on EHRs r m for years through hearings, briefings, site visits, document requests. The oversight work continues. The ranking member invited Oracle exactly as our rules allow. Unfortunately, due to scheduling conflict, Oracle could not attend. The ranking member then invited GAO at the last minute, and they will t- be testifying today. We are also expecting a bipartisan GAO report to be released on this issue in October of this year. Today, the Deputy Secretary is sitting in front of this committee, and I expect him to provide direct, focused answers. Because when it comes to the p- this program cost, performance, and path forward, the spot the buck stops with the Deputy Secretary. And I promised the ranking member that oversight of this issue will continue after this hearing today. This is not a check-the-box activity. This is our committee fulfilling its responsibility for robust oversight of VA which we have done for years and will continue to do on this issue. It's the one issue that we've actually agreed pretty well on, but yet you're coming up and saying, " Oh no, we're not doing it." We had people that we or invited. They chose not to come and could not come. We did not force them. We will hope that we can have some time where we can hear from them later. Today we're gonna have this hearing.

Well, Mister Chairman, I shared with you the email chain

And I just sort of shared with you what we're working on.

where where where Oracle originally accepted and then suddenly they don't accept. And I think we could have been a little more insistent together to make sure that Oracle, I mean, it's kind of ridiculous.

Well, I was pretty insistent, and the way it is right now, they are a private company. and we did argue and we we did try to get them there. But we can we do have who we have before us now and we will have the other panel next, and we will continue with the work that we have s laid out today. So thank you very much. We will now turn to our witness testimony. Testifying before us today is the Honorable Doctor Paul Lawrence, Deputy Secretary at VA. Accompanying the Deputy Secretary is Doctor Neal Evans, Program Executive Director of the EHRM. in in uh integration office. Will the witnesses please stand? And you please raise your right hand. Do you solemnly swear that the testimony you are about to provide is the truth, the whole truth, and nothing but the truth? Thank you. Let the record reflect that the witnesses have answered in the affirmative. On night, I now recognize Deputy S- Secretary, Doctor Paul Lawrence, for five minutes to deliver your testimony on behalf of the Department of Veterans Affairs.

Chairman Bost, Ranking Member Takano, and distinguished members of the committee, thank you for the opportunity to update you on the momentum behind VA's electronic health record modernization program. As the chairman has pointed out, Doctor Neal Evans, our Program Director, joins me. When I came into this role, the program had sat largely dormant for nearly two years. Thanks to President Trump's leadership and Secretary Collins' leadership, we were able to accelerate deployment of the electronic health record. The program is back on track. The system is stable, strong, and reliable. Performance is no longer aspirational. It's a reality. We're delivering real, measurable results for the veterans we serve. Right now, the system is supporting thirty-five thousand end users and serving approximately six hundred and seventeen thousand veterans at seventeen VA medical centers nine new one clinics and a hundred and sixty-five remote service locations. Let me hit a few highlights. In April, we deployed in our facilities in Michigan, Ann Arbor, Battle Creek, Detroit, Saginaw. In just the first three days of operation, our Michigan team scheduled more than three thousand four hundred appointments and migrated one point two million active prescriptions, at success rates above ninety-nine point five percent, completing cut-over ahead of schedule. On the fourth day, Ann Arbor completed an open-heart surgery using the electronic health record. In June, we successfully deployed in our Southern Ohio facilities, Cincinnati, Chillicothe, Dayton, and Fort Thomas. Southern Oh- Southern Ohio's success proved that Michigan wasn't a fluke. On Southern Ohio's first day using the new system, Cincinnati successfully completed gallbladder and sh- shoulder surgeries. On the second day, they completed an unscheduled appendectomy. At the end of August, We successfully deployed in our facilities in Indiana, Fort Wayne, Marion, and Indianapolis. Consistent with the trends we saw across Michigan and Ohio, feedback from Indiana has been encouraging. On the very first day after deployment, Indianapolis completed completed three procedures, including one surgery. At every site, we are closely watching return to normal productivity. Several facilities have already met or exceeded pre-deployment benchmarks. In October, we are scheduled to complete this year's Go-Lives in Cleveland and Anchorage. And looking ahead to next year, we plan twenty-six more sites to go live. With the exception of Anchorage, I have visited each of the thirteen sites to go live in twenty twenty-six three times, and I'll be back in Anchorage later this month. And I've already visited ten of the sites that'll go live in twenty twenty-seven. During my visits so far, I've engaged more than one thousand two hundred VA team members. I'm spending time with the executive leadership team, the change leadership teams, the chiefs of medicine, and super users. I'm monitoring progress, I'm listening to issues, and I'm asking what help I can provide. I can report that our teams are motivated and energized about their deployments, and I'm always impressed with their talent, their commitments, and their very strict mission focus. And I'm also meeting monthly with senior leaders from Oracle and our major subcontractors to hold them accountable and to strengthen our collaboration. For too long, this committee has heard false promises. What's different about my appearance before you is that I presented results. And what's also different now is that our leadership is focused, engaged, and accountable, and the results reflect that. In short, we have momentum. With our proven execution model and this committee's continued strong support, we will continue to deliver a modernized EHR for our veterans, clinicians, and staff. Thank you, and I welcome your questions.

I thank you for your testimony, and we're now going to y- uh go to questions. I'll now yield myself five minutes for questions. Um, Doctor Lawrence, the VA uh expects to reach uh the original Oracle contract ceiling uh early fiscal year twenty twenty seven did VA leadership expect this when it committed to the sk- new schedule or was it w- was it accelerated rollout driving the higher costs?

The costs were stipulated in the document we gave you in September of last year, explaining what would happen during the remaining period of time. We hit the ceiling as planned. The contract extension and the ceiling uh modification reflect us hitting the ceiling and the cost we predicted in the documents we gave you last year.

Have you concerns that um how how confident are you with the fact that that seventeen billion to this program will be the finished rollout?

I'm very confident. What I can tell you, cuz I wasn't here in the past that would already been described, what I can tell you is since I showed up at the end of March, we have spent exactly the money you have allowed us. We have deployed and scheduled exactly as we said we would. We have had serious conversations with our contractors that this is the money available to do the things we need to do. The secretary has been very clear about the importance of this mission. I'm very confident that is the money we need.

Okay.

A complete life cycle cost estimate should include the program's historical cost, its full operating and susp sustained cost, and an assi- uh, at assessment of future risk. The estimated VA uh provi- provide the estimate VA provided to Congress,

Yeah. There must be some confusion, cuz we have that numbers and I'm surprised you don't, because we tried to share that with you directly. And I know coming out of the hearing in Tech Mod in December, that was the request to provide, not only to you, but I believe GAO, and I might m- be mistracking on that. But we have those numbers and we'll just figure, have to figure out how to give them to you.

Well, I, well, I'm gonna, I'm gonna tell you, and then I'm gonna veer off of my questions here, cuz I've, I, I've dealt with this issue so long. Um, when some of the, I, I don't agree with everything that the, the ranking members said, but I guarantee you the statement that they said that they would eat the cost, they were gonna do it, when Oracle took over. That's exactly what they said. They said, " Oh, we should be able to do this." They, I can remember sitting in my office and said, " If you have a problem with something and you can't clear it, clear it up in thirty days on an issue, they obviously don't know what they're doing." That's what they said in my office. And th- the - This - this has been - And I'm - I know you're here to - to tell us, and I'm - I'm - I wanna hear, and we have several questions that are gonna come up from everybody, but - but this has been the biggest boondoggle I've ever seen. And - and I know that's not - th- this was before you got here, okay? And and and the frustration that we feel on this committee, and the subcommittee as well, is is beyond measure. And I know you know that already. You knew it when you took it over. When staff noticed a a uh migration problem with the new system, they f- they filed what was called a trouble ticket, which could relate to a patient's safety concerns. Can you assure the committee that these tickets are being resolved, not just clo- clo- close to keep peace, with this program.

Absolutely, absolutely, and I will tell you what's going right r- on right now with the Indiana deployment, is we are resolving tickets very fast. We are paying great deal of attention to those tickets that are identified as patient safety issues. We've identified those. None of them are have gone into the category of critical patient safety issues. We resolve them quicker. There are fewer tickets in Ohio than there were in Michigan. There are fewer tickets in Indiana. then that we're in Ohio and that's the learning of what's taking place, that's the familiarity of our team with the workflows and the system, and their understanding that it is safe and it works and we need to train them better. And and let me let me ju- uh, Doctor Evans, jump in here, cuz I know this is something you and I spend a lot of time on.

Um, I agree, I would use the example of Indiana where day twelve, post go live, and more than seventy-five percent of tickets, travel tickets that were submitted have been closed. And we do not close tickets without validation. from the submitting end user. So we don't close tickets until the individual who raised the issue says this has been fixed satisfactorily.

Real quickly, because I'm short on time, what metrics does VA use to determine when a site has returned to normal after you turn up?

Um, after we turn up we have um fifteen measures that we are looking at uh to return to normal operations these are for example the throughput in the emergency department how many ambulatory care visits are completed at the site how many surgeries are completed inpatient care volumes so it's looking at the sort of how care is delivered um we look at a

good

pre go live baseline that is the average of care delivered the year prior and two years prior so we're looking at twenty five and twenty four

so so my time's expired but if you would could you get a those fifteen listed to our staff so we know what we're looking at if you Thank you. Rank Administrator Conner, you're recognized for five minutes.

Yeah, thank you. Uh, Doctor Lawrence, in between your roles uh between the two Trump administrations, you were employed as a consultant uh with a number of different companies. Is that correct?

Yes, that's correct. I was also an a author too.

Yeah, thank you. Um, I thank you, sir. Um, were you you were a consultant for BDR Solutions LLC between twenty twenty three and twenty twenty four, correct?

That's correct.

Thank you. Are you aware that just a week ago BDR Solutions LLC was awarded a

I was not aware of that.

You were not aware.

No.

Um uh now that you uh are also a consultant for you were also a consultant for steer bridge strategies in twenty twenty three, is that correct?

That's correct. And as you know,

And steer bridge and later uh sir,

when somebody becomes a federal government employee,

sorry, I I go in that short time,

they sign an agreement.

and steer bridge strategies later went on to be awarded a contract to conduct a pilot for AI assisted disability benefits tool in twenty twenty four, is that correct?

I if if what you say is true, then it's correct.

Okay. Uh another one of your clients, CGI, was awarded a contract in January to support the FMBT project, a modernization effort that you oversee. Is that correct?

Yes.

Thank you. Uh now these are just three examples from your past work history, and there are certainly more. Um and at least a few of these organizations actually had contracts with VA to the tune of hundreds of millions of dollars. awarded since Donald Trump took office. Um, how much did you make off of all these private consulting roles?

I don't remember the exact number. Perhaps you have it in front of you.

I'm, I do. Well, luckily we have the math from your financial disclosures. It appears to us that you made over a half million dollars. Um, while I'm not here necessarily to debate the righteousness of all these contracts, I do want to narrow in on one of these. Last year, Accenture Federal Services, your former employer and client, was awarded nearly a half a billion dollar contract to be the EHR M systems integrator with a questionable history of performance in this work. Now my question to you is were you or other officials at VA aware that Accenture was removed for failure to perform as a subcontractor to Leidos the EHR systems integrator for DOD acquisitions are done by our acquisition group

Acquisitions are done by our acquisition group. I was not involved.

Were you aware or not, sir?

I was not involved in the acquisition and therefore by definition I was unaware

Mister uh Mister Mister Under Secretary,

of any interesting things.

were you aware that extensor was removed for failure to perform as a subcontractor to Leidos?

I was not involved in the ac

You were not you were not so you were not aware?

I was not involved in the acquisition.

That's your testimony? You were under oath,

I was not involved in any acquisitions related to this program.

Mister Chair, the Chairman took you under oath. You're not a you're non-responsive, sir. Either way, you see how this looks. You are accountable, you're you are the accountable official, I know we did this in We made this position your end, the accountable person for this program. You enabled a billionaire tech, billionaire tech firms to get billions more with the knowledge of their poor performance, or I'm gonna assert that you did, uh and you don't know the basics about the contracts you work with. My Republican colleagues here talk about a lot about fraud and mismanagement, but I was shocked when they remained silent about when the Washington Post and the Wall Street Journal accused disabled veterans of defrauding the government. But I'm not surprised that uh many are seem to be turning the other way as far as the Trump administration is concerned. Now your answers today make it abundantly clear just how far uh the pay-to-play mentality seems to be seeping into the department. And rather than provide quality care to veterans in a competitive market, this administration would rather fund itself and their billionaire buddies. So I have a great example as a comparison. On the one side, VA prepares to send an additional seventeen billion dollars owned by Larry Ellison on the on the top of the ten billion on on top of the ten billion they've already blown through in eight years. On the other hand, uh veterans and military retirees are told that the major Richard Starr act, which costs uh thirteen billion dollars, is just too expensive to pass. So y'all can throw seventeen billion dollars at Larry Ellison, who uh whose company already said that they would eat the cost if they h- if they had cost overruns, uh, but you can't find thirteen billion dollars to take care of combat veterans, uh, who wanna get concurrent receipt of their VA benefits and their military pensions. I find this unacceptable.

General Bergman, you're recognized for five minutes.

Thank you, Mr. Chairman. Um, Three hundred and thirty years ago, the Salem witch trials were going on, just so you know. That's really, all that means is that was three hundred and thirty years ago. Um, thirty plus years ago, I was involved with the operating room equipment business and watched the transition of the da Vinci, the introduction of robotic surgery, and saw how new technology was trying to be introduced for the right reasons, but there was pushback because this is not the way we've always done it. So let's focus forward here and see what's gone right rather than getting into things that may not or uh will not provide better outcomes for veterans. Doctor Lawrence, you personally visited all thirteen sites scheduled for deployment this year, including four in Michigan. Michigan was the largest single wave develop single wave deployment in EHRM's history. Ann Arbor, Bell Creek, Detroit and Saginaw all at once. Tell us what you saw on the ground. Uh, more importantly, what did Michigan teach you about executing a transition this complex as you head towards full deployment in twenty-eighty-one?

What I saw on the ground in Michigan was a highly motivated team that very much was embracing the new electronic health record. Through the training, they realized how much easier and better it was going to be to provide care for our veterans. They realized that our old system was antiquated, required too many clicks, too many references to other screens, too many chances for typos as information was entered over and over again. They were concerned, given that in the previous administration they got waved off at the last minute, so they were apprehensive but comforted knowing that they had a lot of help on the go-live day, as well as the two weeks afterwards at the elbow support, super users who had been extra trained. That was really informative. Yes, along the way we found some things that we needed to emphasize better, part of which was, you know, do a bunch of work up front so it doesn't result in manual work afterwards. So that affected our training in Ohio and Indiana, as well as really appreciating the role of the super users to augment the training wh- when they we actually turned the system on.

Yeah. So, in any implementation process, no matter what business you're in, you're gonna you're gonna find that in the initial implementation, Things never go a hundred percent right. Question is how do you mitigate those little mistakes that occur naturally pop up and then you fix them. Okay, let's go forward here to Michigan goes statewide in twenty twenty seven. That means that Iron Mountain, which is in in my district, and a would be a rural but in some cases remote facility. Every VA, every facility VA has deployed to this year has been a mid-sized or larger one. So now you're gonna have that small market. area. Iron Mountain is the small hospital serving veterans across the entire upper peninsula and northern Wisconsin. What specifically changes in your deployment model for a facility like that?

Certainly. Um, Iron Mountain is very, very special, but it's not unique in the sense that Saginaw has a very similar footprint, not quite as large, not quite as, but very similar, hospital with a lot of C box. What's different about Iron Mountain is the C box are far away, and when we go live in January of twenty twenty seven, it is likely to be very difficult weather conditions. So our team there has to be prepared to go there and provide assistance far from the hospital and stay for long periods of time. So we're very attuned to that, we're very attuned to when the care is gonna be provided in these remo remote facilities and what time you know time of the year it's going to be so we're very much attuned to that we've checked on the technology to make sure it works. augmented that and we very much have our team ready to go. So I expect Iron Mountain will go live on January fifteenth as planned, to it I will go visit them once again to make sure we understand the footprint and the complexities of it.

Okay, um any any comments on how community care um relates to all of this is how we uh basically introduce it, uh fine-tune it, ensure that the front-line operators uh have the confidence To do things differently because that's what they're gonna have to do?

Certainly. So the do things differently is true for so many of our providers, cuz the system is different and that's what the training is about. But the concept of community care is very similar and easier in the new system. Information transfers seamlessly out and more importantly, when something's been done to our veterans, the information comes back so our providers have it all there. It's very similar process, it's just using different technology.

Okay, thank you, and I I see my time is about up. I'll back.

Representative Browning.

Thank you, Mister Chairman, um thank you uh Doctor Lawrence for being here. Um my first question is goes back um to I think the Chairman's question in terms of um what are the life cycle costs and you said that's already been submitted to the committee is my understanding, right? Is that what you said?

That's correct.

So can you uh I I don't have that. And, um.

Certainly. Let me tell you about it. Okay, so with the addition what what the document we gave you in June thirtieth of last year gave the cost through go-live completion twenty-thirty-one of about thirty-seven billion dollars. We then were asked what is the sustainment cost. We gave an estimate of approximately one billion dollars. Please don't hold me if I don't have it exactly right. So adding it for the remaining time of eleven more years got to about forty-eight billion dollars.

So thirty-seven plus forty-eight?

No, thirty-seven plus eleven to total forty-eight.

OK.

So it's the deployment plus the sustainment for the period of time that syncs up with I believe some of the GAO estimates.

OK, and I presume you've given that to the committee and it's

Yes.

Yeah, OK.

Oh yes.

All right. Those those exa exact numbers. I mean, you're quoting the exact numbers that that are in the report.

Uh, give me a little plus plus or minus if I don't remember exactly right, but that's right.

OK. All right. And um So, I mean GAO, who we rely on um for independent assessments and certainly non-political assessments, if you will, you know, has said that VA still lacks that update. So that's where I'm coming from, cuz I haven't seen anything else.

Sure.

Um the, you know, the GAO will also say that um we need life cycle cost estimates and we also need a reliable integrated master schedule. And so and we need those two things to have the appropriate oversight and be able to monitor this as it goes through to twenty thirty-one, when it is scheduled uh to be completed. So we know the beginning time and the ending time, but we don't really have anything sort of in between.

Sure. I'm I'm concerned about that too. We spent an awful lot of time collaborating with GAO, inviting them to our trips, uh demonstrating the the um system to them, and providing them information. Our schedule is well known, the costs are well known, so we're going to have to figure out why this is. Neal, you work with them all the time.

I th- you know, we've delivered the schedule, so you were asking about the integrated master schedule. We've delivered the schedule that we delivered the schedule for deployments through twenty thirty-one, uh last September, September thirtieth. twenty twenty five the questions are around the integrated master schedule that is what is happening every week every day between now and then from a deployment schedule we have

yep

the integrated master schedule for all of the twenty six sites and the eleven active waves where we're currently deploying and are building out the full integrated master schedule and anticipate demonstrating those dashboards and providing a view to the GAO of that within the next month or two, it's very soon.

OK, and - and - and - and - OK. Let me move on. So of the seventeen billion dollars, um how much of that is tied to uh demonstrating improvements in uh system performance, clinical satisfaction, patient safety, accessibility, et cetera? So, I'm assuming that the seventeen is - is to ensure that you complete the rest of the cycle here i'm wondering if the a portion of that is you've identified certain areas that need improvement how much of that is dedicated to that

I don't have the exact figure for the amount that goes to optimization what I'll say is this um we within that figure are the costs to deploy so to we we will train for example over five hundred thousand individuals when you consider VA employees plus the trainees, over a hundred and twenty thousand trainees who come through VA every year. We will train more than five hundred thousand folks. We will deploy all of the equipment and run the go-lives, et cetera. We will operate the system. And there is within that money and the there are there are funds to optimize to continue to improve the system. That is change requests and the like.

OK, I still am a little confused on how how we're gonna oversee all of that, but I will move on. You mentioned training. Um you know, we're we're hearing reports uh from VA employees that the training's not going so well from their perspective. And we're also hearing that there are a lot of people who are leaving the VA for a number of different reasons. So you know, my concern is, you know, how are we gonna improve the training um and secondly, so that employees are satisfied, cuz that's a huge indicator for us. Um, and at the same time, how do how do you manage people leaving the organi training, people leaving the organization, or people who have left the organization, and then patient care is just over here somewhere, where uh, you know, we already our wait times are already too long, and if they are so focused in on training, they're not focused in to on patient care. And so there's an obvious trade-off here that I don't think is gonna work too well. And so that's a b- a big, big concern for me.

Let me start, let me start.

I'm right.

Um, in terms of, in terms of training, we paid great deal of attention to our training and the satisfaction, though I'd love to hear specifics around what you're hearing to better understand, because we know that some training works for some people and it doesn't. We've augmented the training in two different ways in response to the feedback we've gotten from our team. One is to introduce something we call adoption training. Or afterwards we have very customized training where we walk through the system with certain providers. So for example, anesthesiologists get on a call and train anesthesiologists who are using the system, share screens and explain how that works. So we have very customized training to our specialized medical people who may need more because of the complexity. That has been very well received. We've also in an effort to make the information easier for folks to obtain faster, which is introduce an AI chat bot where you can ask questions about workflows, where it goes only to the sources of information we've put, so you can more quickly get it as opposed to having to search for it. So we're very concerned about getting folks the right information. That's been a huge success. This was introduced about a month ago, about a hundred and fifteen thousand questions. And we're paying attention to the questions to make sure they get answered, but also to see what they're asking about to see how that reflects us to change the training. We're very sensitive to what you said, which is highly skilled providers cannot be away from their patients very long. The training has to be very, very efficient and very precise. We can't ask them to leave patients for forty hours like we can an administrative person. And the final thing is what happens when providers leave or we have new providers is we train them on the system, just like they would learn any other system when they went to another hospital uh hospital group.

Why are you in a state? I really think the issue within the it takes it takes time for that to happen. I I I do think there's an issue here around patient care uh and the delay of pa- patient care and the wait times to get that care but I will yield I'll yield back.

So I I'd love to talk to you more about that.

Thank you.

I'd love to talk to you more about that.

For the purposes of the committee's knowing and understanding, Doctor Lawrence, um, what you sent us was a preliminary estimate. It is not a GAO recommended official estimate on the price. We do not have that.

So with that,

Thank you, Mr. Trump. Thank you.

uh, Representative Luttrell, you're next. You're recognized. You came in late.

Yeah, I had to do it again. Fuck. Thank you.

Mr. Lawrence, Mr. Evans, Doctor Evans, good to see you again. Um, explain to me the initial cost of the EHRM was ten billion dollars for a ten year con- for a ten year life span. And now we've bumped it up another seventeen billion dollars. Can you explain to me the conversation between Oracle and VA? And by all means, please put it in crayon so I can understand it.

So I was not here with you this year,

Okay, but I'm not talking to you.

so so I cannot give you that information and I don't know that you were involved. So I don't know that.

No, I th- I I was not involved with the initial discussions on pricing.

All right, so we got a crew in front of us that can't explain to Congress why we bumped up seventeen billion dollars on contract that initially ten billion. S from my the way that I understand and what the ranking member stated was that the CEO of Oracle said that they would eat the cost, any over expenditures of this project. Is that correct?

I read a quote on the board that said that. I don't know where that came from.

It came from their moms. I heard that.

Then then I b- then I believe you I can't validate it, so if you ask me if it's correct. But it is inaccurate to state people in front of you do not understand the program. What we do understand is what uh what I do understand is what took place when I showed up on March late March of twenty twenty five which was we had a schedule, we had a set of money that was you know d- d-

Now Congress gave you an uh uh ten billion dollar, not you, the VA and Oracle to to to get this project completed. And then it went into a freeze and then we're an increase of seventeen billion dollars, but um I'd like to submit something for the record from investor dot Oracle dot com Mr. Chairman.

Objective.

It says Oracle announces record Q four FY twenty six results driven by cloud infrastructure and cloud applications. The net profit for twenty twenty six was seventeen billion dollars. Uh, record remaining performance obligations grew of eighty five billion in Q four. Record Q four earnings per share went up twenty one percent. Record Q four total's revenue is nineteen billion. Record Q four total cloud revenue is nine point nine billion. So my question is, if the CEO of Oracle said that they were willing to eat the cost on the EHRM, per the contract, why is the taxpayer spending an extra seventeen billion dollars?

I'm not gonna be able to answer that, I do not understand the history you're talking about, I understand the situation we faced when we came in, what we did based on Secretary Collins' instructions as to execute the program for that task.

Secretary Collins told you if Oracle walks up and says we need an extra seventeen

S- no, no, it's not.

billion hold on I'm not finished yet if

I did not say that, I did not say that.

So what did, so secretary, so Oracle came in and said we need an extra seventeen billion dollars to complete the project that most likely won't be completed by the end of the actual contract.

That's inaccurate. That's inaccurate.

So explain to me, again, you can put it in crayon if you like.

Certainly. The ceiling for their contract was expiring. We would have no legal document to do business with them without extending the ceiling of their contract.

So in in in order to extend the ceiling, they asked for another seventeen billion dollars?

We needed seventeen billion dollars to complete we,

Who's we?

the VA, needed we needed to complete the deployment. We made it.

Why did the VA need seventeen billion dollars if So Oracle asked the VA for seventeen billion dollars.

No, no.

And where's the seventeen billion dollars going to?

We produced a schedule of what it would cost to complete the telewa- deployments to twenty thirty-one. This is the schedule we were just talking about. And there are costs

So the seventeen billion dollars is not going to Oracle?

No, it it may go to Oracle.

It may go to Oracle.

It's a time it m- it's a time and materials contract. We increased the ceiling. Each task has to be negotiated underneath the ceiling. So seventeen is the maximum.

Where did the seventeen b- who initiated the seventeen billion dollar number? Oracle or the VA?

We asked for a proposal, so let me just, if you'll let me finish? Can I finish? We estimated what it would cost to complete the deployment through twenty thirty-one. Of that, some require some of it is for the services that Oracle provides, software as well as some training and some other things. Okay, coming to the conclusion of this contract, the the ceiling, we asked them for a proposal. This is the part where our acquisition team kicks in. Broadly, cuz I'm not involved in this, they get independent estimates of what it should cost. We negotiate. That's where the seventeen billion dollars comes from.

So that that came from Oracle.

That came from Oracle. But it was a it was it was a request it was a request for the lawsuit.

Okay, so that's a yes. So my second question is, why didn't the VA hang on for a second. Why didn't the VA negotiate back to Oracle on why can't you complete the project with the ten billion we gave you?

Again, this is the part I'm not gonna be able to tell you. Acquisition is done by a separate group. I have no involvement of that, neither does Neal, because of you.

In your position, you're allowed to ask the Acquisition Officer what's going on?

That's how the structure of the government works, yes sir.

That's how the structure of the government works,

Government Acquisition Acquisition

that a seated secretary can't ask an Appropriations Officer where that money's going?

We get a a broad discussion of how it takes place, the negotiations are done by a separate team, that's it.

And nobody at the VA said, " Hey, why are we adding on another seventeen billion dollars of taxpayer money?"

I don't kn- I don't know that for a fact, I don't know what took place in the acquisition conversations.

So who do we need to talk to that would know the answer to that question?

We could probably arrange

Is it somebody inside the VA?

We could probably arrange a briefing for your team on some confidential information.

Human time expired.

Probably arrange a b- You could probably do that for me?

Gentlemen, the time has expired.

I mean, if I said, hey, I'm probably gonna give the VA some money, you think the VA the veterans and the United States veterans would be pissed off about that?

Gentlemen, the time has expired.

You know, it is our job. Yes, sir.

Representative Pappas, you're over at recognized for five minutes.

Thank you, Mr. Chairman. This issue is incredibly important to every member on this committee. We've been working for it for on it for years, and we've gotta make sure there's maximum transparency and accountability for veterans, for VA employees, and for taxpayers. Um, I want to zero in on the training question that, uh, Representative Brownlee was asking about, because this system is only going to be effective and be able to be fully implemented if the people using it are receiving sufficient training and can incorporate that into their daily workflows, as they take care of veterans. Now, since twenty eighteen, VA's obligated about six billion dollars to the program's contract. Included in that is virtual-only training at fifteen to twenty-five hours per position. We've heard some comments from front-line employees that I think are concerning, and I would like you to address them. Uh, multiple facilities that have asked for someone to deliver training in person, that weren't uh those requests were denied. Staff that finished Oracle's training modules left feeling with uh uh left feeling uh unconfident about uh the fact that they understood the basics of the program. And new hires who were left unable to document patient care for two to four weeks. I appreciate you talking about some augmented training steps that the department has taken. But I also want to focus on what Oracle's role here should be. We're paying them a significant amount of money. Included in that, uh, is ensuring that they're providing adequate training. Um, and I'm wondering, um, a decade and six billion dollars later and with this increase in the ceiling to seventeen billion dollars, if we're getting good bang for our buck from Oracle on training. Uh, because I've learned that VA staff picked up the slack, has created their own training program, EHRM supplemental staffing unit, um, which they've done on their own time, and they say it helps more than anything that Oracle has been providing. So can you talk about how you measure success with respect to training and whether you feel like Oracle is just going through the motions on this, and if they need to step up to the table in a bigger way on this. I - I know that one of the measures for, uh, deciding whether a site is ready to go live is if eighty percent of staff have completed training. um, which is a metric Oracle cites in their statements to show that training is working. But is the focus, should we be focused on completion rate or should we be focused on competency and whether the staff feels confident uh that they'll be able to utilize the the system, and incorporate that into their workflow?

Let me start and jump in here. Um, I th- I think both, and I think what happens is what you see when we talk about this is to go live, we ask the Medical Center Director, are you comfortable your team is trained to uh execute and provide medicine. And the answer has been yes before we've gone live in each of those. And eighty percent is the minimum we shoot for. We'd have some facilities that get one hundred percent of the folks trained, okay. And the hours vary by based on position and specialty. And the feedback, again from my visits when we go out, is here's what we like, here's what we don't like, here's how it's augmented, right. So we have additional training. But by and large when you see us getting to normal, and when you see our team providing the kind of services I talked about, open heart surgery and the like, those are indications that the training is successful. Could it be better? Yes, of course. We spent a lot of time thinking about that. We're balancing time, like we talked before, the providers to their ability to do this, right? And so we're listening carefully to what they're telling us, but yes, by and large the training has been good. Neil, you wanna

I agree. I mean, we spend a considerable amount of time, so uh uh hundred percent agree with you that there we are going to listen to users and continue to improve training. I'll say a couple things, um, with regard to where training fits in an overall adoption strategy. We've mentioned GAO several times. GAO um advised us at the beginning of the reset to say you need a comprehensive change management strategy that thinks about how do you take a an end-user who's been using Vista CPRS for many years and walk through them through the journey of understanding not just how to use the software, but how this is gonna impact the daily work that they do. The federal EHR is a role-based system. There are more than three hundred roles, and there is unique training for each of those roles.

Mm-hmm.

And we are working to improve each one of those training tracks with Oracle. Uh, you mentioned NSU, the National LA EHR supplemental staffing unit. We are, I'm hugely proud of what they have done. They provide training and support for only a handful of roles. There are many, many roles that NESSU does not provide support for. That is where we introduced learning labs, which is in-person opportunity to practice that comes after training. We're getting great feedback about that. So the short answer is we are going to continue to work to make training better and more efficient for all users not just for our clinicians in primary care and mental health et cetera.

Thank you, I yield back.

Thank you, gentlemen, I yield back to Representative Ben Arden.

Thank you, Mr. Chairman. Uh last night I got together with uh my colleagues, Mr. Bergman and Mr. Littrell with uh just about every veteran service organization we we could get together and we started talking about stuff and got contentious for a while. I'm gonna ask you a question. What does the Veterans Access Act, the Major Richard Starr Act, the Love Lives On Act, the Coordinating Care for Senior Veterans and Wounded Warriors Act, the Hope for Brave Act, the Optimizing the VA Workforce Veterans Act, twenty twenty five the vital act of twenty twenty five the honor act the precision brain health research act the veterans caregiver reduction re-employment re-entirement act the veterans spine trauma access to new devices act the disabled disabled veterans dignity act the fallen service members religious heritage restoration act the fisher house availability act the veterans disability exam modernization and license probability act the caring for veterans and strengthening national security act the veterans community care schedule improvement act the sherry bailey and eric edmondson veterans benefit expo Expansion Act, the Justice for All ALS Veterans Act, the the Reducing Arbitrary Barriers to Apprenticeship Act of twenty twenty six, the Vet Pack Act, the Link VA Act, the Rep VA Act, the Supporting Rural Veterans Access to Healthcare Act, the Critical Access to Veterans Care Act, the Avert Crisis Act, the Insurance Suc- Vet Success on Campus Act, the Service Women and Veterans Menopause Research Act, the Improving Veterans Access to Healthcare Act, the Improving Access to Care for Rural Veterans Act, and Veterans Overdose uh, Act, the Veterans Service- Service Dog Assistance Veterans Act, the Recovery Act, the Assistance Act, the Fairness of Veterans Education Act, the Insurance Veterans Final Resting Place Act, and the Dennis and Lois Kurfalsky Act, the Veterans Support Act, the Delivering Dignity to our Veterans Act, the Clearing Communication for Veterans Act, the Travel Act, the Veterans Mental Health and- and Addiction Therapy Quality, Care Act, the Caring for our Veterans Act, the Saves Act, the the Molly R. Loomis Research for Descendants of Toxic Exposed Veterans Act, the Tap Promotion Act, the Lactation Space for Veteran Moms Act, the Review, Every Veteran's Claim Act, the Vet Opportunity Act, the Veterans National Traumatic Brain Injury Treatment Act, the Simplifying VA Forms Act, the Producting Veterans Access to Telemedicine Service Act of twenty twenty five, the Start Act, the Expanding Act for on-line veteran student act, the Rep- the Representing Our Seniors at VA Act, the Blast Over Pressure and Research Mitigation Task Force, the ETS Act, the VA Fiscal Management Modernization Act, the Cruise Act, the VA Contacting procurement Act, the Leasing Infrastructure Act of twenty twenty five, and the Modernizing All Veterans in Service Act and the Beacon Act. of twenty twenty six. What do those all have in common? They cost seventeen billion dollars to fund. This is corruption. This is corruption. How how many years have you been doing this this, sir, garbage? How many years has this project lasted?

The project originated in two thousand, well, it's a complicated answer. The project origi-

It's not complicated, and you better be mindful, sir. You are addressing Congress and we have a direct constitutional oversight of your job.

Respectfully, I'd like to explain. VA's contract began with Cerner, I believe, in two thousand eighteen, but I'm not precise,

Okay.

cuz I wasn't -

All right, that's too long. Good? Fine. Um, how much is the total cost of this project, Ben?

I don't have those numbers in front of me. Do you know?

Those are numbers you should have been v- that should have been on the top of your head. You know what this hearing's about. That - that is inexcusable. How much does this project cost?

The um we're approaching uh ten billion dollars as was the initial ceiling as we mentioned which will come in fiscal year two thousand seventeen.

Yep. Yep. Yep.

And then there's the cost for infrastructure improvements.

Can you can you can you tell me how many of our our medical residents train in a VA facility?

There are over a hundred and twenty thousand per year across the enterprise.

And what what ERM is predominantly used around the country? Is it Cerner?

There are multiple electronic health records used.

You should have that.

The Market Leader.

That's bad too. It's Epic.

The Market Leader, yeah.

Epic. Why do civilian hospitals only use Cerner when they can't afford Epic?

I don't know.

Because it's not user-friendly. And stuff like this happens all the time, and you know it by now. So if I had my druthers, you would sever this contract with Oracle, cuz that person lied to us. They said they'd pick up any o- extra nickel over that ten billion dollars. They said that. And when me and Mister Takano agree on something, you better pay attention. So, that's reality. So, they said that, and you need to hold them accountable. And like I said, these sixty-two acts that we were arguing for two hours last night with our, our VSOs, trying to get to the bottom of this, we can't find the money other than these pay-fors. that can affect future generations of veterans, which we don't wanna do, but we have to take care of our catastrophically injured people now. We really do. But all of that money could be taken care of if you guys could figure out how to run a damn electronic medical record. This is absurd. This is absurd. With that, I yield back.

Representative Buszynski, you're represent- you're recognized for five minutes.

Yeah, thank you, I would just start out by saying I add my voice exactly to Congressman Van Orden's uh point here that you ask a question, what's the final cost on this project, and they stutter because they don't know, and that ultimately this is just a blank check for Oracle. So I'd like to ask just a few questions here, and these are kind of yes or no questions. Do you know the full amount? We say seventeen billion. What is the full amount of taxpayer dollars that you're asking taxpayers to pay for on this program right now, in addition to the ten?

Yeah.

In addition to to ten, we told you it's twenty seven billion additional dollars to complete the deployments.

Mm.

No. It's I have the number. It's seventeen billion, five hundred and eighty-one million, six hundred and forty-nine thousand, five hundred and eighty-eight dollars, taxpayer dollars that you're asking for, in addition to the ten billion that you've been authorized. You've not even been authorized for that seventeen billion. And you tried to redact it, and we found out because reporters released the fact that it was seventeen billion, so there's a total total lack of transparency on this. So a few questions that I have for you, Doctor Lawrence, these are yes or no questions. Um, just to be clear, these funds are all going directly to Oracle?

There's a little confusion here, I think. So the document that got redacted is the Oracle contract.

Okay, I don't have a lot of time, so it's yes or no. Is the twenty-seven billion dollars in total,

So it's

if you get this seventeen billion, is that all going to Oracle?

No.

No, it's not.

No. So the twenty it's um it's very difficult for me to explain the complex math which I don't think we're t- I think we're talking over.

But I think what you're hearing is the frustration of a committee that we're asking very clear questions about we have a responsibility for the taxpayers that we represent to get answers and a bunch of gobbledygook regarding seventeen billion dollars that you can't answer, is malpractice. So, let me get back to these are yes or no questions, this twenty-seven billion dollars, that doesn't even account for the four hundred and thirty-nine

The twenty-seven billion dollars is the addition to the ten

So you're not answering the question again, it's just it's really frustrating. So this twenty-seven billion dollars is also not going to be included in projects like sustainment, programmatic cost, infrastructure cost, none of that is included in this twenty-seven billion dollars.

That's not correct. The twenty-seven billion dollars is the addition to ten billion dollars. It includes the Oracle contract, and as Doctor Evans tried to explain when was asked a few minutes ago, it includes other things like what you're talking about, training,

So all of that will be in the cost.

operating. That's correct.

All of that will be in the cost.

It will be in the doll

Okay. I just want to point out again, I think, Rinkya member made this point, is that the beneficiary, you know, Larry Ellison, the eighth richest man in the world that is the founder of Oracle, it's really ironic to me that this administration can find out of their back pockets seventeen billion dollars, but not for our veterans, thirteen billion dollars for the Nature Ridger Star Act, or let's just set aside, we've been asking as Democrats to extend the ACA tax credits, so eight thousand of my constituents can maintain their health insurance, but there's no money to be found for them, but there is money to be found for Mister Ellison and Oracle on a failed project. You have had eight years at the VA to execute on this. And quite frankly, this is all just overrun cost. You're not managing this project. And so you're coming, um, at this by just throwing more money, and I'll start where I began, which is this is a blank check for Oracle, and it is unacceptable. So a few other questions. Despite previously testifying that O- Oracle could provide this program on schedule and on budget, these reach- recent contract modifications show

In twenty twenty two, twenty twenty three and twenty twenty four that was another team that was their job to

mmm

binge those complexities I'm pointing out what happened and so when I showed up

so you're passing the buck

in twenty five we discovered those problems listed we discovered we were running out of money and we're dealing with them the testimony I gave today and the results are important today are the success of our team riding the ship and now delivering

yeah

electronic health record which I agree with you stumbled for too long so we're in the process of delivering results

yeah I'll I'll tell you I'm the remember this One of the other issues we've been raising is the fact that this administration failed until I think March to like nominate a CIO, even though there was so many big projects that were happening. So welcome to the team and I'm glad that you're finally on this, but we are demanding accountability on this full project. The second question I have is, are VA and Oracle going to come back to Congress in another two years and ask us for more money? Is this the end of the gravy train for Oracle?

The answer is no, they're g- we're not gonna come back and ask for more money.

That's it. It's all gonna be completed. Cuz I do just wanna say that there are a hundred and seventy health clinics over the eight years that this that the VA has been tasked with implementing this program,

You know what I'm You know what I'm I'm passing by.

only seventeen have been executed on. That is ridiculous, and I yield back.

Representative Mason.

Mm. Uh, good morning and thank you, uh, Mr. Chairman. Uh, Mr. Lawrence, so this

This program started what, two thousand eighteen?

If you'll bear with me for one second.

No, I I just what year did this program start?

VA VA VA started th- our part of the program in two thousand seventy. Recall this is a joint program with DOD, so that's important too.

Okay, and in the original quote was ten billion dollars?

Yes.

Okay, and then they've asked for another seventeen billion dollars, then we're put we're at twenty seven billion dollars is the math. Total, so far for the program through twenty thirty-one?

Uh, well, No, it's gonna be thirty seven billion. So you describe the Oracle part of it. There's additional cost, so the total is ten plus twenty seven.

So thirty seven billion dollars. How much is that per patient at the VA?

I can't do the math in my head. It's thirty seven billion divided by seventeen and a half million veterans. That's the math.

What's the math? Someone do the, do the math for me on that. Um, and how many, so how much has been spent so far?

Ten billion dollars.

And how many sites has this been implemented at?

It's been implemented as of this weekend or a couple weekends ago, seventeen.

And have there been detailed reports about the implementation at those seventeen sites provided to Congress?

So eleven, eleven have been done by this team since April, so we've experienced what those have gone on. There's a host of GAO reports and IG reports about the six that were previously implemented, primarily by another team in the previous year. So there's a host of those things. which we've studied and incorporated learning in the go-forward deployments. We have plans to finish the deployment in all one hundred and seventy sites by twenty thirty.

What have you, what are some of the um lessons learned from the implementation of the first seventeen sites?

Listening to our team, providing sufficient change management, providing change uh f- sufficient training, understanding the importance of the patient safety issues which came up in the pr- in the previous attempts, and um

How many safety incidences were there in the

We

first seventeen sites that this was implemented in?

Jump in here.

There have been no critical patient safety items found for the last eleven sites that have gone live since the beginning of this.

I'm asking about the first seventeen.

I would have to get you that information.

It can't be zero, because that would be a lie.

But It's not zero. We we an- we ask, I mean, one of the things that we do with this program is we encourage and frankly train all of our end users about how to raise their hand. We would rather have over-reporting about patient safety concerns so that we can identify where patient safety issues are that we can address. Patient safety

The math is just over two thousand dollars per patient. How is this compared to the average implementation of electronic records in the private sector and at a private or commercial hospital?

I'd have to get you the information. I don't know.

What have what have gotten out out of this what are they gonna get out of another twenty seven billion why is it costing twenty seven billion more

the as we indicated unclear uncertain results in the ten billion dollars to get six sites but now to complete our meeting

how do we have uncertain results

is exactly what I said the six sites delivered uncertain results to our veterans a small fraction

is it because the VA wasn't tracking data how do you have uncertain results this is software that should be tracked in real time

so we we certainly We understand that, but what I'm talking about, the vision, the vision of what was supposed to happen was we were supposed to provide seamless connection with the Department of Defense across all one hundred and seventy medical centers by doing six prior to the Trump administration. We have delivered a small fraction of those results we promised. Our attempts now are to get all the remaining sites on board so that we have seamless interface with the Department of Defense.

Have have there been complaints about the use of the software, that it being numerous clicks in the software just to get to a single piece of data?

Most clicks are now reduced, so I'm sure there are

So how what's the average number of clicks to get through to a single piece of information?

I don't know, but we report times from the recent goal as most versus

Well you just said there've been complaints about it, so

No, no, I'm sure there are complaints about it. I'm seating that there might be somebody who is complaining, but the vast majority of the feedback we get to include direct view, fewer clicks, fewer screens, saving me an hour every day.

What's been the improvement though? I mean from what was the original average?

During the reset we spent a considerable amount of time listening to our end users and then adjusting the configuration.

Are we using AI at all in within this implementation to make it better, more improved for the physicians treating our veterans?

Yes, you heard Doctor Lawrence mention earlier that we released a new AI chatbot, VA chatter, we call it, uh which allows clinicians, front-line staff,

How does it compare the AI we're using at the VA to what Oracle and Cerner offer in the private sector?

We are del- we we are del- we are deploying the same technology that is available in the private sector.

Okay. Thank you and I yield back.

Representative Goodlander.

Thank you, Mister Chairman, thank you to our witnesses for being here today. Uh, Mister Deputy Secretary, I wanted to start with you. You testified earlier in this hearing that you do in fact have updated and independent total life cycle cost estimates for this? Can you share those numbers with me?

Certainly, I I I if I said what you said, I m- I might have misspoke, cuz I didn't mean to apply independent I meant I meant to say we have a life cycle

Okay, could you clarify for the committee?

cost estimate of what we believe it's going to cost to implement this program. Yeah, I did not use the word independent.

Okay, so an a non-independent estimate. What is that estimate?

It is our estimate. It is our estimate.

What is the what is the estimate?

It's certain it's It's about thirty-seven billion dollars to complete the deployment and then to sustain it to line up with the GAO time frame, another eleven billion dollars, for a total of forty-eight billion dollars.

Forty-eight billion dollars. Okay, and when do you expect to have an independent assessment? Will you commit to getting this committee an independent assessment by the end of this month, by the end of the fiscal year?

I'll commit to considering it and coming back to you with that.

Well, that's very disappointing. Mr. Deputy Secretary, I want to ask you about the a document that I found through a link from a news article, a Fed scoop. It's a August eleventh, twenty twenty-six document entitled " Justification for Other than Full and Open Competition." Uh, this is a document that is redacted in key parts throughout. And I want to ask you, Mr. Deputy Secretary, did you inform the committee? directly about the new estimate for this contract? And why did you reject this document?

I don't know the document about which you're referring to, so I'm sorry if I can't comment on that. Um, we provided, as we indicated earlier, the committee, the our estimate of what it would cost, the twenty, the thirty-seven billion dollars and the addition, or maybe not the addition, back in September of last year.

And then why in August of this year, just last month, did the department renegotiate and up the ante for Oracle?

Certainly. Our contract was expiring, the ceil- we were hitting the ceiling at the end of it. In order to continue to do business with them, we had to alter the contractual documents.

Mister Deputy Secretary, it's been established in this hearing on a bipartisan basis that Oracle has had committed to eating the costs, any additional costs, for this contract. So why why are you asking American taxpayers to bear the burden here?

Yeah, I have to run that down. I still don't understand that part of that, so I'm not gonna give you a very satisfying response to that answer. I've gotta figure out what was promised and see how our acquisition folks dealt with that.

So you have no answer for the committee at this time.

I said I'm gonna go run it down and figure it out and get back.

And you commit to to informing this committee why in an an extremely unusual move your department redacted key numbers that this committee, the Congress, and the American people as a whole deserve to know. Do you commit to

Um, so I commit to I

to explaining to us why that that happened?

I absolutely, I'll commit to explaining to you why that happens, and I don't think it's unusual in highly sensitive acro- uh acquisition information for things to be submitted, nor for certain groups of people to not understand the mechanics of how those acquisitions happened. That's how the law um the federal acquisition law sort of sets in motion these sort of things. So I'm happy to make sure you have sufficient explanation because

Yeah, this is a very basic transparency issue, Mister Deputy Secretary, and this was a highly unusual move. We're talking about billions of dollars. American taxpayers are being asked afoot for this, um, maybe for no reason at all, if a commitment was made by Oracle. And this is basic transparency that every d- American deserves. Doctor Evans, I wanna ask you, as a practicing physician, I was really struck reading the testimony from the Nurses' Organization of Veterans Affairs, NOVA, in which they made clear, and I'm quoting here from their written testimony, that " across all Go Live sites, patient safety event reporting peaks at three times the baseline and remains elevated up to one point seven times the baseline, through twenty-four months with no return to the pre-auricle Cerner baseline. So can you tell us about this very unusual and disturbing statistic on patient safety event reporting?

Right. We encourage reporting. So I think I

But can I ask you more specifically, was the VA aware of this statistic and and this state of play before you requested a seventeen billion dollar increase and set a twenty thirty-one acceleration target.

I'm very much aware of it. But patient safety is our clinical,

You were aware in advance.

patient safety is our priority. And so if we want individuals, I don't care who it is, any VA employee, if they have a concern about something that may be a patient safety concern, they need to raise their hand and bring it to our attention. So our patient safety professionals and our teams can evaluate that.

Absolutely. Absolutely, Doctor Evans.

So I think the difference between reporting and substantiated patient safety findings is very, very different. We want to see an increased reporting rate, and that is what is good and best practice during a change of this type.

General

Thank you, and I yield back.

Moment of time is expired. I wanna yield back. Doctor Murphy, you're recognized.

Thank you, Mister Chairman, you know, when I c- came on this committee, close to seven years ago, I was um, very upset about the lack of speed seven years ago in implementing this electronic medical record system. In my medical institution we started this twenty-two years ago. And uh uh uh to be disappointed is to an understatement on how I feel now. This is just an example in my opinion, uh a bipartisan example of the absolute disastrousness of bureaucracy. I think it was an absolute disaster that this uh Oracle was picked or its predecessor was picked in the first place. I think it was a ridiculous thing. CERNA is not meant for large institutions, especially the largest hospital system in the nation. And I look at the comparison to GoLives, and I've been involved a lot in personal GoLives, and I have to push this back on Oracle itself. There's no reason the CEO of the company needs to be a be involved at a a GoLive at an institution. There's none. They don't need to be there. In fact, they need to be as far away as possible, cuz the uh positions and all the people go crazy on the first few weeks of these go lives. So I I have to say I'm just despondent at the at the ridiculousness of now a request for more and more money for them to do a job they should have been done they should have done a decade ago and I don't know where the accountability goes. I don't know where in in a in a room where you sit down and say what the hell is going on, what the hell is taking so long with these individuals, cuz I guarantee you when I was chief of staff of my institution, those are the exact words I would use. I would hope that you would be just as equally irritated, despondent, and outraged at the lack of movement that's happened with this. I - I wanna know why. Why do you think it has taken so long for the VA to do this? Now, let's just be fair here. There have been multiple administrations that have occurred with this. So this isn't all just on this administration right now. The Biden administration, the same damn slowness occurred there. What is taking so long for these places to go live?

There's a series of answers that were well documented in GAO reports and IG reports, so accept that. The reality of the situa- the reality of the situation is when I showed up in March,

Is it?

the charge was complete this. This is an important tool to have as you understand. That was the charge going forward. So we understand those things to help us inform the way we're gonna do it better, training and the like. But that's where we are. The schedules we have are to complete the remaining of the one hundred and seventy hospitals to fulfill the vision. You're right, past could have been different for a whole lot of reasons, but that's not where we are. Here's where we are. We have a schedule, we have an estimate of the costs. It's very solid. We're working closely with Oracle. We have our teams going as witnessed by the fact that the Go lives are going so well in twenty twenty six. It's our intention to roll it out per the schedule to complete by twenty thirty one.

So why are they, why is it so slow? I mean, I I'm I'm gonna just play devil's advocate here. Epic has done twice as many in two years. What does Oracle say to that?

We are about to see a significant acceleration, so as we mentioned

Again, I I'm not pushing it ag- on any administration, because the Biden administration is just as culpable, uh if not more so, for the slowness that occurred during the last administration. I just want to see results.

Right.

I just want to see what the hell has taken so long for this to happen, cuz I've been involved in this process intimately myself, and I just don't understand what is taking so long.

Uh, I completely understand thirteen sites and all of their associated clinics going live this year. Twenty-six sites and all of their associated clinics going next year. Twenty-eight, thirty. We are significantly increasing the pace. We moved from a single going one hospital a time to a multi-wave approach. Uh, every wave where we go live, we're going live with, uh, eight thousand to twelve thousand end users and accelerating that path forward.

I- is that the problem? We don't have enough end users?

We currently have eleven waves and it's probably close to forty sites that are in active preparation for go live. There is a significant lead time, as you're well aware, of the need to do the infrastructure improvements, make sure that we have everything set up for the hospital to succeed. acquisition timelines.

Uh uh uh, let me ask you one more one question real quick. Are you allowing each institution to have their own picks, or are we doing something standardized throughout the entire VAD?

Yes, standardized, standardized.

Yeah.

All right, so it should even be faster.

Correct. And that is the w- the only way we are achieving wave-based deployments and now deploying at the at the pace that we are. Effectively, next year we're gonna be having a go-live wave every eight to twelve weeks, throughout the entire year and through the rest of the program.

Well, I I mean, Look, I I I know you're working as hard as you can. I put a lot of burden on their company for them coming back and asking for more money to do a job that they should have done a decade ago. I think personally that's resi- that's ridiculous, and I would hope that the VA would push back hard as hell against these individuals and say you haven't d- you didn't do your job a decade ago, let's do your job now. So thank you, Mr. Chairman, I'll give you back.

Dr. Dexter.

Thank you, Chair Boss, for holding this hearing, for your dedication to transparency and oversight, and thank you to our witnesses for being here today. Members of Congress share responsibility for ensuring the billions of dollars being spent on VA's modernization of its EHR used effectively. Last month, the VA, as we all have heard, announced it was increasing the ceiling on Oracle's contract to manage the VA's electronic health records from ten billion to twenty-seven billion, nearly tripling the contract size. And this was a no-bid, sole-source contract extension with no competition allowed and established clear performance, clearly poor performance. My home state of Oregon also had a disastrous experience with Oracle when it contracted to create Oregon's state-based health insurance marketplace and our own experience feels eerily familiar to what we are hearing today and as a former VA doctor I've heard complaints about Oracle's performance in real time from VA physicians as members of Congress we have a responsibility to conduct oversight and make sure this decision was made on the merits and is responsible use of taxpayer dollars. I appreciate how thoroughly my colleagues on both sides of the aisle today have established our concerns. Mister Lawrence, do you know how much Oracle stock price rose at the opening of the market after VA announced the tripling of the contract ceiling?

No, I do not.

It was three percent, and some market analysts attributed this directly to the VA announcement. Mister Lawrence, do you personally hold any Oracle stock?

No, I do not.

I'm glad to hear that. How about President Trump? Does he own and trade any Oracle stock?

I do not know.

The most recent data we have is from the first quarter of this year and it shows that Donald Trump while serving as president has been buying and selling millions of dollars worth of Oracle stock when agencies award billion dollar no-bid contracts to companies that President Trump invests in that raises a question about corruption, Congress needs to investigate. But that's not the only questionable part of this contract. Not only is Donald Trump an investor in Oracle, he has been a beneficiary of massive political

I do not know.

He gave forty five million, and he has given millions more to groups supporting Trump since then. Now look at, let's look at Oracle's record. The original contract was given to Oracle during President Trump's first term, and it has been plagued with problems from the start, as we have heard today. Again, my home state of Oregon had an equally unacceptable experience with Oracle, and in fact sued them, for fraud which Oracle settled for one hundred million dollars. Miss Carol Harrow Harris from the Government Accountability Office is here and will testify today. Last December she testified that GAO had made ten priority recommendations that the VA h had not yet implemented. And I quote, quote, "Until VA fully d- implements the priority recommendations, for future deployments risk prolonging management challenges, and users will likely not be positioned to achieve optimal usage." unquote, end quote. The GAO is here to ensure we are being good stewards of taxpayer dollars. From their outstanding recommendations, I have a hard time believing the seventeen billion increase in the contract will be used properly and is the best inter- in the best interest of our veterans. And here's the important context. Context. These questions about Oracle's contract are happening in an administration that is the most corrupt administration in history and just his first year in office, President Trump increased his net worth by over two billion dollars and contracts and loans worth hundreds of millions of dollars were awarded to companies, which ties to Trump family members. I am not saying this contract is corrupt. That is not my job here. But there are plenty of red flags to raise concern. A seventeen billion dollar no-bid contract extension has been given to a company that our president invests in whose founder has contributed heavily to our president, and that has a terrible and and that company has a terrible record of past performance using taxpayer dollars. That's why we need to investigate. And that is why, Mister Chairman, pursuant to clause two K six of rule eleven, I move that a subpoena be issued to Larry Ellison, the executive chairman of Oracle, and Mike Sicilia, the CEO of Oracle, to provide testimony at this hearing. I seek recognition to explain my motion. Mister Chairman, may I be heard for my motion?

And explain your motion.

Thank you. Immediate options. Recognize, okay, I'm sorry. Um. I'm sorry, I'm trying to find, I wasn't necessarily expecting to be recognized right away. Okay, sorry. I am moving to the subpoena Larry Ellison, Chairman and Chief Technology Officer. of Oracle Corporation and Mike Sicilia, Chief Executive Officer of Oracle. Chair Boss wrote a letter inviting Oracle to testify today, and Oracle declined to attend. I do not take this step lightly, and I do not believe any member of this committee would. We are here because we care about the same thing, making sure veterans rece- receive the care they were promised, and making sure taxpayers get what they are paying for. When the vendor responsible for a tax pair funded contract going from ten billion dollars to roughly t- twenty-seven billion will not sit at this table and answer our questions, all of us are being prevented from doing our oversight duties. I agree with my colleague, Congressman Van Orden, that this sounds like it could be corruption. Oracle has still not provided a complete and comprehensive cost estimate for this contract, and it is not sufficiently documented that the additional funds already committed are being used effectively. A closed-door private round table cannot replace congressional oversight that happens here in this hearing room. Oracle needs to appear before this committee in this room in a formal setting to answer our questions. I'm asking my colleagues to join me in this motion. This is not about one company. It is about the committee's authority to do a job veterans and taxpayers expect of us. A system that works for veterans and a contract taxpayers can both trust and requires that the people responsible show up and answer for it. I ask for your support to my colleagues and I yield back. Thank you, Mister Chair.

The chair at this time uh holds a general lady's motion in abeyance until the end of the hearing which is a common practice of the committee to allow today's witnesses to be heard and then we will deal with it. Okay. Uh Representative Siskamani, you are recognized for five minutes.

Thank you, Mister Chairman, and thank you to Dr. Lawrence and Dr. Evans, um, and uh Mrs. Harris also for being here today to testify on this important issue. Thank you uh, Mr. Chairman, and um thank you all for your time and answering our questions. Veterans across the country rely on the VA every day, including to keep their health records accurate and secure. The rollout of electronic health record modernization at VA medical centers is a real opportunity to improve the experience And as a member of the Appropriations Committee as well, besides being a member of this committee, I take programs of this size and the cost of them very seriously. Real progress has been made. Recent deployments have gone more smoothly than earlier ones, I'll say that, and it's clear that VA is taking this seriously. But it's important that these lessons uh carry forward, uh so future deployments continue to improve rather than repeat the past mistakes as well. So I'd like to start with you, Doctor Lawrence, uh on this issue of of the of the deployment as you evaluate new deployments and where they will uh be located what are the most critical lessons learned from the twenty twenty six deployments and how is va making improvements to system to the system into the deployment process going forward

certainly one of the big lessons learned was to do things on a market basis so sort of all the sites in michigan for example tend to serve our veterans they cross cross site care and so as a result doing all things together so that they all the veterans in the area are on the same record is really important the other thing is getting out and listening to our providers directly so that's resulted in me going to the sites to talk to them and hear about their concerns in the system um the other thing is as we talked about earlier standardization there was one version of the record not like before where there was a lot of customization we're we're stopping that training obviously matters but the other thing And then another thing we're also discovering too is how much knowledge sharing is taking place na- naturally in our system providers medical center directors are hearing how good this is and they are going to the live sites to learn to see the deployments in northern Indiana two weekends ago they were representatives from twelve sites that will go live in the future to see what's going on and to see the system in place cuz they've heard how good it's it so we need to good it is so we need to enable the knowledge sharing. Bojo.

And w- and what are what metrics is the VA using to determine whether a deployment has been successful before moving to the next site?

Well, there's a whole series of metrics. Have you done the training? Are the is the infrastructure in place? Is everybody ready? The most important is the conversation with the medical center director. Is your team ready? And by and large, those have been not only ready, we wanted earlier.

W- would any threshold trigger um a pause in the rollout?

Uh, certainly, if we had

Like what?

patient patient safety issues.

Okay.

We are concerned patient safety.

L- let me um ask one more question on this. Given that um that the Cochise County VA, Cochise County is in my district in southern Arizona, clinic is uh Sierra Vista, serves a significant veteran population in my district, the most dense veteran population in the state of Arizona. In my district I've got about eighty thousand veterans in my district. Um so uh what what is the current timeline for the modernization deployment at the southern Arizona VA healthcare system site and what steps are being taken to ensure that rural and satellite clinics, like Sierra Vista, are not left behind as the system is rolled out in the at the larger medical centers.

Sure, give give Neil a second to look up the date for your site, the site, your your area. Well, let me tell you about the satellite clinics and the C box and the like. That is done altogether with the facility, the corresponding hospital. That's done altogether, so the rollout takes place with the hospital and the corresponding C box. That's done as one initiative, one effort. So folks come to the hospital, teach and train, and be with them when they go live, and they go to the remote site. So part of what happens in the deployment is we figure out where the remote sites are, what type of medicine is provided there, what hours is it open, and who needs to be there when they go live to help them. So they get just as much help as they can possibly have as if they were at the main facilities.

We already have for tucson and all associated facilities the community clinics uh the pre-deployment work started in may of twenty twenty six we then start to prepare the end users the adoption support the training that all starts in may of twenty twenty seven and go live is currently scheduled may of twenty twenty eight

well i'm i would like to fit in one more question but i'm gonna be overtime so i'm i'll be respectful of everybody's time mr. chairman now you're back thank you

Mister Chairman,

Yes.

I'm not sure if Miss Dexter's um uh amendment or offer is uh needs a second or not, but if it does need a second, I want a second to her motion.

Thank you. We'll let the parliamentarians figure that one. And if you're accepted and in ne necessary, I thank you for volunteering that. Mr. Conaway, you're recognized for five minutes.

Uh, thank you, Mister Chairman, and thank you, Ranking Member, uh, for this hearing and thank you, uh, Doctor Lawrence and Doctor Evans for presenting yourself, uh, to us today. I wanna start out my own comments by, uh, saying that I share the outrage of many on this committee, uh, for the, uh, cost overruns and delay of, uh, the most expert care that could be provided uh to our our veterans. I'm a physician myself, I have been involved in about um one small transition uh to uh electronic medical records and three others uh in larger uh hospital systems. And uh they're always difficult um but um these uh the numbers involved here and the delays involved here and just as um dishearteningly I think is the word that's been used, the stink of corruption that seems to be involved uh in uh this deployment is something that um uh that every American ought to be concerned about. I appreciate the chairman trying to bring a light uh to this situation uh but clearly uh a lot more uh needs to be brought forward to this committee than the American people. I wanted to um I wanna ask as you think about these large deployments and these contracts, do you believe that the government has sufficient capability uh to uh properly assess the costs that are being prevented for technology such as um uh Oracle and other companies bringing uh very complex solutions uh to government problems. Do we have enough person power to properly assess whether or not we're being sold a bill of goods?

Um I think our acquisition team is really very very good, for more broadly speaking. Um also we get help on complicated matters like this from what's called federally funded research and development center, FFRDC, this is something set up coming out of world war two, company that doesn't compete for services but supports the government, so we draw on our FFRDC for technical expertise. So I believe between the combination of two, we have sufficient horsepower to deal with the issues in front of us.

And so why do you think that we're dealing now with with this now ballooning number, uh and yet uh so much of the system not being uh not receiving the kind of technology that that inures to the very best of patient care for our veterans.

Everyone agrees with your assessment that it's a disappointing how we get here. I do not know how the past happened. I wasn't here. As was pointed out earlier, others were, but the reality of it is here's where we are. The charge coming into this administration was go deploy the system in the remaining of the remaining one hundred and seventy hospitals, and that's what we set out to do since March of twenty-five when I got here. And well, reporting on today is the success we've had, the eleven sites on time as we said we would.

Thank you very much.

What's more important is the spend.

I'm gonna move on. I wanna move on. Um, Doctor Evans, uh, you mentioned that um safety is a a top priority. Now we've heard from um our uh uh community and and the Veterans Affairs uh that some three hundred dermatology patients have had their referrals cancelled at a VA facility and uh and that facility was using the Oracle system. And um uh m- many of these patients had cancer diagnoses and of course, suffered delays of care as a result. Uh, this doesn't stri uh strike me as providing the very best and and and and working to ensure patient safety. Can you explain uh how this happened and what steps are being uh taken to deal with this particular situation uh of these uh dermatology consultations being cancelled and other situations uh like this that uh have a rhythm?

Uh, Doctor Conaway, I would would love to have information on that if the committee could share what you have heard about uh, specifically to dermatology referrals, we would be happy to look into that.

Thank you, and we'll get uh more information to you so that you can get that information to us. Um, uh the under this contract, and I think for the first time in the VA's uh uh history, um you're authorizing uh AI as part of the chat box that you've mentioned. uh what uh steps are being taken to ensure uh that the um that this system, this AI system is securing uh the um the protected information that veterans are providing uh as they use this uh this AI chat box.

The AI chat bot is not used for personal health information or personally identifiable information it is a chat bot that um end users can use to ask questions about how do I use this electronic health record in the care of the patient. So for example, how do I properly place a dermatology referral, as you just mentioned. So it is a it's a means to s uh supplement

Yeah.

in-person end-user support.

Thank you, I've have to move on to another question as my time is running out. One of the um other things that we heard from the field uh was that um uh physicians are having a difficult time and maybe it doesn't re rest with them, but having a difficult time directing patients to the right uh dispensary or pharmacy to get medications that they've provided now it should um is that a situation that should occur that is if I write a prescription to a veteran and um uh for a particular medication uh I have an expectation it's gonna be available to them just as if I you know in in the private sector um sometimes I go to the pharmacy and they say they don't have and they have to find it but Uh, are w- you, do you recognize that uh as a problem, that the, there's not enough feedback to determine where the veteran needs to go when they leave the office to pick up the medicines that been have been prescribed uh for him or her?

This is one of the significant enhancements that we are achieving by implementing an enterprise-wide electronic health record. When I'm in clinic in on Friday seeing patients in primary care, I will be able to write prescriptions that can only be filled in person at the Washington DC VA pharmacy which is right there in the lobby of the Washington CBA I cannot electronically write a prescription that could be filled at the Baltimore pharmacy if my patient happens to be there for convenience by moving to an enterprise system we will be able to direct prescriptions to the location where the veteran wants to pick them up where of course we prefer and most veterans prefer to receive them by mail but but this is actually what you just highlighted there is actually one of the real advantages

Very good. Thank you and I yield back. Thank you, Mr. Chaer. Representative Kagan is your representant,

Thank you.

you're recognized for five minutes.

Thank you, thank you, Mr. Chaer, and thank you for our witnesses for being here. I represent Virginia's second congressional district, so we have the Hampton VA not too

While while Neil looks that up, I wanna claim pride in ownership, my Sunday's residency at the Hampton VA Medical Center,

Yeah.

five, six, seven years, unbelievably great training, so I'm not surprised by the quality of care that goes on there.

We're working on it. It's gone a long way and I'll I'll

Current Girl Live um

Sorry.

The Current Girl Live is scheduled for October of twenty thirty.

Twenty thirty, okay great, thank you. I appreciate that and look forward to it. I know how hard it is to roll out electronic charting as a geriatric primary care nurse practitioner having sat through two CCRCs, continuous care retirement communities where we integrated with electronic charting going from paper charting to electronic charting. Back in the day it was a long process over a year uh in both facilities. End up with a there's obviously a lot of great things that come with electronic charting that you've been discussing, but one of the things that I remember and that was most helpful to me as a provider, was being able to sit with the they brought in a whole mobile home and they had computers and we were doing charting with the tech reps or with the company reps, uh in this case maybe Oracle or, you know, who sat with us and said, what is gonna help you, what is gonna help you to write this note to be able to to prescribe that medication. And and I just thought it went a long way, so much so that I always would would call them. They stayed on campus for over a year and I could call them and have them sit right next to me and they could take that you could tweak it tweak it right there or show me how to do it or bring it back and tweak it you know in the program side so are we doing that as well because I I care about providers and we struggle and we talk about you know provider uh just recruitment retention in this committee and and I know that how great electronic charting can be but also how frustrating it can be so what are we doing to be helpful to providers in that space?

Absolutely, we're doing that. That is a best practice for electronic health recter rollouts as you, yourself experienced. Two things I would highlight. Before Go Live, we introduced in the first six sites we did not do this with the exception of FHCC. We introduced what we call learning labs, which is exactly what you described. It is the month before Go Live where we sit, we bring the team together and we wor- and we actually practice workflows.

Yeah.

For FHCC we had nine scenarios, we had more than ninety scenarios we worked through the teams with, so essentially everybody has an opportunity to participate in a learning lab. Post Go-live there's adoption support, so Oracle Health staff support providing adoption support as well as what we call the Pay It Forward program. These are a hundred at each site, each wave we've had almost a hundred eighty plus folks who are at the existing sites who come forward and are your colleagues from other VA sites who travel to you

Mm-hmm.

where you are and sit side-by-side with you during the go-live to make sure you understand how to use the system based on their learning.

Good. Good, that that was actually my next question was what are we doing to take some of the changes and and uh not have to re re you know re relearn them at every facility, so that that's very good news to hear and can you tell me, I don't know if you talked about it a little bit yet or not, but does this system at all or does it have the potential to communicate with tri-care or for our active duty military and how That that's such a big disconnect for me personally as a TRICARE family, representing a lot of TRICARE people, that we've all these people leaving the active duty and getting them rolled to the VA system and just a big disconnect how does that work with with this system?

Uh, two things. Number one, it is the very same system that the that DOW is using for care. So any care documented by the military health system to include any records that they may retrieve from care delivered in the community. um, is in the very same system. So a progress note written by a provider in the DOW carries the very same weight as one written by the VA provider that's next door to you. They're all in the same, it's it's all one.

That's good. Good.

Second, we are now exchanging health data through our joint health information exchange with greater than ninety percent of the hospital systems in this country. And countless clinics, I think it's over three hundred thousand clinics. And so one of the other things that is a significant improvement is the ability to integrate data from community parter par providers who may be delivering care to somebody through their tri-care benefits and ingest that information again as a first class citizen document that is you know it is the

Right.

care is around the patient not around the location of care.

Right. Well that continuity of care piece, I mean that was a s huge source of frustration providing community primary care.

Yeah.

If I for my large veteran population if I wanted to know what they were doing at the VA hospital, print it out they'd ask their v a doctor print it out and hand carry it to me because it was a source of frustration we couldn't get those those v a notes so whatever we can do to partner with that i i'm not currently practicing but i look forward to hearing about this implementation especially in a place like campton roads where we have so many veterans who use this v a healthcare system but being able to liaison with our community partners cannot be overstated uh just the importance of of that for continuity of care but Uh and then my last question is there, although I'm over time, can I ask one last question? Is uh is there will there be yearly visits to i- i- or with some frequency maybe every year every two years to come back to sit with their providers again? I know at some point they'll wrap up and they'll say you're on your own, but is there any plans to revisit so that there if there are remaining questions years later?

There is support for a year post Go-live that is provided from a contractual standpoint, and of course One of the big things that we have done as part of the reset is to really beef up our informatics teams at the facilities to provide that at the elbow support in perpetuity. The last thing I would say is that ten percent of our workforce are super users, so when we train folks to go live, we train ten percent of folks to be really, really good and support their colleagues. We are committed to maintaining that workforce in perpetuity. Super users don't become less super the day after go live.

Great. Thank you so much, and I yield back.

No one else seeking recognition? Uh, this panel is excused. Uh, Doctor Lawrence, thank you for being here, Doctor Evans. We do have our second panel. We're gonna we'll still work on that. So um, we have a second panel to come up. I hope you stay around for the second panel. We'll take a brief recess while we're All right, um. Miss Harris, we're gonna we thank you for waiting around. Miss Carol Harris, Director of IT and uh Cybersecurity from the Government Accountability Office, I ask you to please stand. You would raise your right hand. Do you solemnly swear under penalty of perjury that the testimony you are about to provide is the truth the whole truth and nothing but the truth? Thank you. Let the record reflect that the witness has answered uh in the affirmative. Miss Harris, uh, you're now recognized for five minutes to deliver your opening statement. People are gonna be moving in now, but we we'll get it on the record that way.

Sure. Thank you. Thank you, Mister Chairman. Um I, um, a ranking member Takano, members of the committee, I I wanna thank you for inviting us to share our observations about the VA's recent work on the EHRN program. You know, the department initiated this program in June of twenty seventeen to replace the legacy Vista system, and has to date deployed the new EHR to seventeen of its medical centers. According to VA, it will hit the ten billion dollar ceiling of the current Oracle Cerner contract before the end of the year with seventeen months left on the contract. In light of the situation, VA modified the contract, adding three more years, moving the end date from twenty twenty eight to May twenty thirty one, and increasing the ceiling to twenty seven billion dollars. Over the past five years, we've issued five reports on VA's efforts to deploy its new EHR system. These reports describe the challenges in VA's implementation of the new system, and include eighteen recommendations, Exactly. twelve of which we have marked as priority because of the critical impact that they have on strengthening successful future deployments. While VA has taken actions to address our recommendations, it has not fully implemented fourteen of them. And this morning I'll highlight three key points from our work. The first is this, VA needs to produce a reliable cost estimate and schedule. Last September the department shared an updated total life cycle cost estimate that included thirty seven point two billion to go live at all a hundred and seventy sites by twenty thirty one. and another nineteen point three billion to operate and sustain the system for another ten years, bringing the total cost to fifty-six and a half billion dollars. As of today, we have yet to receive an underlying analysis to support this figure. Furthermore, VA has stated this estimate does not include relevant costs incurred by VHA or OIT, which makes this figure incomplete and therefore unreliable. A credible estimate is imperative to understanding the full magnitude of VA's investment. We have also yet to see an updated integrated master schedule, and without this we can't know whether twenty thirty-one is a realistic end date. Consequently, as the department increases its deployment momentum, more information critical to controlling risks and informing congressional oversight is needed. And now to my second point, which is that more work is needed to address user concerns and system issues. And I do wanna say, I think that the work that um that Mister Lawrence and and Doctor Evans has has done. Their leadership has been very effective during, you know, the the twenty twenty-six uh reset period a and the deployments. Um we we have seen a much smoother deployment than what we have seen with the initial six rollouts. Um however, we do feel that there is still more work that needs to be done. Uh we've reported on these gaps in VA's organizational change in management activities for EHRM. We've also reported that users expressed dissatisfaction with the new system and that VA did not adequately identify and address system issues and so we have ten priority recommendations to address these issues um in those areas. As of today, VA has partially implemented one of the ten priority recs and continues to work towards implementing the remaining nine. So for example, VA has taken steps to remove users' barriers to change through the use of innovative learning labs as Doctor Evans had and an increase in the number of super users at each of those sites at ten percent. That is something that we are very supportive of. And during my time in Michigan, um in the lead-up to the Go Live, I did hear positive feedback directly from users on these specific actions. However, more work is needed. Among other things, VA has yet to meet established user satisfaction goals for this the use of the new system. And finally, to my last point, um this is something that we have not really talked about in this discussion with the first panel, but um something that I think is important, which is that VA ought to be making plans for turning off the legacy Vista system. You know, we we can't lose sight of this piece of the modernization puzzle because a legacy environment is extremely costly to maintain and very difficult to secure, from a cyber-certi cyber-security perspective. Uh Vista's annual cost is not well tracked within the department, but it is in the hundreds of millions of dollars. And it will be difficult to turn off because Vista does provide numerous functions beyond what the Oracle Cerner system is intended to do. So I'd, I would urge you uh to press VA on their plans and time frames for decommissioning Vista. And so moving forward, again it will be critical for VA to address the twelve priority recommendations as soon as possible. Um, doing so will position VA to more effectively deliver modern health care uh health record system our veterans do deserve. And that concludes my statement. I look forward to your questions.

Thank you, and and ap- as I said, I appreciate your your patience. Miss Harris, I've got a couple questions and then we'll we'll um we'll pass on to the other members that might have questions. Um, provided a life cycle cost estimate labeled preliminary

Mm-hmm.

is what we received, uh in GAO's opinion, is this a reliable c- uh comprehensive cost estimate or not?

No, it's not. It so it is it is um excluding costs associated with VHA and OIT, the Office of Information Technology for example. They are the ones that bear the brunt of the infrastructure costs, so you know to deploy the Oracle Cerner system, you have to make sure that the facilities themselves are ready to implement from a technology standpoint making sure that all the networks and, and everything else is is brought up to date. So those costs could potentially be very significant and that's something that is missing from that fifty six and a half billion dollar estimate.

Wow. Okay, um when VA has uh relied heavily on Vista platform for various items, uh VA accelerates deployment, how costly is it to decommission Vista A?

Yeah, so with decommissioning Vista we don't yet have a cost estimate associated with even just operating Vista annually. It is in the hundreds of millions of dollars. The best that we've been able to do over like a two fiscal year period was like two billion dollars and we were only able to verify one billion of that number as just an example so it it is um it's a little bit of a black box but we do know that it needs to be decommissioned as you know once you know once uh Oracle Cerner is fully deployed. because otherwise you're carrying two very large health record systems, and that's just not sustainable from a taxpayer perspective.

Sure. Representative Brownlee, do you have questions?

Uh, thank you, Mister Chairman. Um, thank you for being here, and particularly being here at the last minute, so we appreciate that very, very much. Um, I I was just going back through an email because you mentioned Michigan. And um it was brought to my attention um that uh that there were thirteen thousand consults or referrals that were transferred into the EHR system, into an unknown queue. Um the referrals in this queue only list the veteran's name and demographic information not what the referral is for, where the patient needs to go or who specifically they need to see. It's to cert- Disturbing to learn that over fifteen hundred of those initial referrers were for mental health care so obviously a big concern I was made aware that the health care workers were told by management that it would take thirty-two weeks with two specialty nurses per department working on the unknown cue to process all of the referrals in the cue does that are you aware does that

Yeah.

We we have heard similar issues in terms of referral management still being a challenge um at Michigan and and the other deployed sites um consistent with with what you're hearing uh we've we've heard um the need for greater manual intervention and work arounds to ensure that referrals you know get to where they need to be um so those are issues that we are currently working through right now as we do our work for you.

Very good. So the number that you um spoke about in your testimony fifty six point five million dollars.

Billion.

Why is that different from um what the VA just quoted?

Um I I'm not quite sure, but we received the same letter that that you received, which is what Mister Lawrence had cited from June thirtieth of last year. Um and it did include the fifty six and a half billion. It also included forty eight, but as part of that letter it said there was an additional eight

Very good. So um I just wanted to talk about sole source contracts for a minute.

Mm-hmm.

So I I know that there are reasons why the federal government would have a sole source contract. Um, in this case where there are other options, I'm not sure I understand why there would have been a - a - a contract negotiated by that. Is there - are there regulations around that that were broken?

Um, you know, I'm not the - the best expert to - to comment on the - on whether it was appropriate or not to - to sole source this particular contract but what I do know is you know predating twenty seventeen DOD and VA had been struggling with this uh this notion of interoperability. I mean there were multiple attempts at trying to get interoperability between the two systems. I think ultimately there was a decision made to use the same system to basically answer the that big problem of interoperability and so I I believe that could have been the reason why VA chose to go with the system that DOD had already awarded the contract.

Okay. Um, and my understanding too that the original Cerner contract was um an I D I Q contract which is um indefinite delivery indefinite quantity, and then sometime along the way the contract changed um to include a t time and material clause so that you know so what what they committed to in the in the beginning of the ten million dollars, no matter how long it took, it was gonna cost ten million dollars, no matter what the materials were, et cetera. Then that changed. The VA changed that contract to a a time and material. Do you know why that happened?

Um, I I believe it may have been because of the performance at Oracle Cerner or Cerner at the time um they were they were struggling in with a timely ticket resolution, is is one area that I know that w my team has has definitely taken a look at where um the cerner folks were not meeting the time frames that were specified in the contract. Um and so that that was I believe one of the issues that played into why the contract was restructured.

You mentioned enter uh a probability. Can you talk a little bit about where we are on that?

I mean I think that the system that VA is deploying is the same system that DOD has fully deployed at this point so you know theoretically the

well the commitment was it was gonna be compatible with the community too

correct and uh we're still working through the the issues associated with community care um uh my understanding is that's you know um what what mister lawrence's comments uh in terms of the it is the same in of community care uh processes are not necessarily different in the new system environment, so we still have work that we need to do to evaluate. Um, but uh

But uh but is the are they communicating with the community in these locations where they have already instituted the program?

Yes, I believe that that they are.

I it's still

Um, I I do know for example with the scheduling piece of things, there are fourteen additional systems that VA schedulers must use, um, in the new system to be able to schedule an appointment with the community care. for example so there are some inefficiencies that that VA will have to deal with in in that aspect for example but we still need to do a comprehensive review of all the impacts to community care but as far as DOD and VA are concerned the the records should be interoperable because they are on the same system.

Thank you, I yield back.

Well I was going, Mister Chairman, I was just going to defer and and to Mister Takano so I can organize my thoughts since I'm next, so can I still do that? Mister Takano, you're recognized.

Thank you, General. Uh, Miss Harris, thank you so much for joining us today, um, especially on such short notice. A hearing on this monumental project with life cycle costs estimates reaching over fifty billion dollars and likely higher would not be um true oversight without GAO at the table. Um, has VA provided you a

No, they have not. I mean, they've s- we've we've seen the top-line numbers, but we have not seen any underlying information to show the basis for that estimate. We've not, we don't have any of them.

And that's incredible to me because this has been a project that's been uh, you know, eight years, nine years in the in the making. Uh, what is missing from the estimate that you received?

Um, at least from VA's own disclosure, it uh costs associated with VHA and OIT, so um on the OIT end of things that would be the IT infrastructure to ensure that the sites themselves are able to to um implement the uh the new system.

Is there a federal definition of what a LCCE includes? Uh, does VA's most recent LCCE comply with that?

No, it doesn't. What you would expect from a life cycle cost estimate, uh, both in terms of OMB's definition and also with IT best practice, it would be every single element, um, included. That would be a full, um, everything associated with development and also with operations and sustainment. And as part of development costs, that would also be the underlying infrastructure costs as well.

So there's a federal definition of the life cycle cost estimate. Um, it's that's it's clearly defined. It's a government practice.

Yes.

And VA has not um fulfilled uh, you know, has not produced a document that that conforms to this definition.

That is correct.

Has VA developed an internal the internal capacity and skills to be able to develop complete and accurate um life cycle cost estimates?

You know, we have not delved into the um the program support workforce associated with cost estimators and schedulers and other engine you know engineering and and technical staff like architects, for example, for the EHR program. Um, so right now it is unclear to me how many cost estimators are on the EHR program or schedulers. But I will say that for programs of this magnitude, because I've done a number of space programs, for example, you have like an in-house staff of, you know, at least ten to fifteen people for for a program of this magnitude.

Mr. Chairman, I would hope in a bipartisan basis that uh we could uh you know, uh uh demand that VA uh get its act together. Uh, we need to find out um if they have the appropriate staffing to be able to actually even do the life cycle cost estimate. Um, I I think you would agree with me that this is crazy, all this time, we still don't have a life cycle cost estimate. Um, I think I think it was probably I think we're we're all in agreement. So, what you're saying is that VA has not done necessary work to truly give us, and the American taxpayer, and the American people, an idea of how much this program would cost. Is that correct?

That's correct. I mean, we have an outstanding recommendation, or uh outstanding request with VA to provide us with the underlying documentation. It's been over a year at this point and typically if we haven't received it, I you know, I ra I have red flags about whether it exists.

And yet we know we know from the amended contract that uh they have put a new ceiling of seventeen billion dollars without a life cycle cost estimate.

Yeah, typically what you would wanna see is a program estimate independent of what the contractor has developed. So it's unclear to me whether the twenty seven billion or the the additional seventeen billion is an estimate that was that was um sourced from Oracle, or if it was sourced from VA. We don't have any insight into that. But typically in an acquisition process, the government will have its own estimate to compare whatever cost a vendor will provide.

So that didn't occur. That didn't occur. I mean, we we

It could have.

It could have, it could have, we don't know. Um, and certainly it's the job of the oversight committee, the the authorizing committee, to do this, uh to make sure that this happens and to sort out uh how the acqui- acquisition pr- pr- process um uh worked. Um, alright. Um, I yield back, Mister Chairman.

Representative Berkman, you are recognized for five.

Thank you, thank you, Mister Chairman. You know, uh, I'd like to Addressed to Miss Brownlee, you you you dusted off a brain cell that I haven't thought about in twenty years, because when I was recalled to active duty in two thousand three, as you mentioned about how DOD and VA struggled with interoperability, I was in the middle of that on the D on the uniform side back in two thousand three, two thousand four, so here we are twenty some years later, and the the key word here is interoperability in any set of agencies that have in this case dealings with service members and then veterans. OK, so thanks for dusting off some old thoughts. Um, I may need an extra beer tonight. Based on that, um, Miss Harris, your testimony notes that VA has not implemented a VA specific change management strategy to formalize how it will improve front-line staff readiness. Can you tell us how an effective change management plan could impact the training and the site readiness uh in future deployments? Cuz there's gonna be more. You got initial rollout and then secondary and That's a good question. tertiary until you got everybody up to speed. It was a good question. And what strategies from this past year should VA include It's a fast one. in that plan. So ask it like a thirty-seventh or a forty-seventh. Or maybe something that stands out as they should s stop doing. That's the question on record.

Mm-hmm.

Okay, exclude from the plan. Thoughts?

Yeah, so um VA has produced a change manage change management strategy that we have seen as in response to our recommendation. However, we are still holding the recommendation open in that particular case because we want to make sure that what is contained in there, um will be effective and so we need to see how Indiana goes and we wanna see how the two other deployments go uh for the for the remainder of the year to see whether or not their um their plans for improving training and ensuring that um each of the sites are are are basically have they they have a standard approach to the way that they are changing their business process um that that that is effective. And so I I will say like with the training piece, one thing that I have heard overwhelmingly across all the sites is that the Oracle training is not good. Um, the

Is not what?

it's not good.

Okay.

The the learning labs that VA has implemented, those are all good things. The additional um increase in the number of super users, all very positive. But the the overwhelming sentiment is that the Oracle training when the Oracle folks come in, and they show you how to use the system itself, that has not been effective for for the majority of users.

Okay, okay, on thank you. Uh, I mean that's that kind of data is I think ver- I know it's very valuable, thank you. On site readiness, what differences do you expect between the twenty twenty-six deployments and next year's?

I think it's gonna be interesting because when you look at Michigan and Ohio, they actually had been preparing for the cutover to the Oracle Cerner system before this big reset happened in twenty twenty three. And so they have had actually multiple years to prepare for this this change. Um so now we're seeing Indiana and we will see with these additional sites that have not had that um that that length of runway, um the the effectiveness of of VA's actions to ensure that they are that those sites are appropriate appropriately ready.

So, to restate your words in the in the last, you know, few seconds here, the the initial rollouts, the Michigan four f- the four sites had a long runway.

They did.

Okay, um But the lessons learned, the lessons observed, the lesson and the changes in the next rollout.

It may look different and I wouldn't be surprised by that because the runway that Indiana had was not the same as what what Michigan had in comparison. So I think time will tell um how how effective VA has been in implementing that those change management strategies.

So in comparing and contrasting first rollouts, current rollouts, future rollouts,

Mm-hmm.

it's gonna be important that we that we, if you will, adjust our our optics to see that there has been change, uh doing things a little differently based on different criteria, not get caught in evaluating always by the same criteria initially that may have changed.

Absolutely, that's exactly right.

Okay, with that, Mr. Chairman, I yield back.

Representative Brzezinski.

Thank you, uh, Mr. Chairman, and I just wanna echo, um, what others have shared, which is appreciation for you, Miss Harrison, GAO, important role I think as really a steady and independent hand as um, yeah, as a ranking member on uh tech modernization, how important the GAO is to providing that oversight. So thank you for that. Um, I actually, you know, it's disappointing the Deputy Secretary didn't stick around. Um, but I I did want to talk a little bit about, I mean, some of this, you have eighteen recommendations, is it correct? And only four of them have been closed.

That's correct. That's correct.

Okay, to the VA. Um, some of my questions actually are are similar to what General Bergman just asked specifically about um the training and I wondered, Miss Harris, if you would be willing to spend a little bit more time on especially because it's been an identified issue I too have heard this from VA employees that the training um is lacking how could you could you speak a little bit more specifically about how that could improve. And then my next question related to that is are you seeing the VA take any next steps to make those adjustments, to make improvements in the training?

Yeah, so the Oracle training that is delivered right now is not adequate, based off of the feedback that we have received unanimously across all of the sites.

Mm-hmm.

So part of that issue is that it's it's not um it's not helpful to them because it's not role-based necessarily, it's just you know, here's a system, here's what you do,

Yeah.

and it's not um it's not effective when, you know, you're a nurse going in and, okay, you know exactly what you need to do. Mm-hmm. And that's why these these learning labs are so helpful, Mm-hmm. because you're actually in like an a scenario, like an an actual environment, okay, this is this scenario comes in, this is how I need to to do my job in the system. Um, Mm-hmm. and you're actually clicking buttons, and then it will respond to you, okay, this your your order has now gone to you know somebody else and and then and then from there

mmm

you see ok now here's the next step from that response now i have to do x so

mmm yeah

that is actually been very helpful we've seen we've heard very positive things about the learning labs because it is you know

mmm

it's not a live environment but it's a it's it's um it's sandboxed but it's a it's an actual

mmm yeah

virtual scenario.

Is that, can I ask is that staff intensive or to set those up or who runs those?

I I don't know whether it's staff intensive,

Mm-hmm.

um but it is run by VA, that is my understanding.

Mm-hmm.

Um I'm sure Doctor Evans can provide more information about that,

Mm-hmm.

um but we do know that that they have a very positive response to that. I do, I have heard just anecdotally that sometimes the learning labs are not available. like they go down from time to time and so that's not so some users have not been able to take Mm-hmm. full advantage of that because of those situations but again I don't I can't generalize that

Right.

but I do know that that is something that is effective um but I do think VA needs to explore more what Oracle needs to do to improve that training that Oracle provides just on the system itself.

Okay, that's helpful. Um, you know, the other things, and I think we've talked about this a lot in the subcommittee, is just um you know the oit team and this endeavor with the ehrm there's just more and more coming at them they've sped up the go live schedules and is there the staff capacity is there the capacity to ensure moving forward um that all of these go lives that are now being really expedited in a pretty rapid pace that the resources are there um to make them successful and i just wondered if you could spend a minute just talking about kind of how you view that do you think that or do you have concerns with that as well um share any thoughts

yeah I mean at this time we do have concerns about the acceleration

mmm

um relative to the current resources that they have I'm I'm concerned about staff burnout um especially like with the NESU for example they I mean right now they they say that everything is fine and they are they have um put in place I wouldn't say workarounds, but like they're doing more um like virtual intervention uh versus

Mm-hmm.

in-person to kind of give those traveling nurse corps uh, you know, a break so that they can be with their families.

Mm-hmm.

Um but I would also say that um, you know, with um you know, with with with with the the system itself again, I VA needs to sp- the VA workforce um needs to be evaluated. We're currently looking at at it but i do think the acceleration will um will will spread them very thin and so for yeah example with oracle cerner they're there at the sites for i think one to two weeks after you know all the go live work is done and then they leave and we have heard mmm mmm anecdotally from folks that you know it's they wish that they were there for longer mmm and when you accelerate that pace they most likely you know will will be there for a shorter amount of time yeah Um,

Okay.

but but again, it all of that we we need more information from VA as to their plan of action for when the acceleration takes place.

Okay. Thank you. I yield back.

Dr. Dexter. I apologize, I apologize, I went the wrong way here. Represent

Thank you, Mr. Chairman, um, Ms. Harris, the um, the GAO reported VA had not fully implemented the daily data quality performance measures. Um have unresolved data quality issues affected continuity of care or patient safety during this past years ago lives?

Um we have heard some data migration issues occurring in Michigan for example, um where there has been an increase in manual intervention to make sure that that um the the data is there f- for example with referral management, I believe that referrals the the information there was was um the most current information about a patient was not easily accessible for the clinicians and so they've had to have manual interventions to make sure that that was more apparent. Um and I know VA is working on that issue currently, so I would say that with data ma- you know, the data quality, that is something that VA is, you know, they're they they are aware of it and they are currently managing that issue.

Thank you. And uh based on this year's deployments, what additional oversight mechanisms beyond GAO's uh recommendations um should Congress consider imposing to ensure transparency during the accelerated deployment?

I mean, I think continued hearings like this has been very effective um to ensure that VA and and Oracle Cerner are are um held accountable to the plans that they have in place. Um I think that would be a very effective effective measure for sure. But also, um, I think your your assistance in getting GAO the, um the underlying cost and schedule information, if that does exist, um I think that I think we would appreciate your your help and partnership in that.

Okay. Um, and another quick question here. As of yet, um, VA has not submitted or has not submitted or built the integrated master schedule. Yeah, um how important is it for Congress to view this product in order to understand milestones, specifically, and keep contractors accountable on on performance metrics?

Well, it's very very important for GAO to to see that and have our in-house schedule experts um take a look at the integrated master schedule that the VA has produced. I did have a you know off-line conversation with Dr. Evans after the first panel and um and did come to agreement that it would be helpful for our experts to sit with their scheduling experts to take a look at the schedule together in real time. Um, but it is very important that we receive that because otherwise we cannot know whether the completion date of twenty thirty-one is actually reliable, or whether it will push to the right.

One more, um, JAO recommends that um recommends VA to establish independent operational assessments before each go live and to our understanding VA has not shown GAO a complete review yet. Um how has the the lack of this assessment impacted twenty twenty six deployments

Yeah.

and what should the committee be concerned of as um as VA accelerates their uh modernization implementation?

I mean VA agrees with this recommendation in principle, but instead of actually doing a formal operational analysis, which is what DOD did, in deploying the MHS genesis, uh which is the the the Oracle version within DOD. Um instead of performing that analysis, what they are doing is that, you know, they they have more more boots on the ground, I believe is what Doctor Evans would probably characterize it as, in identifying issues um in real time as best they can, leading up to go live. Th- there's much more intervention, I think that's how he uh VA c- would probably characterize it as their mitigation or - or substitute for an actual analysis this way. Um once Go Live hits they - they believe that they are in a position to know all of the issues that will occur um at Go Live. Do I think that that's sufficient? That's okay. Time will tell if - if that is, again we wanna see more results from from Michigan coming out as well as you know Ohio and Indiana to see whether or not that is an effective way to go but I will say that having that operational analysis for MHS genesis on the DOD side of things allowed them to ramp up and escalate very quickly um and do so successfully

well thank you very much for your time being able to fit in four questions and still have ten seconds over is not common for any committee hearings so I appreciate your concise and direct answers to the questions and with that, Mister Chairman, I yield back three seconds.

Representative Gudlander.

I was really confused.

Thank you Mister Chairman, and thank you Miss Harris for being here today. So, I I just want to ask what is a realistic time line for the VA to produce, you know I'm looking at this very reasonable list of priority recommendations, in your judgment what is a realistic time for the VA to produce an updated and independent total life cycle cost estimate, and of a an integrated master schedule.

I mean, to to develop an a comprehensive reliable cost estimate, it could take months to do. Um, we have no visibility into the work that they did to arrive at the fifty-six and a half billion number.

Mm-hmm.

Um, but typically for a program of this size and magnitude, one would expect quality information coming out of perhaps, you know, six six months' worth of work.

Thank you for that. It - in light of this, it - has - has VA given you a reason for not producing these two most basic submissions for anyone to be able to evaluate this p- this line of effort?

I mean, from what I have seen, I think VA believes that what they provided to us is the the comprehensive full-on life cycle cost estimate I don't think it's in their letter I mean they keep

I- in their letter of from twenty twenty five?

citing that letter the the contents of that letter as we have a cost estimate. Um there may be things that have been lost in translation as part of our request of the underlying basis for those those numbers,

Of course.

um but but I mean I Yeah, you we would expect whatever they use to produce those figures, that's what we wanted to see. I thought we were very clear at our request for that.

Uh, it seems pretty clear to me. I mean, crystal clear in fact. Can can Congress or the American taxpayer meaningfully evaluate whether a twenty-seven billion dollar or seventeen billion dollar increase in the overall contract ceiling is necessary or reasonable or even adequate without this underlying

no

no

no

in in your experience how long have you been with GAO

um for over twenty years at at this point

is it common practice to redact critical numbers from a contract modification

no once a contract's modification has been completed uh we typically see the the full numbers or there shouldn't be anything procurement sensitive at that point

so this decision to to redact key numbers in this contract modification of August eleven, twenty twenty six, highly irregular in your judgment.

Yes.

M- Ms. Harris, I I wanna ask i look y y your list of priority recommendations are all seem very reasonable and important to me and pressing, but as you think about what matters most for patient safety, are there particular recommendations that you would highlight for this committee that we should be focused on? We will be focused on all of them, but in your judgment what are the most important with respect to patient safety?

I think that um the training piece is uh critically important as well as, you know, the the organizational change management um metrics that we expect to see and we expect VA to continue to monitor so that they are meeting the goals that VA have outlined. Um and if the actions that they are taking are not I I mean if if if they are not meeting those goals then VA should be evaluating whether the current actions that they have taken are actually effective or they if they need to pivot. Um, as Doctor, as General Bergman said, I, you know, we need to continually um refocus and and alter and and tailor where necessary. So we wanna make sure that VA hits those targets. So for example, with user satisfaction right now, there have been improvements, you know, from the initial rollout of like seven percent of users saying that it's an it's allowing them to enable um high quality care and now we're at about thirty six percent um but VA's own target is fifty six percent and so we wanna make sure that VA is able to hit that, especially if they're gonna accelerate the the deployment hitting those numbers sooner rather than later is a good thing.

Miss Harris did you have the opportunity to review Oracle's written testimony for this hearing today?

I have not.

As you sit here now, are there questions that this committee should ask of Oracle? And if so, what questions do you believe are most pressing?

Um, well, I I do think that understanding the basis for the twenty-seven billion dollar, um, total ceiling is important. I think understanding from them exactly what they intend to do to ensure that it will not go over that number and that they will, um, that they will deploy by twenty thirty one is important and if there are risks that they believe or if there are cost drivers or risks to those deployments um what those are because if again if if the costs are drive are driven up or if or if the the deployment's pushed to the right I mean that impacts the taxpayer and so we need to know and you need to know in order to effectively oversee the contractor as well as VA

Thank you, Miss Harris. I yield back.

Representative Kiggins.

Thank you, Mister Chair, Miss Harris, VHA is undergoing a significant reorganization of its central office, affecting reporting lines at its central office. As reported previously in the JAO's high risk listing for VA health care, senior executives in VHA's office of digital health and strategic investment management were designated with co-leading IT initiatives and the VHA's new organizational structure what components,

I wish I could answer that question. It's still t we still don't know. We're still waiting on VA to um to outline what what that is. Um

Do you kno- do you know when we might know by?

I I don't know. Hopefully they will have that soon because uh um a change of that magnitude, obviously um combined with an accelerated deployment um, you you would think that that information should be done should should be received sooner rather than later.

Great, we'll be watching for that. And then also, the VA has an array of systems and tools that comprise the complex environment that supports scheduling appointments, managing referrals, and monitoring wait times. Schedulers at the facilities that have the new Oracle health system have an additional set of fourteen scheduling systems and tools available to them. In its accelerated deployment of the new EHR, how is the VA ensuring the EHR integrates with other legacy systems or tools, such as those used for scheduling medical appointments?

We still we still have work that we need to do to fully evaluate that. Um, I am concerned with the the the higher number of systems because the VA's schedulers are already having to deal with dozens of systems on the the legacy system side of things so um having to

Mm-hmm.

to do both during the transition period or even just within the Oracle Cerner. Like if once Go Live has already been made, uh dealing with fourteen systems is is quite complex.

Yeah.

Um so how VA intends to deal with streamlining that process so that um veterans can get in um to their appointment and you know have access to to the health care that they need um efficiently and quickly is very important. So definitely a a very large question for VA.

But ultimately you are hoping that this will improve the scheduling system, obviously, and and some of the challenges we're seeing with the legacy systems,

Yes.

this new the new H EHR, the new scheduling is going to be better than anything we've been using traditionally,

That's that that that's the goal.

correct?

I mean, the in the legacy system it is a very labor and resource intensive process.

Yeah.

So with the new system, We would hope to see it more streamlined and less intensive, but given that they're having to deal with fourteen systems, I don't know if that is going to answer the problem of of labor and resource intensiveness.

Yeah. Right, and I'm sure there'll be a a period of gr growth and adjustment always requires it's not really uh it's it's hard to get a perfect rollout so we'll we'll be patient

Sure.

and we look forward to hearing about health outcomes just going forward and seeing how they have moved in the the positive direction of reducing wait times, and just the ease of scheduling.

So

Right, right, absolutely. Because, I mean, as what we have heard from from, you know, we we've not heard direct patient safety issues, but we have heard excess like having timely appointments at still as an issue that we've heard from um, you know,

Yeah.

from the work that we've done in Michigan and in Ohio, for example.

But you mentioned patient safety, and so a lot of those when we think of things like allergy and test results, and and your medication lists and all that, those those really key corners don't vital to patient safety. Those things are solid. We're we're not having any issues, okay.

We've not heard any any any patient safety issues to date.

Okay, good. I appreciate that. And uh let's see, I have one other question. The VA continues to maintain the legacy, you know, environment that we talked about, the VEASTA environment, which comes at a high price and requires ongoing updates to maintain operations and securities. What are the department's plans and timelines for decommissioning the VEASTA? what challenges are impacting these efforts.

Uh we don't we don't know VA's plans for decommissioning this uh um I think it's very important that um that you will press VA on the game plan for decommissioning it because it the legacy environment costs hundreds of millions of dollars on an annual basis to maintain, it's getting more difficult to um to to secure uh so so we wanna make sure that uh once once deployment all the deployments are complete uh that's that we are not carrying Vista for you know for a very long time we wanna make sure that that's that's turned off as quickly as possible.

Great. My time has exp has expired I'll yield back thank you.

Doctor Dexter.

Thank you, Chair Boston, and also the ranking member for again holding this hearing and and thank you again. I just wanna echo my thanks and gratitude for Ms. Harris, your work um helping us um have transparency and accountability with the GAO office. There is clear misalignment of priorities when the VA is pouring billions into a mismanaged contract while simultaneously letting go of physicians and staff. And as members of this committee, it is our job to protect veterans as well as protect taxpayers from fraud, waste and abuse. It is offensive and completely unacceptable that Oracle pulled out of this hearing. How can we hold an oversight hearing on this rollout without the prime vendor in the room? So I'm grateful to you, Miss Harris, from the Government Accountability Office, for your help providing needed oversight. Miss Harris, back in um December you testified that GAO had made eighteen recommendations as discussed with you by my colleagues and the VA had not yet implemented the majority of them and to quote you from then, quote, " until VA fully implements the priority recommendations, future deployments risk prolonging management challenges and users will likely not be positioned to achieve optimal usage. Ms. Harris, do you stand by that testimony today and does GAO remain concerned about the risk to veterans' health care and the taxpayer of proceeding with the future deployment of the Oracle system?

I do stand by those statements. Um, I also think that from December of from December of twenty twenty-five to today, VA has made some very important progress.

Yeah.

Um, I don't wanna dis- discount that for sure. Um, the rollouts have been much smoother than the initial rollouts. Uh, there's no doubt about that. Um, and I am very pleased that, uh, Mister Lawrence, for example, does, you know, he's been to every single one of those sites.

Yeah.

He, you know, there are like weekly conference calls and just within my time in Michigan, uh, the executives there have been very appreciative of the senior level of res- uh, uh, leadership. uh their presence. So I I you know I I do wanna make sure that that I I I say that. Um but I also think that um you know there's still a significant amount of work done, uh that needs to be done. The cost estimate is very alarming to me. Uh we need to get more transparency and visibility into that. So moving forward that as well as you know ensuring that the um the pace at which they are they are doing this yeah that's why we need to see the integrated master schedule because we wanna make sure that they have the resources necessary to carry this out

timely yeah agreed

otherwise this twenty thirty one date I mean it who knows if that's reliable or not

I totally agree with you on that and thank you for you know giving the VA the do that it has with the work they have improved upon um in panel one Doctor Evans stated that the VA did deliver the full integrated master schedule and comprehensive I think we've established that that's not true, it's that accurate.

That's right. What they provided to us was a list of sites and the dates that they intend to complete. That that's not a schedule.

Okay, great. And since twenty twenty the GAO has issued multiple reports on the EHRM rollout. Across those reports GAO's made those recommendations. We've we've talked about that. Um and I think we've also established that you are n- not confident in the cost estimate that we have currently.

That's right.

Today I heard um Mister Lawrence talk about the additional um seventeen billion for a total of twenty seven billion and mentioned an additional eleven billion ha- have you seen something with that documentation or with that information

We do have that letter that they sent to you all as well. They sent that same letter to us.

Is that the September twenty twenty five letter?

Uh correct correct,

Okay, great, I just

so that eleven billion from that letter is those are the sustainment costs. So it's the development costs of the thirty thirty seven point two plus the eleven,

Okay.

which got you to the forty eight. However, in that same letter there is an additional eight billion um for sustainment costs.

Okay.

So their their actual total cost that they are projecting is fifty six and a half billion. But again, in that same letter they state that that's incomplete.

Okay. And just being mindful of time, uh, Ms. Harris, in light of everything you have seen, do you think the increase of seventeen billion dollars is a good use of taxpayer dollars?

I mean, I we need more transparency into into the estimate itself. I mean, certainly our veterans deserve a modernized health uh health record system.

Agreed, agreed.

There's no doubt no doubt about that, but we need to make sure that um that the the project controls in place are solid.

Great. And, Ms. Harris, are these concerns that I share with you sufficient to warrant a pause of the program so that the VA has time to produce a reliable cost estimate?

I don't know if, I don't know if a pause is necessary, but certainly it's worth exploring whether we go slow to go fast.

Great. Thank you very much. With that, I have my time's expired. I yield back.

Thank you. Miss Harris, thank you. Uh, we appreciate you, uh, as e- each member said, thank you for being here today. I'm going to, you're dismissed to go. We are going to, uh, the the committee is going to go into a short recess because as we have a motion, we were not intending to vote uh today, uh so we're still trying to figure out are we going to bring out buttons, are we going to go to the old system and how do we do that, uh along with negotiate uh talking with the uh minority uh to figure out where we're gonna go with this. So, if everybody can just stand by.