Hearing of the Senate Committee on Veteran Affairs - Update on VA and DOD Cooperation and Collaboration

Statement

Hearing of the Senate Committee on Veteran Affairs - Update on VA and DOD Cooperation and Collaboration

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SEN. ROGER WICKER (R-MS): Thank you, Mr. Chairman. I appreciate the fact that Senator Isakson and Senator Tester talked about the progress that's being made. And certainly when good things are happening, they ought to be mentioned and credit ought to be given where credit is due.

I do hope we can -- having said that, I do hope we can spend some time in this hearing today talking about a real frustration of mine. And that is the slow progress being made by VA and DOD with regard to the interoperability of medical records and the seamless transition of health information technology, electronic medical records from the Department of Defense to the VA health care systems.

My understanding is this has been a 10-year process. Ten years ago the DOD and VA began pursuing ways to share data in their health information systems. But today the information across different service branches in the VA still remain a mirage of data with pockets of progress and piles of duplicative paperwork.

GAO evaluated the progress last year and recommended that the departments, number one, designate one lead agency; number two, establish a clear line of authority; number three, develop a master plan with agreed-upon milestones.

In October of last year, I was ranking member of the VA-MILCON Appropriations Subcommittee, and DOD provided me with a summary of progress on these recommendations which basically set forth that, number one, DOD rejected the need for a lead agency that had been recommended by the GAO.

Number two, said their line of authority was basically as good as it gets for bureaucracies. And number three, said that they are developing a master plan, but their timelines and priorities within it are likely to shift.

Now, we responded -- this Congress responded with language in two Appropriation conference reports. The language from the conference report in the FY '08 Defense Appropriations Bill said this, electronic medical record interoperability.

The conferees direct the Departments of Defense and Veterans Affairs to issue a joint report to the congressional defense committees by March 3, 2008, detailing the actions being taken by each department to achieve an interoperable electronic medical record, EMR.

The report should include, but not be limited to the detailed spending plan for the use of funding provided in the joint incentive fund as well as identify all ongoing and planned projects and programs, a master plan, if you will.

The language from the conference report of FY '08 MILCON-VA Appropriations, the conference reports was similar. The appropriation committees, House and Senate direct the Departments of Defense and Veterans Affairs to issue a joint report to the committees on appropriations detailing actions being taken by each department.

The request, the directive, March 3rd and April 1, was explicit, neither one of those dates have been met. Now, two weeks ago, my office contacted the VA and DOD to check on the status of these directive reports. We were told in response that the departments were finishing up an interim report to explain why the progress report has not been finished.

But also we were assured that the master plan would be completed by April 30th, a date which is fast approaching. I still have not received an interim report detailing why the progress report has not been submitted. And I will say to our distinguished panelist and to my fellow Senators that I am disappointed and frustrated at the lack of attention to an explicit directive by the Congress.

So I would hope that we'll have an opportunity to discuss this, and to talk about what the departments need from this Congress to move forward on a system to develop an electronic medical record that can be used by the serviceman when he is -- he or she is in the DOD, and can seamlessly transfer over to the veteran when that veteran comes under the jurisdiction of the VA.

Thank you, Mr. Chairman.

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SEN. WICKER: Thank you, Mr. Chairman. Just to immediately follow up, Secretary Mansfield, this group that you have set up that you are speaking about a group that is going to deal with the specific issue of a seamless, common, mutually accessible, electronic medical record. Okay, and who is going to be the head of that group.

MR. MANSFIELD: Senator Wicker the National Defense Authorization Act, section 1635 established a DOD Department of VA Interagency Program Office, and with requirements for them to move forward with timelines et cetera.

So we have now moved to the point where we have got that office being set up and individuals dedicated with lowest -- (inaudible) -- and as the program office director and Cliff Freeman as the acting deputy director that is the person from the VA.

SEN. WICKER: Okay.

MR. MANSFIELD: So both departments are recognized in the establishment and leadership of this office.

SEN. WICKER: All right. So Dr. Chu, when you responded to Senator Tester that we are near the goal line, that's really just an interim goal line. Would that be fair to say?

MR. CHU: No sir, it's a goal we've had for sometime as you have observed to make it possible to exchange on electronic basis, everything, each agency has electronically regarding health. And we are going to get there, so that you can see what VA has about a patient and we can see what -- and be able to rehab our patients by 30 September. Most of that has already done. Anyway the program office is about okay what does the future look like and what --

SEN. WICKER: Right that is right.

MR. CHU: And beyond that and --

SEN. WICKER: I really that certainly is my goal which is a much more complicated and long-term goal than what you will be able to achieve on September 30, which is sending records back and forth. That is not -- I don't view that as an ultimate solution, but let me ask --

MR. CHU: Nor do we, sir. I don't think we have a quarrel on that -- (cross talk) -- important achievement and we will make it possible for the clinician to look at the data, that is really where I think we need to be immediately, and Senator Tester asked about something that has been of great importance to the commission and that is the discharge summaries, which are now viewable electronically by the clinicians on both sides of this agency scene.

SEN. WICKER: Well, congratulations on that. But let me ask Secretary Mansfield and Secretary England this -- I went ahead and discussed my frustration at length in my opening statement. The departments were directed by the Congress to report back with a detailed master plan on actions being taken to achieve an interoperable electronic medical record.

And when I have -- by a date certain, March 3rd, on the part of the Defense Appropriations Bill, and then look on VA April, 1. Either one of those dates would've been fine.

But, do you view it as acceptable that we have not received such a report and that when a senator and -- I take no personal affront in this, but when a senator and his staff contacts the department and we are told that a temporary report should be forthcoming explaining, why the departments are late on these two requests, and we haven't even received that, so I'll let you comment on that.

I don't want to fight and fuss but it does seem to me that the department should be responding to the directives of the Congress.

MR. CHU: We agree sir.

SEN. WICKER: I actually was directing my question to Secretary England and Secretary Mansfield.

MR. CHU: I'm sorry.

MR. : It's okay. This is a response by Dr. Chu in his reports -- (cross talk) -- he has in his responsibility. No, we do take it seriously and we are working and I believe we are a day or so away from getting that report Senator, so it is very close -- (inaudible) -- we are very close on that report.

MR. : Let me recheck, I thought we had sent one of the transmissions that you cite but let me recheck that point. We certainly --

SEN. WICKER: We received nothing.

MR. : Let me check.

SEN. WICKER: Well, Okay Dr. Chu, how will this detailed report be submitted to the various committees and to the Congress?

MR. CHU: They are in the normal -- (inaudible) -- sir. We transmit it over the safety of the public official, that could be myself, probably would be in this circumstance. I think as you cited, the important date here is April 30th, when you want a fuller report, but let me check on what happened to the interim reports. My recollection is we did comply with that, but I could be wrong on that point.

SEN. WICKER: Secretary Mansfield, I'd let you comment on that, do I have a -- (cross talk) -- to be concerned?

MR. MANSFIELD: Yes sir, I think you do.

SEN. WICKER: That the date was not mentioned?

MR. MANSFIELD: And I'll make the point that I know Secretary England and Dr. Chu feel the same way I do, that we should make every attempt to comply with the requirements put on us.

I do know that part of the concern here was the passage of this bill, and the time it took between the first time the dates were identified when we actually got it, the other part is, this is a vastly complicated area with two separate systems as you know, one in DOD and one in the VA, and the effort to make them compatible and work together as an interoperable system, is not a simple task and it has a lot of high-level IT people working very hard and long hours in an attempt to figure out how we can do that.

As DR. Chu indicated, we've come forward and are transmitting more and more information that will allow the clinicians to use that to do a better job of treating the patients and that remains our goal. But we have to also deal with some of the realities involved here.

SEN. WICKER: Dr. Chu, will the report include timelines and an ultimate goal of actually reaching this interoperable seamless type of electronic record that can move back and forth between the systems?

MR. CHU: That is -- (inaudible.)

SEN. WICKER: And this report that I am going to be allowed to see within a day or two, it is going to have those timelines?

MR. CHU: I believe the original statute requirements for that report by April 30th, let me look at what happened to the interim products. I apologize if we did not deliver on time, which was not our intent to deliver these things on time. And so I'll check what happened to those transmissions. But the final report yes sir, it does need to address the various statutory directions.

MR. MANSFIELD: Senator, if I could also add, let me also make the offer I just made to Senator, because I think there is maybe not a full understanding of what we are doing today and what we will do by September 30th.

You know a lot of medical data has already been exchanged, there will be a lot more, come September in terms of medical records and the question is, for interoperable, what is it that the doctors may need in addition to that, that they can act on?

And so that requires literally, some consultation discussion in terms of what sort of data would be available that doctors may want in addition to what is being made and also how are those records then modified, who has the right to do that, what's the process to do that.

Because obviously, the doctors in each side, and so what are those kind of procedures, but it maybe useful frankly, for us to spend some time with you and discuss this in terms of where we are, and maybe perhaps what your vision is, as this goes forward. Because I think for us come September 30th, we will have a lot of these processes in place, a lot of this data being exchanged.

And then the question will be beyond that, what is it that you know, the clinical people themselves need to do in addition to just receiving data between our organizations. And so, whatever extent -- you go, perhaps, you know, further describe that, that would be helpful to us.

SEN. WICKER: I am way beyond the time. I appreciate that offer. And I would simply say this, that staff-to-staff, we have been actively engaged with both of your departments in this respect. And we have been having a continuous conversation of this area, which I believe is very important to the servicemen and the veteran, since we became engaged in it last year. So I appreciate your invitation and I thank the Chair for indulging me on the time.

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