tv VA Secretary Testifies on Electronic Health Records CSPAN July 16, 2021 3:34pm-5:27pm EDT
about his own life. the national book review rights "he's not written a memoir so much as a report from the front, make that many fronts, of the great news events of the past half-century." we talk to him about his time in vietnam and soviet union, among other things. announcer: the reporter in publisher on this episode. listen at c-span.org/podcasts or wherever you get your podcasts. announcer: veterans affairs secretary dennis mcdonald testified about monitor -- health system. the committee also heard from v.a. deputy inspector general david case.
hours. >> if my memory serves me correct we've got another boat yet to vote on and votes in a bit? >> the second most used called i just voted on. >> great. i haven't. so since i already know what he said since since of righty i may leave. [laughing] >> you read every word. >> if you can pull that off that would be great. [inaudible] >> you did say that? okay. the commerce v.a. hearing to order. good afternoon. i want to thank you all for being a today, and special thank you to the secretary of the v.a., thanks for being here, secretary mcdonough. nearly nine months ago the v.a. rolled out its new electronic health record. at the time v.a. officials describe the rollout as
flawless. former secretary said it was revolutionary. boasted that we just pulled off the most expensive i.t. program in government history. he said we only heard crickets because critics from the critics because it had gone so well. well guess what. since a lot of the statements were made we're hearing from v.a. medical staff or demoralized by new system that is making their job far more difficult. we are hearing from gao prior to the launch last october which i might point out was right before the election, v.a. had not result of the critical and high severity test findings that could result in system failure. we are hearing that the v.a. office of inspector general and the v.a. had not reported to congress as required by law. all of the projected costs associated with it nationwide. that includes an estimated 2.7 billion in projected fiscal
infrastructure costs, additional billion in projected cost for i.t. infrastructure. that means the program could potentially cost 21.3 billion over ten years, not 16.1 billion as the previous a projected. that's 32% increase and by the way that's $5.2 billion. in january we heard from a group of senior v.a., vha leaders who visit spokane and said they found a dedicated and highly demoralized workforce. communications breakdown in the absence of on the grant program and vendor management and problems leading to patient safety risks and heart activity loss. we are also hurting from the ig that the dedicated v.a. staff in washington state were not given adequate training on the new program. these folks couldn't fully use it months after the goal line date. they were taught to pushbuttons but not actually how to use the new system with patients.
an acerbic only 5% of staff reported being able to use all four four core function of the new h.r. after training and two to three months of use. so while there are some who might describe this effort as a flawless rollout, i think most people would use the words alarming or something far worse. and, frankly, i for one am fed up with the amount of taxpayer dollars were spending on this program without any demonstrated benefits to veterans or v.a. medical staff. this simply cannot continue. we have literally been working on this for almost my entire time in congress and on this committee, 15 years.
and i need a commitment that congress will better respect oversight rule than it has the last few years. transparency and truthfulness, quite rightly, have been absent. there's simply too much at stake to get this wrong, but before i close i want to touch on one more final thing. in the current law, the deputy secretary has the lead oversight on modernization. the v.a. deputy secretary. despite advancing that nomination out of this committee six weeks ago, that position remains vacant, as i speak. because of what i view as political gains. this is six weeks in which of the v.a. has not had a deputy
secretary to manage this effort to protect taxpayer dollars and deliver for our veterans and the dedicated employees that serve them. so, i would remind those who want to be critical of secretary mcdonagh and this administration, to keep that reality in mind. but once we get mr. romney -- mr. remick confirmed, then we will take the gloves off. with that i will turn it over to the ranking member. >> i share your exasperation on this topic. it has been around as long as i have been in congress. and your point about a deputy secretary, i understand, will be resolved by tomorrow. and we will have someone specifically to deal with, responsible for the implementation of electronic health records at the department of veterans affairs. it's exasperating because the
potential of benefits that can accrue from this effort are tremendous. and it's potentially cost saving, but more importantly it is for the ability for the veterans affairs department to care for veterans. it's for our men and women to easily transition from active duty to becoming a veteran. the longer we delay, the longer we have challenges with the program, the less likely the veterans who are living today will benefit from this opportunity. so, while i have not prepared an opening statement, mr. secretary and mr. chairman, i would again offer my assistance, the assistance of this committee to see that we get this right. i am critical of the department, i thought the inspector general's report was very damaging and damning, and i hope that -- i have the expectation that secretary mcdonagh will
respond appropriately to correct the problems outlined in that report. i'm anxious to hear from our other witnesses as well. i know that mr. pabst and his organization have been through this and has expertise. i just would they that the challenges we have often with the department of veterans affairs involves its bureaucracy and i think we have conflicting aspects of the department that either are resuming responsibility or refusing to resume response ability on to be working together. for this to be judged a success, i think the pause is important for a strategic review that produces quality standards for electronic health records, gets our employees and practicing medical community trained, all this is important.
i just need to be convinced we have a roadmap to get us where we need to be and gain benefits that veterans will be able to attain because of electronic health records. so, i look forward to hearing the path forward from you, mr. secretary. and in the absence of the chairman, i would say that today's hearing will consist of two panels, in the first we will hear from secretary mcdonagh on the v.a.'s progress and findings of the strategic review and the department's proposed path forward. on the second, we will hear from external experts on the transformation efforts, challenges faced and lessons learned from the private sector. secretary mcdonagh, the floor is yours. sec. mcdonagh: thank you for the opportunity to be here, and for your steadfast support for our
veterans. before i get into that topic today, i want to highlight a crisis we are dealing with. over the last month, we have lost four of our dear colleagues to covid infection, spurred by the highly transmissible delta variant. we are seeing a surge of infections that has necessitated the deployment of dozens of disaster emergency medical personnel to supplement our workforce. a level of deployment that mirrors prior surges and warns of what is the common. thsi underscores the need for everyone to be vaccinated, especially our v.a. personnel, to keep her veterans safe. back to today's focus. i appreciate the opportunity to update you on the initiative to modernize our electronic health records. the mission of the hrm has always been to create a platform that delivers the best access and outcomes for our vets, and best experience for our
providers. but as you, members of the press, oig, gao and others have now rightly noted, v.a.'s first and limitation of the program, which occurred in 2020 at a medical center in spokane, did not live up to that promise, either for our veterans or for our providers. this has been exemplified by a story i heard from one of our great pharmacy staff. a a few months into it and limitation, it began hearing reports from mail in pharmacy teams, from the team, that they were receiving duplicate prescriptions. the issue was that the veteran'' old prescriptions were not automatically being canceled when new ones came in. recognizing the threat to patient safety, the team immediately collaborated across the v.a. to create a workaround
to eliminate the duplications and nature that our veterans did not receive more medication than necessary or safe. those efforts were largely successful, but also demonstrate the length to which are staff in spokane had to go to simply do their jobs. on top of that, i heard from another clinician that help with the new platform was not always easy to find, even when asked for. when she called the helpdesk, the person told her he had just started a week prior. in other words, she had more experience using the platform then the person who was supposed to help her navigate it. stories like that are what led me to launch the top to bottom review of the program. among other challenges, the project was being run in an organizational silo, meaning relevant stakeholders did not
have a chance to shape it success. the ig report found no evidence that our health care experts at vha had a defined role in oversight or decision-making of the modernization project. there's also a lack of testing and training for a real-life clinical environment. for some providers, the first time they used the final program was the day it went live. these findings are extremely disappointing. but the strategic review provides reasons for optimism as well, because i also found we have what we need to succeed, starting with dedicated employees. most challenges were not breakdowns of the technology, nor of the great people who did the best they could in the worst of circumstances, implemented the program in the heart of a pandemic, shared findings that improved the system and insured our veterans were safe, despite the challenges they faced.
instead, the mess ups were ours at v.a. and now that we have identified the problems, we can solve them. as a result of the review, we are reimagining our approach to the system, establishing an enterprisewide effort led by our deputy secretary, who we have just discussed, and i am grateful for the chairman's work to get him confirmed this week. this structure will incorporate the perspectives of clinical, that a call it a financial leaders, guaranteeing that everyone who builds the platform will work in concert with one another from day one. second, we will shift from site by site deployment to an enterprisewide readiness and planning approach. this means we will deploy the program based on evidence of readiness, evidence of which sites are most trained and technologically ready, therefore
setting each site up for success. we will create a fully simulated testing and training environment , so veterans can properly evaluate and learn the system before it goes live, not during or after. by making these changes, and the others in my written testimony, we can and will get the effort back on track. that means buildinga system where veterans are able to access the records in one place, from the first day they put on their uniform to the last day of their lives, a system that helps them receive care anywhere. whether it is from dod, the v.a. or community providers, without worrying about paperwork or potentially harmful -- in records. a system that helps providers understand injuries so they can provide the best care possible today. that's the goal and i know that many folks are concerned we cannot, or won't, get there.
but we can and we will. we are now in a position to move ahead as one unified organization in partnership with the dod. as senator moran suggested, sensitive to congress's oversight role, to deliver a system that improves the outcomes for our vets. and that is exactly what we are going to do. so senators, senator murray, senator moran, collects them think the deputy to appear here today. i look very much for to your question. >> secretary mcdonough, thank you very much for chess money. according to the inspector general of the d failed to report the programs to cost to congress as required by the veterans benefit and transition act of 2018. what actions have been taken to correct this and what steps has indeed taken to hold those
responsible? >> so we have taken beginning steps to ensure that we, as ig recommended, are in a position to provide full lifecycle estimate, the cost of this program to the we were going about it including by taking a readiness deployment method rather than a geographically based or time-based deployment effort will allow us to do a better job of that. so we are getting to the bottom of the facts. we're going to deploy based on the facts. i will continue to report regularly to you on those facts, and as to the question of accountability, as that and then another finding mentioned to you recently i was in friday's inspector general report, , whih suggested unwillingness to provide potential information to the ig, i won't run an organization that withholds
information from congress or the ig. so if i find that to be true there will be consequences. >> mr. secretary, electronic health records modernization programs organizational structure seems to me to be dysfunctional. i think that was indicated by the oig and each of the reports. the gl has also reported on this as well. i think this is the basic premise of the findings speak to any written testimony regarding the governments and mentioned. what was your reorganization of the program, and when will it happen? i ask this because based on your written testimony doesn't r anything is changing other than the title of the groups. >> yeah, thank you. you will see it. we do have it. it's not quite done. in all cases i want to talk to deputy secretary when confirmed because statutorily he is in charge of this and will manage this as a management question and is a budget question, and
statutes in vision. i would just ask forbearance to spend a couple days talking with him about it and then i next frequently happy to come up and show that too. i think you see significant change, including reduction of what i consider to be redundant positions. and most importantly clear accountability among each of us to one another and to you to ensure that decisions taken our decisions peppermints or i can see why you're anxious at the deputy position filled. it's concerning, i don't know i understand exactly what these words mean, but the result what you said was the result of strategic review you found persistent issues with the definition of what constitutes a patient safety issue. when can we expect to see vha's definition of patient safety issue, and when will it be put into practice? >> so there's a big question now
about how quickly we go to next, go live at the next sites. the next sites as envisioned in the record are vision at 20 and vision can come so basically and then pacific northwest. i hope to make a decision on that by the end of this calendar year. the question you raise about patient safety both defining it and identifying where concrete issues exist and importantly where mitigations are necessary will be the principal base on which i make that decision. the other two things i'll consider in that decision are access. we are seeing as i'm sure senator murray can report, access, questions as a result of ehr in mann-grandstaff and
questions round building or the revenue cycle. i think we get our hands around those this fall but i won't live at those next to sites point until i have answered those questions, including this definition of patient safety you are asking for. >> i had another question but 39 seconds i've left i would highlight what you indicated in your opening comments. my conversations with abyei official earlier this week in regard to covid-19 and the department of veterans affairs and particularly in kansas, the numbers are increasing, increasing in ways that are alarming. and i would begin use this opportunity to encourage kansas veterans, american veterans and americans generally to utilize the safety that comes by being vaccinated. and every day that goes by i think increases the chances that there's more risk for more people, including those who we serve, who served our country and who we care for in our v.a. facilities. >> thank you.
appreciate those comments. >> senator murray thank you, mr. chairman. mr. secretary thank you for being here and thank you for visiting mann-grandstaff in spoken earlier this year. i appreciate your commitment to sting involving these issues. let me just say back in 2019 i heard about and standing infrastructure issues and ongoing staffing challenges that can make limitation of this new ehr system at mann-grandstaff more difficult and elderly threaten patient care. because of those reports i caution the v.a. in january of 2020 in a letter to make sure a prioritized veterans access to care and support for their staff. though it was over your and half ago and these issues should have been addressed as you know. since the implication of the cerner program last october i heard like you just talked about a number of serious patient safety issues that could put our veterans at risk. and i'm also very troubled by
reports of exhausted staff are struggling to learn the system because of the workflow design issues, lack of adequate training. and i expect those issues to be resolved. i know you know that as well. i would like to ask when the strategic reviews completed i would like your team to give a detailed briefing on how that is going to help folks in washington state and i know you inherited it, this multiyear multibillion-dollar electronic record health modernization program and all the challenges that come with it but i know we can from you for this position because of your management skills and the ability to tackle heart problems. i know you know we need leadership to get this back on track. on the topic of patient safety i want to share a few examples for the committee that i've heard from clinicians and constituent constituents. that mann-grandstaff medical direct report in april 2021 hearing that 247 patient safety reports had been documented
since bill live, which is a troubling number to say the least. i heard of cases of veterans not receiving the correct medications and another cases medications that have been sent to incorrect addresses. i raise that concern about prescriptions during dod's botched rollout and i caution the about it. this could've been foreseen. whether those problems are because of poor data migration or flaws in the system, this has got to be fixed. its series and his problems need to be resolved. mr. secretary, i'd like to ask you who's responsible for reviewing the ehr flow design specifically for patient safety? >> right now we with patienty team on the ground, and so one of the things that came out of my visit if we set a team, patient safety came to spokane. we now have a patient safety team resident on the ground. at the end that they i guess my present today i'm telling you that i'm taking responsibility.
>> can you commit to reducing the system and giving this committee the results of that? >> yes. >> i'm also really troubled by staff burnout and patricia and i know you know this. when it comes to training staff for not being adequately prepared to navigate a system that makes what used to take just a few clicks now is a lot more complicated, providers are burning out as he tried to balance securing for the veterans which is the charge and navigating this new ehr system. how is the support staff do this transition working to keep morale up and avoid burnout? >> it's a perfect question. we do have consistent with the pandemic as well as with the added requirements of ehr some management incentives available to our team there. so we're making sure where you are using those. we are trying to be sensitive to
the many demands on the team on the ground. so we're trying to manage the obvious, obvious intense interest across the enterprise and what's happening there but we try to make sure people lap e distance to do their work. and then i also in trying to communicate directly as a did earlier today with med center director, dr. fischer, that they are not in this on their own, that we're in this together. >> i had extensive discussions with the v.a. before the rollout in spokane and i insisted that the v.a. had plans for medicaid mitigating the loss of productivity so veterans didn't lose access to care, increasing staffing in clinical space to compensate come making sure the physical i.t. infrastructure was ready and i was told repeatedly that everything was under control. yet the v.a. could not get additional clinical space. was enough staff or providers even before covid hit and it's
just one example if the facility had to put a tarp over one of the new servers to keep water from leaking on it and destroying it. as we transition to other facilities we have got to make sure that space and staffing and infrastructure and anything else you have a need before they go live. my time is out but i just want to say one thing really quickly. i was very disturbed from the leaders from the v.a. change management withheld from training evaluation data that was requested by the oig and all the other data prior to sending to the oig. the integrity and thoroughness of information provided by v.a. is required by law and it is critical to the oig's mission. so lying to come withholding information from the ig or from congress for that matter is really outrageous and unacceptable. i know you agree with me on that
i but i just want to say very clearly that i expect anyone and doing that to be held accountable immediately. >> yeah, i actually commit to that. i was struck by defining as you are, and i know you will hear from the deputy ig in the second panel but also know the ig is looking at that specifically. i will look into it myself. and if it's confirmed, obviously there will be ramifications for that. >> thank you so much to your attention to all this. >> senator boozman. >> thank you, mr. chairman and thanks to senator moran for having the hearing and the focus on this so, so very important subject. it's not a very glamorous one i think it's the key to getting the v.a. in this century. it's going to take a lot of work. i would also like fashion appreciate emphasis on the training aspect of things and
then as ranking member of the v.a. appropriations subcommittee i remain committed to providing the v.a. with the resources that you need to take care of our veterans. however, in order to be helpful we've got to have accurate costs and execution estimates from the department. last year the electronic health modernization, the v.a. system was allocated roughly $2.6 billion. this dollars. this year's request is for 2.7. mr. secretary was a be able to execute last years allocation? and then despite pauses in the program, i think he believed the funding request for fiscal year '22 is executable and appropriately programmed given what you learned? >> we were able to execute the appropriation last, from last year, so thank you for that. the request, we're not asking to alter to change the request for next fiscal year based on the
review. but in all cases, and as i said to many of you, i recognize importance of staying within the budget envelope that we have. i've said too many of you and i reiterate again today in public that if there are changes to that, we will be early and transparently before you. >> we appreciate that very much. >> you mention following the 12 week review of the program for training and technology will be a focus of the v.a. moving forward. without bite is receiving proper training, the program will fail to meet the goals of this modernization certainly. i appreciate the example you know of the person calling, and they knew more about the system regarding when they're trying to receive help. the other thing i was impressed with is the fact that you knew about that. you are the top guy and again that information giving up as
high as you and you taking that interest you because that's how we're going to get this solved at your level and again at the committee level. so, so very important. after evaluating the resources allocated to the first test site in washington where funding levels and time dedicated adequate and did they contribute to any issue seen with it training everybody? >> i think a principal finding, spent a lot of time at the ig report on training. i think, and we had a lot of feedback on training including the right feedback that got. i think there's just no doubt that the training was wanting. that wasn't -- do not believe that was a function of funding. i think i was a function of hobble the a range of things. i think it's very obvious that the pandemic wave into that. and basically you have a system that investigation is you
basically an elbow to elbow deployment of clinician with trainer. and when you are socially distancing that's not possible. so that's a big challenge. i think it's really important though going forward for us to learn the lesson that some more clinically relevant training is necessary in the lead up to go live. not just starting at go live. one of the things that you e in my prepared testimony is a focus from us on a more clinically relevant training module that will allow us to get more people through that anymore timely way so that when we do flip the switch to go live on for example, in these next two sites, more broadly in the upper midwest and senator brown's state and back in the pacific northwest, where people have had more time on the target
clinically relevant way. so that they can then intensify that training on the job. >> well, thank you, mr. chairman. >> senator hassan. >> thank you, mr. chairman, thanks to you and the ranking member for this hearing, and thank you, secretary mcdonough for being here today. i have three questions for you. the first one has to deal with veterans feedback. it was important obviously that the v.a. here about how the new electronic health record system actually impacts the veterans health care experience. and to build on the commerce we heard from senator murray, senator boozman, july 2021 v.a. office of inspector general report found that v.a. facility patient advocates did not receive direction or training to consistently track and report patient complaints about the new electronic health records system. so how will the vehicle about establishing guidelines, training and the method to
capture patient complaints about the new electronic records and ensure it implements improvements to address patient concerns? >> thanks thanks very much. working backwards, i think oig focus on patient advocates is really smart. i think that's, as a general matter i think an underutilized tool. they made some recommendations to us and we've indicated to them that will take those and implement those. directly relevant to your question. on the question of feedback more generally, this is an obvious point but one of the things we have to make a decision about is the portal into the electronic record. i remember being confronted relatively early, well, very early in my tenure or summary said judge make a decision on on the patient portal. i said why would i make a decision on the patient portal? i'm neither a patient there nor am i going to be using the portal.
what we did is we pushed that into our veteran experience office. they have just now completed a month-long review engaged with veteran patients on what they want to see in the various options of a portal. we look to as a general matter at v.a., and this will be a particular concern of mine, ensuring the question run usability are decided not by cerner and not by us but informed either user. >> okay, good. thank you. i want to go to a new hampshire specific concern now. new hampshire's going to one of the last states where implementation occurs. it's currently scheduled for 2026 and that seems pretty optimistic under the circumstances. that's quite a potentially create problems for veterans to move from a state like new hampshire that has a get implement the new system to a state that has. what's your plan for ensuring that the healthcare
professionals have consistent access to both old and new electronic healthcare records so there won't be gaps in care for medical errors from incomplete medical records? >> a very fair question. i guess what i would say is as indicated earlier, this question about the next two go live sites, vision 20 and ten, after we get past those we will be going to a system readiness decision-making matrix whereby will make a decision as to where to go next in which case maybe it's new hampshire based on infrastructure readiness. this is also a finding from the ig. training readiness, we're building this more clinically relevant training facility, and then change management or leadership readiness. so it could be that this is a long way saying that appointment schedule itself will change.
as a relates to ongoing training, we recognize that will have to continue to have an ability to walk back and forth between the two. in an ideal world that doesn't drag on for more than a decade after all we we've invested n this. >> i appreciate that. just focusing on future outreach needs so the system isn't caught short as veterans began -- veterans move around, we all do. i appreciate that. last issue is cybersecurity. it's a focus of my on the homeland security and emerging threats work ideal, hospitals are obviously a big cyber target. how is the v.a. prioritizing cybersecurity as it implements the electronic health record modernization program at its continued use of legacy systems. >> us we are continuing to make cyber fundamental priority. it's a personal priority of mine and i had basically regular
interaction with our system. also recently asked the director of the national security agency to come take a look at our systems to make sure we're in a position to be confident that our highest priority assets are well protected. i be more than happy to make sure given your personal interest in this i would have a regular back with you to assure you that we're asking the right questions and making the right decision. >> that would be great. thanks so much thank you, mr. chairman. >> senator rounds. >> thank you, mr. chairman. mr. secretary, first of all thanks for your service. i recognize in the middle of the rollout of a major system you find yourself coming in and defending and trying to explain major problems with it. i would like to have a conversation with you about it. let me lay out the concern and
the reason for pushing this particular direction. the v.a. oig has released a report regarding the training deficiencies with the new electronic health record system. employees who went through the training at the first hospital to use system were given a test afterward to see whether they had learn to use it proficiently. the data provided to the v.a. oig showed 89% of the proficiency checks were passed with a score of 80% or higher in three attempts or less. that was in the report. then, however, it was later discovered that the employees within the office of electronic health record modernization had altered this data. in fact, only 44% of proficiency checks were passed with a score of 80% or higher in three attempts or less. have you been able to determine
yet what was the reasoning why the folks within office of electronic health record modernization for altering the data? >> i haven't. it's obviously a particular interest of mine as of indicated a couple of times. i know the ig has gone back at it, to. so it's been particularly pertinent. >> i think it points out, i recognized anytime moved to a new system you have a learning curve. but part of learning curve requires integrity in the data. would you agree with that is all? individuals a mess with that and intentionally dishonor that responsibility, they make the lives of veterans at risk. i would hope that you would deal very sternly with that type of activity. i don't even think have to ask your commitment. i'm just assuming that would be
the case. >> correct. >> thank you. corresponds in the oig's report notes and exchange between the o ehr and staff regarding the altered data prior to its submission to the oig. in the corresponds the v.a. change management leader asked the v.a. director of change management, this is in quotes, do we need to add a bullet discussing the outliers or let it ride and offended if they ask? in response the v.a. director of change, o ehr in director change management replied, i'm good with basically said the changes, thanks. i'm concerned these employees once again willfully chose to literally not tell the whole thing and hide the information. i presume you're aware of it and i presume that will be part of the review you are doing? >> yes. >> and that will be dealt with. >> correct. >> thank you.
finally, this system, the cerner system, this was chosen in part because dod is also going to use it and so the idea of a transition should be simple to move from dod back into v.a. were hoping seamlessly. have you found that it is a near seamless transition for information, or is a substantially a start over again process? >> at the moment i'm told by the clinicians that all the data is available to an individual clinician, data from the dod, data pool, data from the v.a., data pool, and then data from care in the community. unfortunately, i'm also told it doesn't all populate the same screen at the moment. so that place -- and is not all apples to apples across those three data pools.
which is kind of the point. >> right. >> so one doctor told me today, reminded me today that the place where it's all aggregator is in the clinicians had. we always have got to get to the place where that's not the case. >> look, this is not something that we should be reinventing the wheel on. and then know when it was first put in, the intent was there was a commercially available product and that it would work, other systems were using it as well. if that's found not to be the case and if this really is to the point where it is not doing what was expected, i presume will hold them accountable and that we will find either a fix for it or we will count our losses and actually get a system that works? >> what i would say, senator rounds, through this review i have satisfied myself to the
answer of that question, which is i think the technology is basically sound. and i think as i talked with a number of you in different settings, so much of these technology questions in terms of execution really endeavor being governance and management challenges, which is why i think it is on me. i don't think we're going to find an answer that says i have not yet found at a do not believe i will find an answer that says that technology is wanting. this question of the three data pools. where the best data scientist in the government at v.a. and we're going to fix that. so -- and we're a learning organization. the part that is so troubling about the anecdotes that you and i are both focus on and the ig is focused on is that v.a. is i think uniquely a learning
organization that holds itself to a very high standard and performance. when the outliers like that it's particularly noteworthy. i guess what i'm trying to say is i don't anticipate changing this. i said that publicly and i say publicly again now. it's now a question of management and execution, , and that's on us. >> thank you. thank you for your answers. mr. chairman, thank you for the time. >> thanks for your questions. i would you say i agree wholeheartedly if there's people out there that are intentionally changing metrics within v.a., not only does he need to be held accountable for the people who oversee their positions need to be held accountable. senator brown. >> thank you, mr. chairman. mr. secretary, thank you. i've been on this committee for beginning my 14th year i think, 15th year, and i've never seen a v.a. secretary as responsive as you. thank you for your call last night may think you've done. i know chairman tester who came on the committee same day i did share so sentiments. you said the v.a. has the best
data scientist. i hope that tax commissioner has equally good data scientist to get the child tax credits checks out today, tomorrow and monthly. >> i think there's a lot of attention. >> i think so, too. i know we have seen since 2007 we seem v.a. have several ehr updated iteration before deciding on cerner. we know this project to challenge of your i hear from v.a. employees in spokane, your first thought it you will in columbus now about these challenges. there are concerns in columbus that v.a. facilities lack the proper physical infrastructure, server rooms, cables, hvac to accommodate the new system. any thoughts on that? >> yeah, i'm worried about that, too. the ig made that out quite
clearly for us. i will say that the ig gao, your letters, your interactions with us helped undergird the strategic review. i think we, our review confirms much of that. this is why i think it's really important to go to this readiness deployment posture rather than a deployment schedule that is tied geographically to dod. that was a mistake i think are two recent one, we're off kilter with dod anyway geographically. two, we did not, we're not in position to can't adequately prepare for the structural and maintenance requirements. as result ended up not being as transparent with you all as we should've been in the process. so, yes, i am worried about it. yes between now and would make a decision about go live in columbus will allow us to get to
the bottom of those concerns but we are also going to be doing that across the enterprise to make some determinations on who was ready when based on infrastructure, leadership and training. >> let me drill deeper. the largest city in my state, it's the home of the charmers why the facility. you know all this. it's not inpatient hospital which means veterans have to rely on local hospitals for inpatient care. maybe one threes what columbus was selected i'm not sure of that. walk me through the steps you take to ensure interoperability between mr. cerner and other hospitals and based on that review when do you think these issues will be resolved and go online? >> so we are in the midst of an aggressive process to get to columbus prepared for deployment and that's been going on as you vindicated now for more than a
year. that will continue appear we are taking, because of the ig investigation, a particular look at infrastructure and make some determinations about readiness. i also indicated earlier there are three big questions remaining about the experience in spokane that i need further clarification on before i agreed to go live in columbus. .. >> this was in columbus. thank you. >> mr. chair man, secretary denis mcdonough and thank you for meeting with me we could go on friday, that was good information and good pretty to this meeting read when you not talk, it sounded like the kind
of the problems that large enterprise systems encounter and so i would expect the next generation, your readiness assessment and just ask a question about that or are you going to be in a position where you have got a one or more facilities you could implement and so that if columbus is not ready, you could move to one if it needs or meets the criteria for your assessment. assorted to the right pretty. >> normally the answer to that would be yes and one of the things really appeal to me about this readiness assessment of the deployment postures it draws on something i witnessed in our operation system of how individual facilities are handling the pandemic. what is really interesting is the date: 10:00 o'clock, the directors from all around the country, sitting there and comparing performances with one another which is really good
information but interestingly, it's pretty competitive group. if we have a scenario where inside of this now increasingly integrated system, there is competition for readiness because as the senator's just sit and could suggest progress in the technology and if there competing on that, i think that is a good thing at the end of the day. >> so part of the readiness assessment is also leaves in proficiency of the sandbox that you're creating. correct and i want to go back to the inspector general's report particularly with respect to questions that senator murray and senator brown's asked. in a cynical view could be that you had people in the process they were doctoring the records and inflating the preparation and readiness from limitation up in the northwest.
to what extent could some of these failures have just been systematic, what extent are we talking about somebody did not do the job. and to what extent could there have been process errors that led to some of the misreporting of information. >> has a general matter, i think that the people have been carrying out this effort are unbelievably earnest and doing it in a very difficult scenario. and with a very focused so i start from the proposition that i think that whether it is systemic or process reason for this that is where i start but, the enormity of that concept is such as now several of you have suggested that it would to get to the bottom of that to answer that question. >> that is what i wanted to ask you, he may have somebody who acted irresponsibly the my
experience with reviewing test problem reports and readiness assessments when i was doing things of this gal that you're talking about in the private sector, that you can find a lot of that is a combination of process felt. which is why it wouldn't mother people out there working today getting ready for the next deployment to think that this is some sort of a witch hunt for bad actors my guess is that you're going to find maybe some bad actions but probably some processes need to be tightened up and look forward to see more reports on that. >> implementation come the longer term full implementation implementation, how far as the shifting to the right from the last appointment to visit. >> do you think there will be made up for lost time pretty. >> i want to be careful to not overpromise there is a logic to it but i guess before kind of getting over my ski tips
terrible to make sure that we can dig into the readiness stuff to make the determination predict. >> but it was kind of hard when you're dealing with the first generation you have a lot of other things to have limited but what are the things when you all going through this decision, there were a few other platforms at the department was working. we also recognized that this is rep one. and rep two is a gets into some of the more exciting things were you saw the white space and you have other things that add value to the clinicians in the veterans and the men and women transitioning from active status reserve guard status into veteran status. are you already thinking about what version two and what the northwest looks like in with the janice pretty. >> i think most importantly the clinicians are things that are to be honest with you, i can think of a lot of things i guarantee i would not be a great value added in that exercise but what i do know is i spent time this afternoon missing directors
on this and i see them thinking this through and is here clinicians thinking through the possibilities here and i think that's the exciting part of it. >> and drive up adoption and people embrace if they see that vision for what you can build on the platform and you're probably going to find out successful conditions. and i have other questions predict i'm only when asked one, has to do in the pitch. >> the announcer said it was a strike. [laughter] okay. >> friday afternoon in charlotte on friday afternoon predict. >> that was enough pitch. [laughter] [inaudible]. >> thank you for being here today. the reports have pointed out the mie continuing misrepresentations to congress
and you've got the cost estimates in the employee and things that we have discussed here already and this hearing. and of course we all want to get us moving towards an electronic health record is to be seamless. from the day the 70 less to the last day of their life as a va the me ask you this. with the inadequate and been voided out, has anybody been removed from their position. because of the findings. >> no, not yet pretty. >> and why is it not happened if you have trouble with the talent pool in the training to send this up and why are we not doing that card. >> as i have said i find that
any suggestions of withholding information for not being fully candid with congress i consider to be uniquely important developments so i'm going to the bottom of those under the ig is also you will hear from the ig yourself printed i'm told that they were following this up directly themselves that i have confirmation of that, yes that would be consequences. >> so we can expect accountability to be forthcoming pretty. >> yeah and i am here because they expect you will be accountable. >> to me ask you this, the overview, the report you exhibited to us is an overview but not a copperhead saved strategic review, correct pretty. >> there's a lot of different parts of the document and i've a lot of different documents that we generate here but we provided you with our lessons learned and we will obviously as i indicated earlier be talking to some of our management changes in the coming weeks.
>> so when should we expect that full review. >> for the questions about how going to structure govern and manage the program, will be coming to the soonest donald is confirmed it was time to sit down and talk to him and i think i oh that to him and i want to talk with him and then we will come talk to you guys. >> and then talking to the senator bozeman you made a comment, it because change and were talking about the system that is oig had already tagged $5 billion to that so you are anticipating additional cost, is that what i infer from that pretty. >> no, you may have been for something they did not imply in the ig cited a series of technology upgrades that are necessary at the facility
sprayed in the maintenance upgrades necessary at the facilities. and we as part of the readiness deployment schedule will be looking at that across the system i think it is very fair point that they raised in fact it helps informs the decision we made to go with's readiness standard. as it relates to what the senator boozman was asking about specifically about the monies in our view is that money, my view is that money has been executed this year and we just got the last quarter from the treasury read and they have been the appropriations committee and we are not changing next year's request either. we think that is ample pretty. >> okay let me ask you if it is not able to meet your quality
standards, we talked a couple of times this hearing about metrics changing so if they are not able to meet your quality standards soon, what is your plan beat. >> will lead to the real hard look at that and that is a technology and have no reason as i've said publicly, we think that the technology is sound that the remaining challenges, there are technological challenges for us to fix including new data questions that we just discussed but really what we face here management structural changes, governance changes. >> thank you mr. chairman. >> thank you. in alabama, hope your trip went well alabama. and i will say this, after being here for five months, get more
calls about the va a know it's not your fault to this point were not going to blame you to this point but, your situation it reminds me of me taking over a football program when i did not have a quarterback in offense of lineman everybody wonders why. it was not my fault. but, thank you for being here in answering this questions. i just got one question here for you. image of the government management changes to the hr program. i'm concerned about who is leading the governments of the management of your digital modernization, the medical logistics system, the financial accounting systems and all the systems have to work together. how are you going to ensure we don't get set aside from the hrm pretty. >> a very fair question. and we are undergoing really three fundamental technological
upgrades the building right now, the electronic health records in the business management system as you suggested and then our supply chains management. each of those is a big piece of the action and touches the other pretty and so continue to be a major priority for the management team like the means e secretary will be major portion for the cio, the chief information officer. that is a vacant position where the process of filling so the person will be before you hopefully the coming months. >> thank you and that is at. >> we all know that you always have a quarterback and running back, and offense of line and all that, there's no reason you should have one a national championship rated. >> going into again you better have everything but you better have a defense, you better have a defense and thank you.
>> spoken from april okay mr. secretary, once again thank you for being here as i've said in my opening statement, we see a report showing several categories that to be a summary been reporting to progress related to this program. by the way, this reports required by law. i need to tell you this is not acceptable in the we know the program is likely will be is by the overbudget reporting out and when to be a different structure and costs are included. have likely pushes program to more than $21 billion. and i know you mentioned a cost analysis in your testimony that the me ask you directly, can i get your commitment to the va will provide this many all projected cost yes and for the remainder of the hr project, as well as encouraging the programs start. yes. that is good.
so going back to 2017, quite honestly the va has not been candid if the know you committed to transparency and i hope you affirm that commitment and you are ready have. we provide the committee with the following documents most of which we i've already question but we have yet to provide to us and they include, the complete institute defense analysis, the ida and review of this program. >> yes. >> the review of the program. >> yes read. >> any additional reviews including - >> yes, i'm not sure what those are the yes pretty. >> in the va action and plan in response to this reports. yes.
so is in my opening statement, about how long we been working on this and to be honest with you, your from minnesota, great dairy industry. i had the impression for some time that folks out there are milking the cow and every day come they go out and they see this is a cash cow the getting every dime they can get out of it read and there's been low can ability and quite frankly, these folks are in the business and we all have our own areas of expertise and i would just tell you and i hope some are watching us, they're not up to making a user-friendly laconic health benefit medical records, and in fact, was transferred here's where going in the opposite direction. and give money back so that we can start over. and i would just say that this is really important, it was 2001
i think when we started out with this, 20 years ago. we're still not where we need to be in this is not all your fault and i don't know if any of it is your fault yet the truth of the matter is that that we have not gotten to where we need to go pretty there's been many administration between 2001, and today in of them got the job done. and so i would appreciate it number one, and you've already committed to it, we get the reports we are entitled to lawfully and you're as transparent as possible that this turns into be just another pile of you know what, that you let us know. >> there's no sense managing a status quo on this. >> is her final statement before we bring up the second panel pretty. >> no, just the fact that all
the question, is a lot of money to the taxpayers annual have entrusted with us is why our partnership with you is so important life partnership vig in the gao, u.s. overseers is so important and if there's any sense of where not being transparent on this, i hope that you will let us know. and we will make sure that we are and we need your help on this. >> we are here to help, we want to see you be successful we think that this can be improving the work that the va does and the experience of veteran has and we think that is important about awakening to the point of the va will do this right, it is a game changer for medicine. so thank you for being here today and will move on to the next panel we appreciated. >> thank you. >> now as we concluded our first panel, i think you again and
secretary denis mcdonough, i want to hear from two experts on electronic health records and for someone introduced david case deputy inspector general for the va office of general who will talk about the vrm and i would also like to commend the ig entire staff the tireless work examining these issues and their these two oversight reports this last week which is very timely for this hearing. and as i would like to introduce mark, chief innovation officer and he is an outside expert on health it and will who's actually been through and hr deployments and i'm interested to hear his advice for the va. fellows, thank you for being here and we will start with you mr. david case new happy for you each will have five minutes in
your entire written testimony will be part of the record. >> thank you chairman and members and thank you for the opportunity does yes the office of inspector general's of va's electronic modernization health program at first we want talk about the va employees, and the medical centers, and across va, to show the veterans receive timely high-quality healthcare during the hr transition, vertically during the pandemic. since april 2020 we have issued a five report, primarily focused on planning, system training, and other deployment activities and grandstaff them and help va leaders feature deployment and while va hasn't plummeted some of our recommendations from 2020, there's much more work remains and we like other stakeholders look forward to the strategic reviews results in the va keeps improving the program and va needs the dollars of
physical and related infrastructure upgrades. the oig connected to audits a process cost estimates for the infrastructure upgrades and followed our april of 2020 report, found the va did not meet its own deadline for infrastructure upgrades. by the grandstaff and we found the process cost estimates were unreliable, not comprehensive, not well documented, and inaccurate in not credible. we also found 38 did not report accurate and complete information to congress and nine congressional reports to date read and the hrm did not report the estimated 2.7 billion physical interceptor upgrades an estimated 2.5 billion with it infrastructure appraise because they believe the upgrades for outside of their responsibility. despite the va and the gao guidance requiring lifecycle cost estimates to include all costs regardless of funding
source. that said, we have seen some improvements in the it cost estimates and last week we published a healthcare inspection of the development of the delivery of training concept to the users the new bhr in the assessment of close training staff positions. the sound decision-making did not appropriately engage the staff will use the system to be a program was structured to benefit and lessons learned after the encounter problems in staff training during its deployment of the system. nevertheless, we found va suffered in many of the same problems. training on these new workforce and education of staff on how they fit into the overall delivery of the care, we found of the training concept was inadequate. vanessa found the training delivery to be problematic pretty with issues concerning the training, pending domain and the assignment of user roles, and training support.
finally, va failed to effectively evaluated training. and when we ask the hrm to provide training evaluation data, i initially told us, 89 percent of proficiency checks were passed with a score of 80 percent or higher and three attempts or less". >> however without an earlier version crafted by the hr staff showing only 44 percent proficiency checks were passed with a score of 80 percent or higher and three attempts or less that was in". the oig concluded the data was removed it and offered prior to submission we're reviewing the issuer thoroughly informing the va leaders into themes emerge from these reports first the need for a governance structure that meaningfully engages all components of the eight compensation program on a sustained basis. second, there is a need for
better transparency including between bas components. the oig will continue oversight in several additional projects ongoing. they're working with the dmv oig to review the extent to which the new system will achieve an opera lability amongst departments and community healthcare providers. we have started a review of the national deployment schedule. and the reviewing patient care issues and pharmacy operations with the staff the grandstaff and the chairman, this concludes my statement i be happy to answer any questions you or other committee members may have. >> i appreciate your testimony david case. >> thank you and good afternoon chairman and members of the committee as stated, mark of the chief innovation officer at healthcare technology services organization likely more relevant to this, recently retired as a chief information officer and mountain healthcare in salt lake utah where he
served for 17 years and for over 35 years have been involved with electronic health record systems never by witness a simple implementation of hr pretty much my goal today is to share some of the lessons i've learned in my career with dhr's and it may be used to the committee in the va. for decades in healthcare where i spent a significant part of my career and related internally developed information systems as a systems agent to come only made it several attempts to modernize and replace them. after several years, the efforts were stopped and begin a process to select and implement a commercial off-the-shelf the hr solution individually and a suite of applications. initially the project was heavily focused on enhancing and modifying solutions to meet the unique needs. in 2018, mountain and cerner executive refocused the hr implementations project of her
better use of approving an existing functionality and cerner in the overall approach changed from a making the system and do whatever the end-users want to how can we best meet the needs of the end-users with the least amount of vacation to the cerner system and with a new approach and committed leadership of both organizations, the starter set a solution for successful implemented but it was by no means and took a lot of work and time. from my experience, i've observed several keys that increase the likelihood of success in the major initiatives such as this. number one, a strategy for the process, stephen covey second habitant state begins with the end in mind predict the hr for the early dhr efforts began with the goal of building the hr the future which is an aspiration and, not a strategy. however we achieve successful week and a strategy based on actual operational need is the technologies supporting those operational need to spread into many times a strategy this
implement in hr and purses improving care making processes more efficient through the implementation of the hr. and number two, accurately understanding the environment, the project an english author wrote that if you do not know where you come from, then you don't know where you are and he don't know where you are, and you don't know where you are going and if you don't know where you're going, you're probably going wrong. too many times in technology implementation, such an bhr, the truth current state of the problems trying to be resolved or not well understood and in these cases time energy and resources are spent either explain the misunderstanding or worse, pursuing solutions to a problem does not really accessed. for example have a number of times that the way of the medical records and the dod the beat a hr systems is manual predict the paper charts if i strives. however, from what i understand the electronic transfer of records between the systems has
been updated for years between va and the dod and the two organizations transfer medical data electronically today. significant time is wasted if you do not clearly understand our current environment there of problems trying to be resolved. and number three, realistically user expectations and detailed requirements. the old saying, measure twice cut once and when my wife and i build our home, we had ideas for what we wanted it and how it should look like many couples. our ideas didn't always match and it took as much time working with the architect and defining our requirements as it took to build the home. many times the architect would have to manage our expectations and the realities of engineering the cost of what we wanted it however, before the first brick was laid, it was clear that we were building predict and the hr must be that expectation with thousands of people documented requirements with these diverse expectations is arduous and time-consuming it however understanding of the expectation that the user becomes the
foundation and meeting those expectations, or for managing them when engineering and posturing around realities right number four, team of qualified experience professionals this almost seemed too obvious to even include however can't overemphasize the importance of relevant experience in successfully implementing hr. i doubt many of us would like the commercial airliner, is been designed and built by car mechanics. successes much more likely a project leadership has experience in bhr implementation and hopefully several and his team members who understand the technology and the operational work loads under close of the medical workforce being automated. synergy is real and takes a large team to implement in hr and the team is many times composed of multiple organizations and it takes a team of partnership and is my the partnerships do not happen just because there is a contract. partnerships are made when their aligned in leadership demands
cooperation all parties involved understand the project successes the only path to individual success. thank you for the opportunity to share my thoughts on successfully implementation. i'm happy to answer questions. >> i appreciate your testimony thank you and you have said that the processes in this for unreliable. i assume this will cost estimates that the va had made or they came from cerner purported they come from. >> yes looking at the cost estimates, between physical and structure cost estimates of those were done by dha and if you look at the id cost structure estimates of those were prepared by ot are hm and the ones that we called out in our reports, by dha and oit and they were va prepared cost
estimates. >> okay then when was the last cost estimate done. >> to lesson that we seen a physical and structure was dated june the 2020. i think it needs to be working to finalize and reviewed in the same on it costs on infrastructure. >> i am sure, did you do of analysis in october 2020. >> southern three reports were published, when does the analysis is focused on training. it was a window that allowed us to go in and look at several aspects of the rollout. our training illuminated a lot of these printed smacks of going off of the senator's questions, we won the found out that stuff had been changed on the testing.
>> coming personally but the oig team did. >> do you have the ability to tell me if you think that was done because people intentionally dented. >> we haven't addressed yet we felt it was important to identify the issue. the office of special reviews is taking an in depth review of that particular incident in the information it that week of cough printed. >> so you think the biggest training issue is printed. >> there is really three, one of the training content needs to address workload changes as part of the training and the second would be the training presentation which means they need more time for a training domain and the need better people assisting in training. in the third is that they need better evaluation of the training once it is out there,
is it effective and how is it working. >> thank you for being here today. you oversaw electronic health record is in salt lake, it's probably a pretty good size. >> yes, 23 hospitals at about a 10 billion-dollar operation. >> that is significant, pretty good output in my book. you think it's possible for the va to implement these records based on what your expenses with the 23 hospitals. >> i absolutely believe that is possible. >> and he started out by talking about a number of things, accountability, understanding your environment, the strategic strategy for getting to the end in mind. i don't know how much you know about the va and hr and you obviously know a fair amount about cerner, that is the one you implemented.
just based on what you know, what you thank you so correct, what is the issue here because man, we have pumped a lot of money into this bad boy. >> it is presumptuous of me so let me tell you what happened to me, i inherited a project in 2018 that was going tremendously south and it was the cerner into into implementation challenge of it was that we had not well managed the expectations of the end users and that whole about defining with the requirements are, so that we could never manage those expectations because that would never have been set. i think it was a key challenge to what we were doing it and from what i understand are the va implementation, expectations and requirements were never done to the level they would need to be done to manage those
expectations. >> so as you look back on your implementation, after it was implemented, was it a system that was easier for the employees to utilize an easier for the patient to understand or was it more difficult. >> it absolutely was more difficult because it did more. so i told you, we self developed our own applications, that took 40 years of development. these systems were very much motivated to the specific needs of the individuals and individual departments and individual areas so that when we went to and were standardized system like cerner, it required a lot of people to meet us halfway. that goes back to managing those expectations and you cannot just bring in the system to the people pretty estate that you're going to do everything they want, there's a give-and-take and you gotta come to the system as well read and that takes time but is more difficult and
continues to be more difficult and to think that every user is happy with the cerner system, that would be impossible to say. but overall has been successful, yes. >> so how do you measure success pretty. >> british success by the number of functions we are able to make an standardization we were able to bring across the organization, and our ability to better secure the system because we didn't have so many applications. overall the use of the ability to automate new functions that we never had before. >> thank you pretty. >> thank you for being here. in the circumstance we are in it now, you read or heard it in the testimony today, or that va and implementations. what should congress expect from the va as we try to provide oversight, what should we hear from them six months now or three months now are you for now, we should look like. >> if you do not have a clear
vision of what this is going to do, the benefits that you're going to get from it, i would hope that those are well defined so that you understand the goal. what is at the end of the project. i think you are going to need to see productions in the number of complaints or tickets that come through and hopefully over time, your boy to see that what you're going to see them pretty heavy upfront in every implementation that you're going to see that pretty and i would like to see if i were in your seat, i would like to see real milestones and are they hitting those milestones and if they are not, why are they adjusting because it is very common for these implementation for those milestones to change what you need a rationale for why that is happening. so that everyone is aligned with what we are doing and i would to see a real partnership developed with each of the parties involved in that includes the va, cerner, and anyone else that is involved in the project read see that they are well aligned and that the partnership the synergy is happening read. >> there a couple of things and
it's never easy t4 while things have the water to things but useful as you try to grab your mind around at this big project. other couple of things that stand out to you that you would strongly encourage now beyond what you've already said. >> if i were involved, i would want to go back and start to manage those expectations so that even though the requirements were not developed in the beginning, it is not too late to go back and to find out with those requirements are so i would love to see the put in place because that allows everything else to be managed. that would be one i would like to see the milestones the detail project work plans and the goals be trying to. >> thank you very much and mr. david case reports mention what cost may actually be as compared to the reported costs, could you tell me what your meeting there. >> yes senator, the reported cost included 10 million-dollar
contract cost and $6 billion for it infrastructure upgrades. and for project management. what is missing it and reports to congress, is 2.7 billion physical infrastructure cost. and now we have not a lot of confidence, that is not a reliable estimate is used to .7 billion and also missing the number is roughly 2.5 billion and it infrastructure upgrades which would be funded by vha and so that gives you missing number of over $5 billion. >> is a good explanation why this cost not reported is it so unique for somebody might not understand the needed to be concluded that report pretty. >> ba provide a rationale to us which was that the cost that were not reported, coming out of the funding source a different one in a vha funding source.
in the vha and oit funding source, not the oe hr funding. if we not find that rationale persuasive. we thought the legislation was clear and from 2018 and we think the requirements for lifecycle cost estimates are clear. which is all costs and funding source, we also but it was clear those costs necessary to the successful implementation of the hr. >> was advantage to could be obtained by understating those costs. >> not that i am aware of, transparency usually has no disadvantage to it. >> well said. leadership they can see the changes in personnel, impact governance and follow the ability to close out the recommendation and attend at recommendations. question is are those problems existing here in the follow on
read. >> will that remains to be clear in the sense that what will happen in the follow on, we want to see the results in the strategic review that is happening and we know there has been consistent leadership on the grandstaff and we know that the secretaries undertaken the strategic review to try to get in place, the management team and that will work together across all components of va and also i think importantly, there's going to be transparency across all components of va. vha, op irm, they'll need to be transparent as to what is going on. >> city be satisfied with the response to date and it is their response in any way different than response that other reports in the past pretty. >> neither aa with all other recommendations, we made it 38 recommendations and some have been implemented and some are in the process of developing the plans of implementing it and we monitor that in the 90 day
basis. we have other projects underway already where we are going to be able to look in part is how they are doing in implementing the recommendations to date predict. >> in the second inspector general i spent time with today, mr. horowitz was with us our investigation into the u.s. olympics amateur athletes and abuse report which was issued today read and i value the work of the inspector general and thank you for your testimony and network. >> thank you senator and it's really between the date the work here pretty so they deserve all the credit. >> and the ranking member's comments we appreciate the aig the work you guys do and appreciate your eyeballs on the agency which basically utilizes thank you very much. and i have one more question. in a written testimony you said it's very important to have experience team running the hr project and i agree.
you said and i quote, can emphasize the importance of relevant experience and successfully implementing hr i doubt many of us would like to fly in a commercial airlines this been designed and built by car mechanics, and you are right read and can you talk to us a little bit more about what type of skills qualifications that your team is had in your involved these projects in the private sector. >> the leadership skills and if you can think about that, doing a project it was going south. what kind of people were you looking for to make it go. assuming north is a good thing. >> beyond the specific skills required it started at the top by the ceos is my partner in doing this and he worked with us and we brought in the ceo of cerner and we worked out the planet unhealthy were going to successfully implement the product and the team itself, we
needed people that had implemented electronic health records in the years are extremely complex systems pretty to think about it, we are automatically every function in healthcare delivery systems. that is hundreds if not thousands of functions we needed people were experience not just in those individual functions, but others individual functions related to each other and process with each other. we also need a doctors when we were doing work for doctors when needed technology people and understood it positions and help physicians and how they did the business. the nurses and respiratory therapists, pharmacist and think about it, for an organization which is a fraction of what the vas, we had hundreds of people that were relevant in our clinical areas supporting the implementation of the product and we needed technical expertise because of all the infrastructure problems that we had an interest va had we had people needed to understand data and data integration we needed data scientists read sanchez relevant expertise the relevance
experience to bring this because the problems happen immediately we need to go to committee and o solve the problem we can have people there this been through it and understand what to do in those situations, that is what i wanted on my team. about 40000 employees. [inaudible]. [inaudible]. >> most everyone but the administrators, yes. >> so if you are going to do an assessment today, as to how many people those 40000 actually like this medical record, will that percentage be. >> like it, under 50 percent. tolerated, music, fighting advantage in it, 80 or 90 percent. >> that is helpful.
and go-ahead senator. the honorable senator from kansas read. >> a follow-up to your question emma you heard the description of who is necessary to make this work is there any one at the va that has dea a hard experience in the process. >> people to be able have experience in various aspect of the bhr, don't think there's probably one person or one set of people. and the secretary, this is going to require all hands effort across the vha, the oh hrm to say the data scientists who will have to deal with the new data streams the center provides an opposed to the old systems. for a long time va will have to have both data streams and be able to use them both. there are people whether there is a sufficient number of people
and best augmentative by working with contractors, that is something i thank you so strategic plan will have to address. thank you both read. >> so i'm going to hold them there. [inaudible]. >> so the good senator from louisiana get squared away here, you are up to bat. [inaudible]. [inaudible]. >> i've been in six different places try to do six different things in which case according to a report, on the training, the staff reported absence of workflow pretty conference, from. [inaudible]. you might need a microphone on.
[inaudible]. >> the facility staff reported absence of workflow training content associated referencing materials that prevented them from not only understanding how to apply what little they had learned in their daily work but also presented a basic understanding of the meaning behind the workflow processing. i am a doctor 11 hospitals recent there for an hour and a half and you have a training seminar, a walkout to go to where you're supposed to be, and have no clue how to apply it read just given a whole chunk of materials and now go use it. it's very practical. so i guess, a couple of questions, didn't somebody think that's true. you don't dislike look them up. i'll start with that one. >> was not thought through adequately agreed i think the new not intuitive that is the
feedback that i have heard. so the let me ask the clinicians involved in the development of the workflow process. >> yes, initially they were from the teams are put together that amongst the clinicians . [inaudible]. >> let me ask you, is a keyword, initially that is a keyword. [laughter] were the initially and subsequently and subsequent to the subsequent etc. etc. etc. pretty. >> you picked up on a deliberate
modifier, yes but they were notably not involved in the design of the training and how to present the training to the clinicians. >> that is frustrating as you might guess because i found that in my physician colleagues verified in this experience, it's real time killer pretty so productivity is flushed by that. let me ask, i think under the original law, they're supposed to be the program update on nano cost. which stated that the lifecycle cost estimate should be regularly updated. and doesn't seem as if that is current. >> that is correct, and that is understated by roughly $5 billion to xo's anybody been held accountable for this, who was responsible and to what
degree is a taxpayer being reassured that the personal responsible is being held accountable. >> the decision on how to help people cannibalize of the secretary to think this secretary will want to investigate the facts and potential motives involved in this before the secretary decided, uniquely within his purview. the va provided a rationale for what they did or failed to do. and i did not find it persuasive pretty. >> did we know the individuals help as possible pretty. >> we have not identified those individuals and not to disclose us and we heard the rationale and that's not been disclosed. >> it seems almost unfathomable that you would not know who the decision-maker was pretty. >> i think that is part of the issue with the overall management of the hr up to a degree is the decision making can be paid.
and we have started in investing in for an invitation goes into issues of candor and potential manipulation information the tort cig and towards congress and as part of that, i think we can try to narrow down the individuals. >> so really were talking about even broader issue that incompetence, it also includes - >> i cannot say that you, we have not reached a conclusion as to the motive read but as all possibilities are open. >> and then will finish by this i think you all for allowing me to do this. the deity obviously has problems and was there any lessons learned from the deity experience with the bhr, number one and number two, is a desire to have to what degree did it complicate issues. >> so there were dod lessons
learned per dealer with our initial rollout. in the pacific northwest and they included the problems with training and insufficient computer-based training and a lack of clear role definitions, backup support and others. and lack of content. those lessons appeared not to been embraced in va when they did their own training rollout with the staff in the grandstaff and some of the same issues occurred again so there are lessons to be learned predict and further lessons to be learned that they have to be attended to and really grasped y proceed on their way forward. >> i don't quite understand what i am about to say but you will totally i was told the part of the problem in terms of the interoperability is that it was happening it has a responsibility lay on a sub secretary level now there were
turned over last and ministration both in the secretary to both parties that we received a commitment at some point, the secretary at the let that level that this interoperability would be made a priority and what i was told at the time was that much of the secretary and the secretary responsible, and that is when things would actually begin to move because it would become a sufficient priority that it would be driven. you may dispute that and say no, that is not true read but i guess my question is, it is never rise to be in a secretary to secretary issue with the inherent what i'm told, the inherited prioritization it in the inherited increase accountability. >> center we have joint project undergoing right now with the report looking at the very issues you just described from a joint project it the dod office
of inspector general looking at the question of interoperability and will be able to achieve it, and is there a governance structure that can get this to parties together to make sure it's achieved and we are looking at the governance structure as part of that so it is an issue. >> to i understand, and i think you for kind of, your areas where is my name expecting that you have more frustrations than me but, my question is to make sure you understand it. when you speak of governance, did it ever rise to the secretary to the secretary level sponsor of the covenants or know it never rose they are not truly governments. >> i'm not sure it ever grows of the secretaries with the same room or on the same call. addressing the interoperability issues at any level of specificity and not sure the current governance structure cannot really accomplish the mission in terms of doing that.
and bringing it to the secretaries the decision and that they need to make. since one of the strong points of our current joint project with the dod. >> is to see if that occurs, exactly. >> so in the gospels, there's a parable of judas and judy says you need to come to my house, i'm a leader and i can tell somebody to do it for me so i don't actually expect to do secretary will know nothing about hr and speak to himself but i do expect that they have at the tenant who makes it a priority if you will. so that is what i always assume that the secretary to secretary meant, my trust is in three times a day my latina it will take charge of this and make it happen. is that what you're describing to me not sure it occurred. a. >> that is exactly what i'm describing is not sure. the deputy secretary in the congressional responsibility at
the va to make sure this is happening of the program the buck stops of the deputy secretary in terms of va. >> they have themselves or people that they trust working together with the deity to make of right decisions on him profitability so it can be accomplished rated. >> you doing that but the dod heavy a side predict. >> that is correct and this is one of the few projects where ids are working together a strong cooperative basis make a joint report and that's because it's the same system of fundamental the deity and va. >> i'm going to ask one more. are you also looking into whether or not he interpret turner has the ability to do the job. >> generally what we found is that the system itself from a technical basis, is working.
now there are opportunities for us to review as cerner have they done the job so far and are they going to do it in the future those are projects we can try to plan for and would not made any review or decision on that yet rated. >> thank you for indulging. >> i appreciate your life questioning that what we way today have glad you made it. i would also say that is 530 we got about on the undersecretary of the va and it's going to be in charge of this. i can tell you in the last administration, that position was very fluid it opened a lot of the time and i think i'm saying it could be part of the problem that i would hope that is the it's confirmed it so that they have people hold accountable and i agree with you, from he cannot get the job done than turn it over to the secretary so they can do it and it's there to be done. it is made a priority and i
think there are plenty of screw ups can point to i think the ig has given us that roadmap i do think the oversight by this committee, we can make serious progress on this read so thank you all. i want say thank you to you guys for being here and i look forward to more details from this review findings and how the va will write this and improve quality of care and proper leadership team in place, nba manages this change, changes in this program needs is also improving and needs is a pointed out, deputy secretary david case and we will vote on and about eight minutes and as i said earlier the va must be straightforward with congress on the cost and the challenges and the path forward on this program. if they cannot be, there of course will be consequences read and this will be open for a week
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