- Contact the Committee

Good morning. Today’s hearing is entitled, VA’s Role in the Development of Interoperable Electronic-Medical Records Systems in the Federal Government. During a recent visit at the Baltimore Veterans Medical Center, President Bush said: “The 21st-century health care system is using a 19th-century paperwork system.” He went on to say: “These old methods of keeping records are real threats to patients and their safety and are incredibly costly.” The President has proposed $100 million for 2005 for demonstration projects of IT health care.

While this Subcommittee has held a number of hearings on the importance of moving toward electronic medical records, today’s hearing will bring a new element into the discussion. I am referring to the potential savings in health care costs that could be realized by moving from paper records to electronic medical records.

According to Dr. Blackford Middleton, Chairman of the Center for Information Technology Leadership, and I quote, “Standardized information exchange would save the nation $86.8 billion each year. Clearly, we must accelerate efforts to focus national policy discussions on implementing standardized healthcare information exchange and interoperability.” Dr. Blackford made this statement before the Healthcare Information Management Systems Society (HIMSS) on February 23, 2004. In fact, we asked Dr. Middleton to be a witness at this morning’s hearing. Unfortunately, he was unable to do so but indicated that he would be happy to testify another time.

Dr. Middleton’s statement is a fitting introduction to today’s hearing and the important steps that have already been taken to standardize health information.
The VA has played a pivotal role in laying the groundwork for setting health information standards to be used across the government. Over the last two years the VA has worked with the Departments of Defense and Health and Human Services to build upon the five standards which were announced by HHS on March 21, 2003. More recently, on May 6, 2004, the Departments of Defense, Veterans Affairs and HHS announced the adoption of 15 additional standards agreed upon by the Consolidated Health Informatics Initiative, which is an integral part of the
e-Gov Initiatives of the Administration.

Dr. Jonathan Javitt, a member of the Subcommittee on Health Care Delivery and IT of the President’s Information Technology Advisory Committee is our lead witness today. I am sure we all look forward to hearing his perspective in his role as a member of the President’s health IT team.

Today’s hearing will also focus on the progress which has been made by the VA and DOD in their joint effort to develop and deploy electronic medical records that are interoperable, bi-directional and standards-based. According to the GAO’s current assessment of the top five priorities that still need to be addressed in 2004, I was surprised to learn that the basic fundamental process of program design such as the development of an architecture for the electronic interface that articulates system requirements, design specifications, and software descriptions have not been agreed upon. I must ask a basic question, Shouldn’t these basic functions have been identified before the project got under way? GAO also cited the need for project milestones and precise performance measures to provide for the basis of comprehensive program management, progressive decision making, and authorization of funding for each step in the development process. Again, this is rather basic. Having a business plan with measurable outcomes should be in place on the front end not on the back end of a project. VA and DOD have been working on this initiative since 1998 -- without these key elements in place. This does not represent good program management.

So, after 6 years and $ 668.7 million we have a system that is capable of a one-way transfer of information. I’m not sure I would categorize this as a great success. I hope you prove me wrong today by telling me that you have made substantial progress beyond the Federal Health Information Exchange and that the implementation date for CHCS II is on target. I will close by saying that I believe with thousands of service members returning from Iraq and Afghanistan they should not have to endure other battles in order to receive timely transition to VA health care and benefits.