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Witness Testimony of Dr. Maureen McCarthy, MD, Deputy Chief Patient Care Services, Veterans Health Administration, Department of Veterans Affairs

Good morning Chairman Coffman, Ranking Member Kirkpatrick, and Members of the Committee.  We appreciate the opportunity to discuss the Department of Veterans Affairs (VA) contributions to the Vision Center of Excellence (VCE) and VA’s work to provide access to resources for visually impaired employees and Veterans.  We are accompanied today by Dr. Mary Lawrence, Deputy Director of the Vision Center of Excellence and Mr. Pat Sheehan, Director, 508 Compliance Office.

Vision Center of Excellence

The VCE was established by the National Defense Authorization Act (NDAA) (Section 1623) of Public Law 110-181, in January of 2008.  It stated, “the Secretary of Defense shall establish within the Department of Defense a center of excellence in the prevention, diagnosis, mitigation, treatment, and rehabilitation of military eye injuries to carry out the responsibilities in subsection (c) {of Section 1623}”.  In a memo dated May 18, 2010, the Under Secretary of Defense (Personnel and Readiness) established the Navy as the Lead Component of VCE.

NDAA 2008 further mandated that the “Secretary of Defense shall ensure that the center collaborates to the maximum extent practicable with the Secretary of Veterans Affairs, institutions of higher education, and other appropriate public and private entities (including international entities) to carry out the responsibilities in subsection (c) {of Section 1623}.”  A VA and DoD Memorandum of Understanding, dated October 8, 2009, established VCE under the authority of the Secretary of Defense in collaboration with the Secretary of Veterans Affairs.

NDAA 2008 also required the implementation of a Vision Registry to collect longitudinal data on eye injuries, guide research, promote best practices, guide clinical education, and inform policy for the treatment of eye and vision-related injuries for Servicemembers and Veterans.

As per Public Law (110-181; Jan 2008), VCE’s congressionally mandated core mission areas include surveillance of DoD eye injuries via the Vision Registry, the integration of clinical care, education and training of healthcare team members, and guidance on eye research focused on rehabilitation and reintegration.  To this day, VCE provides leadership and advocacy for programs and initiatives focused on improving eye care and contributes knowledge and guidance that will further the goal to continuously improve quality of life for Servicemembers and Veterans.

Funding and Staffing

To date, VA has allocated $6.9 million from fiscal year (FY) 2010 through FY 2014.  VA’s budgets include funding for Civilian Pay ($3.3 million) and operational support ($3.6 million), which primarily includes research prioritization, development of clinical recommendations, and education and training initiatives to contribute to improvements in clinical care.

            Currently, VA has six authorized full time equivalent employees (FTEE) in the VCE.  Five of those FTEEs have been filled.  A candidate has been selected for the sixth position and Human Resources is finalizing the paperwork to establish a report date.  Additionally, VA has filled a 0.6 FTEE who is a non-permanent, incumbent-only staff member.  This individual is a former VA Armed Forces Institute of Pathology (AFIP) health scientist who was relocated to VCE when AFIP closed.

Defense and Veterans Eye Injury and Vision Registry

      The Defense and Veterans Eye Injury and Vision Registry (DVEIVR) is a DoD and VA joint capability that was developed to support readiness, enhance clinical best practices, guide research and inform policy regarding vision injuries incurred by a member of the Armed Forces while serving on active duty.  DVEIVR empowers the DoD and VA vision community with the ability to conduct longitudinal analyses on outcomes across the continuum of clinical, surgical, and rehabilitative vision care of Servicemembers and Veterans.

The DVEIVR program is on schedule and budget.  The system achieved initial operating capability in March 2014.  As of May 14, 2014, there were 23,664 unique patients enrolled in the Vision Registry.  We have also successfully tested and implemented the ability to seamlessly transfer VA vision care data to the Vision Registry.

DVEIVR has received the following awards:

  • Selected as one of the top 8 finalists for the American Council for Technology and Industry Advisory Council (ACT-IAC) "Igniting Innovation 2014 Showcase and Awards”
  • Named a finalist in two categories, Health Information Technology and Collaboration, for the 2014 American Council for Technology-Industry Advisory Council (ACT-IAC) Excellence.Gov Awards
  • DVEIVR Program Manager recognized as Federal Top 100 in Information Technology

VA Data Abstraction Support Contract

VA requires a contractor to provide Data Abstraction Support Services for manual extraction of clinical ocular and related information from medical records from Veterans Health Information Systems and Technology Architecture/Compensation and Pension Record Interchange (VistA/CAPRI) that are maintained by the VA into a computable database, the VA Eye Injury Data Store (VA EIDS) (also known as VA Eye Injury Registry-VA EIR and Defense and Veterans Eye Injury Registry-DVEIR).  For the purpose of the contract, VA EIDS will be used.  The VA EIDS data will be electronically transferred to DVEIVR.  VA clinical and related data will be used to establish mechanisms to longitudinally identify and collect data and conduct analyses on eye and vision-related injuries and diseases of Wounded Warriors.  

VCE’s Significant Accomplishments

VCE has achieved many significant accomplishments since its inception.  VCE has identified and addressed 33 process improvement opportunities (systems or clinical issues) through the VCE-hosted monthly World-Wide Ocular Trauma Video Teleconference, which connects providers across the continuum from combat support hospitals and coalition providers to VA Poly-Trauma Centers.  VCE continues to move forward on addressing remaining issues.

VCE has led the way to initial inclusion of protective (Fox) eye shield in joint first aid kits (JFAK). It is coordinating with the Armed Services to expand into individual first aid kits (IFAK).

In addition, VCE, in collaboration with the VA Blind Rehabilitation Service, has designed an educational pamphlet geared toward inpatient care teams caring for blind and visually impaired patients in a hospital setting.  The pamphlet is being distributed to hospitals throughout both DoD and VA healthcare systems. VCE has also hosted a knowledge-based workshop in collaboration with the VA Employee Education System, entitled “Managing Vision Disorders Following Traumatic Brain Injury” to train VA and DoD ophthalmologists and optometrists to improve clinical assessment and management of eye and vision disorders associated with Traumatic Brain Injury (TBI). Lastly, VCE, in collaboration with Defense Centers of Excellence (DCoE), developed a clinical recommendation and reference card: “Assessment and Management of Visual Dysfunction Associated with Mild TBI.”

Vision Research

VA-funded vision research (intramural only) supports 19 funded projects, including pre-clinical, translational, and clinical studies, as well as two vision research centers of excellence, one in Atlanta, Georgia, the other in Iowa City, Iowa.

DoD-funded vision research (intramural and extramural) supports 67 funded projects covering prevention, genetics, treatment, and rehabilitation services.

The following is a list of VCE’s interagency vision research coordination:

  • VCE tracks vision related research outcomes (publications, patents, product development)
  • VCE established and chairs Interagency Vision Research Scientific Steering Committee
  • VCE chaired Clinical and Rehabilitative Medicine Research Program (CRMRP) Joint Programmatic Committee-8 (JPC-8) programmatic review for 2012 – 2013 program and are key participants in the 2014 program
  • VCE chaired CRMRP JPC-8 programmatic review of proposals submitted for the Assistive Technologies Research Award (including VA, National Institutes of Health representatives)

508 Compliance

VA considers its responsibility to provide access to electronic and information technology resources to its employees with disabilities and customers as one of the critical aspects of our service.  Recently, VA has made significant progress enhancing access to electronic mediums such as Web sites and Information Technology through compliance with 508 requirements.                                                                                          

Section 508 of the Rehabilitation Act of 1973 was enacted to eliminate barriers in information technology, open new opportunities for people with disabilities, and encourage development of technologies that will help achieve these goals.  The law applies to all federal agencies when they develop, procure, maintain, or use electronic and information technology.  Under this law, agencies must provide employees and members of the public with disabilities access to information that is comparable to access available to others.

Since 2001, VA’s Section 508 Program Office within the Office of Information and Technology has provided validation testing on VA Web sites and applications.  To identify VA’s compliance with Section 508, VA continually audits its Web sites to determine their level of adherence to Section 508 standards.  Due to the vast size of VA’s web presence, VA focuses the majority of its Section 508-related analysis and remediation efforts on its most frequently visited Web sites.

To validate conformance with Section 508 requirements, VA uses a combination of automated tools and manual auditing, the latter of which is performed by users who have a disability, including visual impairment. Automated tools enable VA to monitor web-based applications for ongoing compliance with Section 508 standards.

In addition, since 2012, VA has trained more than 4,200 stakeholders on the legal requirements of Section 508 and the proper use of VA’s Section 508 tools. VA also provides personnel from the Section 508 Program Office to provide guidance to developers who create Section 508-compliant solutions for Web-based and client server applications.  Our goal is to ensure that information and content creators know their responsibility to conform to Section 508 guidelines starting at the beginning stages of their work.  We are focused on providing employees with the tools and training they need to make information and content accessible.                                            

When VA identifies non-conformant applications or Web sites, its Section 508 staff conducts a thorough analysis of these applications(s) and works with the relevant developers or development teams in creating a remediation schedule to correct or remedy Section 508 accessibility issues.

As a result of our efforts to train employees and remedy issues, VA has made notable progress in achieving Section 508 conformance for our highest-volume Web sites.  Since January, 2014, 85 percent of errors in VA’s user interface for the Computerized Patient Record System), a tool used by clinicians during patient care, have been remedied.  Since November, 2013, VA has improved MyHealtheVet conformance – VA’s one stop portal for Veterans to access their healthcare information –from 16 percent to 95 percent, and we are working toward to achieving a 100 percent conformance level.

VA has also made significant progress in reducing the number of non-conformant applications that were granted waivers from the Section 508 requirements.  In January of 2013, VA’s Chief Information Officer revoked all waivers for applications that are non-conformant with Section 508 and mandated that these applications meet all Section 508 technical standards.  As a result, the Department has reduced the number of these applications from 200 to 26.  The use of waivers provided an excellent balance between execution demands and the necessity for accessibility, as all waivers come with a Plan of Action and Milestone for mitigation and are presented to the VA’s Chief Information Office to emphasize the importance of 508 to the project management community.

As critical as it is for VA to audit and improve its existing Web sites and applications, we also take seriously our need to ensure all future applications and web developments are in conformance with 508 standards.  In support of this commitment, VA has instituted formal policies requiring all electronic and information technology developed by VA to complete a four-step “Milestone and Review” process prior to being released.  This process requires project managers to certify their applications for 508 conformance prior to release and all new releases are subject to random audits by the 508 Program Office.

Finally, it is important to note that VA is committed to an extensive and robust dialogue with our disabled Veteran stakeholder groups and address their concerns.  VA will attend the Blinded Veterans Association’s (BVA) upcoming national conference to pair IT experts with BVA stakeholders to review recent updates to eBenefits, MyHealtheVet, and Web site access and to discuss how accessibility can be improved.  We will work together to see where we can improve usability, even in areas where we are already Section 508 compliant.  We also regularly meet with Veterans Service Organizations, and accessibility issues are a standing agenda item.

VA will continue to audit its Web sites and applications for Section 508 compliance development and is dedicated to ensuring the Department meets all of its customer and workforce access requirements.

Conclusion

Mr. Chairman, the consequences of vision injuries to our Servicemembers and Veterans will be with us for decades to come.  VA will continue to partner with DoD through the VCE to provide eye care providers, other clinical care practitioners, and researchers, as well as to develop strategies that will enhance and improve patient care outcomes.  Additionally, VA will continue to build on our significant progress in achieving conformance with requirements of Section 508.

Mr. Chairman, this concludes the testimony.  My colleagues and I are prepared to answer your questions.