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Ranking Member Roe Opening Statement: MISSION Critical: Assessing the Technology to Support Community Care

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Washington, April 2, 2019 | Molly Jenkins (202-225-3527) | comments

Today, the House Committee on Veterans' Affairs held an oversight hearing assessing the technology to support VA MISSION Act's community care program.

Below are Ranking Member Rep. Phil Roe's, M.D. (R-Tenn.) opening remarks:

Opening Remarks As Prepared for Delivery:

I welcome the opportunity to be here this afternoon to discuss the implementation of the new MISSION Act community care program.

That program is intended to take the place of the many disparate community care programs that the Department of Veterans Affairs (VA) uses today and create a streamlined process for veteran patients to be referred to community providers.

The MISSION Act requires the community care program to begin on June 6th - just a little more than two short months from now.

I know that Secretary Wilkie and his team are working hard to meet that deadline.

However, the U.S. Digital Service (USDS) issued a report last month that was highly critical of VA’s implementation of the law to-date and called into question VA’s ability to ensure timely access to care for veterans using the authorities Congress provided under the MISSION Act. 

Some of the media reports, especially the headlines, about the report were downright alarming.

Unfortunately, alarming reports about the readiness of major VA modernization efforts are nothing new.

We have seen VA stumble too many times because of inadequate IT solutions, poor communication, failure to properly train clinical and support staff, contract problems, and more.

This Committee has done deep-dive work into all of those areas in the past and I am sure that work will continue moving forward.

But, in the meantime, veterans are counting on us to deliver. 

You have all heard me say before that I believe in taking the time to get things right.

I said it in December when I chaired the first oversight hearing regarding MISSION Act implementation and I will say it again now - I would rather VA postpone implementation of this program than rush to implement it in name only and have veterans pay the price for it.   

I do not want to repeat the mistakes that were made with respect to the GI bill last year.

As such, I am taking the Digital Service’s findings seriously and I am focused on solutions.

The way I see them, they fall into three general areas.

First, there are concerns about the Decision Support Tool, the new eligibility determination software under development to support the community care program.

Second, there are various critiques of the strategic decisions VA made with regard to the community care network contracts.

Third, there are continued alarms that VA needs to institute better interoperability capabilities with community providers right now.

I think the Digital Service’s recommendations are right on target with respect to interoperability and the need to use data standards and what are called application program interfaces  (APIs) to jumpstart interoperability with community providers’ electronic health records.

Cerner will undoubtedly improve interoperability, but the nationwide rollout is 9 years away.

We are working on legislation that would create a comprehensive interoperability strategy to make sure we solve this problem as soon as possible.

I look forward to discussing that bill in a future hearing.

As for the other concerns detailed in the report, there is no doubt that the rollout of the new community care program will bring with it its own set of complications that VA will have to overcome.

The same could be said of any new endeavor.

Transformation is never easy, especially for an organization as large and as complex as VA. 

I want to hear today how VA is preparing clinical and support staff on the front lines for the rollout of this new program; how they are training them on the new processes, procedures, and systems that they will need to work with; and how VA will mitigate any setbacks that may occur to prevent disruptions to veteran care.  

As to DST, my understanding is this new system is meant to create an automated system to replace a manual process that has been used for a number of years.

If done well, DST would make processing veterans’ eligibility more efficient, but its failure or delay means continuation of the status quo not the falling off of some sort of cliff.

The Digital Service’s report raised the possibility of a worst case scenario that VA’s daily appointment capacity nationwide could be reduced by 75,000 if DST usability issues are as severe as their report suggests.

I want to be sure we all leave this hearing today absolutely clear on what would have to happen for that worst case scenario to come to pass.

My understanding is it would entail rushing DST into use after inadequate testing, that only doctors are permitted to use DST rather than nurses or medical support personnel, that VA employees try to use DST with Web browsers other than Google Chrome, and that a glitch between these other Web browsers and VA’s EHR cannot be fixed.

I want you all to know this is not an infomercial for Google, but it sounds like it would be a good idea for everyone at VA to download Chrome.           

Now that we have this report out in the open and we are discussing these issues, my sincere hope is we can help VA work through them rather than arguing later about what happened.

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