REPUBLICANS DAVID P. ROE, TENNESSEE, CHAIRMAN GUS M. BILIRAKIS, FLORIDA MIKE COFFMAN, COLORADO BILL FLORES, TEXAS 390L152 (If iRepreSentatihes BRUCE POLIOUIN, MAINE NEAL DUNN, FLORIDA I JODEY TEXAS COMMITTEE ON VETERANS AFFAIRS CLAY HIGGINS, LOUISIANA JACK BERGMAN, MICHIGAN JIM BANKS, INDIANA JENNIFFER GONZALEZ-COLON, PUERTO RICO BRIAN MAST, FLORIDA ONE HUNDRED FIFTEENTH CONGRESS 335 CANNON HOUSE OFFICE BUILDING WASHINGTON, DC 20515 JON TOWERS, STAFF DIRECTOR http.//Veterans house 90V October 15, 2018 The Honorable James N. Mattis DEMOCRATS TIM WALZ, MINNESOTA, RANKING MARK TAKANO, CALIFORNIA JULIA BROWNLEY, CALIFORNIA ANN KUSTER, NEW HAMPSHIRE BETO TEXAS KATHLEEN RICE, NEW YORK .J. LUIS CORREA, CALIFORNIA CONOR LAMB, ELIZABEIH ESTY, CONNECTICUT scorr PETERS, CALIFORNIA RAY KELLEY DEMOCRATIC STAFF DIRECTOR The Honorable Robert Wilkie Secretary Secretary US. Department of Defense US. Department of Veterans Affairs 1000 Defense Pentagon 810 Vermont Avenue, NW Washington, DC 20301 Dear Secretary Mattis and Secretary Wilkie: Washington, DC 20420 We were reassured to receive your joint statement of commitment of September 26, 2018, communicating the Department of Defense and the Department of Veterans Affairs? intent to institute an ?optimal organizational design? and ?a more ef?cient overall construct and plan of execution" for Electronic Health Record (EHR) Modernization and Military Health System (MHS) Genesis. Since the inception of EHR Modernization program, we have been focused on the level Ofcollaboration between the two departments. Many questions remain even after the joint statement. As planning has evolved over the course of this year, it has become clear that the integrated single common Cerner EHR, which has been agreed upon as necessary to achieve the interoperability goals, raises the stakes as to the level of collaboration. DOD and VA must make an extremely large number of technical and operational decisions swiftly and accurately, and the implementation schedules for the two programs, which are at different points of maturity, become bound together in some respects. Dependencies and joint decision making are far and away the most signi?cant risks. We do not believe the tentative governance structure, especially its inter- agency components, adequately meets that challenge, and we welcome your acknowledgement of this. Of the inter?agency, joint components of the tentative governance structure, the Executive Committee (EXCOM) is the most concerning. This is the highest joint body, tasked with coordinating and resolving differences between the top leaders of the EHR Modernization and MHS Genesis programs and, ultimately, you and your deputies. However, the co? chairs, the DOD Assistant Secretary for Acquisition and the VA Executive in Charge for the Of?ce of Information and Technology, are not those top leaders. The Deputy Secretary of Veterans Affairs is ultimately accountable for the EHR Modernization program by law. The Under Secretary of Defense for Personnel and Readiness is ultimately accountable for MHS Genesis, and the Assistant Secretary of Defense for Health Affairs and the Director of the Defense Health Agency exercise executive oversight. Yet these senior leaders do not chair and, except for the Defense Health Agency Director, are not members of the EXCOM. Because the objective is a integrated, single EHR, we expect that many decisions about the internal management of EHR Modernization and MHS Genesis will increasingly blend together and become joint decisions. Therefore, the boundaries between the governance structures for the individual programs and the joint governance bodies may blur. What is important is that the governance bodies, however they are drawn as boxes on a chart, are responsive and effective. We agree that, as witnesses have testi?ed many times, routine and noncontroversial decisions should be made within the programs at the lowest possible level. However, we encourage you to streamline the programs? governance structure in a way that involves the top leaders, who are ultimately accountable, more regularly and formally in the programs? pivotal and dif?cult decisions. Relatedly, your joint statement alludes to the concept of a joint program management of?ce to run EHR Modernization and MHS Genesis, essentially tearing down the wall between the two programs. This idea has been discussed in the past, and there are several possible gradations, from a merger of some aspects that preserves the programs? separate identities to a total merger. Your leadership teams have been consistently vocal in expressing their disinterest in combining budgets. Without a doubt, a joint program management of?ce presents great opportunities if executed well but substantial risk if executed poorly. It is not to be entered into casually. We believe a lesser gradation of the concept that uni?es the functions of identifying requirements, system architecture design, implementation planning, testing, project oversight, and other functions that do not infringe on the individual programs? unique activities should be thoroughly examined. We ask that you inform Committee staff of the intended future governance structure before, not after, it is ordered implemented. If you have any questions, please do not hesitate to have your staff contact Mr. William Mallison, Majority Staff Director of the Subcommittee on Technology Modernization at (202) 225-1900 or Sincerely, JIM BANKS MIKE COFFMAN Chairman Member Subcommittee on Technology Modernization Subcommittee on Technology Modernization