Sec. 734. Integrated Electronic Health Record of the Departments of Defense and Veterans Affairs
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It is the sense of Congress that— despite repeated attempts at cooperation over the past 20 years, the Department of Defense and the Department of Veterans Affairs have failed to implement a solution that allows for seamless electronic sharing of medical health care data; the recent decision by the Secretary of Defense and the Secretary of Veterans Affairs to abandon their earlier agreement and pursue separate paths to integration jeopardizes the stated goal of providing a patient-centered health care system that delivers excellent quality, access, satisfaction, and value, consistently across the Departments ; despite the repeated concerns and objections of the congressional committees of jurisdiction, the Department of Defense and the Department of Veterans Affairs seem to be on a continued path to fail in achieving the goal of creating a seamless health record that integrates data across the Departments; and the President should make the necessary leadership changes to assure timely completion of this requirement.
The Secretary of Defense and the Secretary of Veterans Affairs shall— implement an integrated electronic health record to be used by each of the Secretaries; and deploy such record by not later than October 1, 2016. The integrated electronic health record established under subsection
(b)shall adhere to the following principles: To the extent practicable, efforts to establish such record shall be based on objectives, activities, and milestones established by the Joint Executive Committee Joint Strategic Plan Fiscal Years 2013–2015, including any requirements, definition, documents, or analyses previously developed to satisfy said Joint Strategic Plan. Principles with respect to open architecture standards, including— modular designs based on standards with loose coupling and high cohesion that allow for independent acquisition of system components; if existing national standards do not exist as of the date on which the record is being established, the Secretaries shall agree upon and adopt a standard for purposes of the record until such time as national standards are established; enterprise investment strategies that maximize reuse of proven system designs; implementation of aggressive life-cycle sustainment planning that uses proven technology insertion strategies and product upgrade techniques; enforcement of system design transparency, continuous design disclosure and improvement, and peer reviews that include government, academia, and industry; and strategies for data-use rights to ensure a level competitive playing field and access to alternative solutions and sources across the life-cycle of the program. By the point of full deployment decision, such record must be at a generation 3 level or better for a health information technology system. Not later than January 31, 2014, the Secretaries shall jointly develop and submit to the appropriate congressional committees a program plan for the oversight and execution of the integrated electronic health record program established under this section. This plan shall include— program objectives; organization; responsibilities of the Departments; technical system requirements; milestones, including a schedule for industry competitions for capabilities needed to satisfy the technical system requirements; technical system standards being adopted by the program; outcome-based metrics proposed to measure the performance and effectiveness of the program; and level of funding for fiscal years 2014 through 2017. The Secretaries shall jointly commission an independent assessment of the program plan under subsection (d). Not later than 60 days after the date on which the program plan under subsection
(d)is submitted to the appropriate congressional committees, the Secretaries shall jointly submit to such committees the independent assessment conducted under paragraph (1). Not more than 25 percent of the amounts authorized to be appropriated by this Act or otherwise made available for development , modernization, or enhancement of the integrated electronic health record within the Department of Veterans Affairs or for operation and maintenance for the Defense Health Agency of the Department of Defense may be obligated or expended until the date on which the program plan under subsection
(d)is submitted to the appropriate congressional committees. On a monthly basis, the Secretary of Defense and the Secretary of Veterans affairs shall each submit to the appropriate congressional committees a report on the expenditures incurred by the Secretary in the development of an integrated electronic health record under this section. Such reports shall include obligations by major categories of spending and by support of milestones identified in the program plan required under subsection (d). Not later than October 1, 2014, all health care information contained in the Department of Defense AHLTA and the Department of Veterans Affairs VistA systems shall be available and actionable in real-time to health care providers in each Department through shared technology. At such time as the operational capability described in paragraph
(1)is achieved, the Secretaries shall jointly certify to the appropriate congressional committees that the Secretaries have implemented such operational capability. Neither the Secretary of Defense or the Secretary of Veterans Affairs may obligate or expend more than 10 percent of the amounts authorized to be appropriated by this Act or otherwise made available for the research, development, test, and evaluation, or procurement for the Virtual Lifetime Electronic Record until the date on which the certification is made under paragraph (2). The Secretary of Defense and the Secretary of Veterans Affairs shall each identify a senior official to be responsible for the electronic health record established under this section, including the operational capability described in paragraph (1). Such official shall have included within their performance evaluation performance metrics related to the execution of the responsibilities under this paragraph. Not later than 30 days after the date of the enactment of this Act, each Secretary shall submit to the appropriate congressional committees the name of the senior official selected under this paragraph. If the Secretary of Defense and the Secretary of Veterans Affairs fail to meet the requirements under paragraph (1), the Secretaries shall jointly conduct an accountability review to identify the following: The root cause of the failure and if the failure is a result of technology or human performance. The work sections responsible for the failure. The milestones and resource investment required to achieve such requirements. The recommendations for corrective actions, to include personnel actions, to achieve such requirements. If the Secretaries conduct a review under paragraph (5), the Secretaries shall jointly submit to the appropriate congressional committees a report of the results of the review by not later than November 30, 2014. Not later than 60 days after the date of the enactment of this Act, the Secretaries shall jointly establish an advisory panel to support the development and validation of requirements, programmatic assessment, and other actions, as needed by the Secretaries, with respect to the integrated electronic health record established under subsection (b). The panel shall certify to the appropriate congressional committees that such record meets the definition of integrated as specified in subsection (j)(4). The panel established under paragraph
(1)shall consist of not more than 14 members, appointed by the Secretaries as follows: Two co-chairs, one appointed by each of the Secretaries. The chief information officer of the Department of Defense and the chief information officer of the Department of Veterans Affairs. One member from the acquisition community of the Department of Defense and one member from such community of the Department of Veterans Affairs. Two members from the academic community appointed by the Secretary of Defense. Two members from the academic community appointed by the Secretary of Veterans Affairs. Two members from industry appointed by the Secretary of Defense. Two members from industry appointed by the Secretary of Veterans Affairs. The Advisory panel established under paragraph
(1)shall submit to the appropriate congressional committees a quarterly report on the activities of the panel. The panel shall submit the first report by not later than December 31, 2013. In this section: The term actionable means information that is directly useful to customers for immediate use in clinical decision making. The term appropriate congressional committees means— the congressional defense committees; and the Committees on Veterans’ Affairs of the Senate and the House of Representatives. The term generation 3 means, with respect to an electronic health systems, a system that has the technical capability to bring evidence-based medicine to the point of care and provide functionality for multiple care venues. The term integrated means one single core technology or an inherent cross-platform capability without the need for additional patch development to accomplish this capability.