I bring the subcommittee to order. A great deal has changed since our last hearing. They are finally acknowledging oracle Electronic Health record systems not fully functional and not suitable in any other facility. After nearly three years across the board despite the mounting consequences to better than safety, staff burnout and billions of dollars wasted, secretary mcdonagh have become realistic about the future of this illconceived project. Thats encouraging. What has been painful and very expensive to watch this disaster unfold its been frustrating to argue and plead with the va not to march off the cliff only to be ignored or stonewalled. Thankfully the department is now listening to what veterans and its own employees and this committee have been saying for so long. It is far past time to look under the hood and see if it can be fixed and whether progress is even being made. But be assured thats exactly what we are about to do. We are here today to take an indepth look at one particularly dysfunctional aspect of the pharmacy. Pharmacy is crucial to Veterans Health and wellbeing and unfortunately, its one of the most overridden and dangerous parts of the system. First and foremost, we need to listen to the va pharmacists who use it every day. To that end, the subcommittee sent questionnaires to each of the five Medical Centers using oracle. We received responses from walla walla, columbus and british burn. The situation they described as outrageous and dangerous. The pharmacists cannot trust the system so they have to work in a constant state of hypervigilance. The Spokane Medical Center has been liable for two and a half years and yet they continue to discover new problems every week. Across the sites patients are up over 300 since it went live and about a quarter of these incidents are directly related to pharmacies. The Medical Centers have added on an average of 20 more pharmacy employees to perform the same workload on top of relying support from remote pharmacists. Columbus even had a dedicated pharmacists to manage the help desk tickets fulltime and created a management position at the pharmacy just to deal with ve hr. Altogether the pharmacy operations at spokane and columbus have seen a more than 9 million deficit from increased staffing costs and lost copays and collections. On average, they struggle with the hr saved about 22 points off the Medical Center scores and the best places to work survey. The pharmacists are in distress and do not feel their concerns are being taken seriously. That is deeply unfortunate because they, not the va central office, have been doing the crucial work to document the systems flaws since the very beginning. It was the pharmacists who wrote the initial 57 page Patient Safety domain report in august of 2021. The pharmacists that these Medical Centers who identified the 79 business requirements change request and continued to track them. Some of the findings went into the improvement report that doctor evans Office Released in march but appears that much more was excluded. Oracle released pharmacy updates in february and late april and another one is slated for august. The pharmacists believe some of these updates have been successful, produced incremental improvements. As for the more significant updates, they seem to have created as many new complications as they even resolved. The va and oracle server are barely scratching the surface, tackling only a handful of the highpriority issues from a list that is approaching 100. With that i would yield five minutes to Ranking Member. Thank you so much mr. Chairman. Thank you to our witnesses for being here today to discuss the critical project at the department of Veterans Affairs. I want to start by saying i hope support the vas decision to to alert how they fix the issue five sites currently live on the system. Im a cosponsor along with chairman and Ranking Member on the dhr reset exact fortitude talking to my colleagues on do not arrive at any future sites until we fix the system. These sites have borne the brunt of be a struggle to properly manage this project in the very beginning we owe them our focus that being said number of concerns with the delay. Does not provide the committee of the timeline for when they expect the work to be completed at the live site. Very concerned that va has not established a baseline without a baseline every future will bring more changes to the system constant change request will continue to have impact on the cost and timeline of the project will force that at the after site to continually adjust the workflows. Ive already heard from the staff fulfill they are repeatedly bashed by rocks of the ways of change. The change fatigue associate with constant judgment was detrimental to staff morale while lasting effect on the ability to recruit and retain highquality staff and by extension access to healthcare. Must show up process to ensure any changes to the system are both necessary and the best interest of our veterans and the providers. Cannot be allowed to go the way every faculty is operating a different system. The va employees feel like theyre concerned about being addressed under bothered on the path toward communication frontline staff must improve if they expect them to adopt the change. Also there must be more emphasis on empowering employees in the decisionmaking process and having the issues fixed faster. Theres an entire workforce who are being underutilized in this project that could be empowered to manage local configuration changes would drastically improve the timeline. But also improve User Satisfaction. And they want to address recent reports of patient harm caused by new bhr. I spent much of my current healthcare and understand its not as simple as saying some role this incidence. I hope that both the va and center are looking at the system where there is a potential for patient harm instead of reactively displaces her harm has already occurred. On a more positive note im cautiously optimistic the new Leadership Team has made great progress in the short time they have been in place. The attitude and experience has brought to his role is refreshing. Im encouraged the va has chosen practicing physician from system to help turn the system around. Doctor evans you and your work are cut out for you. I look forward to that conversation im encouraged him from every and how to make a reality for all of her vas. Thank you so much leo back to you mr. Chair. Thank you very much Ranking Member. Will now introduce the witnesses first and only panel today. When the Veterans Affairs with doctor neil evans acting executive director electronic modernization integration office. Doctor Thomas Emmons are for the executive director of the Pharmacy Benefit Management services doctor Robert Silverman and chairman of the e hr Pharmacy Council. Next we have mr. Celia doctor james only Vice President for federal health. Finally we have missed carol harris the director of Information Technology cybersecurity i think Government Accountability office. I asked the witnesses to please stand and raise your right hand. You solemnly swear under penalty of perjury this testimony about to provide is a truth the whole truth and nothing but the truth . Thank you that the record reflect all the witnesses have answered in the affirmative. Doctor kevin turner recognized for five minutes simply beer your Opening Statement. Treatment rosendale, Ranking Member, distinguished members of the subcommittee be thank you for the opportunity to testify in support of the ace initiative to modernize its Electronic Health record system. Today is meant; my va colleagues Pharmacy Benefit Management doctor silverman cochair of the council the Pharmacy Council for Electronic Healthcare modernization. Before i speak about the impact of our Electronic Health record modernization efforts in the intersection with these Pharmacy Services elective or to first spend a few moments discussing a recent decision to halt deployment activities of the federal Electronic Health record va. As part of a Larger Program reset. Weve been listening to veterans in the va staff or use an Electronic Health record the Medical Centers va clinics and remote supporting locations associate with her Health Systems in spokane and washington in white oregon in columbus, ohio. Weve also been listening to congress including this subcommittee. The new Electronic Health record is not meeting our expectations. The va is electing to take the time to get things right. The program reset files an extended pause in deployments that began july of 2022 culminating in an effort to assess and address a more narrow set of issues deemed to be the most impactful selected to the lens of Patient Safety. Our network with oracle to address the issues identified on together with oracle during this reset will more comprehensively address both these issues and a broader set of changes necessary for program success. Additional points will not be scheduled to be as confident its highly functioning current sites. And is ready to deliver for clinicians and future sites. This readiness will be demonstrated by clear improvements in the clinician and veteran experience sustained in highperformance high reliability of the system itself and productivity excites dhr is in use and more. Reset. Concludes a plans to release new to point schedule. The only exception to the full staff deployment activities is that captain james a lover of Healthcare CenterNorth Chicago service at this Service Deployment activities there will continue with the plan deployment 2024 per that will of course improvements made during the concurrent program reset. I like to now turn to the focus area of this hearing big deep dive into pharmacy and the new Electronic Health record. The top priority of a Pharmacy Program is to serve and honor the men and women who are americans veterans Pharmacy Programs and the pillars of safety, quality and value. In addition Customer Service is a hallmark of the pharmacy service. One example is that mail Pharmacy Program va runs fulfillment to over veterans every day. Leads the mail order pharmacy business externally jd power and associates National Pharmacy study and of the last 14 years. Managing over 146 million total prescriptions a year at va pharmacists and pharmacy staff are fully integrated into our care teams as firstclass members of the team. The division that exist between the health the system and retail pharmacies in the private sector does not exist in va. Pharmacy programs have achieved success by cultivating a culture of continuous improvement. Want to acknowledge and thank our pharmacy to identify improvement in the oracle pharmacy system and the Electronic Health record. Aspects of Oracle Center pharmacy application med manager retail. Interaction with core Electronic Health records specifically power chart. Series of Development Efforts are underway to improve the visualization of medications for both pharmacy and ordering provider to improve synchronization between a med manager retail and power chart to prove the efficiency prefer staff is a process prescriptions and refills. Some improvements softer updates over the past few months remainder plan between now and february 2024. The feedback my Pharmacy Community regionally deployed enhancements this improvements have in small incremental. These improvements are appreciated va pharmacy staff and providers accelerated delivery of upgrades to eliminate the burden of the more laborintensive human mitigation strategies in place the current pace of new request enhancements focus areas in months to come as a work to optimize and accelerate efforts were possible chairman rosendale, Ranking Member, mccormick and members of the committee thank you again for this opportunity to testify today your continued support of your nations veterans thank you at the written statement will be entered into the hearing record. You are not recognize for five minutes to two of your Opening Statement too. Treatment rosendale members of the subcommittee. Thank you for inviting us here today. Im joined by doctor james owsley for federal team we look forward to this discussion are pharmacy capabilities for new ea. But first with vas announcement on april 21 reset for the e hr program once and stating it oracles proud to continue to Work Together to modernize the system. We support base plan to improve operation like the current sites take the necessary time to institute governance, change management, standardization changes to ensure the success of future va deployments similar to what dot did. The ids modernization is nearly complete on time and on budget. We will continue to closely coordinate with va to provide enhancements and updates to e hr as we have acquisition of certain requesting. Hr system including its pharmacy capabilities. Overall the system performance significantly improved from where it was last summer. The five currently live size on average it 2. 8 have been billed through the mail system. Veteran comes into get a prescription which is below the Key Performance metrics set by the va. The ace pharmacy system does not operate the same as commercial healthcares is a doctor evans noted. Dhr enables provider to order a prescription receiving pharmacy utilizes its own software for dispensing the medication. Va and the dispensing party to its own pharmacy fundamental difference is the reason white outpatient application provider ordering application. After the acquisition close i came to the home of many members who are interested in this program. In every single meeting i heard about pharmacy and the need these enhancements. Members were unhappy had provide a timeline of up to three years to do the work, once the va family settled on its requirements. Is clearly unacceptable. Whats the requirements for the leverage of sin va by va at august we built and deployed the top three enhancements in four months. There are seven total enhancements the order it was prioritized. The remaining four enhancements fully delivered this year for deployment in 2023 and early 2024. It is a significant faster overall time line. We hope it shows you the oracles highly capable partner for va and pharmacy enhancements or other fixes epic tremendous resources into getting the work done well and quickly. We both read survey results matter recently pharmacy enhancements we are not completely surprised first three enhancements delivers prioritized by the va focus more on improving Provider Experience the next set of enhancements or focus more improving the pharmacist experience. We believe wants to live and implemented pharmacists to be in a position to provide a bit about google feedback. What other point about the pharmacist system i like to highlight is opioid advisor tool. This allows clinicians to simultaneously and department of defense opioid advisor tool is alerted providers to avoid prescribing opioids to high risk patients in 1800 times since the member 2020. Opioid advisor the other modern enhancements completed and in process we believe the pharmacy system will provide a high degree of safety for veterans as they receive their medications. However we will continue to review it with va especially given the reset. We are now in. While make sure enhancements which are forthcoming are delivered on or ahead of schedule we continue to prioritize our work on pharmacy we are confident veterans receive the medications they need when needed. Thank you. Thank you. Ms. Harris or recognize for five minutes to deliver the Opening Statement. And members of the subcommittee im pleased to produce by the pharmacy related function of the new system. As requested up briefly summarize the findings recently completed a review this Mission Critical system. Applicable to that term as a whole including the pharmacy related concerns discussed today. As you know va provides Healthcare Services to roughly 9 million veterans and their families legacy system. In june 2017 the department initiate the e hrm program to replace and is obligated at least 9. 4 million of this program to date. This is also vas fourth attempt at replacing the legacy system and the implementation thus far has been just as challenging as the last three attempts if not even more so. We support recent decision to pause future deployments in order to focus on maki