This House Appropriations subcommittee hearing is an hour ad a half good hour and half. [indiscernible] Surgeon General of the United States air force. Assistant secretary of state defense for health affairs. Director of health agency. Officer ofcutive health care and management system. Systems. Today, we have serious questions on how medical reforms have been accounted for in the president s budget for fiscal year 2021. We will have ce, members coming in and out. E are getting briefings on coindividual 19 covid19 as and there are other meetings going on but your full testimony is available. Last members had it night, like i did, to read through it. So well get started. Spectrum in the military Health Care System to benefit care, in many cases the justifications lacks adequate detail for the subcommittee to make informed decisions. The departments study on reducing and eliminating Certain HealthCare Services at many military Treatment Facilities and an update on the departments Electronic Health care records system m. S. H. Genesis. We look forward to hearing about these topics and more. I want to thank you for appearing before the subcommittee and now i want to recognize our distinguished Ranking Member, mr. Calvert, for his comments. Mr. Calvert thank you, madam chairman. To this horrible disease as covid19. From corona, california. I want to make sure we call it is. Hat it ms. Mccollum i did it for you. Mr. Calvert i thank you very much. To welcome the distinguished panel. This is critical for the military Health Care System. E are trying to keep the covid19 virus from impacting readiness while going through significant structural changes to the system. Include Treatment Facilities and consolidating shifting ities and other specialties to focus on readiness all while continuing to implement a new Electronic Health medical system. On your you have plate. Given these issues will impact the broad population to include personnel, dependents and retirees, i cant overstate importance of keeping us apprise of your progress and inform us when you need help. Must insure that health and safety are not adversely as a result of these structural changes. During my time, ill ask you to of these issues, starting with your preparedness and resourcing for covid19. The impact it has gloiblly and ill be globally your ll be interested in plans to mitigate on the force. Ill ask your views on the changes to the military Health Care System and their potential impact on readiness. Finally, i look forward to hearing about the progress on mplementing the new Electronic Health record. Thank you for your service. I look forward to your testimony. Chairman, i dam yield back. Ms. Mccollum thank you. Rs. Lowey and ms. Granger are helping to be joining hoping to be joining us and well break for any statements they wish to arrive. En they as i said earlier, your full written testimony will be placed n the record, and members have copies at their seats and i told read you i was rifted rifbetted reading riveted reading last night. N the interest of time, however, i encourage each one of you to keep your summarized tatement to three minutes or less. And i will let you know when youre at three minutes. I will do so gently. It might get a little louder with the gavel. Dingell, ant general off . He le will you lead us you, l dingell thank chair mccollum, Ranking Member, its an honor to speak to you today. He army is called upon to win ars its part of a joint force thats represented before you today. The chief staff of the army says winning matters because there is no second place combat. I and everyone in Army Medicine recognize the strength of our rely on our people, our soldiers, their families, and my vision s for life for Army Medicine is to make we remain ready, responsive and is complexity, change and uncertainty. Whether the support of multidomain operations, pandemic emergencies. Army undergoes modernization to support the multidomain battlefield, we will lead through change. We organize to remain relevant and responsive to the war fighter. Owever, our unwavered commitment to save lives on the battlefield will never change. Oured adversaries may have robust antiaccess and area will capabilities that test our ability to provide prolonged field care. Will uently, our medics as yustere ain life in locations. To remain relevant, we must leverage 21st Century Digital technologies along with Edge Research and development in order to remain proficient. Army medicines is assisting in prevens, deterrence, detection, and treatment of Infectious Diseases. Ebola to h. I. V. And the responses, Army Medicine is working with leading agencies to combat tions covid19. To medicines ability detect, weedetect ill have an enable and ready force. In closing, i want to thank the committee for allowing my colleagues and i to speak before this morning. America entrusts the military Health System, Army Medicine, services with this most precious resources, our sons and daughters. It is imperative that we get it right and we will. Ment and it sdwrment continued commitment and means we will rt be there ready to respond because Army Medicine is army strong. I look forward to answering your questions. Ms. Mccollum sir, that was timing. D with precision gillingham. Rear admiral beginningham on of the over 60,000 of men part of the have tare Navy Medicine team, mission of is linked to those we serve, the United States navy and the United States marine corps. Prevail across the military operations depends on their medical readiness and capability to enhance their survival on the highend fight. T its core, survivability is Navy Medicines contribution to lethality. To this end, our one navy is the people,ty platforms, performance and power. Meet gically aligned to these impair tiffs. Welltrained people working at ohesive teams on optimized platforms demonstrating high velocity performance that will proje power in support of navy superiority. I can tell you these priorities hold. Pidly taking on any given day, Navy Personnel deployed and are part of resuscitation, surgery teams, trauma care at unit ltinational medical in kandahar airfield, afghanistan, humanitarian aboard our hospital ships, and force help protection world. The theres no doubt that people are the epicenter of everything we do. Active and reserve, civilia civilians and in order to recruit, his we must retain the workforce. Focusedicine continues to specialties uding as well as Mental Health care providers. Mportantly, we are embedding 29 of our Mental Health providers directly with fleet, force, and training commands to improve access to stigma. To help reduce all of us haa responsibility to s have a responsibility to reduce suicide. The impact is devastating and commands. Ipmates and ollectively, substand the National Defense authorization act catalyzed our efforts to integrated system of readiness and help. Navy and marine corps leadership tremendous e opportunity we have to refocus transitioning le medicine. E m. H. S. Reform presents us with both challenges and opportunities. Progress made to date, however, all of us ecognize theres much work ahead. In summary, the nation depends on our unique medical expertise and support our naval forces. Again, thank you for your leadership. I look forward to your questions. You. Ccollum thank Lieutenant General hawk, please. Vice chairwoman mccollum, distinguished members of the ubcommittee, its my distinct honor to testify on behalf of guard, 00 active duty reserve, civilian airmen who comprise the air force medical service. Abroad, air force mettics answer the call medics answer the call across Disaster Response missions. From the clinic to the battlefield and even the back of airplane, our ability to deliver Life Sustaining care is in the challenging most challenging environments ensures that our warriors return families. Eir the air force medical service mediciney of aerospace and evacuation focuses on the need of air and Space Operators maintainers. Since september 11, air force air medical evacuation crews conducted more than 340,000 Global Patient movements, 13,500 Critical Care missions. Environment, d roughly 30 of downrange care is trauma related and the remaining is disease, nonbattle injuries. Hese injuries range from occupational, dental, muscular injuries. Ur training mirrors these scenarios to have wellrounded, work le medics who can under different conditions. As the National Defense strategy conflict and pure competition, the air force will lethality, realign areas. We will invest in our air edical evacuation platforms, ground surgical teams, and broadening every medics skill set. To deliver here in environments where we may not of functionle airfields or saith of ttateof equipment. Young medical te technician, drives home the last point. Airman mitchell was n her first deployment when alshabaab killed three americans. She ned by the chaos, assumed the role of lead medic, working hours triaging, with limited personnel and supplies, she operated well bove her pay grade and outside her comfort zone to save lives. Airman mitchell demonstrates the of what makes our medics critical. As the Surgeon General, my responsibility is to prepare medic to do what airman mitchell did, and i do not take this task lightly. Facilities atment remain our primary readiness platform. Of times falls short offering patient volume, diversity and acuity needed to currency. Inical leveraging additional training opportunities through civilian and Government Health is paramount and will inevitably grow as we system. The health care military medicine presents unique challenges that a civilian Health Care System does encounter. Our medics will continue to rise to those challenges. Thank you for your continued i look forward to your questions. Mccollum thank you. Lieutenant general. Vice chairwoman mccollum, Ranking Member calvert, members committee, thanks for the opportunity. To my d a few comments colleagues. Our mission is readiness. Here are two distinct responsibilities. First to ensure that every person in uniform is medically job to perform their anywhere in the world. Second is to ensure our military the al personnel have cognitive and Technical Skills to perform military operations leaders may call on us to perform. The agency is accountable to the secretary of defense, onorable mccaffrey, the combatant commands. They assume responsibility for managing all military hospitals United States the in october of last year. Working closely with my we continue to view our medical facilities as eadiness platforms where medical professionals from the army, navy, air force both obtain and sustain their skills. These professionals deploy in support of military operations. Leaderships recent assessment of which medical facilities best support this eadiness mission provides the basis for moving forward in implementing these decisions. We intend to excuse this plan in ensures our patients continue to have timely quality medical care. Ill highlight a few important points. First, active duty family who are required to transition to civilian network roviders will incur little to no additional outofpocket costs for their care. Econd, all beneficiaries in these locations will still enjoy access to the m. T. F. Pharmacy. Implement changes in a deliberate fashion at a markets l health care can handle. If it is more constrained than reassess our well plans and potentially adjust them. The Surgeon Generals and i are proposed reduction are iform personnel coordinated. By thenization, required ndaa is due to congress in june. Ell ensure we are using the resources provided by congress in a manner that most effectively supports our readiness mission. Have established four Health Care Markets in specific regions country. Well be establishing additional markets throughout the year. Authority l have the and responsibility to allocate resources in a way that improves atient care and our readiness functions. Im grateful for the opportunity to provide further detail on our military standardize medical support to combat and commands, the military departments, and to our patients. Thank you to the members of this committee for your commitment to the men and women of our armed forces and the families who them. T fferty. Ollum mr. Calf mr. Caffertr area on behalf of defense, its of an honor to speak before you oday representing the military Health System who support our war fighters and care for the that llion beneficiaries our system services. Im pleased to present to you to budget for health iscal year 2021, a budget that prioritizes the midcal readiness of our military force and their force ss of the medical while sustaining access to b ity health care for our beneficiaries. Mr. Mccaffery we request 33. 3 health for the defense program. This proposed budget continues implementation of a number of comprehensive reforms to our by th system as directed congress and department leadership. Some of the significant reforms re the following consolidated administration and management of our military the tals and clinics under Defense Health agency. Right sizing our military to focus frastructure on readiness within our direct care system and finally, the size and composition of the military our al force to best meet readiness mission. In implementing these reforms, he department is guided by two critical principles. First, that our military clinics are first and foremost military facilities hose operations need to be focused on meeting military readiness requirements. That our m. T. F. s serve as the primary platform by Service Members are trained and deployed. M. T. F. s are our utilized as training platforms medicalble our military personnel to acquire and maintain the Clinical Skills for deploymentem and support of combat operations. The d, that as we reform military Health System we continue to make good on our commitment to provide our with access to Quality Health care. While we implement these changes Health System, we also continue to pursue our other initiatives that have contributed to the achievement of the highest battlefield urvival rates in history while providing World Class Health care to our millions of beneficiaries. Hat includes our continued deployment of our Electronic Health record and our ongoing cutting edge ur research and development programs, which congress and his committee have long championed. That work in that area is playing a significant role in of the whole of government effort on the covid19 issue. Thank the committee for your continued support of these efforts and to the men and health the military system and the millions depending on us. Us support has helped achieve and continue to drive forward unpair littled success and sustaining a military Health System that elivers for our Service Members, our beneficiaries and our nation. You. Ms. Mccollum thank you. Vice chairwoman mccollum, Ranking Member calvert, distinguished members of the subcommittee, thank you for your invitation. The Program Executive office Defense HealthCare Management systems, also as the peodhms. We will have a common Electronic Health system for service and their terans, families. Critical data on the battlefield to documenting karat military and veteran medical facilities, we the patient is our f focus. Our patientcentered model Broad Spectrum of eople who depend on m. H. S. Genesis. Systems do not create success. People do. We depend on the hard work of and our s, engineers, business professionals who our genesis team. To thank them for their support. Completeder, 2019, we trafficries without any patient issues. The medical staff at Travis Air Force base demonstrated genesis on n m. H. S. Day one when the patient arrived t the emergency room in sudden cardiac arrest two hours before the go live, the team had a choice. Genesis and h. S. That was the right decision. With every deployment, we hone ur process and improve capability delivery. For instance, establishing peertopeer training successful, so much so that we a workshop as we continued deployments. N summer, genesis will go to wade ellis. As we move forward we seek to process while ur meeting the unique needs of each site in order to optimize enterprise. The we have proven that it improves the patient experience. Nytime we can enhance patient care, we absolutely should. As part of that process, we will ontinue to assess risks and ensure fiscal stewardship making every dollar count. Making every dollar count is optimizing efficiencies. For example, within the next few months, we will launch a joint Health Information exchange with expanding d. O. D. Onnections with private Sector Health care providers. I am truly invested in the success of this program. Significant time at alter reed with my parents, i know about giving patientcentered care. We value transparency and we you, the committee, as the wise sentiment goes, its amazing what can be achieved as care who gets t the credit. The m. H. S. Genesis team wisdom. Ies this together, we have an opportunity to make a tangible difference in the lives of millions of americans. For your time. I look forward to your questions. You. Ccollum thank and with great humility and honor, i turn to the full chair committee,opriations mrs. Lowey, for her first question. Lowey thank you. Boy. Thank you. I need some health care, i think, at this moment. Out. T was all checked i just lost my voice. Come to this o hearing because, as you probably know, this committee and the other committee focusing on waiting with een a health ath to get care record system that works. S you probably know, mr. Tinston, for decades, this funded efforts to Health System at both the v. A. And the department of defense. Efforts to r, address Electronic Health records. Because i hadand, briefings, hearings on this over at least, ve years, so i know its difficult. Our Service Members and their families have been too long. R far and the taxpayers hav invested continue with delays. And im not saying that its all d. O. D. Is perfect. Are you learning anything by this . We had a hearing not too long v. A. Ith the number i looked at, the department is requesting billion, billion, in case anyone in the audience hink i said million, another billion in f. Y. 2021. It. Nt get maybe you can explain why this taking so long. If this happened in the private sector, they probably would be business. Of but you are too valuable, and out of an you be business. But i dont understand why you done. Get this my colleague, mr. Rogers, is not here. Weve had closed dooring hearings closed door open hearings, private discussions. Dollars . Illion why cant you get this right . Mr. Tinston we went to wade travis. Very successful deployment. We changed the way we delivered the infrastructure. We changed the way we delivered training. We prepared people to be effective at doing their jobs nd we found it to be a very effective deployment. At this point we have 66 sites coming up ith nellis next with 10 sites. I think were doing we are progress in dous getting m. H. S. Genesis, the Electronic Health system deployed. We are working very closely with because we are really deploying a joint system here. Its a single record for both departments. V. A. Starts to bring their sites on, we will have one theance of the record about patient, not where the care was elivered or who delivered the any mrs. Lowey can you give us another explanation as to why sites . Bringing on why is this so complicated . The v. A. Isnt up to standards and they cant get from a disastrous incident that happened two years go, they are not getting Adequate Health care. Mr. Tinston so when youre delivering an enterprise system Enterprise Health record, Electronic Health record i. T. M. H. S. Genesis is, the element of it is the small piece of the transformation that must organization. Its an organizational transformation. Its a training challenge. To work so you deliver the right capability in done. Cord, which weve you then have to customize that record to meet the physical of the facilities youre supporting, and then you have to train people to be effective new work with the flows you introduced. Its not just turn it on and let everyone start using it. To be very deliberate about bringing people up to speed so they can be effective dont compromise the Health Care Delivery as we genesis. H. S. Mrs. Lowey 4. 6 billion. Want another 1 billion. Great re that our military has had many, Many Missions and, frankly, i dont understand. Understand what youre saying, but i dont understand why you cant get it right. Just hope that next year you wont ask for another billion billion with her 4. 6 billion and the expertise that you have any military, it that this could have been completed, but i have after aring one excuse another, year after year, and if my colleague, mr. Rogers, was probably would get even edder face than i am because weve had public meetings, onetoone tings, meetings, twotoone meetings. Ok. Give youe will have to 1 billion. I sure hope you get it right this time. Is going arantee this to do it . You have finally the expertise it. O mr. Tinston congresswoman, we the the right people in right place. Mrs. Lowey i heard this the last five years. Expert, they y understand the systems . Mr. Tinston yes. Mrs. Lowey ok. That down in the record. Thank you very much, madam chair. Ms. Mccollum so noted. I recognize mr. Calvert. Calvert thank you, madam chairman. And thank you, again, for you being here. Id like to start off with a question on the covid19 since significant of the impact its having around the world. Was speaking to general townsend, the africomm this week andlier this showed the u. S. Army africa eadquarters, a party they have over ini italy, is surrounded b virus a local e community. Indicated fortunately so far have not not anything new this morning they have not been affected and thats a to the great work that people have done in their to protect our force. S this virus continues to spread, what steps are you taking to ensure installations in the united nd states are protected and do you beyondditional resources the fiscal year 2021 president s request or in the supplemental there may be some the tance available to military also, but to continue he safeguard for the force against covid19. So i dont know where to start. Start with the admiral. Ill start down here at the end. Ill be happy to kick it off and my colleagues can chime in. Mr. Calvert, so when the d. O. D. Covid19 issue, theres really a handful of at. Rities we look first is, is the safety and health and wellbeing of our thats very ers, much tied to our ability to, as issue, to h this continue to meet the mission and, third, how we, the d. O. D. , support the rest of the federal government in the all of government approach and strategy the covid19 issue. Mr. Caffery with regard to the we are giving on that First Priority around the health and wellbeing of our service has rs, the department ssued a series of Health Protection guidance to our ervice members and our commanders. Built largely around c. D. C. Guidance. Identifying und best science and c. D. C. Guidance personnel, Health Care Worker protection, protocols for screening of and reporting virus, ng any detected its also around giving guidance know, protection, you common hygiene in terms of protection against viruses. Guidance o are giving with regard to working with the c. D. C. And the department of guidance in terms of restriction of travel to and from select companies. Recently, sir, iving guidance to Installation Commanders. The combat and commanders with regard to how to assess their situation on the ground, be it at installations overseas and what kind of guidance they should use in aking their flexible judgments about protections to put in place on their bases. Gain, everything from restricted travel and access to their bases. Issues additional guidance, things change in terms we will advisories, continue to update that guidance field. Mr. Calvert thank you for that. Comments on the comments . On the force itself, i was since yesterday, were transmissions . Ms. Hogg for years we had plans and pandemic endsa influenza plans. Now were helping direct our to the in relationship c. D. C. And health and Human Services guidance. Mr. Calvert general. Sir, from the army erspective, we have taken a threeprong approach of prevent, detect, and treat. He prevention is the education awareness of all the soldiers nd family members within that installation footprint. The screenings that were doing veri as the testing to verify, the presence to acknowledge if it is in fact have m attic and those been mr. Calvert south korea, specifically, you still have not had any additional transmissions . No additional. Right now we have one soldier two dependents. Ight now that is the last basis of treatment where we have implemented our Pandemic Response plans or plans. Mr. Dingle Emergency Preparedness and even going as as worstcase scenarios on bed expansion plans. E are taking a holistic approach of prevent, detect, treat as army. General abrams pretty much has all the at this s shut down point . Lieutenant general dingle to and e we are not spreading they have not implemented some of the normal activities that bring together large gatherings. School, each Installation Commander makes the call under the guidance. Sir. Mr. Calvert admiral. Yes, sir. Thank st say id like to the committee for the investment that has been made over the budget the president s for our network, Worldwide Network of Service Research labs. I can specifically say for navy, in Research Labs that are singapore, as well as in italy forefront of the emergingsponse to this pandemic. But that investment has in scientists and really world eading knowledge and research is now bearing fruit. And youre seeing that dividend now have 12 of 14 d. O. D. Labs actively able to testing around the world. Mr. Calvert thank you. Congressman, just d. O. D. Wide, so we have as of cases ght four confirmed and 12 suspected that are being tested. Calvert where are those cases . That i dont have the breakdown. Both s across the d. O. D. Here and mr. Calvert outside of the United States . Any case within the United States, are you aware of . I do not believe d. O. D. Cases as of yet but i can get you the updated numbers today and break down. Mr. Calvert i appreciate that. Thank you. Thank you, madam chair. Ms. Mccollum thank you. Ask you to submit to the report to the committee as soon as possible on the two following questions, following up on my colleague from covid19. On 3 billion of the supplemental oes towards research and development of vaccines. Considering the departments experience on working on sars mers, two respiratory illnesses that are similar to what 19, id like to know the department of defense and army in particular are doing to work with our other federal partners, f. D. A. , c. D. C. , and h. H. S. In developing vaccine. The other information id like you to share back with us as example, ssible, for the federal government maintains and piles of respirators its come to all of our attention that a number of these respirators have been allowed to expire. Once again, the military usually oes logistics and stock filing stockpiling with great, great precision. Id like information on the and how youre maintaining your stockpile of and how rs and masks you would distribute it within he different branches if needed. With your knowledge in the area, what role should the d. O. D. Play or could play in working with agencies to maintain public proper stockpiles of supplies so our country can be better prepared for future health care crisis. Please follow up and get that information to us. On military s downsizing. Ccaffrey, as you know report for had a planned closing and downsizing d. O. D. Treatment facilities and i would stress the word report here because impacted list of facilities. Some of the comments on the downsizing would were no outofpocket costs to families or soldiers or airmen and that their change tions wouldnt but there are other things that can impact the delivery of health care, not only to the wearing the uniform but the families thats behind that person. Members need to know that their families are well taken care of. Bottom line is, we still dont a timeline, projections of cost savings, a real plan for implementation of these and closures. While i understand the department wants to focus on readiness of cal our troops and medical forces, the impacts that this significant will be and trust me, we will hear from the individuals that are changes. By these some numbers i have seen family ter 200 200,000 family members and retirees across the country d. O. D. E pushed away from medical Treatment Facilities and onto civilian providers. To understand what that plan looks like. Office isretary, your has clearly been thinking about this for a long time since you of facilities that have been impacted. There must be a document back up these facilities and how they were chosen. How can you ary, know, do to be, you we havent e when seen a comprehensive transparent lan from the department on what, when, or how this restrict urg will be implemented . The report , submitted on february 19 states, and i quote, upon submission of detailed t, Implementation Planning will begin with implementation less than 90 days later. We need the information. Language to me and to many sounds as though the department does not require congressional approval prior to moving forward with the implementation. Mccaffrey, does the Congress Need the stamp of to the prior departments moving forward with he Implementation Plans to descope services at military Treatment Facilities . Nd the final question for now, as we wait your written response as soon as possible, if you are to transmit to us a and transparent plan, why not ask for a delay of the reorganization so we can get and not cause any confusion for congress in its funds when your patients, our soldiers, marines ask us whats happening to them and families . If i can go through each of the question and if i missed something, let me follow up. Will with regard to the review that the department has done, this out of ndaa 2017 direction from congress to all of our military hospitals and clinics to ensure aligned and matched with mission, being military facilities and platforms for our medical force ensuring our active duty are getting convenient access to care in order to be to do their dy jobs. So that is thats the focus. Reason why in our report to identify some facilities that we are of mmending for a reduction the Services Available to m. T. F. , it is because of this tie the operation of the m. T. F. To that readiness mission. That . Do i mean by there are some facilities where the volume of caseload and the caseload that is provided at that particular good match for the type of caseload that our providers need to maintain proficiency and skills we expect them to have currency in ccaffrey mr. M ccaffery we were given none of the supporting documents up. G followed we are being asked to make decisions and a time frame within a matter of months. Said, congress charged you with this. So when can we expect a ollowup and the supporting documents . Mr. Mccaffery i will outline that. Congress ort to identified and shared that we u. S. Based of 348 hospitals and clinics. Out of those, the department a deep dive7 needed examination. The report went through. Used to dology we identify those, the methodology looking at the communi community, availability of health care. We then out of the 77, we 21 y determined ms. Mccollum sir, we have the report, as you pointed out. Hen is the Implementation Plan coming . Mr. Mccaffery in the report, ach of the 50 facilities that are being recommended for a change, theres an entire use case that goes through all of data we used specific to that m. T. F. He report very clearly says theres not going to be any immediate change to operations. A t its not onesizefitsall implementation timeline. It will be based upon our work the individual m. T. F. And that community our staff seems to think and i would agree with based on what i and that we need en some more information here. To please sk you follow up with the committee because i have a lot of members here who have a lot of other i know youre going to want to hear about, whats on the minds of other congress. I thank you for that. At this point in time i would say that appropriations doesnt feel it is fully informed and ready to go. Ccaffery we will be happy o provide you with additional information. Ms. Mccollum thank you. Mr. Carter. Hank mr. Carter i appreciate all of ou being here. Rying to learn this. Transition of military treatment acilities going . [indiscernible] mr. Carter while they transition to d. H. S. , the ervices are still supporting [indiscernible] mr. Carter continue to provide military treatment. Of is the plan to decrease support from the services . Thanks for that question. In terms of the first part, how is it going . Extraordinarily complex and challenging transformation. That said, overall, i think we are going very smoothly according to the plan, not that everything is perfect and not there have been challenges, but in general as we measure the effectiveness of the care we are giving and the effectiveness of our actions to plan, we are making good improvements in the quality of care and the speed with which we are delivering the care and the resources that the congress has been generous to provide. In terms of the successes, the successful finding is in a particular regional market and ill use d. C. , for example, our ability to include the staff to align them more appropriately to the location where it can best provide health care. We are able to use the particular location whether you are enrolled in this medical Treatment Facility but to achieve the best quality of care. The standard zizzation of the market has been success. In terms of the challenges, you have been right. That is the reliance on the military to provide medical support. Staff that have been doing it for decades and services are transferring into our headquarters and into our regional markets. As we are doing that, we are sharing responsibility for the health care and oversige of that staff. That plan should continue for approximately another six months. My participation is at the end of the summer, the majority of the staff will be transferred into the headquarters and reliance on the Service Medical department at least for u. S. Based support and will be significantly diminished in almost every area. There are some challenges the way we do our financing, because we have different financing. We still have to collaborate on some functions but the majority of them will have transferred. I think i got all your questions. [indiscernible] i would echo, this is a very complicated merger and well get there as long as we get there using manageable risk. What that means for me we need to transition before we transform. We need to be able to continue supporting the Defense Health agency in standing up its capabilities to manage the facilities. If you remember in the past, d. H. A. Didnt come out of that, they came out of the triCare Management activity and they were writing contracts and we need to help them do this mission. And so, i would ask that we not add additional system changes until the Defense Health agency is standing on their own, is well established and has been managing the market with demonstrated success for a period of time. Mr. Carter, i would add the complexity is extremely difficult and from the army perspective, what we have always championed is that we cannot fail at this. We have to get this right. And in order to get it right, the focus should be on the transitions which is at our head quarter. The headquarters is not operational and running, it will require direct support. After you get the headquarters stood up, you can transition the military Treatment Facilities and we should be focusing on that Electronic Health record. From the army perspective, that is the most key thing. [indiscernible] [laughter] indiscernible] its a great point and continue to track the patients satisfaction that has transonned and the Patient Satisfaction scores at each of those sfalingses are at or above at every single location. Its at or above. So not perfect and not trying to tell you that it is, but improving. Indiscernible] Aircraft Carrier or submarine in complications and going to make the naval force. I appreciate that concern and something we thought about and we have worked closely with the c. D. C. , world health organization, north come and joint staff to understand how to eliminate that risk. One of the requirements we have established in the fleet is no ship will go to another port or arrive in another port and disembark within 14 days. Ms. Mccollum mr. Cuellar. Mr. Cuellar thank you for being here. I appreciate your work. I want to direct my question on e coronavirus and use of basis. As you know the secretary of defense approved a request for assistance from the department of health and Human Services for Housing Support for those that have to be quarantined. One of those is in my district. As you know, there was a particular situation that they released an individual and i know that you are providing support services, but i want to know if you are coordinating. They released somebody that was still pending a test. That person went to the north star mall, went around san antonio and that caused a problem because the second test came back. There was a protocol c. D. C. Ion that the director are you familiar with this letter that got sent off on the modification of protocols . Anybody . Im not sure which ommunication you are referring to. Mr. Cuellar modification on c. D. C. Changes. There were two changes. One, that is if you have a quarantined individual, that person will be released if that person had two negative tests in 24 hours, modification number one. Modification number two where i think they messed up was that no person will be released if there is a pending test result and thats what we saw in the san antonio area. My request is that i know that you all are supporting to provide support services, but i think modifications should be something that we should apply whether its in south korea or whatever the case might be. I would ask you to please be familiar with this. Any thoughts or comments on this and i want to ask you a second question. We will make sure that we have the same guidance as i believe we do have what you are showing us and as you pointed out this is a good example of where the department is in a supporting role to make an all government effort and military installations in terms of receiving repatrioted citizens and once e the c. D. C. Ose folks were on the ground and doing the testing and any kind of referrals out in the private health care sector. We defer to them. We will take a look at it. Mr. Cuellar even if you are providing support services. You are off abroad and south korea and i would ask you to do that. Second thing, what i would ask you is Walter Reed Army institute of research is working on a vaccine against the coronavirus. Can you give us the status on that progress, number one, and i think they are working on diagnose gnostic kits and how close are we . It is part of the broader interagency of looking at everything from Vaccine Research and antiviral therapies if you have the condition and how it can be treated. Havee we c. D. C. And n. I. H. In progress have Research Going on on a vaccine and has been ongoing. I believe Clinical Trials for that will not be for another few months. In terms of a final determined f. D. A. Approved vaccine, we are looking to 16 to 24 months. That is the research we are doing. I cant speak to what c. D. C. And n. I. H. Are doing on ta. We may be closer there in terms of having something that can be usable. It is in Clinical Trials for testing of efficacy. Mr. Cuellar i ask you, i know we are putting federal dollars and research and i understand that, in different areas. I want to make sure we are coordinated working together as we use this large amount of federal dollars and you saw the house passed the supplemental bill yesterday. I want to make sure we are all coordinating. Ms. Mccollum mr. Womack. Mr. Womack thanks to the entire panel. I direct my question to the general and the admiral. Im going to pivot away from all these flavors of the month, covid19, et cetera, et cetera. And i want to come back to tactical medicine. It is my strong belief that in the last two decades thanks to in the scenario to better prepare our men and women in uniform, to perform Battlefield Medicine has saved a lot of lives. There are a lot of people that have been able to go home to their families, maybe albeit banged up a lot, that in many previous wars have died in the battlefield. In my recommending meant back many years ago, we had a life Safer Program and that program we robably the reason why have done so well. I know the military services are transonning from the combat lifeSafer Program to a morrow bus task tactical casualty program. It is my understanding that that process is still evolving and tc3 program two, bedrock o be the posture in the event we were to engage in a near pure combat more forceonforce scenario a much morrow bus combat Medic Program would be important. Can you explain to me where we are in this process and how it is going and what you see unfolding in the next year or two . First and foremost, let me thank you for recognizing the First Responders. They did not get the recognition that they deserved when they are the very First Responders that stop the bleeding at our enablelers to the sustainment of life in combat. Our program has grown tremendously and call it the Army Medicine medical Sustainment Program which has combat medic care and teaching them medicine and how to provide prolonged care all the way to where we are taking our trauma teams and embedded them in our civilian facilities so they can get the touches, not just as a trauma surgeon but as a trauma team. We currently have three programs going on right now across the country and going to expand it for the trauma teams to three more and another eight more that are right behind those. In reference to those enlisted training also, we have what we called our strategic medical asset training. That training focuses on the combat medic. Not just training them in putting them into those Trauma Centers so they can get the individual task list trained to proficiencies so when they are called upon, they are ready to respond. As an Orthopedic Surgeon who 2004, charge of a unit in we need to get this right particularly as the nature of our adversary changes. In addition to moving up in terms of the capability of our enlisted providers, we are in the process of training the entirety of the ship to have those basic skills because aster menr ic as our duty corps they would be rapidly overwhelmed. We are in the process of raining the entire crew. Mr. Womack there is a lot of technology out there regarding clotting material in the application of certain bandages. Are we ok with our stockpiles . Are we procuring these new technological advances in a timely way so that we can use the very best that we have because in just in that golden time of equipment is going to be critical to helping save lives when otherwise they would be lost immediately . I cant speak directly to the er there is a haps tremendous commitment in our Research Enterprise to make sure we have the best possible equipment and technology in the hands they were used to dictating the charges that they made the round. That chart would go to medical records. Some he would transcribe that chart in medical records so that they could be electronic. It was very cumbersome. It took weeks and weeks and weeks to complete. I want to know a couple of things. The other thing we found is that , its really difficult to attract young people to residencies in the v. A. So i would like you to address what you are doing to recruit and attract young people into the Health Care System and the Delivery System and what has been done to improve the use of electronic records, let alone interoperability. We cant even get to that until we actually have the electronic records in the system. Question to open anyone on the panel who feels they can address that. Thank you. Let me start with the larger question you asked. Defer to thebly military department in terms of the specific question of things we are doing to recruit and retain young people into from our perspective, and to the medical side of the military. You indicated the challenge of adopting Electronic Health records. I think that is something that is a. For everybody. My experience in the private sector is, even systems like kaiser that have been around, very sophisticated, when they adopted a new Electronic Health record, it took several years for them to do. Its for many of the reasons that you pointed out. Its not the technology. Its about training your workforce, including clinicians, on that new technology, what the workflows are that you need to match it up. It has changed management. Purposefully rolled up for the department of defense. We rolled up the ahr. We force facilities to see what we needed to learn and informed the larger deployment. We learned many of those things. That is what has led to the most recent deployment in september, and went far better. We believe we are wellpositioned now as we pursue additional waves of getting it out throughout the system. I dont know if you have anything to add on that. Mccaffrey, we did learn a lot. [inaudible] sir, speak into a microphone. Time to makeme sure we had the capabilities right with the record in the workflows. We began training those were close to get people job ready. Teaching them how to use the ip, its one of the things we made up. Weve had much better results with this. We anticipate Continuous Improvement as we proceed to future waves. As i said earlier, we have 66 sites in the deployment process. Are you working with medical schools to train young doctors before they get to residency how to use that i. T. Software . I. T. Software . Maam, most of the medical students on the scholarship programs that bring them into our system they do rotations into our organizations. They are being trained on our systems before they get into it. We have been using Electronic Health records for two decades. The challenge that you are describing is not a challenge. We are used to using Electronic Health record. It was home grown but our culture is accepting the Electronic Health records. From our home grown Electronic Health records to the commercial off the shelf that we purchase transitiononning to that. Ms. Kirkpatrick are you using software that you purchase off the shelf . Yes, maam. Ms. Kirkpatrick the other challenge remaining is maintaining confidentiality. When records are being ransferred around to different institutions, how do you maintain the confidentiality of the medical records . We are fortunate in that we are part of the department of defense and from cybersecurity, we have the baseline of the departments cyber rules and standards to base implementation off of. We manage the cyber protections with the v. A. To meet the d. O. D. Standards and as far as the interoperability with external proirgs, we do that through the agreements in place. And we are engaged with agencies, and organizations to make sure we have influence [] ms. Kirkpatrick i appreciate your attention to it. Anything i can do to help to solve that problem, feel free to call me. I yield back. Mr. Ruppersberger thank you for being here and i appreciate your confidence and i want to get into the readiness program, smart. I know congressman would womack. And we must ensure that we continue to take care. Our deputy staff of. [indiscernible] research and development and the air force has been there for many years and have a Good Relationship and we are focused on the navy and marines. Duties of the Smart Program it is taking that combat medic and expounding and building upon what we have in the army called training sir, ill be real quick, mr. Ryan. Have a very pragmatic approach to the health of the force, and we have many programs from go green, healthy choices, spartan that get after the eating as well as the activity, as well as the entire life process or approach to living, and then our Holistic Health and fitness, going after the spiritual, physical and mental well being of our soldiers. The wellness centers, all designed to educate our soldiers where weve got programs that are also inculcated into the e te intend to expand it across the country. As you know, we have used baltimore for quite some time. We have other capabilities out there with cincinnati and yufrlt of Medical Center in nevada. What we are looking at is embeding entire teams in civilian fall silts 24 7, 365 days a year where they are get inthe mr. Ruppersberger i move to move to the peer review Research Program. I would like to ask you about this program the Orthopedic Research program. And this program has demonstrated results in rolling 15,000 in military Relevant Research with the potential to provide health care solutions. Now the conflicts in afghanistan have resulted in deaths among American Service personnel and 2,200 major limb amputations. These are from explosive blasts. Or though speedic Research Program has been funded since 2009 and received 30 million per year since f. Y. 2012. And allows doctors to stabilize with tissue regeneration and even a full transplant. Those are asking for an increase to 35 million. Which includes the major jaups y metric and hopkins university. Can you walk us through the program and the consortium that works and do you believe the program to benefit to support the sources on an ongoing force to provide the greatest return on investment . I thank you for the question. I cannot walk you through the history of this particular Research Program. I would need to get back to you. Im not aware of the requests for increased spending in this particular Research Program but im happy to take back your questions and mr. Ruppersberger ill get my staff to get in contact with your staff and make this a priority if we can. I yield back. Ms. Mccollum let me follow up on that to the committee. Mr. Crist. Crist mr. Crist how many are on life or restricted service. And that is for any of you. This may be a little dated. This is probably numbers from a couple of days ago, my understanding of out of the roughly 109 Service Members that were identified, 75 have been reviewed and evaluated and actually back in duty in iraq. The remainder, i would need to wg going going back and check what is the status with regard to their evaluation and have they been returned to duty. I dont have that handy. But i can get back to you on that. Mr. Crist i appreciate that. The bunkers mostly held and had a. M. Will warning to take shelter over 100 Service Members re diagnosed and thats very disconcerting. That number will likely increase. As general milely, the troops will need to be monitored for the rest of their lives, but he also said there is nothing we could have done, unquote, because the missiles were so powerful. If we are making investments to counter russia and china, we need to protect our Service Members including the Ballistic Missiles. What we are doing to protect Service Members, what are we doing to protect Service Members from Ballistic Missiles . A couple of things. One of the areas that congress has asked the department to work on and we are in process and that is focus especially on the implications of blast exposure. And we are in the middle of doing a study on that to figure out better ways to measure it and more importantly what we find out about the impacts of blast exposure on brain health that needs to inform everything from the weapons we acquire. Training here at home to inform what we can do to best protect our Service Members and then most importantly. You referenced it, was what we are doing. I believe it is a special forces command right now is doing a good job at baselining all of their Service Members with regard to their cognitive abilities and have the benchmark over time to see if any of there training or deployments and any events have affected that baseline as a way to monitor and evaluate. Those are the things we are looking at. Mr. Crist we know that brain injuries are a problem and our adversaries have weapons. What would happen in an attack like this . We have considered based upon the evidence we have and what kind of protective gear, based upon research we have done and what we believe makes sense in terms of protection and most importantly, we do have standard across the board policy with regard to if a Service Member has experienced a an event, there are strict protocols, screen that Service Member, get that evaluation and pursuing whatever medical care is required before returning to duty. Mr. Crist we have seen patches of coronavirus here including my as you know bay, there are larger outbreaks to installations overseas. What are you doing to stop the spread of coronavirus on our troops . We have should force Health Protection guidance built around c. D. C. Guidance and part of that is how we apply that guidance to the military environment and Installation Commanders here and abroad and how to apply that in their particular situations on the grouped and inform what they want to do in terms of screenings and access to the installation as part of the effort to contain any infection at their base or surrounding area. Mr. Crist do military installations have access to testing . And i yield back . The testing is tied to where we have the Lab Technology at litary installations in right now my knowledge is 10 labs vr testing that is approved by the c. D. C. And labs 14, 15 to have that ability. Mr. Crist thank you, madam chair. Ms. Mccollum if you could follow up with the testing on that. Mr. Ryan. Ryan ryan thank you for being here. I want to go in a different direction. Im unique. Im the only one who sits on the defense appropriations subcommittee and the military constructionv. A. Subcommittee. So the issue of health as it relates to all of you and active duty and as it connects to veterans is important. And one of the things and i have tried to look through a lot of your testimony. It is very technical and talking about records and all of that. I want to talk to you about obesity rates. From what i can gather, the obesity rates for active duty re going up. 15. 8 a couple of years back and now 17. 4 . In the navy, its 22 . Air force is 18 and army is 17 . Males between 35 and 44 years ld have almost a 30 obesity rate. And when you look at the increase in Blood Pressure and diabetes and heart disease, all of this stuff you know way better than i do, this is a problem that we arent even talking about and its got a relatively simple or simpler solution than everything we have just talked about. And for the last few years, my staff and i have been trying to dig in on the food that is being ed to our soldiers, the fact that comissaries and calf teryass are closed and only left on the base that is open, they go to burger king over the course of many years. To we need a big strategy reverse the obesity rates. I mean most people would be shocked to think we watch tom brady and see these highperforming athletes and look at their diets and lifestyles and we are spending billions of dollars to have highperforming men and women serving our country performing at peak levels in very highpressured situations and for us to have an obesity rate that is creeping up to 20 and zero strategy a a that is a real problem. And you want money and there are all kinds of research reversing type 2 diabetes where food is medicine and all innovative things that are happening. We have to make sure it is getting in the military. Here is the connection for us that sit at 30,000 feet. The diabetes rate for veterans is one in five. The diabetes rate for average americans, one in 10. We are blowing all this money i have been on ships before and. Lk in and there are sugary im 80 percenter, and work out. But we cant have this, folks. This is unacceptable that we are going to continue. Is there any strategy that is in place, mr. Secretary, that is addressing this in an aggressive way . We have in part working with your office, i know last year have been putting together what i would call a framework or skeleton in terms of what would be the key components. Part of it on the health side are what are the Health Guidelines and Health Recommendations that feed into how our installations are operated in the decisions made about what types of food and here we have not that closure, the link between the medical side and how we are operating our infrastructure in delivery of food. There is more work to be done. And you make a good point. Our Service Members and their health and ability to do their job. And this is a negative impact on that. Ryan ryan its a waste of money and inefficient and it goes to production and goes into the v. A. System and have diabetes. When you look at diabetes with any other sickness, it jacks up your costs. If you have to go to surgery, heart problem and have diabetes. The v. A. And talk about how we dont have any money. So we have to start seeing these systems as integrated and have a whole ug discussion of k12 school and they are getting a rice crispy and chocolate milk and they are on the Medicaid Program and end up getting diabetes with the public money we bought them for rice crispies. This does not make any sense and i want the military and the United States to be the leader. I only have a little bit of time and give it to the surgeon germ if any of you have a comment on this. Would he have a very pragmatic approach to the health of the force and we have many programs from grow green, that goes to the eating and integrity and then our Holistic Health and fitness going after the spiritual, Mental Fitness of our soldiers. The wellness designed are to educate our soldiers where we have programs not just special forces but treating every soldier as an athlete. I agree very similarly. We have a Similar Program and we understand the importance of wellness. One of the things are the social determinative health and the enirmentse our sailors and solders live. So we are working with comissaries to provide guidance and individuals purchase their groceries. We agree 100 and working very hard. Ryan ryan you have a lot of work to do. Ms. Mccollum i think everybody has gotten the message. We actually are out of time for a vote. And i want to follow up with one question not to be responded to today but reported back to the staff. It goes back to the military health restructuring. The d. O. D. In your announcement of the plan, roughly 18,000 uniform health positions will be gone. There is no plan to replace them and talking about putting people in the marketplace. We know there is a shortage in our Health Care System throughout this country. We are also concerned about your ability when these facilities close to retain specialized individuals who are serving us and function as Teaching Hospitals. And Teaching Hospitals are closing and limiting the number of training opportunities all across this country. We cant afford to lose you as part of our backbone for not only our military health, but our overall u. S. Health care obgyn en it comes to and pediatricians and with more women serving, i have to say i have familiarity having an army doctor deliver both of my children and we cant afford to be losing those kinds of specialties and keep, recruit and retrain women as well as women who are family members. Weve got some serious questions on that. We want to be helpful with you but we need to look at a whole of health care. I thank you so much for coming. And this goes to mr. Carters question about some of the outside treatment happening as well. Thank you. Thank you for your service and thank you for getting us back promptly. This meeting is adjourned. Captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org announcer here is a look at our live coverage friday. On cspan at 11 00 a. M. Eastern the head of the National Association of county and city officials talks about the steps that local Health Officials are taking to prepare for the coronavirus. At 1 30 p. M. Eastern, experts in health, Infectious Diseases and Emergency Preparedness provide an update on the coronavirus. And on cspan 2, a discussion on the Coronavirus Response with two former Obama Administration thecials, including response coordinator during the ebola operate. T is live at 11 sadie 11 30 a. M. Eastern. Announcer sunday night on q a, Peggy Wallace kennedy, daughter of former four term alabama governor and president of candidate George Wallace, talks about her fathers controversial career, and what inspired her to write her book, the broken road. In 1996, we took our youngest son, who was nine at the time, to the Martin Luther king Museum Historical site in atlanta. And we went to his church and to andgreat, and his grave, we went to his museum. It was being newly constructed at that time. We went to the exhibits and we came to the exhibit, the alabama exhibit. A bombshowed the bridge, at the 16th street church, fire hoses and dogs, birmingham, and George Wallace standing in the schoolhouse door. And burns looked up at me and he said, he was so said. So sad. Why did pa do those things to other people . And it broke my heart. Never told me why he did those things to other people. But i know he was wrong. So maybe it will just have to be up to you and meet to help make things right. Announcer watch sunday night at 8 00 p. M. Eastern on cspans q a. Announcer coming up next, Infectious Disease experts testify on the coronavirus and other diseases that can spread from animals to humans