on, i believe we're going to get back to you with specific recommendations that we're seeing from our teams going on as to how we continue to move this forward. >> i look forward to that. thank you for your testimony. thank you for your work. >> thank you very much. senator boozman? >> thank you, madam chair. mr. bertoni, who -- who is in charge of the -- we have dod here. we have va. who? is there a person that is actually in charge of the whole process? >> i would say the secretaries would say that they were in charge of this process. >> the secretary of defense and -- >> in partnership with capable folks under them tasked with >> so i guess the question i've got, generally, things work better when there is a person, you know, to oversee. is there a person that the secretary of defense and secretary of the va have designated to have the authority

to get some of these things worked out? >> i know mr. gingrich has been pegged as the man to address many aspects of this process. >> so do you have authority over dod also, or just va? >> sir, i don't have authority over dod, but we have been working remarkably well in partnership. and i don't say that loosely. i sit down with the vice chiefs of staff of the army, for example, because that's 68%. and we sit down monthly. we sit down at different levels in va with the army, and we're working through this. i think part of the issue to address the problem is we didn't have a very good dashboard mechanism prior to when we fully implemented ides in september of last year. we now have a mechanism we can go to every single facility. 116 of our executives get up from my vtcs, the army has the same thing when we do it together.

we can go installation by installation, individual by individual, which we couldn't track before. i know it sounds something like we're not moving. but when we get the vta in place, we'll be able to track every individual, where they are in the system, what kind of rating they got, and where they're going. >> i don't mean to interrupt. i guess -- i guess, you know, in business and in general things, you like for a person to be accountable. >> i'm accountable directly to secretary shinseki for the va portion. >> i understand. but i guess i would like to see somebody accountable for the whole system. and you may be that person, but it's not fair to you, you know, if you really don't have authority to see it through. so i personally think that the two secretaries need to designate somebody that's got the authority. now we don't do that very well -- that is a basic thing. where do you see the bottleneck, mr. bertoni? is it that they can't be seen,

or it is decision-making process after they are seen? >> i've said here many times since 2007 and talked about this whole program process. it comes down to i think three critical things -- people, processes and technology. on many of these sites, there was a sense of urgency following walter reed. there was a rush to stand them up. they didn't have proper technology. they didn't have proper people in sufficient processes in place. staff to service member ratios was insufficient in many respects. they were stood up anyways. the servicemen came. they were overwhelmed. and i think this system is paying for it to this day. processes. we've identified throughout the last several years areas with process that appeared to be inefficient. clearly, we're causing backlogs and inefficiencies. they in partnership would the dod and va have addressed some of them, not all. we keep pressing that they do.

last of all, technology, we have an integrated evaluation system, but the systems part hasn't caught up. we have processes that are combined. we have decision making that is combined. but the systems haven't caught up with the process or the demands of the end user. >> so do you feel like, really, in follow-up to mr. burr's comments, do you feel like the framework that we have now, the ides is such that we can meet the goals that we're -- >> it's a simpler system. it's more transparent in how it operates. it's sort of like a funnel. you take a funnel, you pour water into it, water comes out the other end, it works. but if you pour water into the funnel too quickly, too fast, you quickly find the inefficiencies are. that's what is happening. we've had rapid increases in enrollments. and the inefficiencies and bottlenecks in the system are behind it with some of this mapping and business redesign. >> my concern is that we have a

culture somewhat that just is difficult to deal with these things. i have -- i'm approached by people all the time that are just separating out of va, just retiring. to wait a year before you start drawing your retirement. so, you know, that's without all of this other stuff going on. so, again, i think we've got some real problems that we need to look at. and i would welcome also, and i think it's important that you understand that i'm with you. but i do think that it is important that we get some feedback as to how we can help you to streamline that process and similar processes. thank you. thank you, madam chair. >> thank you. senator? >> madam chair, thanks for holding this hearing. you can tell the frustration of

the committee members and in this town sometimes it's harder to find bipartisanship as we all know. i'll guarantee that frustration is very bipartisan. everybody is frustrated. i don't care which end you -- of the dais you sit on. i was looking at some of the numbers. mr. bertoni, you talked about them a little bit in your testimony. overall average time to complete ides active components of military, the goal is 295 days. we're at 395. but at fort belvedere, it's 595 days. the active members, the goal is

60%. actual results are 18%. at fort immediate, it's zero percent, nobody, nobody. overall average time to complete ides for guard member, excluding those who return to duty. agency's goal is 305 days. 408 days is the actual. 651 days at fort carson. it's just nearly embarrassing to go through these statistics. and the concerning thing for me is that i don't hear anything today that makes me feel, gosh, we're going to turn the corner here. in fact, i must admit quite the opposite. i'm going to walk away from this hearing very, very worried that the system is imploding, that whatever we have done to try to get on top of the system just isn't working.

so mr. bertoni, let me just ask you a very, very direct question. how long is it going to take? one year? two years? five years? to actually see progress to meeting these goals? >> i can't give you a specific time frame. i would say that one thing that the services and va are dealing with is enrollments are up significantly, doubling each year. 2009 there were 4,000 enrollments. 2010 about 9,000. and last year 19,000. so we have multitudes coming into this program very rapidly. and that's going to increase going further. so they really do need to continually look at their processes and look for streamlining opportunities. we have said all along they need to get their staff to service member ratios aligned with what they think they need to be doing.

again, automation. you can leverage so much with automation accounts for many people. there are things in play. they must continue to look at what they're doing and to look for efficiencies. and to their credit, more recent data in the med phase shows that data is trending more positively over the last six months. the va medical exam, they had never been able to meet that goal. at the time of the review was at 70 days. at of this month they're at 39 days, under the 45-day goal. so there is some positive trending in meb. that's the good news. the bad news is most cases are being pushed further to the ped. and those processing times are rapidly increasing. they have a 120-day goal. and they're starting to push against that threshold. so what is causing inefficiencies there? what are they doing to create efficiencies? you can learn from those. this mapping exercise, this business process reengineering

exercise i think could be valuable. should they have done it earlier? yes. they could have done it before each major phase and i think they would have been in better position. so i can't give you a time frame, but i'm hopeful next year the numbers will be better if i'm here. >> do you agree with -- let me ask the two other witnesses. do you think you're turning the corner? >> sir, i'm absolutely convinced we're turning the corner. we've gotten our production up. we can do about 2500 cases a month, which we believe is looking at the flow that is coming in and the flow that is going out, that about 2500, if we can sustain that starting in august, we'll be able to move forward. he is right. we didn't get our claims -- none of our processes in va last year were meeting the standard. we're now 62% in april of the service members that we processed in the process were on time. that's up from 20. now, one of the things we have

done to take some risks here is we decided with at least the army to say let's get all the old jobs. that's why i said 254 day, and let's get them out of the system because they're just holding up everybody, and it's extending it. numbers will go up a little bit when you start taking the older cases out. but those individuals have been in the system way too long. and so i think we are making progress into a turning phase. will we get to 295 days and 60% of the service members by 31 december? there is risks there. but i think the services and dod and va as partners have come together and said how are we going to get there. the secretary said to us that three months ago now when we were sitting at the meeting of the two secretaries, we want to get to 60%. well want to get to 100%. but instead of trying to bite the whole thing, let's get to 60% by december 31st, and then we'll take on the rest of it to get to 100%. because every single one of these service members we're

doing this to and they become veterans, as we've talked before, we've had them for 50, 60, 70 years, and we got to get them in the system right. we got to take care of them and make sure they transition correctly. the other part i would say to answer to your question, if we don't get this right by this summer, we're going to be challenged. because this is 10% of the population flowing through. and the vow act that congress graciously gave us to be able to implement will have a process that is even bigger. i think the things we're putting in place today in va and dod will help us get both those systems done correctly. >> i've run out of time. so i hate to cut you off, dr. rooney, because i'm sure you had a thought here too. and feel free to submit that in writing if you would like. but i just wrap up my questions with a request to mr. bertoni. i think it would be good if you could assess this for us on some

kind of periodic basis, just to give us some indication that progress is, in fact, being made. it would be terribly unfortunate if we showed up in six months and nothing is happening. and that would be terribly unfortunate. so that would be my individual requests. the chair runs the committee. but it would be something that i certainly would like to see. >> and we have been in this mix since it was a tabletop exercise in 2007. i have testified numerous times on multiple products. it would be worse i think if we weren't in there. and i think in regard to your issue of diagnostic differences, two years ago, we said this was an issue. it could be problematic in terms of treatment of service members in terms of backlogs of the cases. if you have a diagnostic difference, you have to keep going back, new exams you. get caught on this medical exam hamster wheel. you have to do it all over

again. we ask that this issue should be looked at. a consultant went in and looked at but didn't do what we thought should be done. what should have been done is what you're doing now, in-depth case file reviews to get an extent of the nature and an extent of the diagnostic differences. then you have guidance around that. you have training around that. and then you capture data going forward so you can identify hot pockets in trouble areas going forward. had vta been in place with the data indicating where they were having diagnostic differences, it wouldn't have taken service members to come forward making noise about treatment at madigan. you could have that mi data at your fingertips and decide whether you need to get out there, see what is going on, do some remedial training, et cetera. >> thank you. >> and i would just add, senator johannes, as a result of what we looked at madigan, that is being reviewed back to 2007, i believe. all the case. but army-wide now as a result of the work i've done, they're now going back to 2001 to review all army cases. but it still is not system-wide.

and i think that that has to be part of it. so it's something i'm very focused on. we'll work with you on making sure that we continue to stay on top of this. i want to go back, dr. rooney, am very concerned about what i continue to hear about the warrior transition units on the ides experience itself. i hear from service members who are in the disability process that they are languishing in this process without any meaningful or productive things to do. service members tell us that they feel that their commanders are out to get them. and on the other hand, we hear from commanders that they feel these service members are being deliberately obstructed and delaying the process in order to be more difficult. that kind of adversarial relationship can't be beneficial either the unit or the service member who is trying to move on with their life. and worse, frankly, i continue to hear about service members who are overdosing on drugs, committing suicide, committing

serious crimes. and at joint base lewis/mccord in my home state of washington, six service members have died from suicide, drugs or auto accidents while they're in the ides process. that's happening across the nation. i hope you share my belief that we can do this better. but i want to ask you, what is the department going to do to make sure there is an effective, supportive leadership at all levels to make sure this is not happening? >> some of the specifics you pointed out in terms of making sure that we're looking at that transition process proactively, working with those service members going through that process so that they can identify skills and possible career opportunities. those programs, some of those are already in place. we'll be doing more and piloting more, not just for those in the disability process, but throughout transition, as we've talked before, starting this summer. that's one piece of it. the second one is we indicated earlier is really making sure that the communication is not

just at the senior leadership, but absolutely is translated down through the chains of command right to the base. and i believe mr. gingrich pointed out some meetings with the sergeant majors and other senior enlisted. and that's going on in the department as well. each of the service chiefs have gone, have been going out to meet directly with various commands. as you know and i've mentioned to you, i spent probably half of my time on issues surrounding this, and have been back out to washington state, have been down to san antonio and others so that i could also go out to the bases and help reinforce and see what is happening there so we can identify where there are those disconnects, and get that message consistently across the department. so it's not only across dod, but it's also with our partners in va that we are continually sending the message and working at this. and where there are issues. not looking aside from those, but going right out and identifying where are they, what's the problem. and whether that is because there seems to be a backlog in

cases, and why is that at certain installations. we'll target efforts to find out is that a process issue, is it a command issue. what are the various pieces to do this. and we do have it broken down succinctly. and that's the way we're following through. >> i appreciate that. and i appreciate you sitting before this committee and saying this. we want results from this. and i'm sure you do too. so it has to be a lot more than just a testimony before this committee. it has to be real action all the way down. we'll be really following that. we can't have these hearings every six months or every year and keep hearing the same things. and i, you know -- one of the things that i hear most often from service members in this joint process is that they don't have any idea of when they are going to separate from the service. they want to make plans to move or go to school or get back with their families or whatever they're doing. and as we heard today, those numbers days keep rising. last last year the time we heard

was 394 days for active duty, 420 for garden reserve. that's unacceptable for someone who is just waiting to figure out what they're going to do with the rest of their lives. i really believe that these service members would benefit from knowing what is the time is actually going to be at the installation that they're at rather than just we have a goal here so many days. but what is it at your installation, an honest approach, even if it's not what we like, but at least telling them a reality number. and i would like both of your departments to look into that and report back to this committee on the possibility of having real information for these men and women. let me also say that the only way that we are going to restore trust, which is really important, is by focusing on consistency and accuracy of decisions. and i hope that both the va and the dod have really learned from va's claims systems struggles

with how important it is to get the disability decisions correct the first time. i'm concerned because committee oversight has revealed this. i talked about earlier, ides ratings decisions with errors. given that the littletary relies on the disability level assigned by the va, these errors could impact the benefits that service members will receive from the military, and also the benefits from the va. so mr. gingrich, when the va identifies an error in a rating decision, do you alert dod that the error can be fixed before separation? >> madam chairman, there is two things we do. if it's before separation, we notify the pb, and the individual and get the correction done before. if it's after and the person is now a veteran and we discover -- we know one case so far that we found, that the individual was a d discrepancy in the rating, we have gone back and helped that individual get the records corrected.

>> if a service member believes has been identified with incorrect, what recourse do they have to go back and get the dod rating changed? >> if we substantiate it, that it would be very fairly simple for them to get it corrected, if it's not a mistake that we made, or it's not an error that was made at the time and the condition has changed to later, then it would be much more difficult. but we talked about it yesterday. and we decided that we need to make sure the process is such that the veteran or the active duty service member doesn't have to do anything. we take care of it and we do it for them to get it started. we give them the information they need. and then they work the system. so we'll be proactively involved in any of these that we find. >> okay. well, we'll have more information on what we're finding and expect to work with you on that. >> ma'am, we look forward to that and we work each case you give us. >> okay. i have several other questions for the record. but i did want to focus on the integrated electronic health record. we know that delays in ides are driven in part by problems accessing information and

sharing paper files between the departments. those challenges are not unique to ides, but they do affect every aspect of a service member's transition to va, including how their health and benefits information is shared. now we have heard a lot of talk from va and dod that they are making progress on data sharing through their work on the integrated electronic health record, and the virtual lifeline electronic record. but according to this week's press release, only two sites will have additional joint electronic health record capabilities by 2014, with 2017 actually being the target date for implementation of this. now the departments have both said that key to their collaboration and key to the success or failure of disability evaluations in transition are these electronic health records. it seems to me that this should be a priority for absolutely everybody. the project has been plagued, as you well know by false starts and budget issues and planning isn't complete.

and i understand that a lot of positions at the office responsible for staffing and managing these projects are unfilled yet. i understand it's only 30% staffed. but how can the department say this is a priority when it's only 30% staffed and we're talking about 2017 as the target date? >> i believe from the staffing, and we'll get you the most recent numbers, we continually add staff so that we're fully staffed up. but that's not impeding progress at the current point. there has been substantial progress made in terms of this interagency program office with the new director actually named within the past three months with extensive experience. and you're right. both secretaries announced jointly this week that by 2014, both in san antonio and at hampton roads, we will have initial operating capability of this system, which will have multiple areas from pharmacy on down to medical records that are functional. and i think they also pointed

out when they announced it was we're moving forward, but we're also moving forward deliberately because we cannot afford to have any errors in these actual records going forward. so this is both safety and concern for individuals to be able to get this right. we do have some systems currently. and one of the things both secretaries viewed when they were in north chicago was an example where we have been able to use existing systems. and it's not the long-term solution, but it's one that is working now, and begin to exchange data much better. so we're learning from that and integrating that into this electronic health record. so it is a priority. we are pointing the staffing, but we also want to make sure that there is no chance for errors because this is people and their information, and we cannot afford to have any errors. >> mr. gingrich, do you want to comment? >> i agree. this is a priority of this department. the secretary has made it his number one priority. he what pushed it as harder, and

we do see glimmers, like the gooie being there. it sounds like it's not much, but with a single sign on being able to look at a screen and get data from vista or alta and be able to do a medical evaluation. it's clear, it's clean, and it's doab doable. we're looking at how do we do that other places. i also think the integration of the hospital pharmacy is got to be done as we talked about. that's very complicated, but they're doing it there and making it work. we are making progress. are we making progress as fast as both secretaries like? probably not. but we are making progress, and we're pushing it. and that's why i talked about things like the vta. that's not the electronic health record, but it will inform the electronic health record and it will also inform vbms and things like that that we will have. so we are doing little pieces as we're going along, in addition to the full electronic health record, ma'am. >> senator boozman? >>

but i do think that's such a little thing, but it is a huge deal. and so if we can work on that. the other thing is that we have a situation where this is the number one goal of the secretaries and things to try and get this sorted out. they're meeting on a monthly basis. something that we might consider is maybe you and the ranking member, senator burr, and perhaps chairman miller, you know, ranking filner, i know they're concerned as we are basis -- i don't know

about monthly, two-monthly, i don't know what you all feel is appropriate or somebody that you designate, for you all to get together and basically let's talk about the -- how things are going. and then the other thing is how we, you know, as a congress, if there are things that we can do, you know, again, to facilitate and really all work together. you know, i know that you all want in all of your capacities to get this worked out as much as anybody. certainly we want to be there to help you. but it is something that we have to get worked out. thank you, madam chair. >> thank you very much. and let me just say that ensuring an accurate, seamless and fish process for our service members is a critical part of making sure they receive the critical care and benefits that they deserve. clearly there is a lot more work to be done. we've seen some steps in the right direction. but it's going to take continued engagement and cooperation from both departments to get this right. so that's the message that i

would really urge both of you, dr. rooney, mr. gingrich, to share with secretaries shinseki and panetta. and you know, we also need to share this message with the lower levels too. it's very clear. squad member leaders and squad leaders who interact every day with these service members, need to get the message as well. so i hope you follow up on that. we all -- this system has been experiencing a lot of challenges for a very long time. but we owe it to our military members who have served this country to get this right. and that's what this committee is focused on. and we want to urge you to really, really from the top all the way to the bottom work to get this done right. so thank you very much for your testimony today, and your work on this. and with that, this hearing is adjourned.

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