Assistant Secretary of Defense for Health Affairs Thomas McCaffery testified March 5 to the House Committee on Appropriations about the military health system's fiscal year 2021 budget request. (Dorothy Mills-Gregg/Military.com)

By Dorothy Mills-Gregg

Lawmakers expressed frustration Thursday over a lack of information on why the electronic health record (EHR) system needs an additional billion dollars and why military clinics are closing to retirees and families.

House Committee on Appropriations members were blunt in voicing their concerns on these two topics during a discussion on the military health system's (MHS) budget request for fiscal 2021.

As all military treatment facilities (MTFs) transition to the Defense Health Agency's management, staff and services have been pegged for cuts in the name of efficiency. In some cases, retirees and military families have already been turned away from base clinics.

Committee member Rep. Betty McCollum, D-Minnesota, said Congress has not received enough details from Assistant Secretary of Defense for Health Affairs Thomas McCaffery.

Related: Military Health Record Milestone Delayed as VA Requests $1 Billion Increase

"How [do] you expect us to do due diligence .... [or] appropriate necessary funds to reorganize the military's treatment facilities when we haven't seen a comprehensive, transparent plan from the department on what, when or how this restructuring will be implemented?" she asked.

McCaffery insisted his department included those details in a report sent to Congress on Feb. 19. That report states changes will begin no less than 90 days after transmittal to Congress.

"That language to me, and to many, sounds [as] though the department believes it does not require congressional approval prior to moving forward with the implementation," McCollum said, adding Congress needs to see McCaffery's documents supporting the decision.

"If you are not ready to transmit to us a comprehensive and transparent plan, why not just ask for a delay of the reorganization so we can get it right and not cause any confusion for Congress in appropriating its funds or when your patients -- our soldiers, [sailors], airmen and Marines -- ask us what is happening to them and their families."

McCaffery assured McCollum there will be no immediate changes, along with a promise to follow up on her request for more information.

Committee Chairwoman Rep. Nita M. Lowey, D-New York, said her greatest frustration is the request to increase the EHR modernization budget by another $1 billion.

The EHR is a joint venture between the Defense Department and the Department of Veterans Affairs to create a digitized health record that will follow service members for life -- from the DoD to the VA. The project has been plagued by delays and increasing costs.

"Another billion dollars; why can't you get this right?" Lowey asked panelist Bill Tinston, the Defense Healthcare Management Systems program executive officer working on the EHR. "I know it's difficult, but frankly, our service members and their families have been waiting for far too long and the taxpayers have invested too much to continue with problems and delays."

Tinston said the primary issue has been staff training on the new program. Last month, the VA delayed training its staff over concerns that going live on the original deadline would eliminate too many features, such as online prescription refills.

"I don't get it," Lowey said. "If this happened in the private sector, they'd probably be out of business. But you are too valuable -- no way can you be out of business. But I don't understand why we can't get this done."