Officials from the Departments of Defense and Veterans Affairs got an earful from members of Congress on Tuesday about continued lack of interoperability between DOD and VA electronic health record systems and failure to identify goals and metrics to clearly define achievement.
At a joint hearing of subcommittees of the House Committee on Oversight and House Committee on Veterans’ Affairs, lawmakers questioned the wisdom of DOD and VA efforts focused on modernizing their respective EHR systems—rather than developing a single system—and the departments’ inability to successfully collaborate to share electronic health information.
“Our soldiers, sailors, airmen, and Marines who are making the transition from DOD to VA healthcare are literally told to print out hard copies of their medical records and then walk then to the VA,” said Rep. William Hurd (R-Tex.), chairman of the subcommittee on information technology. “We have sent men to the moon and robots to Mars. I feel like we should be able to move one electronic file, no matter how big or how old, from one computer system to another.”
While acknowledging the challenges of integrating the DOD and VA systems, Hurd blamed the lack of progress on interoperability as a failure of leadership rather than technical feasibility. “At its core, this is not a problem of technology. This is an issue of management,” he charged.
In 2013, DOD and VA called off a joint development program that was to have resulted in a single system known as the integrated EHR (iEHR). At the time, the two departments cited cost effectiveness as the rationale for abandoning the iEHR program but committed to DOD-VA health data integration through fully interoperable EHR systems.
Hurd noted that the two departments continue to go their separate ways. DOD in July awarded a $4.3 billion contract to a Leidos-Cerner team to upgrade the Armed Forces Health Longitudinal Technology Application as part of the Defense Healthcare Management System Modernization program, while the VA continues to modernize its Veterans Health Information Systems and Technology Architecture, or VistA EHR.
“The current plan for DOD and the VA to modernize their healthcare IT infrastructure in order to achieve full interoperability lacks metrics and goals,” said Hurd. “These are not issues of data standardization. This is management 101.”
A Government Accountability Office audit released in August found that DOD and VA missed an October 1, 2014, deadline established by Congress in the National Defense Authorization Act (NDAA) for Fiscal Year 2014 to certify that all healthcare data in their systems complied with national standards and were computable in real time. GAO also revealed that a number of key activities in the departments’ system modernization plans will be implemented beyond December 31, 2016—the deadline established in the NDAA for DOD and VA to deploy modernized EHR software to support clinicians while ensuring full standards-based interoperability.
Valerie Melvin, the GAO’s director of information management and technology resource issues, testified at the hearing that according to current DOD-VA plans the deployment of their respective EHR systems with interoperable capabilities will not be completed until after 2018.
“A significant concern is that the departments have not identified outcome-oriented goals and metrics to clearly define what they aim to achieve from their interoperability efforts, and the results and benefits anticipated,” said Melvin. “The departments’ decision to pursue separate interoperable systems, rather than a single joint system, adds to our concern. Taking separate paths to modernize their systems increases the risk that there will not be the effective collaboration and coordination needed to establish and convey a joint position on what fully interoperable capabilities will look like, and how and when they will be achieved.”
Nonetheless, Christopher Miller, program executive for DOD’s Defense Healthcare Management Systems, argued that DoD and VA share a significant amount of health data—in fact, more than any other two major health systems.
“DoD and VA clinicians are currently able to use their existing software applications to view records of more than 7.4 million shared patients who have received care from both departments,” Miller testified. “This data is available today in near real time and the number of records viewable by both Departments continues to increase.”
Likewise, LaVerne Council, the VA’s assistant secretary for IT and CIO, told the congressional subcommittees that today VA and DoD share millions of health records between their systems. In particular, Council touted the fact that over the past year VA has seen “rapid growth” in utilization of the Joint Legacy Viewer (JLV), a read-only web based health record viewer that allows both VA and DoD to see a veteran or service member’s complete health history from both departments integrated on a single screen.
“As of last week, VA had over 19,000 authorized JLV users, up from just a few hundred this time last year, when JLV became available at all VA medical centers,” she testified. “Currently, we are making JLV available to nearly 1,000 new users each month.”
According to Miller, DoD has fielded the JLV to more than 70 locations with over 8,480 military users and that as JLV capacity and use increase the department will begin to phase out existing legacy viewers, with full consolidation planned in fiscal year 2016.
However, Hurd commented that the JLV is not “real” interoperability. “The ability to view patient data and the ability to access and use in real time patient data are two profoundly different things,” he concluded. “JLV is the equivalent of using microfiche.”
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