DOD Says it Meets Congressional EHR Interoperability Criteria

The Department of Defense contends that it has met electronic health record interoperability requirements called for in the Fiscal Year 2014 National Defense Authorization Act. But the bar for interoperability remains low, critics say.


The Department of Defense has informed Congress that it has met electronic health record interoperability requirements called for in the Fiscal Year 2014 National Defense Authorization Act. But the bar for interoperability—a viewer that provides a summary of care—remains low.

The FY 2014 NDAA required that all data in DOD’s Armed Forces Health Longitudinal Technology Application system be shared in compliance with existing national standards. According to a Nov. 16 letter to congressional committees from Undersecretary of Defense for Acquisition, Technology and Logistics Frank Kendall, the military has mapped all 21 domains requiring national standard terminologies, representing nearly 1.8 million unique clinical terms.

Kendall told Congress that the Pentagon not only met the NDAA requirement but went even further by integrating data from other DOD systems, including inpatient, theater and pharmacy. According to Kendall, the additional data requirements—which exceed those mandated by NDAA—were established by DOD and the Department of Veterans Affairs as being “important for continuity of care.”

However, an August 2015 Government Accountability Office audit found that DOD and VA missed the October 1, 2014, deadline established in the NDAA to certify that all data in their EHR systems complied with national standards. Still, Kendall told lawmakers that DOD and VA have “closely partnered” to meet the NDAA requirements and that VA is “currently working to finalize their efforts; once both departments have met their requirements, DOD and VA will provide a joint certification to Congress.”

Also See: Congress Takes DOD, VA to Task for Lack of Interoperable EHRs

The NDAA requires that DOD and VA EHR systems are interoperable with an integrated display of data by complying with the national standards. Toward that end, the two departments are using a Joint Legacy Viewer (JLV), a read-only web based health record viewer that allows both VA and DOD to see a summary of a veteran or service member’s health history integrated on a single screen.

Kendall noted in his letter that JLV serves as an integrated display providing “access to more health information than any other viewer or system used by either DOD or VA.” The Pentagon has fielded JLV to more than 70 military locations with more than 8,400 users. As JLV capacity and use increase, the department plans to phase out existing legacy viewers with full consolidation planned in FY 2016.

Still, members of Congress so far have not been impressed with JLV’s capabilities. At a congressional hearing late last month, Rep. William Hurd (R-Tex.), chairman of the House Oversight and Government Reform Subcommittee on Information Technology, charged that while JLV provides the ability to view patient data it does not represent “real” interoperability but is the “equivalent of using microfiche.” 

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