Last year, the Department of Veterans Affairs and the Defense Department shelved plans to jointly develop an integrated EHR system due to cost and schedule challenges, and instead decided to pursue separate efforts to modernize or replace their existing systems. However, according to a new Government Accountability Office report, the VA and DOD "have not substantiated their claims that the current approach will be less expensive and more timely than the single-system approach." 

Ostensibly, VA would modernize its existing Veterans Health Information Systems and Technology Architecture system, while DOD would buy a commercially available system to replace its existing Armed Forces Health Longitudinal Technology Application system, with the departments ensuring interoperability between the two systems. By September 2014, VA intends to deploy clinical capabilities of its new system at two locations and DOD has set a goal of beginning deployment of its new system by the end of fiscal 2016. 

Yet, the departments have yet to update their joint strategic plan to reflect the new approach or to disclose what the interoperable EHR will consist of, as well as how, when, and at what cost it will be achieved. 

"Without plans that include the scope, lines of responsibility, resource requirements, and an estimated schedule for achieving an interoperable health record, VA, DOD, and their stakeholders may not have a shared understanding of how the departments intend to address their common health care business needs," stated the GAO report.

In addition, government auditors found that VA and DOD have not addressed management barriers to effective collaboration on their joint health information technology efforts in the areas of enterprise architecture and I.T. investment management, among others. Moreover, the GAO report revealed the two departments have yet to address these barriers by developing a joint health care architecture or a joint I.T. investment management process to guide their collaboration. 

Making matters worse, the Interagency Program Office which was established by law to act as a single point of accountability for the departments' development of interoperable health records, "has not implemented the IPO in a manner consistent with effective collaboration," charged the report.

To remedy the situation, the GAO recommended that VA and DOD develop and compare the estimated cost and schedule of their current and previous approaches to creating an interoperable electronic health record and, if applicable, provide a rationale for pursuing a more costly or time-consuming approach. Auditors also recommended that the departments develop plans for interoperability and ensure the IPO has control over needed resources and clearer lines of authority. In response, VA and DOD concurred with the GAO's recommendations.

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