Congress has provided $233 million in its final fiscal year 2016 omnibus bill for continued modernization of the Department of Veterans Affairs’ VistA electronic health record system. However, the appropriation—signed into law by President Obama—comes with restrictions.

The EHR enhancement effort, called the VistA Evolution program, calls for the addition of an Enterprise Health Management Platform (eHMP)—a set of new modular-based components—to replace the Computerized Patient Record System, which is the existing user interface that clinicians use while delivering care. Among other capabilities, the new eHMP platform will enable the VA to meet many of the 2014 Edition Meaningful Use certification criteria for HIT components.

However, legislative language restricts the use of congressional funding until VA demonstrates functional improvements in the interoperability of the system to seamlessly exchange veterans’ medical data among the VA, Department of Defense and the private sector.

Not more than 25 percent of the funds can be obligated or spent until the VA Secretary submits a report to both House and Senate appropriations committees providing specifics on the scope and functionality of projects within the VistA Evolution program, including proposed changes to the program as well as the milestones and timeline associated with achieving interoperability.

Lawmakers are particularly interested in the definition being used for interoperability between DoD and VA EHR systems, the metrics to measure the extent of interoperability, and the progress toward developing and implementing all components and levels of interoperability including semantic interoperability.

Although DoD and VA have committed to achieving interoperability between their separate EHR systems, the two departments continue to miss important deadlines and have yet to establish outcome-oriented goals and metrics for measuring their progress toward interoperable EHRs, according to an August 2015 audit by the Government Accountability Office.

According to GAO, DoD and VA missed an Oct. 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.

Auditors also revealed that a number of key activities in the departments’ system modernization plans will be implemented beyond Dec. 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.

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