By Sandra Basu
WASHINGTON — Slow progress by the DoD and VA in achieving the seamless sharing of standardized health data continues to frustrate members of Congress.
“Why is it that two major airlines can merge and put their computer systems together in a matter of weeks or months, but when it comes to merging systems in the government it takes so long, we stumble so often and it costs so much?” Sen. Richard Durbin (D-CT) asked a DoD official at a Senate subcommittee hearing.
Meanwhile at a House subcommittee hearing last month, lawmakers were asking similar questions.
“This is an issue with ‘real world,’ day-to-day implications for our troops and our veterans. The initial mandate for an integrated record was included in the fiscal year 2008 National Defense Authorization Act. Now, seven years later and we have yet to see working interoperable records between the two departments,” Rep. Rodney Freylinghuysen (R-NJ) told DoD officials during the hearing.
In the 2008 Defense Authorization Act, DoD and VA were tasked with jointly developing and implementing an interoperable electronic health record system, but progress in achieving the goal has hit speed bumps.
Last February, then-Secretary of Defense Leon Panetta and VA Secretary Eric Shinseki announced that, instead of developing a new common integrated electronic health record system from scratch, the departments would instead focus on a less costly and accelerated plan that would integrate health records from separate VA and DoD systems.
Under the new plan, VA said it would employ the “core” technology of the Veterans Health Information Systems and Technology Architecture (VistA), which it already uses, while DoD announced its decision to pursue an open competition for selection of its platform.
That new plan continues to raise concerns. Lawmakers repeatedly have asked why DoD did not simply adopt VistA. In addition, the cost of the new plan has been questioned. As recently as February, a Government Accountability Office (GAO) report noted that the agencies had “not substantiated their claims that the current approach will be less expensive and more timely than the single system approach.”
The GAO stated, “the departments have not developed revised cost and schedule estimates for their new modernization efforts and any additional efforts needed to achieve interoperability between the new systems, and compared them with the relevant estimates for their former approach.”
The Way Forward
At the Senate subcommittee hearing, DoD Healthcare Management Systems Program Executive Officer Christopher Miller told lawmakers in written testimony that DoD is “committed to acquiring an EHR system that will appropriately serve the men and women who serve us in the most efficient and effective manner.”
He explained that the military established the DoD Healthcare Management Systems Modernization program to lead a “competitive acquisition process that considers commercial solutions which will offer reduced costs, schedule, and technical risk, as well as providing access to increased current and future capability by leveraging advances in the commercial marketplace.”
“Based on current market research, a VistA-based solution will likely be part of one or more potential solutions proposed in response to the DoD solicitation,” he explained.
He also told lawmakers in his written statement that “DoD has dedicated a program manager to oversee the department’s interoperability efforts and ensure the continued maturation of data exchange with VA and private sector providers.”
During the Senate hearing, Durbin seemed skeptical that there has been much progress overall and questioned loud why the departments’ efforts have stretched over so many years.
Miller responded that Kaiser Permanente is the largest private healthcare provider in the United States, and it took the organization more than seven years to deploy its electronic health record from start to finish.
“We are learning from them and other industry providers how to go faster,” he said. “One of the challenges in DoD is that we don’t just have a few locations that we have to change software today. We have a number of different systems, and our challenge is that we have over 1,000 locations that all have to be trained and taught to use the system.”
Assistant Secretary of Defense for Health Affairs Jonathan Woodson, MD, also responded to questions about EHR progress at a separate hearing. He expressed confidence that DoD would be able to meet the target date for DoD’s initial operating capability of its EHR, which is the last quarter of FY 2016, with full operating capability in 2023.
“I feel more confident today than even last year that we will meet those deadlines because the acquisition process is going along,” he said.
Lawmakers, however, seemed unimpressed pointing out the overall efforts to develop an interoperable system has been slow.
“I can’t believe that given the wealth of talent and knowledge we have in the United States of America that it would take a minimum of nine years to make medical records interoperable,” said Rep. Pete Visclosky, (D-IN).