Controversy Continues Over Abridged Plans to Develop Joint VA, DoD EHR

by U.S. Medicine

April 5, 2013

By Sandra Basu

WASHINGTON – The new plan to develop a joint DoD, VA iEHR is a “lower risk, lower cost path,” agency officials told a congressional committee.

“We believe the path that we have chosen best serves the departments, the special populations whom we are jointly responsible for and the American taxpayers,” Assistant Secretary of Defense Jonathan Woodson, MD, told lawmakers at a recent hearing.

In February, then-Secretary of Defense Leon Panetta and VA Secretary Eric Shinseki announced that, instead of developing a new common integrated electronic health record (iEHR) system from scratch, the departments would focus on integrating health records from separate VA and DoD systems.

Lawmakers, who seemed to be caught by surprise by the shift in plans, expressed dismay at the news.

“I am concerned that this new approach is a setback backward toward the model that was previously tried and failed. Namely, maintaining two different systems between two different departments and wishfully thinking that the two systems will eventually talk to one another,” said House Committee on Veterans’ Affairs Chairman Rep. Jeff Miller (R-FL) at the recent hearing, titled “Electronic Health Record U-Turn: Are VA and DoD Headed in the Wrong Direction?”

While deployed, the 684th Area Support Medical Company, Ohio Army National Guard, used the MC4 system to electronically capture patient care. The electronic medical record system allows providers to track all symptoms, diagnoses and care provided to soldiers while serving downrange. The information becomes available to providers at sustaining base medical treatment facilities, DoD medical centers and VA hospitals.

In explaining the new approach, Roger W. Baker, VA’s chief information officer and assistant secretary for Information and Technology, told lawmakers that, over the past 18 months, the iEHR program had difficulty in “making the milestones it established.” Additionally, “in September of 2012 the interagency office produced an updated budget estimate that doubled the estimated cost to develop the iEHR,” he said.

Those factors influenced the agencies’ decision to no longer develop a single new system from scratch. Still, Baker told lawmakers, the agencies remain committed to achieving the goals of the iEHR program that include common data, common applications and a common user interface.

Under the new plan, he explained, VA will employ the “core” technology of the Veterans Health Information Systems and Technology Architecture (VistA), which it already uses, while DoD will evaluate “core” technology to determine what best fits its needs. In order to achieve data interoperability between both departments, Baker said that both “cores” will conform to an agreed-upon set of standards that enable the secure and interoperable exchange of information.

Lawmakers demanded to know why they were not told about the change in plans before they were made public.

Baker said he was unable to inform VA legislative committee staff in prior meetings because the secretaries of defense and VA had not yet been presented with plans or made any decisions.

“To my view, it would have been presumptuous of me to get out front of my boss on that topic in any briefing with any organization,” he explained.

For his part, Woodson also emphasized to the committee that the intent is to have “a common, single electronic record.” When asked whether the prospect of sequestration caused the agencies to abandon their initial plans, Woodson conceded that the threat of budget cuts forced the departments to make more accurate estimates of program costs. He also pointed out that DoD also has been under a continuing resolution that has caused “enormous” budgetary pressure.

Still, Woodson said the agencies are not going for the “cheapest variety,” when it comes to the EHR.

“We want full functionality. As I have said before, we want a system that will serve us in the future,” he said.

Lawmakers also questioned the new strategy itself and wanted to know why DoD is not simply adopting VistA as its core technology, rather than evaluating a variety of options.

“I go to combat hospitals, and the doctors in those hospitals in theater tell me they like VA’s platform better [than the Armed Forces Health Longitudinal Technology Application (AHLTA)],” Miller noted.

DoD officials said they are looking at VistA as an option, but Woodson explained that several factors need to be considered in the agency’s decision.

“We would need to assess what it would require for us to bring VistA over, modernize it and what the total cost of ownership would be over time, because we would have to develop an infrastructure to maintain it, modernize it and innovate on it so we stay apace with the commercial market,” he said.

iEHR Concerns

Meanwhile, Valerie Melvin, the General Accountability Office’s director of Information management and technology resources issues, said the recent decision to reverse course and continue to operate two separate systems “raises concern in light of the historical challenges” facing the efforts.

While the departments have argued that their new approach will develop capabilities sooner and at lower cost, Melvin said that “long-standing institutional deficiencies in key IT management areas of strategic planning, enterprise architecture and investment management could prevent them from jointly addressing their common healthcare system needs in the most efficient and effective manner.”

Also testifying before the committee was Jacob B. Gadd, deputy director for healthcare in the American Legion’s National Veterans Affairs and Rehabilitation Division. He told the committee that the American Legion found the announcement of change of plans both “troubling” and “unacceptable.”

“Veterans are not getting the single system they were promised. As long as VA and DoD remain in separate camps pursuing their own individual systems, it is the veterans who will be shortchanged,” he told the committee.

He complained that the veteran service organizations were not consulted about the “wisdom of abandoning a single unified record.”

“VA and DoD have spent four years and close to $1 billion to develop this, and we are in the same place we were four years ago,” he said.

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