By Stephen Spotswood
WASHINGTON — Barriers to information technology (IT) compatibility between VA and DoD are endemic to joint healthcare projects across the country, according to a Government Accountability Office (GAO) investigation. The report lists problem areas, the worst being the ability to access and share each other’s healthcare information.
Last month, U.S. Medicine reported on another GAO report released during the summer — one specifically looking at IT incompatibility issues at the North Chicago Federal Health Care Center. The report found that a lack of performance measures to judge progress was a significant factor in delays integrating the IT systems of both departments.
This fall’s report found the same lack of performance measures on a national level.
When VA and DoD decide to collaborate on a joint facility, the number of things that need to come in line is extensive. Each department has its own IT-specific goals, and jointly the departments are looking to cut costs and improve effectiveness in providing healthcare to veterans and servicemembers.
According to high-level VA and DoD officials, the departments do not require all collaboration sites to develop and use performance measures to assess the collaboration’s effectiveness or efficiency. Whatever goals the departments have are not required to be measured.
“VA officials told us they do not want to overburden sites with performance measures and monitoring requirements, which they said may discourage future collaborations,” the GAO report states.
VA officials also noted that the department-level VA and DoD collaboration offices formed to oversee these joint efforts have no direct control over medical facilities and are not required to provide oversight or monitoring when it comes to performance.
Officials did acknowledge the need for some kind of metrics to determine the success of collaboration. According to both departments, criteria are being developed to determine the success of the existing joint venture sites. Those criteria likely will be based on the departments’ shared goals. Those criteria are being reviewed.
The workarounds used to overcome IT incompatibility recently reported at the North Chicago facility are not unique to that medical center. Similar bootstrap procedures are in use at other joint facilities.
In Biloxi, MS, hospital employees manually copy and transfer medical information, including diagnostic images, between VA and DoD’s IT systems. Or they fax the information to their collaboration partner, where it is later entered into the partner’s IT system.
Staffers there have gone so far as to use side-by-side computers, one showing VA data and the other showing DoD data. The officials reported that, while this approach helps, it is hardly as efficient as they would like.
In Honolulu, joint venture officials developed an IT tool that allows providers to view their patients’ VA and DoD healthcare records on a single screen. According to hospital officials, this has allowed providers to work more efficiently, letting them see the full list of procedures the patient has undergone, diagnostic images, medications and allergies. This is a read-only tool, however, that doesn’t allow providers to enter data into the other department’s IT system.
Such workarounds likely will be necessary until the departments develop a single system they both can use.In March 2011, the Secretaries of VA and DoD committed the departments to the development of an integrated electronic health record (iEHR). In May 2012, they announced the goal of implementing it across the departments by 2017. Approximately $550 million has been spent on the project in FY2012, with another $350 million still to be spent and an additional $500 million requested in the FY 2013 budget.
According to the GAO investigators, however, the timeframe for the iEHR’s implementation is uncertain. When the 2017 deadline was announced last spring, the Interagency Program Office (IPO) was not fully staffed, and the departments had not decided on what applications the iEHR would include. According to IPO officials, this timeframe will come into focus after work is complete at iEHR pilot sites.
In the near future, VA and DoD plan to release requests for proposals (RFPs) to develop pharmacy, laboratory and immunization applications for the iEHR. Those areas were some of the significant barriers officials in North Chicago ran into when developing sharing practices.
With a long history of point of care testing at both of its predecessor organizations, the Walter Reed National Military Medical Center (WRNMMC) laboratory services staff were keenly aware of the advantages of using portable testing devices to obtain rapid patient assessments.
Since the launch of the Opioid Safety Initiative in 2012, the VA has implemented a number of steps designed to reduce the use of opioids and the risk of addiction and overdose among veterans.