By Sandra Basu

WASHINGTON – After years of assurances that the project is on track, the VA and DoD still struggle to make their emergency medical records interoperable — which remains a source of great frustration for some congressional members.

Col. Rebecca Douglas, chief nurse of the 115th Combat Support Hospital and Spc. Bryan Draeger, a signal officer, verify that notional patient information is flowing through the Army's MC4 electronic medical record system during a mass  casualty exercise in Louisiana. Army photo.

Col. Rebecca Douglas, chief nurse of the 115th Combat Support Hospital and Spc. Bryan Draeger, a signal officer, verify
that notional patient information is flowing through the Army’s MC4 electronic medical record system during a mass
casualty exercise in Louisiana. Army photo.

At a House Appropriations Defense Subcommittee hearing on DoD’s FY 2016 budget request last month, Rep. Hal Rogers (R-KY), the Appropriations Committee chairman, told a story about a servicemember who served in Iraq years ago who could not get eye surgery at the VA because the agency couldn’t get his medical records from DoD treatment in Germany. The servicemember, Carter said, lost his eyesight “because of bureaucratic ineptitude.”

“DoD says, ‘Oh yes, we’re going fix it.’ VA says, ‘Oh yes we’re going fix it,’ but they still keep to their own systems,” Rogers pointed out. “For the life of me, I can’t understand why you can’t interoperate between VA and DoD on medical records, because people’s lives depend on it.”

Secretary of Defense Ashton Carter responded that he shared the frustration regarding EMR interoperability between VA and DoD and said the agencies “can make them interoperable.”

“This isn’t something that isn’t done every day out in our society. There are lots of medical systems that merge,” Carter said. “This is something that can be done and needs to be done. There is no technological barrier to making the two electronic health records interoperable.”

Since June 2008, at least $2 billion has been spent trying to find a solution for seamless electronic sharing of medical records and that prior DoD and VA secretaries said they could ferret out a solution, but “nothing happens,” Rogers said. 

Carter agreed that the agencies “have to get it fixed.”

“I share your frustration about all of those years and those dollars. The work that has been done has to be leveraged into a final solution. It doesn’t have to be the case that VA and DoD have the same system [but] they have to have interoperable systems,” Carter said.

Integrated EMR

Rogers’ concerns were only the latest voiced since DoD and VA announced in 2013 that, instead of building a single integrated electronic health record system, it planned to use separate systems but make them interoperable as required by law. Earlier this year, DoD and VA’s efforts on the electronic health record system were cited in a Government Accountability Office (GAO) report highlighting opportunities to reduce duplication in the federal government.

In February 2014, the GAO reported that the decision to pursue separate systems was based on the assertion that it would be less expensive and quicker to achieve but said the agencies “had not supported this assertion with cost and schedule estimates that compared the separate efforts with estimates for the single-system approach.”

“Through continued duplication of these efforts, the departments may be incurring unnecessary system development and operation costs and missing opportunities to support higher-quality health care for servicemembers and veterans,” the GAO stated in the recent report.

Also addressing the EMR issue was the Military Compensation and Retirement Modernization Commission, an independent group that made recommendations regarding military health benefits among other issues.

A report from that panel stated that the VA and DoD are “continuing to make progress with sharing data and increasing interoperability efforts as outlined in their briefs to the Congress.”

“The departments have been working together to move forward from read-only data shared through the Federal Health Information Exchange and Bi-Directional Health Information Exchange applications to enhance interoperability that provides data that is more integrated into clinical workflow,” the report stated.

Yet, the commission also noted that “given the history of challenges in achieving interoperability, whether current interoperability efforts will be successful or cost-effective is questionable.”

In fact, the Military Compensation and Retirement Modernization Commission suggested that “a single EHR system is the ideal solution for improving servicemember health care and minimizing overall EHR costs,” but, should DoD and VA adopt separate EHR systems, the systems must have “complete interoperability between the departments and with civilian institutions.”

MHS Reforms

In addition to issues over electronic health record sharing, DoD officials also said at the budget hearing that they needed flexibility to be able to implement internal reforms, including the consolidation of TRICARE healthcare plans and changes to the pharmacy co-pay structure.

“We at the Pentagon can and must do better with getting value for the defense dollar,” Carter said. “Taxpayers have trouble comprehending, let alone supporting, the defense budget when they hear about cost overruns, insufficient accounting and accountability, needless overhead, excess infrastructure, and the like.”

Chairman of the Joint Chiefs of Staff Army Gen. Martin E. Dempsey also shared that same message with lawmakers at the hearing about internal reforms.

“It’s been difficult to communicate to our men and women serving why we have to do it, but we’ve taken that responsibility on and have made several recommendations to you on internal reforms, and we certainly need both the topline increase that the president has provided but, just as importantly, the reforms that we’ve requested,” Dempsey said.