GAO: VA, DoD ‘Years Away’ From EHR Interoperability

by U.S. Medicine

August 5, 2016

By Sandra Basu

WASHINGTON—A modernized VA electronic health record system that is fully interoperable with DoD’s system “is still years away,” according to the Government Accountability Office (GAO).

“Uncertainty and important questions remain about what the department is prepared to accomplish, in what timeframes and at what cost,” Valerie Melvin, director of GAO’s Information Management and Technology Resources Issues, told the Senate Appropriations Military Construction, Veterans Affairs and Related Agencies Subcommittee.

At the hearing last month on VistA, subcommittee members pressed VA officials on the need for “interoperable records” and reiterated their vision for the transfer of records between that agency and DOD.

“Whenever a soldier, sailor or airman leaves active duty and becomes a veteran, we should have 100% seamless transmission of their health record to the VA,” emphasized the subcommittee’s chairman, Sen. Mark Kirk (R-IL).

VA’s Efforts

The questions on interoperability came from lawmakers despite VA and DOD jointly certifying in April to Congress that it met the interoperability requirements set forth in a section of the FY 2014 National Defense Authorization Act.

Kirk questioned, however, how interoperable the systems could be, if DOD and VA are not able to exchange X-ray and CAT scan images on its Joint Legacy Viewer (JLV), which is a clinical application that provides data from VA and DOD providers in a common viewer.

“I think most members of this committee would say that is not interoperable,” Kirk asserted.

“We have to have seamless movement of that information,” said LaVerne Council, VA Assistant Secretary for Information and Technology and Chief Information Officer.

VA officials agreed about the importance of exchanging images in JLV; Council said that, by September of this year, clinicians will have the capacity to do that.

In Council’s written statement, she also explained that the Enterprise Health Management Platform (eHMP) ultimately will replace the read-only JLV.

“We are deploying an initial read only version of eHMP now, and will begin deploying eHMP version 2.0 with write-back capabilities in the second quarter of FY 2017,” she explained. “Clinicians will be able to write notes and order laboratory and radiology tests in version 2.0. eHMP 2.0 will also support tasking for team-based management and communication with improved tracking to ensure follow through on tasks.”

In response to a question about when VA will be “satisfied” with the transfer of information being complete from DOD, VistA Evolution Program Executive David Waltman explained that would mostly be accomplished in 2018.

Screen Shot 2016-08-05 at 4.37.19 PM

GAO Findings

VA officials also defended the decision for it and DOD to pursue separate EHRs, which continues to be a recurring concern among lawmakers.

“The reality is that there is no system that can support both DOD and the VA at the same time. It will not scale,” Council told the congressmembers.

Melvin pointed out, however, that VA has yet to “substantiate its claim that modernizing VistA together with DOD acquiring a new system can be achieved faster and at less cost than a single joint system.”

“Thus an important question remains as to how VA and DOD can continue to justify the need for separate systems,” the GAO official said.

Melvin also cited “uncertainty” about VA’s future approach to addressing its EHR needs as an ongoing concern.

“The chief information officer has also indicated that the department is taking a step back in reconsidering how best to meet its electronic health record system needs beyond fiscal year 2018,” she said in her written statement.

As part of VistA’s modernization, VA will release VistA 4 in FY 2018 but has suggested that VistA might not be the EHR that it uses in the future. During a Senate hearing in late June, VA Under Secretary for Health David Shulkin, MD, testified that VA officials have reached a consensus that “looking at a commercial product is probably the way to go.”

“But we need to do this in a way that incorporates our ability to integrate with community providers and all of the unique needs of the veterans,” he said.

Sen. Patty Murray (D-WA) said at that hearing that the “the decision of whether to use an upgraded version of VistA for the long run or to purchase a commercial product should have been settled years ago.”

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