DoD and VA: When will your EHRs really interoperate?

GAO says 2018 at the earliest. Even that appears overly optimistic
By Tom Sullivan
07:51 AM
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doctor and patient on tablet EHR

Talk about a daunting deadline. 

The National Defense Authorization Act (NDAA) for Fiscal Year 2014 mandated that the Defense and Veterans Affairs departments "certify that all healthcare data in their systems complied with national standards and were computable in real time," by Oct.1, 2014.

What with DoD's 9.5 million patients and the VA's 8.3 million that's a terrifically ambitious goal, to be certain, and not one that can be rushed.

"Both departments stated they intend to do so later in calendar year 2015," the Government Accountability Office wrote in a report published on Thursday. "Further, the departments' system modernization plans identify a number of key activities to be implemented beyond December 31, 2016 -- the deadline established in the NDAA for the two departments to deploy modernized electronic health record software to support clinicians while ensuring full standards-based interoperability."  

Indeed, DoD's modernization plans took a step forward at July's end when officials revealed the agency awarded its EHR contract to the team of Leidos, Cerner and Accenture – at which point DoD also said it intends to deploy the new EHR at eight sites in the Pacific Northwest by the close of 2016, with plans to have it installed at more than 1,000 sites around the globe by 2022. VA, for its part, is sticking with its proprietary VistA EHR and will modernize it incrementally toward a full installment at VA locations in 2018.

[See also: 7 things DoD demanded in Cerner EHR.]

"These plans  if implemented as currently described  indicate deployment of the new systems with interoperability capabilities will not be completed across the departments until after 2018," GAO states in its report.   

This is not to say that VA and DoD don't share records already. They do. DoD officials asserted that "there is not a big interoperability problem with VA," and, instead, the agencies "share more information than any two large institutions today," to the tune of approximately 1 million pieces of information every day.

What the DoD and VA currently lack, GAO continued, are "outcomes-oriented metrics and goals for defining and measuring interoperability progress."

That's where the report paints a messy picture.

The joint Interagency Program Office, which essentially sits between the VA and DoD, told GAO it assigned a team to work with VA, DoD and the Office of the National Coordinator for Health IT to identify better metrics, such as user experience and improved outcomes. But that team had yet to commit to a delivery date when those would be incorporated into their guidance, at least as of late May, GAO noted. 

"Officials of the departments and the IPO explained that defining appropriate outcome metrics for interoperability is not just a DoD and VA issue; rather, it is a national challenge to identify how to measure interoperability and what data are needed," GAO reported.

Fair enough. It's safe to say that at this point in history health information interoperability is a problem that the DoD and VA cannot – and should not – solve by themselves. 

But it does raise the question of whether they can move as far forward as they need without private healthcare organizations and technology vendors measuring interoperability progress in lockstep. 

"Until they establish a time frame, complete steps to define outcome metrics and goals, and incorporate these into IPO guidance," GAO contended, "the departments and the IPO risk not knowing the status of program operations and areas that need improvement, and ensuring accountability for end results."

All of which makes even GAO's estimate of 2018 look perhaps overly optimistic, doesn't it? 

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