Full VA/DOD e-health sharing several years off

By Mary Mosquera
01:00 AM

The Veterans Affairs and Defense departments may take several more years to develop modernized electronic health records systems that can seamlessly exchange medical data. The departments expected to accomplish that goal in 2011 or 2012, but they have not given the Government Accountability Office a certain end date because of changes to the milestone schedule.

The ability to exchange medical data would speed treatment for injured warfighters returning from Afghanistan and Iraq, especially those who suffer from traumatic brain injuries.

DOD and VA can exchange only limited categories of medical data because the data-sharing initiative is taking longer than anticipated. The effort bogged down because of a lack of effective project requirements and management, said Valerie Melvin, director of GAO's workforce and management information systems issues.

As a result, DOD and VA have worked on developing the capability to share medical data for 23 years. GAO has monitored the agencies' data-sharing development since 1998. Congressional oversight, however, has been critical to moving the departments forward as far as it has, she told the House Veterans Affairs Committee's Oversight and Investigation Subcommittee.

"The project has experienced repeated changes in strategy, repeated changes in milestones and a lack of clarity," Melvin told lawmakers. The medical data-sharing initiative needs a more defined timeline and risk-management activities

At the same time, VA and DOD are continuing to modernize and integrate their individual electronic medical record systems.

"The development of modernized systems has always been on separate tracks," she said.

VA is replacing its comprehensive Veterans Health Information Systems and Technology Architecture (VistA) system with the modernized HealtheVet electronic records system. DOD needs to integrate its Armed Forces Health Longitudinal Technology Application system with its Clinical Data Repository and other patient applications.

"The real problem is foot-dragging by DOD," said Rep. Ginny Brown-Waite (R-Fla.), the subcommittee's ranking member, who recommended that DOD adopt VA's VistA system.

"It's certainly an option that should be considered," Melvin said.

DOD and VA say that by the end of this year, they will be able to share major elements of an electronic medical record as part of the Bi-Directional Health Information Exchange.

The departments are exchanging electronic medical data such as pharmacy, pathology, blood work, lab and radiology text reports that is viewable and computable on shared patients at seven locations, said Gerald Cross, VA's acting principal deputy undersecretary for health.

Next month, VA and DOD will share added capabilities that they had been pilot testing to all sites for sharing digital images and patient narrative text documents, such as discharge summaries.

"Throughout the remainder of the year and into 2008, the types of data shared bi-directionally will increase by adding domains such as progress notes and problem lists," Cross said.

DOD also has transferred electronic health data on 3.8 million service members to VA.

VA now is able to track injured service members more effectively as they move through the medical care system to veteran status because last month it implemented a version of DOD's Joint Tracking Application case management system. VA physicians were not receiving DOD medical information in a timely manner until DOD made its system available to VA.

Access to DOD's tracking system was a major issue that came out of revelations of poor treatment of injured warfighters at Walter Reed Army Medical Center. The system provides medical data from the point of injury in the field through VA and DOD health care.

Separately, House Veterans Affairs Committee Chairman Rep. Bob Filner (D-Calif.) said he planned to increase VA oversight.
Also, VA Secretary Jim Nicholson announced the creation of a 17-member panel to advise him on how to improve care for veterans of Iraq and Afghanistan.