iEHR cost estimates doubled

DoD, VA backpedal on plans for joint health record
By Erin McCann
12:00 AM
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With the U.S. government's priority set on fixing the federal deficit, developing an integrated electronic health record system for the Departments of Veterans Affairs and Defense as previously planned has been forgone. 

VA Secretary Eric Shinseki and then DoD Secretary Leon Panetta in February announced unexpectedly that the full integration of the VistA EHR between departments would be scrapped due to cost concerns —  a decision triggering fierce criticism from both sides of the political aisle. 

By working toward interoperability and integration of EHR systems in a handful of pilot sites, rather than building an iEHR entirely from scratch as previously proposed, officials anticipate a cost-avoidance of hundreds of millions of dollars. Original estimates for the iEHR were pegged at $4 billion to $6 billion. However, in September 2012, the Interagency Program Office revised its previous estimates, figuring the final price tag to be from $8 billion to $12 billion, which officials say necessitated a change in strategy. 

"This (new) approach is affordable; it's achievable, and if we refocus our efforts, we believe we can achieve the key goal of a seamless system for health records between VA and DoD on a greatly accelerated schedule," said then DoD Secretary Leon Panetta in a Feb. 5 press conference.  

A common joint graphical interface, however, will still be newly deployed in seven of DoD and VA facilities by the summer, Panetta added, which are slated to be interoperable by the end of July 2013. 

Department officials say they still anticipate meeting the President Obama's goal of implementing a seamless EHR system in the end. The path to get there, however, just looks a bit different now.  

"We would like to dispel any notion that VA and DoD are moving away from a single, joint, electronic health record," said VA Assistant Secretary and CIO Roger Baker in a Feb. 27 hearing. "What has changed is the strategy that we will use to accomplish that goal."

Baker said the departments would be able to exchange the "most important" medical information in 2014, including prescriptions and lab results. VA serves more than six million Veterans each year. 

"In 2017, the goal is that we're exchanging all patient information," he said. "And so it is a substantial software change by 2017, where the 2014 date is primarily oriented around the data interoperability." 

Despite similar goals in place, members of the U.S. Senate Committee on Veterans Affairs were displeased. "The decision by DOD and VA to turn their backs on a truly integrated electronic health record system is deeply troubling," said Jeff Miller, R-Fla., chairman of the House Committee on Veterans Affairs, in a committee news release.  

Bernie Sanders, I-Vt., chairman of the Senate committee, echoed Miller's sentiments, saying he was "deeply disappointed." 

Mike Michaud, D-Maine, ranking member of the House committee, called the announcement a "huge setback and completely unacceptable," adding, "We have just witnessed hundreds of millions of dollars go down the drain." 

When asked by reporters whether money had been squandered on the time and effort put toward creating this joint record only to essentially forgo it in many ways, Baker said, not entirely. 

"What we've been doing to this point is pulling together the common requirements between the organizations for, for example, a common pharmacy system or a common laboratory system," he said in a February press conference. "And so all that is valuable as we move forward in building the joint system, even if it's based on existing technology. We still want to have common applications inside of there." 

Two weeks after the press conference and close to one week before the two departments were scheduled to take the stand in a congressional hearing, Baker announced his resignation, followed shortly after by the resignation of VA Chief Technology Officer Peter Levin.  

The biggest concern now, officials say, is the looming debt crisis and the foreboding sequestration cuts that hit March 1, which could remain for weeks if Congress and the White House fail to reach an agreement. If the cuts were fully implemented, the DoD would need to cut a potential $45 billion from its budget by Sept. 30.  

"We're very concerned about the effects continuing resolutions and sequestration and many of the financial pressures," said Jonathan Woodson, MD, assistant secretary of defense for health affairs, in the Feb. 5 press conference. "I think, though, that what we've mapped out as a strategy, of course, takes into account an increasingly more austere fiscal environment, and that's why we're driving and accelerating the program and reducing risk and accelerating schedule to make sure that we're as efficient in this process as possible."

"(An) entire consolidated medical history from the moment you raise your right hand will be available to those that are going to provide you with service, and even to you to download onto your own PC," said Baker of the original joint iEHR plan, in a January interview with Healthcare IT News. "It's a huge, huge step forward from a federal standpoint."

Seeing as how the iEHR plans have been altered and Baker has resigned, it appears as if the two departments will no longer be taking that "huge, huge step forward" into the future but rather will attempt to make the best out of the present limbo they now find themselves in.