EHR interoperability for VA and DoD, who’s responsible? Lawmakers, officials can't agree
The Interagency Program Office (IPO) has not fulfilled its legal mandate to be the single point of accountability between the Department of Defense and Department of Veterans Affairs interoperability efforts. But both officials and lawmakers can’t decide who should reconcile the differences.
The inaugural House Veterans Affairs Subcommittee on Technology Modernization hearing, held on Thursday, revealed, not surprisingly, governance and accountability are still major points of contention for the project.
Government Accountability Office Director of Management Issues Carol Harris testified that while the VA has signed the contract with Cerner, created a program management office and drafted high-level governance plans -- program officials haven’t designated “what role, if any, IPO is to have in the governance process.”
Rep. Jim Banks, R-Indiana, supported Harris, remarking that the IPO is “one of the few aspects of EHR modernization mandated by law.” He also stressed IPO’s governance role in the projects was not only important -- but permanent.
The departments need to clarify the IPO’s powers, which was established in 2008 to not only oversee the initial EHR collaboration -- it gave them authority to resolve these differences, said Banks.
“My hope is DoD and VA will hash out what that looks like and come to mutual agreement,” Banks said. “I am willing to give them additional time to do that, but I will not wait forever.”
GAO is recommending the VA clearly outline the role IPO will have over the EHR project, specifically around governance, as “focusing on a single point of accountability is critical in moving forward to make sure that interoperability is functional,” said Harris.
But the VA Office of EHR Modernization Office’s acting Chief Information Officer John Windom told the committee that he doesn’t believe IPO has any decision-making authority of his office.
And IPO Director Lauren Thompson pointed out that her office isn’t equipped to be the single point of accountability for VA-EHR interoperability, citing a lack of authority, resources and staff.
“At this point in time, we do not have the decision-making authority,” said Thompson.
But Harris continued to press that the law makes IPO the “single point of accountability, so that would include responsibility, authority and decision-making.” In fact, the testimonies of both Windom and Thompson are in conflict with the statute’s expectations.
Further, Harris stressed that both DoD and VA have ignored GAO advice over the years on empowering the IPO. The role needs to be clearly defined, such as through Congress, which could relieve the office of its legal responsibilities.
“If the IPO continues the way that it is operating today, we are going to continue to have dysfunction in moving forward,” Harris said.
Discussions on better governance policies are ongoing, Windom testified. The conversations are overlapping with the VA rollout of its Cerner EHR. VA and DoD continue to work through the data sharing roles at the agencies, as well.
Thompson proposed governance should be broken down into three boards. One, a functional governance board, would handle disputes among clinicians and other healthcare employees. Two, a technology-focused governance board, would have the same function but for purely tech issues.
The final board would be solely focused on decision-making, designed to resolve problems the other two boards could not, said Thompson.
But Windom quickly countered Thompson’s idea, and said those low-ranking disputes could be resolved on the ground -- without having to involve “high-ranking staff members.”
“I can't impress upon the committee enough that governance has to be successful at the lowest possible level,” sad Windom. “Things can’t rise to the superior level on every matter.”
Harris agreed: With that many boards involved, accountability is “diffused so when the wheels fall off the bus you can’t point to a single entity… When everyone is responsible, no one is responsible.”
In the end, no clear decision was made at the hearing. Rep. Scott Peters, D-California, said the issue may need to be resolved by either Congress or the president, as the single point won’t be created without help.
Indeed, VA has struggled with both maintaining leadership and with governance issues for the past year. Since the dismissal of former VA Secretary David Shulkin, MD in March, at least 42 senior staffers have left the VA. The most recent came from the EHR project office itself, with the departure of its CHIO Genevieve Morris and CMO.
VA officials continue to double down on their projected 2020 go-live of its own pilot EHRs in the Pacific Northwest, designed to follow the DoD rollout. But GAO may also be investigating the DoD project, after an audit deemed the new system “not operationally suitable.”