Interoperability still years away for VA and DoD

'The inability to integrate these two systems is a problem of leadership'
By Jessica Davis
10:38 AM
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Interoperability

The Departments of Defense and Veterans Affairs were both admonished on Tuesday for their inability to work together to create a fully interoperable electronic health record system.

[See also: Interoperability 'taking so darn long']

The DoD and VA have been attempting to work together for more than two decades to create an interoperable system, and at a Congressional hearing on Tuesday, the House Information Technology Sub-Committee chided technology leaders from each.

"I don't mean to understate the enormity of the challenge of integrating the two largest federal bureaucracies," said Rep. William Hurd, R-Texas, chairman of the House Subcommittee on Information Technology during opening statements, "but it's clear to me that the inability to integrate these two systems is a problem of leadership, rather than technical feasibility.

"We have sent men to the moon and robots to Mars," he added. "I feel like we should be able to move one electronic file, no matter how big, no matter how old, from one computer system to another."

[See also: Interoperability aids patient engagement]

The VA cited "persistent internal challenges" and "external pressures" as compelling reasons for change within the department. It also stated its intent to roll out another program to combat interoperability roadblocks.

"This transformation will be different," said LaVerne Council, assistant secretary for information technology and chief information officer for the VA," in prepared remarks. "We will measure success, ensure accountability, invest in the capabilities of OI&T employees and collaborate across the VA to build trust."

The VA also noted that it is working closely with the DoD/VA Interagency Program Office and the Office of the National Coordinator for Health Information Technology to ensure coding and data accuracy. However, these facts were not seen by the Congressional Subcommittee on Information Technology.

"The members of our armed forces are still coming home to find that two decades was not long enough for these two departments to get together and develop a workable and fully interoperable EHR," said Hurd.

"At its core, this is not a problem of technology," he added. "This is an issue of management."

The DoD had an equal amount of reasons for a failed interoperable EHR system. Listing the amount of active armed servicemen, civilians and National Guard and Reserve members, David DeVries, Principal Deputy Chief Information Officer for the US DoD, pointed out the enormity of their network and "the $5 billion invested in cybersecurity" as reasons for integration complications, in a prepared statement.

But all of these reasons can't explain how over $564 million dollars was spent on the failed iEHR attempt between the DoD and VA between October 2011 and June 2013. After which, the branches went their separate ways in terms of EHR development.

The DoD was awarded $4.3 billion to upgrade their Armed Forces Health Longitudinal Technology Application, while the VA is still struggling to modernize their own platform, VistA.

"Missed deadlines, cost overruns and failures to deliver on expectations, leave me with serious doubts about these two departments ability to work towards this common goal," said Hurd.

The DoD and VA predict a 2022 completion date for their interoperable EHR, long after the 2017 timeframe given while the two organizations were still working together.

While the U.S. Government Accountability Office has noted some small improvements in inter-department connectivity, there is still a long way to go.

Both missed a critical Oct 1, 2014 deadline established in the National Defense Authorization Act for Fiscal Year 2014 that called for compliance with national standards, certify that all health care data in their systems complied with national data standards and were computable in real time, GAO chided.

Moreover, it noted, "the departments do not plan to complete the modernization of their electronic health record systems until well after the December 2016 statutory deadline by which they are to deploy modernized electronic health record software while ensuring full interoperability. Specifically, VA plans to modernize its existing system, while DOD plans to acquire a new system; but their plans indicate that deployment of the new systems with interoperable capabilities will not be complete until after 2018."

The government's Interagency Program Office took steps to begin developing metrics to monitor progress related to the standardization of the departments' data and their exchange of health information, GAO wrote in its report.

For example, it called for the development of tracking metrics to gauge the percentage of data domains within the departments' current systems that have been mapped to national standards. However, the office had not defined outcome-oriented metrics and related goals to measure the effectiveness of interoperability efforts in terms of improving healthcare services for patients served by both departments.

[See also: DoD and VA: When will your EHRs really interoperate?]