VA, DoD in hot seat over failed iEHR development
The Departments of Veterans Affairs and Defense have come under fire this past year over their botched development of the integrated electronic health record system, which resulted in a go-live pushback and a doubling of overall costs. The myriad implementation setbacks have prompted Congress to finally put its foot down.
Under the new defense authorization bill, the two departments will have just about a month to develop a plan for interoperable digital health records.
[See also: iEHR cost estimates doubled.]
By the end of January, the two departments will have to provide Congress with "a detailed plan for the oversight and execution of the interoperable electronic health records with an integrated display of data, or a single electronic health record." Then they’ll have almost three years, by the end of 2016, to actually deploy a "modernized electronic health record software supporting clinicians of the Department," as directed in the $625 billion 2014 National Defense Authorization Act that passed the House and was expected to pass the Senate before lawmakers adjourn for recess Friday, Dec.13.
After years of delaying iEHR or interoperability between the VA and the military’s health system, the Defense Health Agency, and some $300 million spent by an interagency office on support contracts, lawmakers working on military and veterans issues have grown increasingly impatient and critical of the work and lackthereof.
"It is the sense of Congress," begins the defense authorization bill’s section on health records, "that the Secretary of Defense and the Secretary of Veterans Affairs have failed to implement a solution that allows for seamless electronic sharing of medical health care data; and despite the significant amount of information shared between the Department of Defense and Department of Veterans Affairs, most of the information shared as of the date of the enactment of this Act is not standardized or available in real time to support all clinical decisions."
The bill tasks the currently dormant and leaderless Interagency Program Office with identifying national EHR architectures and standards, in conjunction with the Office of the National Coordinator and overseen by a new executive committee, to guide the new interoperability project – whether that’s an iEHR shared by the two agencies or a seamless, interoperable connection between the VA’s VistA and a new system the DoD would procure.
The bill gives the two agencies leeway with those two options, but outlines design principles for them to follow either way.
[See also: VA, DoD on tighter leash with iEHR.]
It requires, "where practical," the transition of the Departments and private sector military health providers "to modern, open-architecture frameworks that use computable data mapped to national standards to make data available for determining medical trends and for enhanced clinician decision support."
And it further instructs the agencies to adopt "enterprise investment strategies that maximize the use of commercial best practices to ensure robust competition and best value; aggressive life-cycle sustainment planning that uses proven technology strategies and product upgrade techniques; enforcement of system design transparency, continuous design disclosure and improvement, and peer reviews that align with the requirements of the Federal Acquisition Regulation; and strategies for data management rights to ensure a level competitive playing field and access to alternative solutions and sources across the life-cycle of the programs."
The VA and DoD will have to outline how they’re going to meet those design, standards and procurement principles in a briefing to Congress by the end of January. Otherwise, they won’t be able to spend more than 25 percent of the estimated $344 million in funding needed; they’ll also have notify military and veterans committees before dispensing funds related to the project greater than $5 million.
This article first appeared in Government Health IT here.
March 27, 2020
March 27, 2020