Development of an Integrated Electronic Health Record (iEHR) was, once more, a front-and-center topic of interest during a July 11 joint hearing by the House Committee on Veterans' Affairs (HCVA) and the House Armed Services Committee.
Rep. Jeff Miller, R-Fla., HCVA chair, recalled that last year Department of Veterans Affairs (VA) Secretary Eric Shinseki and then-Department of Defense (DoD) Secretary Leon Panetta pledged to Congress that their departments would work together to develop a "single, joint, common Integrated Electronic Health Record" by 2017. However, that goal remains elusive.
VA and DoD "are, once again, moving on their own tracks with promises we've heard before about making two separate systems ‘interoperable,'" Miller said in his opening remarks. "Pardon my frustration, but it seems the only thing interoperable we get are the litany of excuses flying across both departments every year as to why it's taking so long to get this done."
In response to continued development problems, the House has included an amendment in the National Defense Authorization bill that directs VA and DoD to complete work on an iEHR by Oct. 1, 2016. "The message of the amendment is simple — no more excuses, get this done," Miller said.
Rep. Michael Michaud, D-Maine, echoed Miller's concerns. "I do not believe we have made any measurable progress in getting the two agencies before us today to work more effectively together." He mentioned DoD's announcement that it is putting out a bid for a new system to manage its health records; those records would also be able to operate within VA's software management system. Yet this move does not support the goal of developing a truly integrated iEHR system.
"An integrated — integrated, not interoperable — electronic health record is something that Congress mandated years ago," Michaud said. "We have spent hundreds of millions of dollars delaying the delivery of an integrated — that is, integrated, not interoperable — information sharing system (that) runs directly against congressional intent, and ultimately hurts our veterans."
Frank Kendall, DoD's under secretary for acquisition, technology and logistics, responded in his testimony that VA and DoD "have made important steps toward achieving health data interoperability" and "procuring the foundations of an underlying joint IT infrastructure."
"While some may have interpreted this shift in strategy as backing away from our commitment to achieve an integrated electronic health record, this is not the case," he said.
For the rest of 2013, Kendall said that VA and DoD are focused on achieving full interoperability of health data through a series of near-term "accelerator" efforts. "These efforts will result in each servicemember and veteran having a single, seamless, shared, integrated health record," he said. "All patients, and the clinicians serving them, will be able to access all of their health data, whether the patient is currently a military member or veteran, and treated at a DoD or VA hospital."
Kendall told the committees that such interoperability of iEHR's would be achieved without replacing VA or DoD software management systems for health care.
After conducting a study earlier this year, DoD opted to replace its current AHLTA health-care management system with a new one, rather than adopting VA's VISTA system. "While evolving and enhancing VISTA was a logical business decision for VA, DoD faces a very different situation," Kendall said.
The DoD study confirmed that the department requires a health-care software management solution that can provide capabilities in a variety of environments, often with limited or no connectivity. DoD also needs a system that can easily add specialized modules to address such needs as battlefield casualty care in a timely manner.
"Given the options available to DoD," the best course of action "is to conduct a ‘best value' competition acquisition of a core health-care management system," Kendall said.
Stephen Warren, VA's acting assistant secretary for information and technology, testified that VA and DoD don't have to use the same iEHR software. "Health-record data integration and exchange is possible, regardless of the software systems. In fact, as private-sector experience has shown, using the same system does not guarantee that information can be shared. The important thing is that both systems use national standards and a common language to express the content and format of the information they share."
To achieve the goal of delivering integrated health-care information, Warren said that VA and DoD are taking several steps, including creation of a Data Management Service that will give DoD and VA clinicians access to patient health records, as well as enhance VA's "Blue Button" functionality so patients can download and share their iEHR's, and take control of their own health.
VA has chosen to keep its VISTA management system because "it is still one of the best electronic health record systems available worldwide," Warren said, and "we know that we will be able to achieve competitive pricing for any changes we need to make."