The dilemma of electronic health records

A recent decision by the Departments of Veterans Affairs (VA) and Defense (DoD) to cancel development of the Integrated Electronic Health Record system (iEHR) was challenged by The American Legion at a Feb. 27 hearing of the House Committee on Veterans’ Affairs.

The Legion’s statement, submitted by Jacob Gadd, deputy director of health for the Legion’s Veterans Affairs & Rehabilitation Division, called the iEHR system "something seemingly well within the grasp of a modern, 21st-century nation…. Sadly, four years and a billion dollars later, veterans are left with the feeling their government is throwing in the towel."

During a Feb. 5 press conference, VA Secretary Eric Shinseki and then-DoD Secretary Leon Panetta announced that the iEHR project — scheduled for completion by 2017 — would be shut down. Instead, electronic records would be developed that could be read by both VA and DoD systems.

"This is not what the veterans of America were promised," the Legion stated.

The American Legion has recognized the need for an integrated EHR system that would make all VA and DoD records available to veterans and servicemembers alike. Last October, the National Executive Committee passed Resolution 42, supporting VA’s plans to develop a Virtual Lifetime Electronic Record (VLER), which would track an individual’s records from the day of military enlistment to the day of burial. iEHR would have been a critical component of VLER.

Access issues with veterans’ healthcare records are impeding the disability claims process and contributing to VA’s backlog. This is happening at every level, from currently transitioning veterans to those who left active duty some time ago. Improving access to health care records will help the claims process and aid VA in its goal to reduced its claims backlog. Most importantly, it will help veterans get the benefits they have earned more quickly.

Currently, servicemembers leaving active duty for medical reasons are experiencing lengthy delays in the Medical Evaluation Board (MEB)/Physical Evaluation Board (PEB) process. The average number of days pending for an MEB/PEB case is 374 days. Much of the delay time involves medical records and scheduling appointments.

Problems that arise with veterans’ service records range from the technologically complex to the mundane. During an American Legion visit to a DoD/VA joint venture site, Legion staff members had the opportunity to interview veterans about their transition process. One veteran said, "I enrolled in VA and they asked me for my DoD treatment records (because they did not have access to them). I walked over to DoD, and they told me the base had run out of paper to print the record and to come back in a few weeks."

Referring to this incident, Gadd told the committee, "The fact that our government cannot handle this basic task for a veteran in transition is inexcusable."

The American Legion’s work on the Fully Developed Claims (FDC) program has shown what impact that quick, easy access to records can have. These claims require getting all of the information together up front to expedite the process for veterans, a process that would be improved for all veterans with a single, unified electronic record. While traditional claims spend an average of 257 days in the VA system, FDC’s are averaging 120 days. In some VA regional offices, such as Pittsburgh, the Legion has seen some claims decided accurately in 30 to 35 days. Providing veterans total access to their health records would greatly assist them in submitting FDC’s, which, in turn, would help VA to reduce the claims backlog.

Communication between VA and DoD has improved somewhat over the past four years, with beneficial results such as the eBenefits portal and the "Blue Button" that allows veterans to download their health-care information. Yet, veterans are still not receiving what they were promised — a single, integrated system to track their health.

Abandoning iEHR should justly raise an alarm throughout the veterans’ community. This action may save money now, but it wastes a portion of the billion dollars already spent. Furthermore, it abandons a technological initiative that could help solve difficult problems the claims system faces.

In its resolution, the Legion also recommended that VA and DoD include veterans service organizations (VSOs) in meetings to offer stakeholder input and share mutual concerns; this was not done.

Gadd told the committee "the VSO’s have been left out of the majority of the planning for this (iEHR) record, and we were not consulted about the wisdom of abandoning a single, unified record for veterans.

"Solutions to the access and management of health records should be forward-looking, not a retreat to the legacy of the past, where VA and DoD maintain their own separate camps. The men and women who have served in uniform defended one federal government – that same government should be able to deliver one health-care record to them. This technology should not be out of our grasp."