Defense and Veterans Affairs department officials are reassuring House lawmakers that just because they are developing separate electronic health systems, it doesn’t mean the two departments aren’t sharing electronic health records today and will share even more in the future.
Officials Wednesday tried to separate and clarify for lawmakers the different goals of sharing health records and having one electronic health system. “All of these terms, like integrated record, carry an awful lot of weight and are interpreted differently by different people. My view is that by 2014, we will have integrated records that we share with VA. That is what the near projects are doing,” said Frank Kendall, the under secretary of Defense for acquisition, technology and logistics, who Defense Secretary Chuck Hagel recently put in charge of DoD’s electronic health record system effort. “It’s important for the committees to distinguish between integrated records and health care management software. Health care management software doesn’t just make a record, but it helps the physicians do their job. That’s a very important reason for us to modernize our systems. As far as records are concerned, we will have records in common standards and they will move seamlessly between DoD and VA for use by both benefits adjudication purposes and for health care purposes.”
Kendall tried to tamp down the frustration by members of the House Armed Services and Veterans Affairs committees during a joint hearing Wednesday.
Data not wedded to systems any more
Several times, Kendall told committee members that the two departments can and are sharing data without having the same systems.
The confusion stems from the decade long effort by DoD and VA to share data and have a joint system. For so long, Congress, DoD and VA focused the discussion on this single interoperable system. But Kendall and others who testified say the two no longer are related.
“We are currently talking to each other. I think there is a misconception about this. VA can read DoD’s records when we send them,” Kendall said. “We want to have an improved system from that where we are not just reading the records, but actually using them and the data that is provided. We also want to eliminate the paper that’s currently part of the records that we are sending. So we are moving very quickly to accomplish those two things.”
DoD, meanwhile, also is going down a new path to create a health care management system. It announced in May it would buy a commercial system to replace its legacy AHLTA system.
“We were on the path to develop an entirely new system. It’s a tough path. We decided to get off of that,” Kendall said. “The costs for that were going to be exorbitant. The last estimate that I saw was $28 billion in lifecycle costs.”
Kendall didn’t offer more details on DoD’s plans to buy a commercial system, not mentioning nor being asked by lawmakers the timeframe for a release of a solicitation or any details of the acquisition strategy.
But he said DoD’s market research showed 15 viable options, including three that relied on the software behind the VA’s VISTA system.
Kendall said DoD and VA share short term goals that the interagency program office oversees. He said he’s reviewing those goals now and will ensure Congress knows about the specific benchmarks they intend to meet.
While some committee members seemed satisfied with DoD and VA’s answers, the frustration among many of the lawmakers who more closely follow the decade-long process was clear.
Reps. Jeff Miller (R-Fla.), the chairman of the Veterans Affairs Committee, and Mike Michaud (D-Maine) expressed frustration and disappointment over DoD and VA’s progress.
Michaud said the fact that neither Hagel nor VA Secretary Eric Shinseki showed up to testify demonstrated a lack of commitment and leadership.
Miller said the frustration about the lack of progress boiled over into the House version of the 2014 Defense Authorization Bill.
“The amendment that was developed in collaboration of HASC, VA and the appropriators to direct the completion of an integrated health record by Oct. 1, 2016,” Miller said. “The message of the amendment is simple: No more excuses, get it done.”
Miller expressed the same frustration later in the hearing when Kendall asked the committee for patience as he is new to the program and still figuring out the best path forward. Miller shot back that plenty of people and money had already been spent, insinuating his patience is more than just thin.
Kendall said he understands the committee’s frustration, but doesn’t think the provision in the NDAA is necessary.
“I am concerned with the language in the House FY14 NDAA and the House FY14 MilCon and Veterans Appropriations Act may overly restrict both VA’s and DoD’s options going forward as well as impose significant oversight burdens on the programs,” he said. “We would like to work with the Congress on less restrictive language that would both address your concerns and allow for efficient program execution. I commit to you that DoD will keep the committees informed of our progress and of any major developments of our health care record and health care management acquisition programs.”
Kendall added DoD will work closely with VA to improve short term information sharing and long-term health care system development.
DoD and VA need to take steps to get the programs on track, but the provisions in the bills would make it difficult for DoD to do that, he said.
Kendall said he needs some time to sort a few things out, including updating its strategic plan from last fall. He said that plan doesn’t reflect the changes since it was written last fall.
Next steps of information sharing
Even with all this concern by lawmakers, witnesses reassured lawmakers that DoD and VA are making real progress on information sharing.
Jonathan Woodson, the assistant secretary of Defense for health affairs and the director of TRICARE Management Activity, said the data currently shared between DoD and VA has more functionality than most private medical offices and most integrated hospital systems.
Woodson said DoD and VA have plans to do even more.
“By the end of the year, not only will we be able to exchange that information so it could be read by whomever might need the information in the Veterans [Affairs] system, but it will be computable data,” he said. “Through the ongoing projects we have, through the Interagency Program Office focusing on this accelerator for this data interoperability, which is really an important feature, it will be computable data that will be real time, that allows providers as well as administrators to use the information for the benefit of the transitioning service member.”
Another example of the future of DoD-VA information sharing is a project called the health artifacts information system. Woodson said the health artifacts information system will transfer data that often is hard to find and is the reason claims processing is delayed. This includes private sector medical information, which accounts for about 60 percent of all health data coming from DoD to VA.
Kendall said DoD and VA share short term goals that the IPO oversees. He said he’s reviewing those goals now and will ensure Congress knows about the specific benchmarks they intend to meet.
He said the IPO is taking steps to deliver seamless, shared integrated health information on an accelerated basis:
Developing and deploying a data management service to give DoD and VA clinicians access to integrated patient health record information by the beginning of calendar year 2014.
Accessing data through a single integrated view to nine high priority sites by the beginning of 2014.
Making standardized, integrated clinical record data broadly available to clinicians across the DoD and VA later in 2014.
Enhancing Blue Button functionality, which will give patients the ability to download and share their own electronic medical record information, enabling them take greater control of their own healthcare.