The departments of Defense and Veterans Affairs are preparing to release a new request for proposals under their integrated electronic health records (iEHR) initiative, a move that will represent the latest sign of renewed progress in a complex effort to marry both departments’ health IT systems.
The RFPs, expected in late October or early November, will support digital clinical capabilities, such as pharmacy services and immunization records, said Barclay Butler, the head of the Interagency Program Office (IPO).
But in a broader context, they also will serve as a reminder that DoD and VA so far have managed to revitalize a floundering effort to modernize how both departments deliver healthcare to service members, veterans and their families.
Why health IT was rated effective
Reason #1: VA and Defense sign policy memo enshrining the creation of a common EHR system
Reason #2: VA announces its electronic health records are open source for others to share and develop
Reason #3: DoD and VA ahead of schedule on EHR system due to lessons learned from pilot programs
(More primary source material available on The Obama Impact Resource Page)
“We are just completing the development of our plans,” Butler said. “We are now deploying and developing our infrastructure, and we are working to have our early clinical capabilities competed.”
For these and other reasons, Federal News Radio is rating the Obama administration’s efforts to modernize DoD-VA electronic health record as effective as part of our special week-long multimedia series, The Obama Impact: Evaluating the Last Four Years. Throughout the series, Federal News Radio examines 23 different administration ideas and initiatives and ranks them as effective, ineffective or more progress needed.
Defense and VA leaders have a 2017 deadline to meet full operating capability, but they already have achieved success in a number of areas, Butler said.
In 2011, for example, VA announced plans to open its electronic health record system for others to share and develop. And both departments launched a pilot to test the interoperable record at the VA medical center in Chicago.
Bounce-back from a shaky start
Defense and VA leaders began discussing iEHRs before the Obama administration took office. But the initiative failed to gain much traction because of management and resource problems, said Butler and industry experts working on the health IT effort.
The IPO, which coordinates the program, “really got its strength when the secretaries re-chartered us in October of 2011,” Butler said. “This is when the secretaries saw that they needed a more robust program office, an IPO that was staffed and funded in order to accomplish this very large effort.”
DoD and VA have increased IPO staffing by more than 90 percent since 2008, growing the office’s payroll to about 240 employees.
To push the iEHR initiative forward, the IPO deployed an incremental development approach with the aim of helping DoD and VA adapt to fast-changing technologies. The first increment of the iEHR will begin to roll out this fall to pilot sites in San Antonio; Portsmouth, Va.; Honolulu and Germany, with initial capabilities including single sign-on.
“Single sign-on means that as a doctor moves from exam room to exam room, they just pull their common access card, or their personal identity verification card, out of that computer that’s in the first exam room and plug it into the next exam room, and their system immediately comes up,” Butler said. “They’re not wasting time doing logins and spending time focusing on the computer. They’re taking that time and focusing in on the patient.”
Extra resources for the IPO serve as evidence the administration is committed to generating meaningful progress in the health IT initiative, said Ed Meagher, a former VA chief information officer and a supporter of the President’s reelection effort.
“When I was at the VA, we talked a lot about doing something like this. But I will tell you that the difference … here [is] leadership,” he said.
DoD and VA leaders have increased their involvement in the initiative.
Additional support from the top has proved to be the impetus behind progress, said Dr. Robert Wah, a CSC vice president and a former deputy national coordinator for health IT.
“I think it’s been successful in that they have moved, I think, a great deal in terms of organizationally and governance-wise to come together,” he said.
Too little, too late
But the act of combining millions of health records from two complex, separate systems has its challenges. And progress made comes too late for Rep. Jeff Miller (R-Fla.), chairman of the Veterans Affairs Committee.
“I guess the grade of the month that people talk about around Washington these days is ‘incomplete.’ And if there was a grade worse than incomplete, I would give them that,” he said. “I’ve heard a lot of talk, seen a lot of money spent and really have seen very little in terms of receipt upon the investment that’s been made.”
Miller said DOD and VA are stuck in health IT leadership turf battles, which has slowed their ability to deploy common standards and technologies for iEHRs.
“The problem has been the systems won’t talk to each other,” he said. “I’ll bet you that you could set up some type of a contest up in the Northwest and some enterprising, young IT professional could solve the problem quickly. Why we can’t do it at the federal level is beyond me.”
While he didn’t embrace the concept of a contest, Meagher said the IPO must find a way to overcome the challenges of modernizing the same system servicemembers, veterans and their families rely on for healthcare in the here and now.
“I would liken it to completely overhauling two airplanes while they’re both in flight, and trying to decide how they become one airplane while they’re in flight,” he said.