Senate threatens DOD over health data standards

The Department of Veterans Affairs and the Pentagon have made significant progress during the last year improving interoperability between the two agencies’ electronic health record systems. But the ultimate goal of providing end-to-end access to health information throughout a veteran’s career is still years away, prompting a renewed threat in the Senate to force data standardization between the two bureaucracies.

When asked about the status of EHR interoperability efforts between VA and the Defense Department during a Senate Appropriations subcommittee hearing Tuesday, VA Secretary Robert McDonald called VA Chief Information Officer Stephen Warren out of the audience to help explain the lengthy development process that has plagued EHR interoperability efforts to date. Among the issues Warren identified as a priority for the next several years was data standardization between VA, DOD and the larger national health care industry.

According to Warren, care providers are now able to see VA, DOD and private third-party data in the same EHR screen, but the data cannot be manipulated. “The data has been normalized, the providers can look at it and they can actually make decisions based on a continuum of time,” Warren said. However, “the viewer that shows that data is just for viewing,” he said. “We’re not able to actually go in and change the data. That’s the next generation.”

But getting to the point where care providers are able to interact with the data will take at least another three years, according to Warren, primarily because of the work that remains with DOD and the private sector through the Office of the National Coordinator for Health Information Technology.

“So, a lot of effort over the next couple of years to make sure the right standards are in place and then we need to go through and convert the data to meet the standards,” Warren said.

Warren was then interrupted by Illinois Republican Sen. Mark Kirk, chairman of the Subcommittee on Military Construction, Veterans Affairs and Related Agencies. “Let me step in here and deliver a threat that I’ve been saying to DOD. If they insist on having different standards, we will go with just the VA’s standards because you represent 10 times the number of patients in the population,” Kirk said. “That will force the two bureaucracies to agree on a common standard and it will be a VA standard.”

Two distinct programs

The two agencies have spent the better part of the last decade trying to improve interoperability between their distinct electronic health records infrastructures. Between 2011 and 2013 alone, they spent more than half a billion dollars on an effort to develop a new joint-integrated EHR that could serve military personnel from enlistment through retirement and veteran status, only to see extreme bureaucratic infighting and turf battles derail the project.

Today, the agencies are moving down separate modernization paths, with DOD working on its Defense Healthcare Management System Modernization program and VA planning commercial acquisitions for the next generation of its Veterans Health Information Systems and Technology Architecture, known as VistA.

As documented by FedScoop last year, less than two months after his confirmation as the nation’s 24th secretary of defense, Chuck Hagel found himself answering questions from lawmakers about the status of the department’s electronic health record development work and its ability to share information with VA and VistA. Hagel acknowledged to lawmakers that the Pentagon had decided to restructure its EHR modernization effort, placing the program under the authority of Frank Kendall, DOD’s undersecretary for acquisition, technology and logistics. It was Kendall’s study of DOD’s EHR efforts that led to the Pentagon’s decision to go down a separate and seemingly parallel modernization path from VA’s VistA.

A fact sheet detailing DOD’s work with VA on the Interagency Program Office shows the bulk of the work to date has centered on agreeing to national interoperability standards, and ensuring consistency in data terminology, content structure and exchange methods. A contract award for DOD’s new $11 billion EHR is expected later this year. However, the agencies’ decision to abandon the joint EHR initiative in favor of separate modernization efforts was not justified, according to a GAO report released in February 2014.

Late last month, Rep. Phil Roe, R-Tenn., reintroduced a bill that would allow the private sector to develop an Integrated Electronic Health Record, or iEHR, for DOD and VA to use. The bill calls for $50 million in lump sum funding for creation of the iEHR, with $25 million per year for five years after that for maintenance.