DoD/VA public relations debacle could provide valuable lessons for laboratory organizations looking to implement large-scale IT or operational innovations

Even as the federal government is incentivizing hospitals, physicians, and all types of healthcare providers to adopt and use electronic health records (EHRs), it has admitted failure in its own attempt to integrate EHRs that serve two of the nation’s largest health benefits programs.

Those two programs, the Veterans Administration (VA) and the Department of Defense (DoD), provide healthcare to millions of individuals. In recent years, the two agencies have spent hundreds of millions of dollars to interface and integrate their respective EHR systems.

In the short term, this development won’t have much impact on clinical laboratories and pathology groups practices throughout the United States. That’s because medical laboratory testing within the VA and the DoD is generally provided by internal clinical laboratories owned and operated by the two agencies.

On the other hand, the failure of this massive effort to interface and seamlessly integrate two EHR systems may be an early sign that achieving interoperability of EHRs across all sectors of healthcare will be extremely difficult, time-consuming, and expensive.

Congress Reacts with Bipartisan Displeasure to Sudden Change of Plans

DoD Secretary Leon Panetta and VA Secretary Eric Shinseki announced plans earlier this year to abandon efforts to build an integrated electronic health record (iEHR) system. This decision was reported in a story published by Modern Healthcare.

This announcement took lawmakers on both sides of the isle by surprise. “We have just witnessed hundreds of millions of dollars go down the drain,” said Maine’s Democratic House Representative Mike Michaud, in an official statement. “This is a huge setback and completely unacceptable.”

GAO Report and VA/DoD Reassessment Spurred an About-face

In December 2012, the VA and DoD announced they would be ready to deploy the iEHR ahead of schedule. However, a report by the Government Accountability Office (GAO) concluded that the agencies’ projections were overly optimistic. Further, GAO criticized the two departments for lack of preparedness and effective collaboration, reported a story in ehrintelligence.com.

After spending four years and $1 billion to achieve full interoperability of electronic health record (EHR) systems operated by the Veterans Administration and Department of Defense, the two federal agencies called it quits earlier this year. At Congressional hearings, representatives from both agencies acknowledged that the two agencies will proceed with a much less comprehensive plan to allow some sets of patient data to pass between the two EHR systems. Clinical laboratory test data will be one of the first types of clinical data to be included in this feature. (Photo copyright www.ehealth.va.gov/VistA.asp.)

After spending four years and $1 billion to achieve full interoperability of electronic health record (EHR) systems operated by the Veterans Administration and Department of Defense, the two federal agencies called it quits earlier this year. At Congressional hearings, representatives from both agencies acknowledged that the two agencies will proceed with a much less comprehensive plan to allow some sets of patient data to pass between the two EHR systems. Clinical laboratory test data will be one of the first types of clinical data to be included in this feature. (Photo copyright www.ehealth.va.gov/VistA.asp.)

A VA/DoD development reassessment in January convinced Panetta and Shinseki that the GAO was right. Although nearly $1 billion had been spent on this project, the two departments shelved plans for an iEHR system.

“Rather than building a single integrated [EHR] system from scratch, we will focus our immediate efforts on integrating VA and DoD health data as quickly as possible, by focusing on interoperability and using existing solutions,” Panetta said in a statement, according to ehrintelligence.com.

GAO Blames EHR Integration Failure on Poor Planning and Management

Congress remained skeptical. “Previous attempts by the DoD and VA to use disparate computer systems to produce universal electronic health records have failed,” declared Florida Republican Jeff Miller, Chairman of the House VA Committee in a statement.

The VA Committee reacted by conducting a hearing titled “Electronic Health Record U-Turn: Are VA and DoD Headed in the Wrong Direction?”, according to the ehrintelligence.com report.

Valerie C. Melvin, GAO Director of Information Management and Technology Resources, testified at the hearing. She acknowledged that some joint VA/DoD initiatives had increased data-sharing in some capacities. However, she also pointed out longstanding planning and project management weaknesses, including inadequate accountability and poor oversight.

“In particular, there has been a persistent absence of clearly defined, measurable goals and metrics, together with associated plans and time frames,” stated Melvin.

VA and DoD EHR Systems in a State of ‘Disconnect’ for Years

The initial disconnect between the two agencies’ systems began as far back as 1988, according to the Modern Healthcare story. VA has worked on its own iEHR since at least 1977. In 1988 the military began building its new EHR system on free software code from the VA. Upon completion, the military deployed its Composite Health Care System at 750 sites worldwide.

Health IT consultant Tom Munnecke, an independent health IT consultant and Investor, had worked on early versions of both systems. The big flaw, according to Munnecke, was that the military’s new EHR could not communicate with the VA’s EHR.

In a blog posted on Modern Healthcare, reporter Joe Conn wrote that, according to Munnecke, the military took the wrong approach for the iEHR project. They developed the system top-down, instead of bottom-up. This prevented essential, ongoing end-user feedback.

Lab Test Results Included in Initial Interoperability Data Sets

VA and DoD will now focus their interoperability approach on the open source web-based application Janus 4.0 graphical user interface (GUI). “The Janus 4.0…GUI…provides clinicians a common view of both VA and DoD medical data,” stated Open Source Electronic Health Record Agent (OSEHRA) officials in a media release. Janus allows clinicians to view patient information from multiple EHR systems in real time.

The initial standardized data set will cover seven critical domains, according to Roger Baker, former Assistant Secretary and Chief Information Officer at VA. These will include prescriptions and medical laboratory results. The other 40-plus domains, including images and notes, will be brought online over the next four years, reported a story published at fiercegovernment.com.

Once complete, the EHR program is expected to provide complete medical records of more than 18 million service members, veterans, and beneficiaries, regardless of whether the setting is within the VA or DoD.

Meanwhile, taxpayers and lawmakers are left to wonder about the failed EHR integration project, after investing $1 billion and years of work. For pathologists and clinical laboratory managers, the inability of the VA and the DoD to achieve specific interoperability goals and provide universal access can mean one of two things.

First, this could be one more example of the bureaucracy’s ineptness at managing big information technology projects.

Further, it should be noted that VistA (Veterans Health Information Systems and Technology Architecture), a software system that uses the MUMPS language, was developed in the 1960s, and some healthcare IT experts consider it outdated technology.

Second, the possibility exists that the technical challenges in interfacing two EHR systems of the size and scale operated by the VA and DoD are indeed daunting. If that is the case, it raises interesting questions about how complicated it might be to get EHRs operated by hospitals, health systems, office-based physicians, and other providers—including health information exchanges—to interact seamlessly. Because lab results are a “high use” function of EHRs, clinical labs and pathology groups have a major interest in seeing EHR integration succeed.

—Karen Branz

Related Information:

Taking a new route

GAO: Poor project planning, management doomed VA-DoD Iehr

DoD, VA face Congressional probe over “troubling” EHR decision

Blog: The right and wrong decision | IT Everything, the healthcare IT blog by Modern Healthcare’s Joe Conn 

VA and DoD’s reversal on electronic health records criticized

It’s still the Same old story on military healthcare IT

DoD and VA back down from iEHR development