Health Information Management

VA DoD healthcare interoperability issue brought before Congress

HIM-HIPAA Insider, November 2, 2015

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Interoperability remains a challenge even for government entities. A new chapter to the healthcare interoperability standoff between the Department of Defense (DoD) and Veterans Affairs (VA) occurred October 27 when the departments discussed their lack of progress with members of Congress. The hearing, a joint meeting of the House’s VA subcommittee on Oversight & Investigations and the Oversight & Government Reform’s subcommittee on Information Technology, saw DoD and VA officials taken to task for poor management.

Rep. William Hurd (R-Texas) expressed his frustration with the departments’ lack of cooperation.
“Let me start today’s hearing by simply trying to state my frustration . . . We live in a complex, interconnected society . . . but our soldiers, sailors, airmen, and marines who are making the transition from DoD to VA healthcare are literally told to print out hard copies of their medical records and then walk them to the VA. We have sent . . . robots to Mars; I feel like we should be able to send one electronic file, no matter how big, no matter how old, from one computer system to another.”

When questioned about why they abandoned development of a joint EHR system, both the DoD and the VA have said they’re looking into purchasing commercial EHR solutions and maintain that they have separate needs. In response, members of Congress stressed the need to maintain a focus on customers and providing care over internal issues.

Valerie C. Melvin, director of information technology resources issues at the Government Accountability Office (GAO), testified that GAO has expressed many concerns about the departments’ decision to implement separate EHR systems. She stressed the importance of interoperability and the role of leadership in taking action and demanding accountability. The National Defense Authorization Act (NDAA) for Fiscal Year 2014 established an October 1, 2014 deadline for the departments to certify that all healthcare data in their systems complied with national data standards and met real time requirements. Not only has that deadline long since passed, the departments currently estimate that their separate EHR systems will not be implemented or modernized until after 2018. They are currently facing a December 2016 statutory deadline for implementing modernized and fully interoperable EHR systems. The statement goes on to repeat the interoperability recommendations GAO established in August 2015.

“VA and DoD operate two of the nation's largest healthcare systems, serving millions of veterans and active duty members and their beneficiaries. For almost two decades the departments have undertaken various efforts to advance interoperability between their respective electronic health record systems. While the departments have made progress, these initiatives have also faced significant management challenges,” according to the statement.

Interoperability has been a key goal in healthcare information. The ONC’s Interoperability Roadmap lays out the agency’s recommended methods for developing a national set of shared, explicit standards. However, interoperability presents serious challenges for all entities. Variations in state privacy rules, financial costs, insufficient health data standards, and the need for agreements that will facilitate information sharing among all participants are some of the major hurdles stakeholders and initiative representatives described in a September 29 report published by GAO.

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