Smaller VA-DOD deal on E-Health record angers Hill

February 28, 2013

Tom Philpott

The Obama administration pared back its plan to develop a single integrated electronic health record system for the departments of Defense and Veterans Affairs due to shrinking defense budgets and rising costs.

If the single system were built "from scratch,"as planned, it would cost up to $12 billion, double the estimate given to Congress two years ago.

These details came to light Wednesday during a hearing of the House Veterans Affairs Committee where VA and Defense health officials had uncomfortable moments explaining the new plan.

They also heard the Government Accountability Office criticize the DoD-VA electronic record integration effort as plagued "by long-standing project management and planning weaknesses, inadequate accountability and poor oversight, which often has led to changes in the departments’priorities, focus and time frames for completing the initiatives."

VA and DoD officials testified that, while they will not adopt a single e-record health system, they are accelerating plans to make those two systems operate like one, at least from the view of clinicians and patients.

"I would like to assure members of this committee that, press reports not withstanding, the DoD and VA remain committed to achieving the goals of the [integrated electronic health record] program: that is common data, common [software] applications and a common user interface,"said Roger W. Baker, assistant secretary of VA for information and technology.

"We are looking to achieve those goals through a lower-risk, lower-cost path than we were on,"Baker added.

Maintaining separate health record systems adds challenges for making them behave as truly seamless for users. Something called a graphical user interface, for example, is needed to make two different records look the same. Having separate systems also make developing common software applications more difficult.

But VA officials sounded relieved to be able to keep their own health records system, known as Vista. Defense officials, meanwhile, said they are shopping for an e-records system from among commercial sources. They also have not yet ruled out using Vista as the "core"e-record system if ways could be found to modernize it and adapt it to military-unique needs.

Rep. Jeff Miller (R-Fla.), committee chairman, said he and colleagues were surprised and disappointed by the decision. He listed several occasions over the past year, most recently last December, when senior VA and DoD officials gave assurances that progress toward rollout of an integrated health record was steady and its launch in 2017 was on schedule.

"I am concerned that this new approach is a step backwards towards the model that had been previously tried and failed –namely maintaining two different systems between two different departments and wishfully thinking that the two systems will eventually talk to one another,"Miller said.

Veterans’advocates argue that a single electronic health records system would ease military members’transition to veteran status, ending the hassle for newly-separated members of having to hand-carry medical records to VA hospitals or clinics. It also could speed processing of VA compensation claims and help to relieve the rising claims backlog.

"A single unified record was something that actually could have made a dent in the process and delivered benefits to deserving veterans faster,"Jacob B. Gadd, deputy director for healthcare in American Legion’s rehabilitation division, told the veterans’committee.

"The majority of the delay in claims, as we all know, is the collection of medical evidence, which a single unified record could solve…It takes the average claim 257 days to get a decision. Fully-developed claims, when all the information is in place, are averaging just 120 days."

VA Secretary Eric Shinseki and then-Defense Secretary Leon Panetta jointly announced the decision Feb. 5 but awkwardly. Shinseki spoke first and it wasn’t clear from his remarks if the goal of a universal health record was being scaled back or if Shinseki was announcing a breakthrough.

"We had previously indicated our commitment of both of our departments to a single, common, joint integrated electronic health record, the IEHR. And today we affirm again our commitment to achieving the president's goal,"Shinseki said.

Without mentioning the demise of the single system goal, he noted that initiatives to improve interoperability between VA and DoD, by standardizing health care data between departments and by accelerating exchange of real-time data no later than December 2013. More VA and DoD patients, Shinseki said, also will be able to access and download medical records through something called the Blue Button Initiative.

What Shinseki was describing, said a congressional staff member, were the various temporary steps the two departments now must take because they will not be developing a single record system. They will need to share data and somehow give two systems an identical appearance.

Panetta spoke after Shinseki that day and referred to the "complex challenges"of creating a single health record for the two large bureaucracies. He recalled the plan Obama announced in 2009 to "build a single customized, integrated electronic health record system from the ground up."

But after numerous meetings, Panetta suggested, he and Shinseki grew concerned over how long the effort would take and the mounting cost, which lawmakers claims has reached almost $1 billion.

"So we asked the managers of the joint program to take a step back and assess whether we could achieve the president's directive much sooner and for much less money than had been budgeted,"Panetta said.

New goals, he said, are to "simplify this program, cut costs, and to get our veterans the key benefits of this new system much sooner."

Miller said he appreciated the administration’s concern about the affordability of a merging VA and DoD systems.

"But what is going to serve the service member and the veteran the best? The cheap one or the one that is going to cost a little more."

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