Think Epic implementation is a costly prospect? How about spending $1.1 billion on a joint Department of Defense and Veterans Affairs EHR that never even got off the ground? New reports from the Interagency Program Office (IPO), now in charge of the convoluted effort to modernize the Military Health System’s electronic record keeping software, show that the majority of the spending in 2011 and 2012 went to secure service support contracts for employees. While the project made progress in establishing a framework for interoperability and outlining the technical challenges of a joint EHR, questions remain about just how the office spent a large chunk of its budget.
In 2012, the IPO spent a total of $351.9 million, apportioning $329.2 million of that money for support services, intended to help fill the 236 staff vacancies in the office. By the end of the year, 141 of the open positions were filled with federal civilian employees for DOD and VA employees assigned to the project, while the remaining spots were taken by contractors. The interagency office only spent $19 million on securing government staff during the same time.
“In a dynamic and ongoing process of developing a single, integrated EHR system for the Departments, IPO program, technical, and clinical informatics teams fully defined and scheduled joint Departments capabilities and processes for the Departments’ iEHR,” the report notes. “To meet challenges of managing the sizable and complex task of modernizing the Departments’ legacy health IT systems the IPO focused on building and maturing the IPO, designing the iEHR solution, exercising governance, reducing risk to the iEHR program, building iEHR technical infrastructure, and defining clinical and technical requirements.”
However, all this work came to a skidding halt in February as the DOD and VA abruptly announced the end of the joint EHR program, intending to focus instead on two separate systems that will eventually be interoperable. VA Secretary Eric Shinseki and Frank Kendall, Undersecretary of Defense for Acquisitions, who was given budgetary control of the project, said that after laying the foundations for the iEHR, the costs for following through had jumped to a potential $28 billion.
The IPO reports show that staffing challenges and bureaucratic red tape were major impediments to the success of the original blueprints, and that senior officials were lax in their responsibilities to approve requests in a reasonable timeframe.
After facing a Congressional firing squad and significant dissent from within its ranks, the Pentagon and VA have revamped the IPO under Christopher Miller, who has taken the DOD through the process of exploring commercial EHR options to replace its legacy system. “I’m looking for the best value,” Miller said of his recent work. “There [are] no preconceived ideas or notions. We are just trying to make sure we get the best value that meets our requirements that really sets us forward where we need to be for the future.”