- The passing of a $1.1 trillion spending bill has serious implications for the EHR technology in place within the Department of Veterans Affairs.
As reported last week by Meredith Somers of Federal News Radio, the Consolidated Appropriations Act of 2016 carves out $71.4 billion for the VA with a particular portion reserved for improvements to its VistA EHR platform and subject to Congressional approval.
A section of the bill focuses specifically at information technology systems at the VA which makes available $4.13 billion for expenses related to information systems at the federal agency. Of that figure, close to $505 million goes toward "information technology systems development, modernization, and enhancement" through September 2017.
The funding comes with a series of catches. The bill explicitly calls on the VA to submit requests to the Committees on Appropriations in both the House of Representatives and Senate when a given IT project increases or decreases in cost by $1 million. The VA Secretary must also receive the approval of these committees to move forward with IT-related projects as well as associated costs.
Interoperability also features in bill's stipulations for the VA. First it occurs as part of the federal agency's work with the Department of Defense to advance interagency interoperability.
Another and more substantial interoperability-related provision falls under the VistA Evolution project. Congress is seeking a report that addresses 9 areas:
(1) the status of and changes to the VistA Evolution program plan dated March 24, 2014 (hereinafter referred to as the ‘‘Plan’’), the VistA 4 product roadmap dated February 26, 2015 (‘‘Roadmap’’), and the VistA 4 Incremental Life Cycle Cost Estimate, dated October 26, 2014;
(2) any changes to the scope or functionality of projects within the VistA Evolution program as established in the Plan;
(3) actual program costs incurred to date;
(4) progress in meeting the schedule milestones that have been established in the Plan;
(5) a Project Management Accountability System (PMAS) Dashboard Progress report that identifies each VistA Evolution project being tracked through PMAS, what functionality it is intended to provide, and what evaluation scores it has received throughout development;
(6) the definition being used for interoperability between the electronic health record systems of the Department of Defense and the Department of Veterans Affairs, the metrics to measure the extent of interoperability, the milestones and timeline associated with achieving interoperability, and the baseline measurements associated with interoperability;
(7) progress toward developing and implementing all components and levels of interoperability, including semantic interoperability;
(8) the change management tools in place to facilitate the implementation of VistA Evolution and interoperability; and
(9) any changes to the governance structure for the VistA Evolution program and its chain of decisionmaking authority…
The last year saw increasing Congressional interest into interoperability not limited to health information exchange between DoD and VA. For instance, the Senate Committee on Health, Education, Labor, & Pensions held a series of hearings on the subject to identify obstacles impeding interoperable EHR and health IT systems.
However, a lack of DoD-VA interoperability has been a hot-button topic for much longer, most recently culminating in a House Committee on Oversight and Government Reform shining the spotlight on the limited progress that both federal agencies have made toward realizing a goal set many years prior.
Given the awarding of the Defense Healthcare Management System Modernization (DHMSM), the VA should have a clearer path when working on interoperability with the DoD. That being said, the two federal agencies already failed at creating a joint integrated EHR technology and the millions dollars that went into its development.