- On October 27, the House Committee on Oversight and Government Reform held a hearing discussing the Department of Defense (DoD) and Veterans Affairs (VA) health IT and EHR interoperability plans.
Members of the subcommittee for information technology and Veterans’ Affairs committee’s oversight and investigations subcommittee were present at the hearing.
Testifying at the hearing were the VA’s Assistant Secretary for Information Technology and Chief Information Officer LaVerne Council, the DoD’s Defense Healthcare Management Systems Program Executive Officer Christopher A. Miller, and the DoD’s Principal Deputy Chief Information Officer David DeVries. Also testifying was the Government Accountability Office’s Director of Information Management and Technology Resources Issues Valerie C. Melvin.
The hearing generally revolved around the issue of EHR interoperability for both government agencies. Recently, the DoD and VA announced that, in order to save money and increase EHR efficiency, they planned to implement two separate EHR systems. The VA stated that it will enhance its VistA system, while the DoD stated that it will adopt a commercial EHR system. In this hearing, the agencies explained their plans to increase interoperability with each other and private healthcare providers through these systems.
The VA’s Interoperability Plans
Representing the VA, LaVern Council’s testimony discussed plans for bolstering its health IT systems, and specifically of plans to increase interoperability. Specifically, she discussed the Enterprise Program Management Office (EPMO) and how it integrates the agency’s four largest EHR and health IT programs -- VistA Evolution, Interoperability, the Veterans Benefits Management System (VBMS), and Medical Appointment Scheduling System (MASS).
“The IT EPMO will ensure alignment of program portfolios to strategic objectives and provide visibility and governance into the programs. It will also allow for better analysis of and reporting on programs, projects, resources, and timelines to optimize for the best mix of each. This will help ensure the overall health of portfolios through reporting and analysis of portfolio performance metrics,” Council explained.
Additionally, Council explained the strides the DoD and the VA have made toward interoperability. Specifically, she discussed the Joint Legacy Viewer, which allows physicians with both the VA and DoD view patient files, skimming time off of their appointments.
Furthermore, Council introduced plans for opt-out health information sharing throughout the VA. The VA expects that this will be done through the Veterans Health Information Exchange program (VLER Health). This model includes all veteran health information unless that veteran decides to opt-out of his or her medical information being included.
DoD’s Plans for Interoperability
Likewise, Christopher A. Miller represented the DoD in discussing EHR interoperability. First, Miller stated that through combined efforts between the VA, DoD, and the Interagency Program Office (IPO), much interoperability headway has been made between the two agencies. For example, the two agencies now use common data standards to help increase data flow. Additionally, DoD has worked to create a roadmap for their work towards better interoperability.
Miller also discussed the JLV, stating that it has grown far more expansive than it was originally intended, increasing interoperability across far more DoD and VA sites. Additionally, DoD is working to increase HIE between themselves, the VA, and private enterprises through TRICARE.
“DoD exchanges its electronic patient health data with the public and private sector through its connection to the national e-Health Exchange. DoD is focused on deploying private sector interoperability to our military treatment facilities around the country that have an associated private sector Health Information Exchange (HIE) that is connected to the eHealth Exchange,” Miller said.
Furthermore, Miller explained the DoD’s plans to acquire a more functional EHR to help deliver higher quality care. In July 2015, DoD selected the commercial EHR it was going to adopt after rigorous research. The agency reportedly plans to continue rigorous testing to ensure this EHR is the best possible choice for their needs.
“The modernized EHR system will be rigorously and independently tested prior to and throughout deployment to ensure it meets operational and interoperability requirements for effectiveness, suitability and interoperability with VA and private sector healthcare providers,” Miller stated.
The DoD’s Cybersecurity Plans
As both agencies continue to work toward better interoperability, the DoD emphasized the importance of maintaining cybersecurity. David DeVries discussed in his testimony a three-pronged plan to ensure total security.
First, the DoD is beginning a cybersecurity campaign that will increase awareness. Second, it is implementing a cybersecurity awareness plan, making sure that human error does not contribute to any potential cybersecurity attacks.
“Nearly every single one of the successful network exploitations that DoD has had to deal with can be traced to one or more human errors that allowed entry into the network,” DeVries said. “So raising the level of individual cybersecurity awareness in performance is absolutely paramount. Accordingly, we’re working to transform our cybersecurity culture by improving human performance and accountability.”
Finally, the DoD will be implementing the Cybersecurity Scorecard, which will keep track and maintain the progress the agency is making toward better IT cybersecurity.
Despite the promise that the DoD and VA’s testimonies suggest, there are still many issues the agencies are navigating. As made evident through Melvin’s testimony on behalf of GAO, the office believes the DoD and VA’s efforts toward interoperability are not up to standard. For example, Melvin states that the two agencies have not met the government’s standards for health information exchange, and have not made adequate plans to complete their health IT systems by the promised 2016 deadline.
The office believes that better goals need to be set for the DoD and VA to be successful in these initiatives.
“As we have stressed in prior work and guidance, assessing the performance of a program should include measuring its outcomes in terms of the results of products or services,” Melvin maintains. “Establishing outcome-oriented goals and metrics is essential to determining whether a program is delivering value.”
According to GAO, very little has been done to prove to them that the choices to create two separate EHR systems was a better financial choice for increasing interoperability between the two agencies, despite claims to the contrary.
“[W]e noted that the departments did not substantiate their claims that it would be less expensive and faster than developing a single, joint system,” Melvin continues. “We also noted that the departments’ plans to modernize their two separate systems were duplicative and stressed that their decisions should be justified by comparing the costs and schedules of alternate approaches.”
Various committee members seemed to agree with the GAO findings, expressing their frustrations with the agencies.
“I don’t mean to understate the enormity of the challenge of integrating the two largest federal bureaucracies,” said Congressman Will Hurd (R-TX), “but it’s clear to me that our inability to integrate these two systems is a failure of leadership rather than technical feasibility. This is not an issue of data standardization. This is management 101.”
Provided the frustrations present at this week’s hearing, it is clear that tensions may continue to exist as the DoD and VA move forward with their interoperability plans.