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VA, DoD joint EHR hearing exposes rifts, failures, and frustrations

By Jennifer Bresnick

- Members of the House Committee on Veterans Affairs took representatives from the DoD and VA to task for their failure to produce an acceptable EHR system for the millions of service members who rely on the departments for their healthcare.  Chastising VA CIO Roger Baker and other witnesses in attendance, Chairman Jeff Miller (R-FL) expressed impatience and disappointment with the waste of taxpayer dollars, the military departments’ lack of communication, and the unacceptably slow pace of progress towards a “badly needed” system that has been in discussion for more than ten years.

“Interoperable is not the same as integrated,” Miller said, referencing the new plan to strengthen ties between DoD and VA legacy EHR systems instead of developing a brand new joint software package. “While I understand that information can still be shared, VA and DoD have to explain to this committee, to this Congress, and most importantly, to the service members how this new way forward is going to deliver what has been mandated.”

“We haven’t talked about this for over a decade just to keep talking about it,” Miller added.  But there was certainly plenty of interesting talk at the hearing.  Far from a presenting a unified front, the DoD and VA both seemed to be pointing a lot of fingers at each other, and had few concrete answers as to why the joint EHR project went awry.   “No one wants to blink,” Miller lamented as each department tried to defend itself against a series of probing questions.  “I sit on committees for the VA and the DoD, and what I hear the most often is that the DoD guards its turf the most.  But something’s got to give with this process.”

Asked why the initiative was so difficult when the VA has a working, popular EHR system that they’re willing to share, Dr. Robert Petzel, Under Secretary for Health Veterans at the VA asserted, “We’ve had 25 years of experience with VistA, and if you ask our clinicians, they’ll tell you that it’s the best clinical management system they’ve ever used.  I am quite confident that if you interviewed them, they’d say it’s the best.”

“That’s what I’ve heard,” Congressman Mike Michaud agreed.  “Not only from VA employees, but from the private sector.  So I can’t fathom why the Department of Defense won’t use it,” he said pointedly, looking at Elizabeth McGrath, Deputy Chief Management Officer of the DoD. “We’re certainly considering it,” she replied carefully.  “But I don’t have a cost estimate for you.  I don’t know how much it would cost to adopt VistA.”

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When asked the same question, Jonathan Woodson, Assistant Secretary of Defense and TRICARE Director, tried to expand on the reasons. “There are a couple of issues for the DoD.  No matter how you slice this, for the DoD, this is a new acquisition. There’s no infrastructure right now for us to bring VistA into 56 hospitals and 700 clinics and have someone to configure it.  The way VistA was designed…there’s no manual.  There are no master files.  So there’s some risk for the DoD in trying to acquire it.”

So where did the nearly $1 billion in planning funding go, if not to figure out how to acquire and implement a new EHR system?  Michaud certainly wanted to know.  Citing the fact that the original $4 billion to $6 billion estimate was nearly doubled in September of 2012 after a cost assessment, the Congressman demanded to know what drove the inflated estimate.

“The frank answer is experience,” Baker replied.  “We had 18 months to see what it was going to take to look at the requirements for some of the packages that needed to be acquired, and when we looked at what we had seen, the estimate was significantly larger.  The VA is quite happy with VistA,” he added, “and is convinced that it’s a good place to start. It’s a good system and we own it.  The DoD is not yet there, from their perspective.  I’ll just leave it there.”

But the Committee wasn’t very satisfied with the witness responses throughout the two hour hearing.  “When I went into the military 40 years ago, I had the same health record Thomas Jefferson had: a piece of paper,” said Congressman Phil Roe (R-TN).  “It looks like we’re not very much removed from that.  I honestly believe we’re going to be sitting here ten years from now saying the same thing.  Can anyone honestly tell me that if I get reelected for a few more terms, that I’m not going to have the same conversation?  I’ve found nothing in here today that reassures me that I won’t.”




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