View of the Hill
Written by Ted McKenna
In his testimony to the House Committee on Veterans’ Affairs’ Subcommittee on Oversight and Investigations, U.S. Navy Rear Admiral Gregory A. Timberlake, acting director of the Interagency Program Office (IPO), which was established as part of the National Defense Authorization Act of 2008 to take responsibility for the creation of interoperable EHR, noted the numerous challenges involved, including inconsistent standards across medical systems and computer networks and the DoD and VA’s different schedules and processes for acquisition, funding and contracting.
Nevertheless, “the IPO and the two departments are on track to achieve full interoperability for the provision of clinical care by September 30, 2009, as defined by the Interagency Clinical Informatics Board,” Timberlake said.
Valerie Melvin, director of information management and human capital issues for the U.S. Government Accountability Office (GAO), the research arm for Congress, said that the DoD and VA are indeed getting better at interoperability in many respects, particularly in sharing pharmacy and drug allergy data in formats readable by computers.
For example, she noted that a March 2009 GAO report on the EHR effort found that “the departments are now exchanging this type of data on over 27,000 shared patients—an increase of about 9,000 patients between June 2008 and January 2009.”
But Melvin said that analysis by the GAO found that the interoperability effort had fully met only the first three of what are six main objectives:
- “refine social history data,” so that the VA can begin receiving electronic DoD records of “social history” data such as tobacco and alcohol use;
- “share physical exam data,” to give the VA an “initial capability” to receive DoD records of information related to physical exams;
- “demonstrate initial gateway operation,” permitting DoD and the VA to create “secure” paths for sending data among hospitals;
- “expand questionnaires and selfassessment tools,” giving the VA the ability to see both the answers and the questions of periodic DoD “health assessment data”;
- “expand DoD inpatient medical records system,” so that DoD has an inpatient medical records system at a medical department site within the Army, Air Force and Navy; and
- “demonstrate initial document scanning” of DoD documents into electronic records the VA can receive. A main problem in achieving all the goals, Melvin said, is the IPO itself, which currently lacks permanent appointments for key jobs such as director and assistant director, and has not yet taken responsibility for key management jobs in this type of project, including performance measurement, project planning and scheduling.
“To their credit, the [DoD and VA] departments have taken steps to hire a full-time permanent director and a deputy director to lead the office,” said Melvin, noting also that the office has developed 11 standard operating procedures in areas such as program management oversight, strategic communications and process improvement.
However, the office has not yet carried out other key responsibilities identified in its charter that are fundamental to effective IT program management and that would be essential to effectively serving as the single point of accountability, Melvin said.
“For example, the office has not yet established results-oriented—i.e., objective, quantifiable and measurable—goals and performance measures for all six of [its] interoperability objectives,” she said.
DEFINE ‘INTEROPERABLE’
Some lawmakers at the hearing felt the IPO was using too narrow a definition of the word “interoperability” in claiming the deadline would be met—that the VA and DoD systems may be able to share documents electronically, but that the data within documents would not be shared in a completely interoperable, open way.
“Although progress has been made toward our goal of shared electronic health records, I am disheartened at how little has been done,” the chairman of the House Committee on Veterans’ Affairs, Rep. Bob Filner, D-Calif., said in a statement. “Today’s testimony leads me to believe that the Interagency Program Office may meet the deadlines of the mandate, but clearly the spirit of the law has been ignored. Of particular concern is the inability to fill key leadership positions within the IPO. This is a leadership issue and must be given immediate attention.”
But Roger Baker, assistant secretary for information and technology at the VA’s office of information and technology and one of the panelists at the hearing, told MMT that it is in fact fair to say that the VA and DoD systems are interoperable when, for all practical purposes, doctors in the VA system are indeed able to view DoD records of individual patients electronically. Essentially, the records are scans of DoD documents as opposed to data that can be culled and processed individually.
“You have to go out to the hospital and see what a clinician sees when [they view records from the DoD],” Baker said. “When you look at VISTA and what is coming across, if there is electronic information on the servicemembers and veterans, it’s coming across. We have electronic records. If they’re paper documents, scanned information isn’t as useful as information entered into the computers, but it’s still useful.”
VA Secretary Eric Shinseki, speaking at the recent AUSA Medcom conference in San Antonio, Texas, said that since the VA began using the VISTA system in 1997, the agency has made huge gains in electronic record keeping, with every medical record the VA uses now available electronically.
“I’m also very high on [the DoD system] AHLTA,” Shinseki said. “Our problem is that AHLTA and VISTA are not entirely compatible. I probably shouldn’t admit this, but I conducted a small survey about the systems, and all six of the people I talked to preferred the power of VISTA. It’s all there anytime. VISTA saves time and trouble and cuts down on redundant testing. But I could say the same for AHLTA.”
Shinseki said he truly did not care if either AHLTA or VISTA emerged as a dominant system, only that the systems are brought together. In a press conference following his speech, when asked about the criticism levied at the IPO for its efforts so far in working out interoperability of the systems, he said there might be turf battles in the course of working out the problems of interoperability, but that he expected they would ultimately be resolved one way or another.
Most promising, Shinseki said, is the creation of electronic health records for individuals from the first day they join the military, which would be maintaining and adding to throughout the lifetime of that individual, from active duty to retirement to the use of VA benefits. The “virtual lifetime electronic record,” as the effort is called, could even serve as a test case for the civilian world, as it works to reform and improve health care for U.S. citizens in general, Shinseki said.
Prepared statements and video of the hearing may be found at http://veterans. house.gov/hearings. ♦