NDAA redesigns oversight of $20B in health record modernization

Health record modernization projects at the Defense Department and the Department of Veterans Affairs that include upwards of $20 billion in contract spending are getting new joint oversight under a provision in must-pass 2020 defense bill.

The provision in the National Defense Authorization Act, which the House of Representatives passed on Dec. 11, reconfigures the existing DOD-VA Interagency Program Office to serve as a hub for interoperability and management issues as the two agencies progress in separate but linked implementations of commercial health records systems based on the Cerner Millennium software.

The IPO was initially established in the 2008 NDAA to oversee electronic health record interoperability and has since been reconfigured several times. It was the home base for a product called the Joint Legacy Viewer, which served as a read-only interface between legacy DOD and VA systems.

This latest rewrite puts the IPO in a prominent perch to make sure the DOD and VA's Cerner-based systems essentially operate as a single product while also looking to expand interoperability with other electronic health record systems.

Under the new scheme, the IPO has responsibility for maintaining the common configuration baseline for both agency's electronic health records systems, developing a "comprehensive" interoperability strategy and to "implement a single lifetime longitudinal personal health record" between the two departments. The IPO is also charged with preventing contractors "or other non-departmental entities" from claiming ownership or sole control of patient health data and with pushing for the implementation of the API-based Fast Healthcare Interoperability Resources standard designed to facilitate interchange of data between separate systems.

Lawmakers on the House Veterans Affairs Committee also pushed NDAA amendments to formalize a new entity called Federal Electronic Health Record Management. That entity was launched administratively, with Neil Evans, a VA physician and senior executive with deep tech experience, acting as acting director and Holly Joers, deputy program executive officer of the Defense Health Management System, which manages the DOD's push to field its electronic health records system, as acting deputy.

Under the design put forth in the NDAA, the DOD will get the first shot at picking a permanent director for a four-year term, with VA selecting a deputy. The director reports up to deputy secretaries at DOD and VA, and both departments must sign off on each hire. After the initial four-year term, VA gets to pick the next director with DOD picking the deputy.

Between them, the director and deputy director are required to represent multiple skill sets, including experience in clinical management, health record integration and contract management.

If this sounds complicated, it's because it is. Extensive negotiations between DOD and VA and lawmakers on the congressional authorizing committees were needed to arrive at an organizational structure and mission that took the equities of both departments into account, but didn't put DOD -- which has a two-year head start on its health record modernization program -- in the passenger's seat.

The IPO model appears to fall short of the combined management office -- and the single responsible individual -- sought by some in Congress, with the mandate focusing on interoperability.

"We've been promised again and again that this entity will be created and have some teeth," Rep. Susie Lee (D-Nev.), who chairs the Subcommittee on Technology Modernization Subcommittee of the House Veterans Affairs Committee, told FCW in September.

The new IPO will issue reports to Congress, conduct surveys of health record system performance and liaise with counterparts at the Department of Health and Human Services and elsewhere, but doesn't appear to have any budgetary or regulatory role.

That doesn't necessarily mean the IPO will have no role in steering the two projects, according to David Norley, communications director of the DOD Defense Healthcare Management Systems. "Once you appoint permanent directors and have a chance to digest what the NDAA says, there's probably a lot of opportunity for significant management there," he said.