Defense Will Consider Adopting VA’s Electronic Record for its EHR

This story has been updated.

The Defense Department will consider adopting the Veterans Affairs Department’s electronic health record, top Defense officials told a hearing of the House Veterans Affairs Committee today.

Elizabeth McGrath, deputy chief management officer for Defense, said the department will conduct an analysis of VA’s Veterans Health Information Systems and Technology Architecture -- VistA -- along with commercial systems for its next generation EHR, the first time in the 25 year history of VistA.

Dr. Jonathan Woodson, assistant secretary of Defense for health affairs, said that while Defense will consider using VistA, he is concerned that VA might not be able to provide the kind of support Defense would receive from a commercial vendor.

President Obama directed Defense and VA to develop a joint health record in April 2009, but that effort collapsed earlier this month.

On Feb. 8, the Military Health System kick-started the process to develop its own electronic health record with a request for information to potential vendors, and today, VA pitched VistA to meet Defense requirements for an EHR it can deploy “with the most capability in the shortest period of time for the least cost.”

Woodson said that VistA also does not have manuals and needs to be modernized, presenting Defense with “some risk” if the department decides to use the system. He added that commercial systems are generations ahead of VistA, which went into use 25 years ago.

Committee Chairman Rep. Jeff Miller, R-Fla., said he has traveled to combat hospitals in Afghanistan and talked to military clinicians who said they would prefer to use VistA, rather than AHLTA, the Defense Department’s electronic health record.

Miller said when it comes to development of an EHR, Defense and VA have been at a standoff for at least a decade, “and no one wants to blink.” He said Defense, not VA, further frustrates the process by “not wanting to give up ground.”

McGrath said that Defense will need to do a cost analysis before it would consider adopting VistA.

When Defense and VA abandoned the integrated EHR on Feb. 6, then Secretary of Defense Leon Panetta cited cost as the key factor in the decision to drop the project, while supporting the use of key, joint services already in development, such as a common data dictionary and the Janus graphical user interface.

Woodson also emphasized cost savings, an approach that irked Miller, who wanted to know why Defense wanted to use the cheapest system, rather than the best.

Valerie C. Melvin, director of information management and technology resources issues at the Government Accountability Office, said in oral testimony that key management issues derailed the iEHR and other Defense-VA health records projects over the past 15 years. These included lack of investment and strategic planning and lack of a detailed architecture.

VA Chief Information Officer Roger Baker said in his oral testimony that he viewed the adoption of a single data dictionary as the “single most important” outcome of the aborted iEHR process because it will help foster the exchange of health care information between the two departments.

Development of a common interface and data dictionary did not satisfy committee members. Rep, David Roe, R-Tenn., said the two departments failed to develop a joint EHR over the past decade “and I’m afraid we’re going to be discussing this 10 years from now.

Rep. Jeff Denham, R-Calif., blasted the two departments for not adhering to a three year-old presidential directive, which he found “inexcusable. You don’t have the will to get this done. Get over your excuses and get this fixed . . . If you don’t get it right, we will force you to get it right.”