Can a joint DOD-VA oversight body catch up with health record deployment?

Last Thursday marked the one-year anniversary of a joint statement signed by Veterans Affairs Secretary Robert Wilkie and then-Defense Secretary James Mattis to establish a governance process for the joint implementation of Cerner electronic health record software.

The statement promised "an organizational structure that supports the delivery of a single, seamlessly integrated EHR that maximizes commercial health record interoperability" and "a detailed implementation timeline."

That organization has a proposed name and structure, but it hasn't really taken shape. Dubbed the FEHRM, for Federal Electronic Health Record Management, the organization has a director and deputy director but has yet to finalize a charter or get staffed up.

At a hearing last week, Rep. Jim Banks (R-Ind.), the ranking member of House Veterans' Affairs Subcommittee on Technology Modernization, said the moment may have passed for the FEHRM to provide leadership for the integration of the systems at VA and DOD.

"I think we must be realistic about what is achievable at this point. We need to turn the page on the idea of the FEHRM standing up the new EHRs. The critical decision-making window is closing. The FEHRM can still be helpful as a governance body to sustain the EHRs, but we have to calibrate expectations accordingly," Banks said.

The DOD is already rolling out the commercial software in a second round of go-live activations while VA is still waiting on an initial capability to go live in October of 2020. The VA is planning to spend at least $16 billion on its Cerner contract and associated infrastructure updates. DOD has more than $5 billion in contract spending; it's not clear how its infrastructure and program costs shake out.

Subcommittee Chair Rep. Susie Lee (D-Nev.) is still looking for the FEHRM to serve in an oversight and decision-making role as the twin projects move forward.

"This is an issue I've been pounding on," Lee told FCW in a Sept. 20 telephone interview. "We've been promised again and again that this entity will be created and have some teeth."

Lee and Banks are both backing an amendment to the National Defense Authorization Act, considered must-pass legislation expected to be signed into law by the end of 2019. The amendment characterizes the purpose of the FEHRM to include decision-making "on functional, technical and programmatic activities to promote interoperability" and requires the DOD and VA to provide funds, staff and authority to the oversight body.

The amendment was included in the House version of the NDAA, but it still has to survive a conference committee designed to align the House and Senate bills.

"I'm optimistic this amendment is going to get into the NDAA and pass," Lee said, "and we'll have some guidelines."

John Windom, who heads the health record modernization program office at VA, told Banks at last week's hearing that congressional oversight is helping to drive interagency decision-making at the level of joint governance boards, even without the FEHRM in place.

"I can tell you we had 27 joint decisions that needed to be made approximately two and a half months ago, and we're sitting at a point with -- all but eight have been made," Windom said.

The DOD and VA vision for the FEHRM may be a little different from that of lawmakers. At a June 12 hearing of the same modernization subcommittee, William Tinston, the program executive officer for Defense Healthcare Management Systems, said that DOD and VA determined together that "the optimal and lowest risk alternative is to re-charter the DoD/VA [Interagency Program Office]" into the FEHRM. That rechartered body "will provide a more comprehensive, agile, and coordinated management authority to execute requirements necessary for a single, seamless integrated EHR."

DOD and VA have offered their input to the House and Senate defense committees with regard to the FEHRM language, but it remains to be seen what if anything comes out of conference.