IGs Announce Plan to Probe Joint DOD, VA Electronic Health Records Programs

Inspectors general for the Defense Department and Veterans Affairs are teaming up for an upcoming audit of both agencies’ electronic health records system programs to determine whether current efforts will meet the central goal of ensuring the systems are interoperable.

The two agencies have been under a mandate for decades to bring their separate medical records systems in line with one another, ensuring a seamless transition for service members to civilian life. However, in-house systems and inter-agency fighting have prevented the agencies from achieving that goal for some time.

"The joint audit is not predicated on a formal request from Congress or a specific complaint,” VA Inspector General Michael Missal told Nextgov Wednesday in response to a question. “We are, of course, aware that Congress and other stakeholders have an interest in ensuring that the significant investment of resources in the VA and DOD electronic health record modernization project is successful. As such, the VA OIG and DOD OIG each recognizes its responsibility to provide effective oversight of the implementation of this program."

In 2015, the relatively new Defense Health Agency was tasked with taking the lead on a new interoperability push, which started with the implementation of a new commercial system dubbed MHS Genesis, developed by the Leidos Partnership for Defense Health. The main EHR management system under that program was developed by Cerner and is in the process of being deployed across the military health system.

Last year, VA signed a similar contract with Cerner to deploy the Cerner Millennium EHR platform at all VA medical centers. The first deployment of that system was initially scheduled for March, though VA officials said earlier this month that the rollout would be delayed.

As the two agencies move toward full deployment of separate systems with a common vendor, the IGs are interested in learning whether the massive effort will achieve the main interoperability goal.

“The objective of this joint audit is to determine the extent to which the actions taken by the DOD and VA in acquiring and implementing a common, commercial electronic health record system and supporting architecture will achieve interoperability among the departments and with external health care providers,” the IGs wrote in a notice of pending audit issued Monday.

The notice does not offer many details on the impending audit, though the IGs gave some sense of the scope, which will include “the Offices of the Assistant Secretary of Defense for Health Affairs, Defense Health Agency, Program Executive Office, Defense Healthcare Management Systems, DOD/VA Federal Electronic Health Record Modernization Program Office, Defense Healthcare Management System Modernization Program Management Office, and the VA Office of Electronic Health Record Modernization.”

The IGs also withhold the right to expand their review to additional offices as deemed necessary.

Genevieve Morris, who resigned as chief health information officer with the VA Office of Electronic Health Record Modernization in August, told Nextgov she expects the auditors to find evidence that the systems are interoperable, though maybe not to the extent they could be.

“They should find full interop, though it's not really interop,” she said in an email Wednesday. Morris said because the agencies are using the same Cerner database to access medical records, the programs are effectively accessing the same record. “So, it's not really interop because they aren't sharing records across the agencies, they're accessing the same exact record,” though the effect will be the same.

Whether those systems are also interoperable with private sector EHR systems will be another matter.

“It depends on which providers and whether those external providers are connected to any of the national networks like Commonwell/Carequality/eHealth Exchange,” she said. “They should find a wide range of variance across providers.”