Congress Doesn’t Know Who’s in Charge of VA’s $10 Billion Health Records Overhaul

The office created to ensure health record interoperability between the Veterans Affairs and Defense departments will cripple the agencies’ latest multibillion-dollar overhaul efforts if it doesn’t change its role, according to a congressional watchdog.

“Based on the [Interagency Program Office]’s past history, I think it’s evident they never had the clout to mediate and resolve issues between VA and DOD as it relates to interoperability,” Carol Harris, director of IT acquisition management issues at the Government Accountability Office, said Thursday. “If the IPO continues the way it’s operating today, we are going to continue to have dysfunction moving forward.”

The IPO was created by Congress in 2008 to act as a single point of accountability for the two agencies’ electronic health record exchange efforts. But after VA wasted more than $1 billion over six years on failed modernization attempts, Congress is re-evaluating the office’s worth.

In the inaugural hearing of the House Veterans’ Affairs Technology Modernization subcommittee, lawmakers on Thursday questioned whether IPO can hold officials’ feet to the fire as VA embarks on a 10-year, $10 billion EHR overhaul.

And at least for the time being, witnesses said, the answer is no.

Projects of this size are only successful if there’s a single “executive-level entity” calling the shots and taking the fall if things go wrong, Harris told lawmakers. That means deputy secretaries should be leading the program, she said, but instead, agencies are relying on a convoluted web of governance boards and steering committees to do so.

“Accountability has been so diffused that when the wheels fall off the bus, you can’t point to a single entity that’s responsible,” Harris said at the hearing. “When everyone’s responsible, no one’s responsible. That’s [what] led us to where we are today.”

Even IPO Director Lauren Thompson conceded the office can’t fulfill its responsibilities without more funding and manpower. Still, she and Harris agreed IPO could play a valuable role in measuring performance and keeping each agency in the loop on the other’s progress.

Shortly before the hearing, GAO published a report recommending VA clearly describe the role of IPO in overseeing the latest project with Cerner Corp. Harris also suggested Congress consider revising legislation to make the office’s role in the program more advisory than decision-making.

But lawmakers seemed skeptical that the government’s two biggest bureaucracies would take orders from any third-party entity, regardless of the duties it’s given.

“I think from day one, we made a terrible mistake ... in not saying to both these major players ‘one of you is in charge,’” said Rep. Mike Coffman, R-Colo. “I don’t think this is doable. I think we’re going to waste more taxpayer dollars.”

The hearing came two weeks after two top officials left VA’s electronic health record modernization office citing conflicts with agency leadership. John Windom, who became the organization’s acting director after its previous chief resigned, told lawmakers VA expects turnover in leadership and no single person will make or break the overhaul.

VA also will likely face significant technical setbacks in standing up the new system.

Three years after signing a multibillion contract to modernize its own electronic health records system, the Defense Department is struggling to implement the system amid significant operational challenges. The Cerner platform performed so poorly during the Pentagon’s first three field tests that officials decided to scrap plans to test at a fourth facility. Since then, officials said they’ve ironed out many of the technical issues and today the system is showing “measurable success.”

Despite the many impediments that lay ahead, subcommittee leaders reiterated their commitment to seeing the project across the finish line.

Chairman Jim Banks, R-Ind., underscored the fact that it’s rare for a program to have such intense congressional oversight from its inception, suggesting the added scrutiny might prevent both agencies from getting too far off course.

“I think this project has great promise,” said subcommittee ranking member Conor Lamb, D-Pa. “We need to focus on accountability. That’s something that can be difficult to track in an agency as large as the VA.”