DOD and VA's decisionmaking body for health record modernization lacks a decider

The Departments of Defense and Veterans Affairs are preparing to roll out a joint governance board to make operational decisions on the implementation of the Cerner electronic health record across the agencies' massive health systems, but it's not clear which department will play the lead role.

At a House hearing June 12, DOD and VA officials announced the coming launch of the Federal Electronic Health Record Modernization Program Office. The new office will be run by a director and deputy director who report jointly to the deputy secretaries at each department.

The decision to create the new office was made March 1. The governance process is critical to the implementation of the Cerner software because both large health systems -- serving about 30 million patients between them -- must agree on certain common data elements, workflows and other shared aspects of the health record.

"This management model creates a centralized structure for interagency decisions related to EHR modernization, accountable to both the VA and the DoD Deputy Secretaries," Lauren Thompson, director of the joint DOD/VA Interagency Program Office, said in prepared testimony at a June 12 hearing of the Subcommittee on Technology Modernization of the House Veterans Affairs Committee.

"The intention of the FERHM is to be the deciding authority," Thompson said under questioning from lawmakers.

The deciders have not yet been named, according to William Tinston, the program executive officer for the Defense Healthcare Management System. "I think the two departments are in discussions about who is going to be the interim director and the interim deputy director for the FEHRM and then they're going to pursue permanent hires in the future," he said.

Lawmakers have been hearing from contractors and others that the slow speed of decision-making had the potential to delay implementation. Rep. Suzie Lee (D-Nev.), who chairs the subcommittee, worried that the new group FERHM was just a "name change" from a previous entity planned by the two departments.

"For months this subcommittee has asked about a joint proposal to address longstanding problems with the existing [interagency program office]. There has been a name change, but we have seen nothing substantive. There is a one-page slide about a three-phase plan, but it is hard to find where the governance and accountability is in this plan," Lee said in her opening statement. "Based on the timeline for implementation it will come too late to address the critical decisions that need to be made now."

Rep. Jim Banks (R-Ind.), the ranking member of the subcommittee, noted that the "lack of cooperation has been the graveyard of all of the previous efforts" to unify DOD and VA health record systems.

"It is not reasonable to expect this subcommittee to endorse decisions that we have scant details about -- decisions that are the product of a secretive process," Banks said. He also noted that that despite the coming establishment of the FEHRM, "there has been no agreement."

"Compromise has been elusive because the stakes were so high and both sides were apparently dug in so deeply," he said.