NDAA pushes DOD-VA cooperation on health record modernization

The $20 billion-plus health record modernization efforts at the Departments of Defense and Veterans Affairs are going to be linked a little more closely under a provision in the National Defense Authorization Act that just passed committee in the early morning hours on Thursday.

Rep. Jim Banks (R-Ind.) offered an amendment that puts into law a plan being executed by DOD and VA to establish a joint governance board called the Federal Electronic Health Record Modernization Office or FEHRM (pronounced "firm") to coordinate the joint adoption of the Cerner health record software.

Banks' amendment, included in the final bill, requires a director and deputy director to be appointed each for a five-year term to lead the FEHRM. The amendment also requires a range of experience to be represented across the top two officials including clinical experience as a chief medical officer, experience in a top health informatics position and "significant experience leading implementation of enterprise-wide technology in a health care setting in the public or private sector."

The two officials are to be appointed jointly by the secretaries of Defense and Veterans Affairs.

Problems of joint governance have dogged the effort to implement a commercial electronic health record system ever since the VA opted to sole source the Cerner system in June 2017. VA took almost a year to sign the contract, and by that time DOD was deep into its initial operating capability efforts at three military hospitals in the Pacific Northwest. Adding VA to the system has created some conflicts over issues like access to the system, credentialing and cybersecurity.

VA's own initial go-live date is March 2020 in facilities in the Pacific Northwest.

The joint governance body will ensure standards from the two agencies align and work together and will make decisions where needed to eliminate conflict. Banks' amendment is in part designed to guarantee that VA and DOD have a voice in the decision making.

In February, at a hearing of the Senate Veterans Affairs Committee, Ranking Member Jon Tester (D-Mt.) said it was critical to preserve VA's role in joint decision making.

"DOD can steamroll the VA," Tester said.

VA pushes on standards

DOD had gone through a governance effort to unify data dictionaries and workflows and other essential aspects of a health record system in advance of its rollout, and to a certain extent VA is playing catchup. Currently VA is fielding 18 Electronic Health Record Councils made up of clinicians and headquarters staff who work on standardizing clinical and business workflows.

At a June 12 hearing of a House subcommittee charged with oversight of the Cerner deployment, Dr. Laura Kroupa, chief medical officer of the VA's Office of Electronic Health Modernization, said that VA's councils are "hitting their stride in understanding how the systems work and really see the places where we can accept commercial best practices and places where there are specialized things that VA needs to do for our patient population and for our mission."

Going into the contract, it was understood that areas like prosthetics and long-term care were going require special development and coding, and the current Vista EHR system will continue to be used to generate and maintain records in those areas as Cerner is brought onboard. But there are other aspects of care that require some level of customization.

"In probably every council there's something that has been flagged that says, 'We need development in this, we need configuration in this' to make sure it meets the VA's standards," Kroupa said at the hearing.