Congress, GAO take aim at DOD-VA health records program

When the Defense and Veterans Affairs departments last month announced a change of course in a long-awaited joint health records program, it sparked concerns at the Government Accountability Office. Now, the program faces further challenges from Capitol Hill.

Officials from the DOD-VA Interagency Program Office (IPO), which oversees the integrated Electronic Health Record (iEHR) and Virtual Lifetime Electronic Record (VLER) programs, insist they are still on track for a joint records-sharing platform. But the strategy for getting there has changed, now focusing on existing capabilities to improve interoperability.

Testifying before the House Committee on Veterans Affairs recently, outgoing VA CIO Roger Baker addressed VA’s efforts to develop the iEHR with DOD and denied that the agencies were abandoning the anticipated joint health records system.

"First, we would like to dispel any notion that VA and DOD are moving away from a single, joint, electronic health record," Baker said Feb. 27. He noted that VA Secretary Eric Shinseki and Defense Secretary Leon Panetta had each reaffirmed that commitment in their public statements on Feb. 5. "What has changed is the strategy that we will use to accomplish that goal," Baker said.

Before that happens though, the IPO may have to answer to Congress.

Under H.R. 933, the continuing resolution passed by the House on March 6, lawmakers are withholding all but 25 percent of the iEHR effort's funding for IT systems development, modernization and enhancement, pending the submission of information to and approval of the appropriations committees of both chambers of Congress.

The program office must provide Congress with an expenditure plan that lays out the budget and cost baseline, identifies a timeline for deployment, breaks down annual and total spending for each department and details cost-sharing business rules. The IPO must also establish data standardizations schedules between the departments, submit it all to GAO for review, and ensure that the program complies with standard federal acquisition regulations.

Already, GAO officials have voiced concerns regarding the program's change of course.

"Given the long history of challenges in achieving interoperability, this reversal of course raises concerns about the departments’ ability to successfully collaborate to share electronic health information," Valerie Melvin, director of information management and technology resources issues at GAO, said in her Feb. 27 testimony.

GAO has kept its eye on the departments’ efforts over the past 15 years to share data between their separate health information systems and to develop interoperable health record capabilities. Reports issued between 2001 and 2012 noted some progress by the departments. GAO, however, recommended both address “pervasive and persistent” management challenges that prevented the departments from achieving fully interoperable electronic health record capabilities.

In his testimony, Baker acknowledged the iEHR has been “a very challenging program,” but said DOD and VA remain committed to making service member and veteran information seamlessly available across both departments. Other IPO officials also have admitted to stumbling blocks along the way but have echoed that commitment.

VA and DOD were directed in April 2009 to jointly develop and adopt interoperable electronic health record capabilities by September 30, 2009. In May 2009, as VA and DOD established the VLER program to provide portability and accessibility of health, benefits and administrative data for servicemembers and veterans.

In addition to the VLER, Shinseki and then-Defense Secretary Robert Gates in March 2011 agreed VA and DOD would collaborate to create the joint iEHR. In June 2011, the secretaries greenlighted framework that included the fundamental architecture, governance and approach that would deliver an iEHR. The goal was that it would be implemented across the departments by 2017.

The iEHR was initially projected to cost between $4 and $6 billion; however, an estimate in September of 2012 doubled that number, Baker testified. So far, more than a $1 billion has been spent, and VA and DOD officials have touted the new approach as a less-expensive option.

Questions about iEHR come as VA is facing significant turnover among its IT leadership. In addition to Baker, CTO Peter Levin has also announced he is leaving, and Deputy Assistant Secretary for Information Security Jerry Davis departed in February to become CIO of NASA's Ames Research Center. Deputy CIO Stephen Warren is expected to replace Baker in an acting capacity, but permanent successors have not yet been identified.