Integrated health record effort adds to VA's troubles

The Integrated Electronic Health Record (iEHR) program is not the Department of Veterans Affairs' only lightning rod, but it is a major one. Officially in the works since 2011, the records-sharing program took root after 15 years of discussion and cooperation between the two agencies to share military members' health data.

In 2012, however, cracks in the effort began to show. In September, the Government Accountability Office outlined hindrances to collaboration, cost documentation and performance measurement. GAO also highlighted fragmented processes across medical facilities -- a breakdown between regional offices and headquarters illustrative of VA problems writ large.

In February, VA Secretary Eric Shinseki and then-Defense Secretary Leon Panetta announced a shift in strategy that signaled a rift in the joint effort. The announcement was swiftly spurned by GAO and Capitol Hill. On Feb. 27, GAO issued another critical report stating that the change of course raised "concerns about the departments’ ability to successfully collaborate to share electronic health information."

The following week, Congress passed a continuing budget resolution that contained a stipulation suspending all but 25 percent of iEHR program funding for IT systems development, modernization and enhancement until DOD and VA satisfied the concerns of the House and Senate appropriations committees.

In April, Shinseki testified before Congress that VA would move forward with the electronic records-sharing program and said his agency is waiting for DOD officials to decide what core IT platform they want to use. VA is using its self-developed Veterans Health Information Systems and Technology Architecture, and VA officials had hoped DOD would do the same.

Shortly thereafter, Defense Secretary Chuck Hagel told House lawmakers that he had blocked the release of a request for proposals for a new core system pending further review. "I stopped it from going out [at] the end of March because I didn't think we knew what the hell we were doing," he said during testimony on April 16.

The program remains in limbo while DOD leaders mull the best way forward. Insiders say it is possible for the two agencies to share information without sharing the same core IT platform, but it could require jumping through extra hoops -- and, undoubtedly, spending more money.