VA and DOD set to pick health data decider

Top officials at the departments of Defense and Veterans Affairs are closing in on a plan to name a single person to settle disputes between the two agencies when it comes to the implementation of the Cerner electronic health record.

"So we're still baking that over a little bit, but I think the answer is going to end up yes, I think we do need one," acting VA Deputy Secretary James Byrne said in testimony before a House Appropriations subcommittee on March 6.

"The secretaries have not made the final decision on it yet because of how important it is, but that's where we're going and it should be coming out soon," Byrne said, indicating that a decision could be coming in 10 days or a little more.

Currently, the DOD and VA are using their Interagency Program Office for resolving differences that come up with regard to data mapping, workflow and other areas that could inhibit the DOD and VA health records from working together in perfect sync.

Byrne has characterized the official as a "purple person," and likened the concept to the chairman of the Joint Chiefs of Staff who makes decisions that impact all the military services.

Rep. Debbie Wasserman Schultz (D-Fla.), the chair of the Appropriations Subcommittee on Military Construction and Veterans Affairs, said that as far as she knows, DOD is driving the process, with VA in the back seat.

"In spite of the fact that you've got collaboration on paper, the reality is that in practice it seems the DOD has been the decision-maker," she said. "And that's extremely concerning, because obviously, VA's population is much larger than the DOD's."

Wasserman Schultz said she was getting her information from the VA's Office of Inspector General.

"Most of the interoperability decisions are being hashed out at the lower levels, and the feedback I'm getting is that the DOD is not dominating those decisions and that we're working very collaboratively to move forward with those," Byrne said, adding that he hadn't heard the same concerns expressed by the VA's OIG.

"But that's why we're putting together this new construct to make sure that it's joint in nature," Byrne said.

Another interoperability issue Wasserman Schultz is watching relates to clearances and access. There are different security requirements and access card systems at DOD and VA, which has the potential to complicate access to patient records across the two sets of facilities.

John Windom, who leads the health record modernization project at VA, noted that records typically proceed from DOD to VA as active duty service members retire, while "very few records flow back from the veteran environment and into the DOD."

VA CIO James Gfrerer said that "DOD is actually going back [to] re-examine the requirement around tiered levels" of security clearance. He said that while a technological workaround is possible, a policy solution is preferable.