The Defense and Veterans Affairs departments reached an agreement with the White House last December to develop an integrated electronic health record as well a Virtual Lifetime Electronic Record that would include personnel records and benefits information, according to an Office of Management and Budget memo provided to Nextgov.
The document focused on open standards and interoperability and was sent on Dec. 6 by White House Chief Information Officer Steve VanRoekel and Todd Park, White House chief technology officer.
The memo provides context for the announcement on Feb. 5 by then-Defense Secretary Leon Panetta and VA Secretary Eric Shinseki that they had scrapped plans to build an iEHR from scratch. Instead, Panetta said, the two departments would “focus our immediate efforts on integrating VA and DoD health data as quickly as possible, by focusing on interoperability and using existing solutions.”
The OMB memo said Defense, VA and the White House “agreed to work closely together over the next several months to resolve several key issues” with the iEHR and VLER and to set a tight timetable.
“The secretary of Defense and the secretary of Veterans Affairs have directed their staffs to accelerate the current iEHR program to meet or beat scheduled targets [limited deployment in 2014, full roll-out in 2017] using open architecture and non-proprietary design,” the memo said.
Various high level officials of both departments – including the secretaries – have testified numerous times to Senate and House committees since Dec. 6 and have never disclosed this memo and its plans for the iEHR.
The memo said Defense and VA committed to the following steps and schedule:
- By Dec. 7, 2012, they would submit a detailed background document on VLER and the iEHR that includes achievements to date and any deviation from planned timelines; breakout of funding and software and services purchased; planned scale of iEHR in terms of patients and clinical sites; current and future capacities. This background document would delineate two VLER/iEHR milestones: those focused on open standards and data interoperability of current systems and full deployment of iEHR software. Defense and VA also agreed to provide a detailed project plan for VLER and iEHR milestones and objectives.
- By Dec. 18, 2012, they would provide a status briefing on 2014 VLER and iEHR costs.
- By Jan 15, 2013, they were to develop a strategy to “make rapid progress in 2013 on interoperability and exchange of health records” while continuing to pursue development of a common iEHR software platform “in a linked parallel effort.” The project was to include common data models and use of health IT standards developed by the Health and Human Services Department for content, vocabulary and transport. The departments were to detail efforts to share data directly with patients.
- By Jan 15, 201, they were to develop a proposal on how to reconcile plans by Defense to acquire a new iEHR versus VA’s modular development approach, including plans on how to divide the work into chunks that could be defined, developed and deployed in months, not years.
- Beginning Jan. 21, 2013, OMB and the Office of Science and Technology Policy were to establish a VLER/iEHR executive steering committee which would hold quarterly meetings with Defense and VA leadership “to facilitate discussion on issues of concern and help resolve matters that may be in contention between the two agencies.”
- By Feb 4, 2013, Defense and VA would provide new, revised lifecycle cost estimates for the iEHR that take into account work already underway, overlapping capabilities and the range of private sector technologies that could be used.
The White House, Defense and VA did not respond to queries from Nextgov about whether or not the objectives contained in the memo are still operative and if the deadlines had been met.