The Integrated Electronic Health Record Mess

Defense’s decision to upgrade its system with commercial software looks like a big setback.

Secretary of Defense Chuck Hagel’s decision to modernize the Defense Department’s electronic health record through the purchase of commercial software looks like a setback for development of an integrated electronic health record with the Veterans Affairs Department, according to folks I have talked with.

First, except for a passing reference, the Hagel memo makes no reference to the iEHR, and seems more of the same go-it-alone approach favored by the Pentagon, which really does not play well with other children.

This approach could soon run into some serious congressional roadblocks. On May 14 the House Appropriations Committee backed language in the 2014 Defense spending bill that said that no funds could be expended on any electronic health record project unless it is an open architecture system that serves both Defense and VA.

The House bill also would require Hagel and VA Secretary Eric Shinseki to jointly certify in writing to the House and Senate Appropriations committees prior to using development funds that the now almost dead iEHR will be the sole electronic health record. If the Senate goes along with this language, the Pentagon would have a hard time pursuing its solo EHR modernization project.

The Hagel memo also made no mention of the congressionally mandated role of the Interagency Program Office, set up to run the iEHR project and staffed by more than 300 personnel from both departments.

Finally by going the commercial route, the Pentagon has opened up its latest EHR scheme to protests and subsequent delays. Frank Kendall, undersecretary of Defense for acquisition, technology and logistics told a Pentagon press briefing today that 20 vendors have products that could meet Defense’s needs -- and since they all have lawyers, protests are inevitable.

Considering all of the above, the iEHR may never happen in my lifetime.