On Capitol Hill, concerns remain about DOD-VA interoperability

Senate appropriators grilled top VA officials about whether the military and Veterans Affairs electronic health records systems are cooperating.

Shutterstock image: medical professional interacting with a futuristic interface.

Senate appropriators grilled top Veterans Affairs officials about whether the military and VA electronic health records systems are cooperating.

VA CIO LaVerne Council, VistA Evolution Program Executive David Waltman and Veterans Health Administration Deputy Chief Medical Information Officer For Strategy and Design Jonathan Nebeker testified at a July 13 hearing before the Senate Appropriations Subcommittee for Military Construction, Veterans Affairs, and Related Agencies. DOD's director of the DoD/VA Interagency Program Office, Lauren Thompson, and Government Accountability Office Director for Information Management and Technology Resources Issues Valerie Melvin were also at the witness table.

The VA "is still years away" from achieving interoperability with DoD, Melvin testified. She noted that VA still lacks clarity on what constitutes achieving full interoperability and how the agency intends to achieve it. She also added that there are still duplications between the two agencies and that VA has "yet to substantiate its claim" on modernizing VistA.

Back in early April, DOD and VA jointly certified that they were interoperable, but that was related only to a specific provision of the 2014 National Defense Authorization Act. Yet as Sen. Jon Tester (D-Mont.) mentioned in the hearing, while the Joint Legacy Viewer (JLV) was interoperable, it still lacked the capability to view X-rays and other medical imagery.

"You certified that you were interoperable based on the JLV existence and we now know that JLV does not have X-rays or CAT scans and that is interoperable from your view point," Committee Chairman Mark Kirk (R-Ill.) said. "We need to move forward so that there is no net burden to the soldier….that we 100 percent transfer our data to the VA, so the VA that can see all the imagery."

 VA officials told the senators that the image viewer will be fully deployed this September and then it will have access to all records within the JLV. 

"JLV has been a critical step in connecting VA and DoD health systems, but it is a read-only application," Council stated.  "Building on the interoperability infrastructure supporting JLV, the Enterprise Health Management Platform (eHMP) will ultimately replace our current read-write point of care application."

Council testified that the eHMP will "natively support interoperability between VA, DoD and community health partners," and that VA "will begin deploying eHMP version 2.0 with write-back capabilities in the second quarter of FY 2017."  At that point, she said, the system will "support tasking for team-based management and communication with improved tracking to ensure follow-through on tasks."

Council said the eHMP was a critical component of VA's push for a truly digital health platform, which she vowed would be agile and would "leverage international open-source standards."

The lawmakers seemed skeptical of Council's assessment, and some also voiced unhappiness with VA's scheduling system updates.

VA officials recently outlined their intent to pause development on the Medical Appointment Scheduling System (MASS) and instead stick with scheduling solutions developed in-house -- a reversal of plans the agency announced in the wake of its scheduling scandals. MASS was put on a "strategic hold," Undersecretary for Health David Shulkin said in April, because the pilot alone for that program would cost $152 million for testing on three sites, and would take 10 months. VSE, he has stated previously, will cost just $6.4 million for the full rollout nationally, and is expected to finish this year.

Tester told the June 13 witnesses he wasn't buying it.  "We live in a 21st century and our IT systems should reflect that," the senator said. He mentioned that the current scheduling system just "isn't going to cut it," since that appears to the top complaint from constituents in his state.