DOD-VA Health Record Modernization Not Hitting Interoperability Targets, Watchdogs Say

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In a joint oversight report, inspectors general at the Departments of Defense and Veterans Affairs say that some legacy health data isn't being migrated to new electronic health records systems.

The new multibillion dollar electronic health records programs covering the military and veteran patient populations aren’t achieving the levels of interoperability promised by officials, according to an oversight report released on Thursday.

The Department of Defense and the Department of Veterans Affairs separately contracted to use the Cerner Millennium electronic health care system to cover more than 18 million individuals. DOD tapped Leidos to serve as integrator of the Cerner system in 2015, and VA contracted separately with Cerner in 2018. Together, the projects are estimated to cost more than $20 billion – and the true price tag is expected to be much higher.

The two systems are meant to work together as a "single, integrated EHR that has the capability to accurately and efficiently share patient health care information between the DOD and VA to ensure health record interoperability between the departments and with external health care providers," according to a joint inspector general report from the VA and DOD.

Interoperability isn't just an administrative policy goal – Congress ordered the agencies to field systems that could seamlessly exchange information in the 2015 National Defense Authorization Act.

Where DOD and VA fell short, according to the report, is in migrating existing patient information to the new systems and in developing interfaces to move data from medical devices to the Cerner Millennium health record.

While some basic patient information like health conditions, allergies, medications, immunization records and histories of inpatient and outpatient procedures were included in the migration to Cerner, a wealth of information including patient labs, clinical notes and some diagnostic information was not included in the initial rollout of the Cerner system by either DOD or VA. (DOD is about a third of the way through its deployment; VA has gone live with Cerner in three clinical locations and has the bulk of its effort left to go.)

The Defense Health Agency's chief health informatics officer told OIG auditors that the legacy health care data will be migrated to Cerner after DOD completes its entire rollout of the new EHR. 

Under VA's data migration plan, more but not all legacy data will eventually become part of the Cerner system, but there is no time frame for doing so.

DOD and VA are both leaning on the Joint Legacy Viewer, a solution fielded before the agencies decided to use the same EHR system, to access patient data that is not in Cerner Millennium. The Joint Legacy Viewer is a read-only system that does not meet congressionally mandated interoperability requirements. 

According to the report, DOD and VA did not set up interfaces for capturing data from medical devices into the new health record systems. While some devices follow industry interoperability standards, many do not, requiring DOD and VA to come up with interfaces to make sure information from devices ends up in patient health records. 

The IG report also notes that the assignment of privileges for clinical users has been inconsistent across DOD and VA, with many individuals receiving levels of access that are not required by their roles, potentially putting patient data at risk.

Auditors want the Federal Electronic Health Record Modernization (FEHRM) program office to fulfill its role in providing unified direction to VA and DOD on interoperability. According to the report, the FEHRM program office "limited its role to facilitating discussions between the DOD and VA on the functions that would achieve interoperability."

The report recommends more oversight of the FEHRM from at the deputy secretary level at DOD and VA. It also recommends that the FEHRM come up with a definition of a "complete" patient record and develop a plan to migrate legacy health data so that records fit that definition of completeness. Additionally, the FEHRM is charged with planning to support seamless data interoperability from medical devices to the Cerner system.

In reply comments, FEHRM Director William J. Tinston concurred or partially concurred with the recommendations in the report, but he said that his office "will continue to assume greater responsibilities in accordance with the FEHRM charter as funding and resources become available." 

The report states that it is up to Tinston, per the FEHRM charter to identify and request needed resources. The auditors want more information on needed resources and authorities as well as plans to address specific interoperability recommendations.

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