Congress to VA, DoD: Interoperability issues reflect poor management, not technology

House lawmakers grilled Veterans Affairs and Defense Department officials at a hearing Tuesday about a continued lack of health data interoperability, calling the agencies' progress inexcusable and demanding more accountability.

At the hearing--a joint meeting of the House's Veterans' Affairs subcommittee on Oversight & Investigations and the Oversight & Government Reform's subcommittee on Information Technology--Rep. William Hurd (R-Texas) set the tone from the get-go, blaming poor management, and not technology, for the agencies' issues.

"The current plan for DoD and the VA to modernize their healthcare IT infrastructure in order to achieve full interoperability lacks metrics and goals," Hurd said. "These are not issues of data standardization; this is management 101."

Rep. Ted Lieu (D-Calif.) questioned why the agencies abandoned pursuit of a joint electronic health record system, calling the February 2013 decision to implement separate modernizations "ridiculous." He appeared to grow impatient with answers from Christopher Miller, program executive officer for the Defense Healthcare Management Systems, and VA CIO LaVerne Council, about the need to take separate paths. The DoD this summer announced that a team led by Leidos and Cerner won a contract to implement a commercial EHR for the agency, and Council, in her testimony, said a key objective going forward for the VA will be institutionalizing a "buy-first" strategy, looking to "existing commercial solutions first before building internally."

Lieu took issue after Miller remarked that it's important to understand the departments have two different healthcare missions.

"So you're not customer focused?" Lieu asked. "You're not focused on taking care of active duty persons?"

Lieu then asked Council why the VA simply couldn't adopt the DoD's system, maintaining that "if it works on a submarine, it's going to work in a VA hospital."

Rep. Beto O'Rourke (D-Texas) piggybacked on Lieu's comments, saying that the fundamentals of the systems are basic enough and that given the leverage of the two departments, there must be a way to figure out how to either achieve interoperability or roll out a joint system.

"If we are satisfied by the excuses given today, then we share in the culpability for the consequences that I think we're going to be hearing about at a hearing in two, four, six, eight, 10 years about why these systems can't work together, why we've spent billions of dollars and why we haven't been able to get the job done," O'Rourke said. "I think we have to insist on consequences and accountability and performance, and we have not done that effectively to date."

Valerie Melvin, director of information management and technology resources issues at the Government Accountability Office, testified that the GAO has myriad concerns with both the decision to go down separate modernization paths and continued efforts to achieve interoperability between those two systems. She pointed out that plans from the VA to modernize its system and the DoD in its acquisition of a new system would not enable interoperability with each other until after 2018.

"Inherently, each department has its own culture and we understand that," Melvin said. "But we found that there was a lack of joint strategic planning on the part of the two departments to really look at what it is that they could do collectively to achieve … a joint system.

"Over the years, we've had a lot of concerns with the starts and stops of this initiative," she added. "There has not, in our view, been the accountability" for the lack of interoperability. "It is a matter of the leadership taking a stand and saying 'we're going to do that;' we have not seen that dedication on the part of the two departments to take a stand on that and actually make it stick."

To learn more:
- watch the full hearing