DoD, VA must be accountable for interoperability failures

If the law tells me I need to file my taxes by a certain date, I do so. If my editors ask for an article to be submitted at a certain time, it's done. If I have a long term project, I set goals to meet along the way to make sure I don't fall behind.

So why can't the Department of Defense (DoD) and the Department of Veterans Affairs (VA) follow the rules and meet their interoperability deadlines? Why aren't they being held more accountable for this failure?

The Government Accountability Office (GAO) has issued the latest in a string of reports chastising the DoD and the VA for not making more progress in the interoperability of their electronic health record systems. GAO has warned about this problem before, pointing out that after the agencies abandoned their plans to create a joint EHR, they had yet to support their claims that separate EHRs would cost less and be more effective. Earlier this year GAO was so perturbed about their lack of progress on interoperability that it added it to its list of areas in the government at "high risk" for fraud, waste, abuse or mismanagement, noting that interoperability was "continuously delayed," not yet realized and could possibly put veterans' health at risk.

Now comes the GAO's latest report, released Aug. 13, that finds that the DoD and the VA missed a major deadline imposed in the National Defense Authorization Act for Fiscal Year 2014 to comply with national data standards, certify that healthcare data in their systems complied with national standards and were computable in real time by Oct. 1, 2014. The agencies say they'll get that done by the end of 2015, more than a year late. Moreover, the GAO says that the DoD and the VA won't meet the statute's Dec. 31, 2016 deadline to deploy more modern EHR software.

The DoD-VA Interagency Program Office, tasked with coordinating the data sharing efforts, has also dropped the ball. It hasn't specified particular outcomes or established related goals, nor any time frames for doing so.

If the DoD and VA continue on their current trajectory, interoperability won't be completed until after 2018, the GAO warns.  

You can almost hear the GAO staff hitting their heads against the wall.

I presume I am not the only person who is a little sick and tired of hearing about this foot dragging. The DoD and VA's inability to share data, after ostensibly trying to do so for 20 years with little success, is verging on the ridiculous.

President Barack Obama specifically instructed the agencies to get their acts together in 2009; the agencies announced that they would create a joint EHR in 2011 and then shelved the idea in 2013. There's still little data sharing, and the interoperability that does exist is of limited scope and utility.

I had hoped that the GAO's prior warnings about this lack of interoperability would serve as a catalyst to the VA and DoD to spur their efforts. Obviously that hasn't been the case. They both concur with most of the new GAO report but provide no excuse for their poor performance. Nor do they provide any guarantee that they'll shape up. They're not even taking the same path to upgrade their EHR systems; the VA is updating its home grown VistA system, while DoD is buying a new multi-billion commercial EHR product.

So far, they've gotten a relatively easy pass. But that should be reassessed. If we need to follow laws and deadlines imposed by those laws, so should these agencies.

There needs to be some accountability here, and consequences for the agencies' failure to deliver. Otherwise the "high risk" of fraud, waste, abuse and mismanagement will become a reality. - Marla (@MarlaHirsch and @FierceHealthIT)

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