The U.S. Departments of Defense and Veterans Affairs have yet to support claims that building separate electronic health record systems and ensuring interoperability between them will cost less and be more efficient than developing a joint system from scratch, according to a report published this week by the Government Accountability Office.
The agencies, in February 2013, abandoned plans to build a single integrated EHR, blaming the decision on a ballooning budget and unmet deadlines. A year later, however, neither the DoD nor the VA have made much progress revising their plans to validate the stance that individual efforts would work best.
Both agencies, according to the GAO report, "lost valuable time" in helping to streamline care processes for veterans and other service members.
What's more, the report's authors say, "in the absence of credible analyses to guide decisions about how to cost-effectively and expeditiously develop the interoperable electronic health record needed to provide service members and veterans with the best possible care, VA and DoD have fallen back on the divergent approaches that each department has determined to be best for it--VA intends to modernize VistA and DoD expects to acquire a new commercially available system."
As a result, both departments are jeopardizing the Interagency Program Office's ability to function going forward, according to the report. "The departments' failure to implement the IPO consistent with effective collaboration practices may hamper its efforts to serve as a focal point for future collaboration," the report's authors say.
To remedy the situation, GAO recommends that the DoD and VA secretaries create a plan that describes:
- How the iEHR will help patients from a clinical standpoint
- A schedule for implementation of the interoperable record at each DoD and VA location
- Estimated costs for each agency to update or purchase their respective systems, as well as costs involved with ensuring interoperability between those entities
- The roles of various organizations within each agency tasked with EHR and interoperability work
- Any potential risks to those efforts, as well as plans to mitigate those risks
- Plans for tracking progress
Funding legislation agreed to by the House and Senate in December mandated that DoD and VA present a plan for building either an interoperable or single EHR system by the end of January. The bill--the National Defense Authorization Act for Fiscal Year 2014--also required that by Oct. 1 of this year, all healthcare information in both the DoD's AHLTA system and the VA's VistA system be "computable in real time and comply with the existing national data standards and have a process in place to ensure data is standardized as national standards continue to evolve."
To learn more:
- here's the GAO report (.pdf)