I think we've stumbled upon one the biggest barriers to interoperability between the Department of Defense (DoD) and the Department of Veterans Affairs (VA): there's no real consensus on what 'interoperability' is.
The DoD last week said that it has met the interoperability requirements for electronic health records as called for in the National Defense Authorization Act of 2014. According to the agency, its Joint Legacy Viewer, a web-based, integrated system, combines data from both the DoD and the VA's EHR systems, enabling doctors from both agencies to access the data. According to Chris Miller, program executive officer of the Defense Healthcare Management System, "At the end of the day, I think it comes down to some pretty basic things. ... Are we able to share information and are people able to use that information to accomplish their job on the other side?"
However, not everyone agrees that this is interoperability. For instance, the Government Accountability Office (GAO) stated in a report published in August that merely improving the functionality of the Joint Legacy Viewer is not the same as interoperability of the two agencies' systems. The report, which chastised the DoD and VA for missing the National Defense Authorization's Act deadlines and lacking metrics and goals for meeting interoperability, called the viewer a step in the right direction, but warned that it's not the same as full interoperability, which at the current rate won't be achieved until after 2018.
The report went so far as to say that the viewer is merely temporary, anyway; the VA plans on replacing it with its own open source Enterprise Health Management Platform.
So what's going on here? Is the DoD giving itself some nice public relations spin?
Perhaps, but it really may depend on the definition of interoperability.
There appears to be no one standard definition. The DoD apparently is relying on the definition articulated above that interoperability is to "share information" so that people are able to use it to accomplish their job "on the other side."
Other definitions are similar, but not identical, and certainly not as simplistic. For instance, the definition that the Office of the National Coordinator for Health IT uses in its interoperability roadmap, finalized in October, is more robust, calling interoperability "the ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user. This means that all individuals, their families and health care providers should be able to send, receive, find and use electronic health information in a manner that is appropriate, secure, timely and reliable to support the health and wellness of individuals through informed, shared decision-making."
I'm not belittling DoD's achievement with the Joint Legacy Viewer, which is still in the testing phase. Combining the agencies' electronic records and enabling clinicians on both sides to view it is a major step forward.
Moreover, a deep dive into the language of the National Defense Authorization Act of 2014 shows that it didn't require the agencies to move to a single EHR; an integrated display of data was good enough, so technically DoD has met the statute's interoperability requirements.
Yet it seems like splitting hairs. Yes, it's helpful for DoD and VA doctors to be able to view each other's electronic records. But since the viewer is in read-only format, is that really interoperable? The clinician reading the record and making a decision when treating the patient can't then add what she has done right into the record. It sounds like she has to put it in her own record and then get it uploaded into the viewer.
Is that the exchange that people envision as interoperability? The GAO didn't think so.
Why, then, should the DoD get to work with its own definition of interoperability?