Congress between a rock and a hard place when it comes to enforcing VA-DoD interoperability

At a recent congressional hearing focusing on electronic health record interoperability--or lack, thereof--between the Departments of Defense and Veterans Affairs, Rep. Beto O'Rourke (D-Texas) said to officials from both agencies that after nearly two decades of failed efforts to play nicely together, and billions of dollars spent, perhaps it's time to punish noncompliance of federal requests.

"I think we have to insist on consequences and accountability and performance, and we have not done that effectively to date," he said.

In theory, that idea makes sense. Mandate seamless health data exchange between the agencies--whether it be through a single joint system or interoperability between the DoD's new off-the-shelf system and the VA's VistA--or else, making sure that the "or else," unlike in previous years, actually has teeth behind it.

But it will be difficult to achieve.

Consider the public's reaction if Congress decided to pull funding from either the DoD's current rollout or planned upgrades to VistA; that might appear to run counter to the notion that lawmakers care about the health of current service members and veterans. Even though they'd be doing the right thing in making sure that citizens' tax dollars were being spent effectively, taking money away from efforts to improve electronic systems, especially in the wake of the VA's ongoing struggles, likely wouldn't be viewed positively.

Additionally, efforts in this particular case to stop wasteful spending on a project cost more money; it's essentially a Catch 22 for Congress.

What's more, the Meaningful Use program, which calls for interoperability between providers, continues to be adjusted as medical groups raise issues with the difficulty of meeting various criteria. Who's to say the same thing wouldn't happen if deadlines were missed by the agencies? Christopher Miller, program executive officer for the Defense Healthcare Management Systems, and LaVerne Council, the VA's CIO, made it very clear in their respective testimonies at the October hearing that attaining interoperability is no walk in the park.

"We've delivered four releases in 22 months jointly, focused on improving interoperability, getting feedback back, incorporating it in," Miller said. "That's actually a little faster than Apple rolls out their iPhone every year. So we have demonstrated that we can make this move faster. I think the bigger thing we've all got to remember is that this is much bigger than IT. That's the easy part of what we're talking about today. What we don't seem to ever want to tackle is the people stuff, the process stuff, all the things that make business systems really hard."

He added going to a single, joint system would not guarantee interoperability.

"You can go talk to any major national healthcare provider and they will tell you that they struggle when you're talking about regions or working across large geographic areas," Miller said. "I hear what GAO says, and I would like to believe a single system between DoD and VA would be able to be there tomorrow. But we have to view this as an incremental progression."

The horse is already out of the barn as far as a joint system goes; it's simply not happening. And despite massive amounts of money spent on what ultimately turned out to be a black hole, the worst thing that happened to DoD and VA officials was a stern talking to.

Unfortunately, even if the agencies continue to fail, it's hard to foresee anything more than that taking place. - Dan (@Dan_Bowman and @FierceHealthIT)

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