One of the primary goals of the $10 billion project to move the Department of Veterans Affairs (VA) to a new health records system was to enable data sharing between the VA and the Department of Defense (DOD).
The objective was to enable seamless care for military service members as they transition to veteran status. According to testimony from VA officials this week, the plan to have interoperability between the two agencies faces challenges due to laws and regulations over data governance.
During a House Veterans' Affairs Subcommittee on Technology Modernization hearing, Susie Lee, D-Nevada, chairwoman of the subcommittee, grilled VA officials about whether veterans who get care at VA and DOD healthcare facilities would able to get their entire health record once both agencies transition to a Cerner electronic health record (EHR).
"We heard that a patient treated at both VA and DOD will have to request their records separately from the two departments due to restrictions caused by data ownership policies. That's concerning to me because the goal of Congress in establishing the Electronic Health Record Modernization program was to establish one single record as it follows service members from enlistment to military service and then as they transition to veteran status," Lee said.
VA Deputy Secretary James Byrne told lawmakers that enabling VA and DOD providers to see a patient's entire health record in the EHR would be challenging, but "that is a capability that we intend to have if we don’t have it already."
But Laura Kroupa, M.D., chief medical officer for the Office of Electronic Health Record Modernization (OEHRM) within the VA, testified there were challenges with laws and regulations governing what each agency can release. "There has been a lot of discussion about how to adjudicate that and who has provenance over different parts of the record," she said.
Lee responded, "If a patient needs to go to both the VA and DOD to get their complete record, then we’re not meeting the underlying goal of this whole project."
Kroupa said the joint project between VA and DOD represented a "new era."
"The laws and regulations were not written at a time when we had the same instance of an EHR," she said.
John Windom, executive director of the VA's OEHRM, said new legislation might be needed to address those roadblocks to interoperability.
Despite those challenges, Byrne testified that he was confident the VA would have a successful go-live of the new Cerner EHR at its first pilot site, Mann-Grandstaff VA Medical Center in Spokane, Washington, on March 28, 2020. The go-live for a Seattle-area VA hospital system was postponed this fall until October 2020.
The VA signed a $10 billion deal with Cerner in May 2018 to move from the VA’s customized VistA platform to an off-the-shelf EHR to align the country’s largest health system with the DOD, which has already started integrating Cerner’s MHS Genesis system. For the VA, the Cerner EHR will replace the approximately 130 operational instances of VistA, currently in use across VA.
In February 2017, DOD rolled out the first MHS Genesis EHR at Fairchild Air Force Base in Washington. It was followed closely by implementations at Naval Hospital Oak Harbor, Naval Hospital Bremerton and Madigan Army Medical Center.
Lawmakers on the committee questioned the VA's readiness to go live in four months given the VA's track record with past technology projects and the serious challenges with the DOD's initial EHR deployment.
"As I learned when I traveled to Madigan Army Medical Center earlier this year, there were a lot of patient care pain-points, including referral management, pharmacy access, and patient communication. I still have not seen enough information from VA to understand how these issues have been addressed for the VA-go-live,” Lee said in her opening statement.
The VA still faces complex tasks around interface development, testing and training on the production system, not just a mocked-up system, Lee said. "If any of those elements are not completed in a timely manner it will be difficult for VA to bring the system online in a manner that does not compromise patient care," she said.
Rep. Jim Banks, R-Indiana, ranking member of the committee, said he was "cautiously optimistic" about the March 2020 go-live, but he continued to have concerns about the lack of permanent leadership for the federal EHR modernization office designed to help facilitate decision-making between the VA and DOD.
The two agencies have said the organizational structure of that office will be finalized over the next six months.
"We're still uncertain what the ultimate plan for the FEHRM is and we hear about behind the scenes maneuvering over which agency will have control of the office, and that concerns me," Banks said.