How hard could it be to get the Department of Veterans Affairs to the Department of Defense to create electronic health records that will talk to each other?
As a hearing on Capitol Hill demonstrated on Thursday, it's more complicated than one might expect.
As the VA forges ahead with its Electronic Health Record Modernization (EHRM) program, the leading question of the day was just how to create an oversight structure to improve its interoperability with DOD.
Right now, the VA/DOD Interagency Program Office (IPO) oversees the interoperability efforts between the two agencies, but that joint body does not have significant decision-making power. Discussions for stronger governance protocols are in the works, said John Windom, the acting chief health information officer and program executive officer for the VA’s EHRM office. These talks are in tandem with the VA’s rollout of its new $16 billion Cerner EHR.
That 10-year project will also boost interoperability with the DOD, which operates the same health records system.
The two agencies are also determining the power dynamics in their data-sharing project as the VA's modernization program faces a leadership void of its own. Genevieve Morris stepped down from her role as head of the office in late August, and Windom has carried the load in an acting basis since. Rep Jim Banks, R-Indiana, the subcommittee's chair, warned that "deteriorating and rudderless" leadership could be a major hindrance to the program.
Lauren Thompson, Ph.D., director of the VA/DOD Interagency Program office, who also testified before lawmakers Thursday, said the planned structure would include three governance boards.
The first would be a functional governance board which would mitigate disputes between on-the-ground clinicians and other healthcare staff. The second: a technology governance board, which would do the same for issues related to tech itself.
The final board, a decision-making board, would resolve issues that could not be solved by either the functional or technology governance boards, she said.
Caring for our nation's heroes must always remain above partisan politics. I’m proud to work with @RepConorLamb and the @HouseVetAffairs Subcommittee on Technology Modernization as we provide oversight of the @DeptVetAffairs's overhaul of their electronic health records system. pic.twitter.com/jEeKh7ExkV— Jim Banks (@RepJimBanks) September 13, 2018
Windom said the goal is to ensure as many disputes as possible can be resolved at lower levels without involving high-ranking staff members. “I can't impress upon the committee enough that governance has to be successful at the lowest possible level,” Windom said. “Things can’t rise to the superior level on every matter.”
Carol Harris, director of IT acquisition management issues for the Government Accountability Office, warned the idea sounds like bureaucracy at its worst. When there are that many boards involved, it can lead accountability to be “diffused so when the wheels fall off the bus you can’t point to a single entity," Harris said.
And while the IPO plays a key role in setting interoperability standards and measuring progress, it has been toothless in resolving problems.
Instead, the VA and DOD should build a structure that has a single point of accountability, which could, for example, be comprised of a deputy secretary-level staffer from each agency, Harris said.
“When everyone is responsible, no one is responsible,” Harris said.
It may not be up to them.
Rep. Scott Peters, D-California, said it’s more likely that Congress or the president would have to step in and figure it out. “I don’t think this created without some action by us,” Peters said.
A video of the full hearing is embedded below: