GAO Wants More Details From Pentagon, VA on EHR Plans

The departments of Defense and Veterans Affairs "have not substantiated their claims" that implementing separate, interoperable electronic health record systems will be more affordable and quicker than their original plan to develop a joint EHR system for both agencies, according to a new report from the Government Accountability Office, Health Data Management reports (Slabodkin, Health Data Management, 2/28).


DOD and VA first launched an effort to create a joint integrated EHR, or iEHR system, in 2009. The iEHR project aimed to allow every service member to maintain a single EHR throughout his or her career and lifetime.

However, DOD and VA officials in February 2013 announced plans to halt the iEHR project and instead focus on making their current EHR systems more interoperable.

The House and Senate in December 2013 approved a funding bill -- the National Defense Authorization Act -- that required VA and DOD to develop a plan for an interoperable or single electronic health record system by Jan. 31 (iHealthBeat, 2/11).

Report Findings

In the report, GAO found that DOD and VA have not yet:

  • Addressed potential management barriers to effective interagency collaboration on the project in terms of enterprise architecture, IT investment management and other areas;
  • Detailed what that interoperable EHR approach consists of, how much it will cost, or when and how it will be completed;
  • Developed a joint health care architecture or joint investment management collaboration to guide the EHR system collaboration; and
  • Updated their strategic plan to specify that they will pursue an integrated approach (Health Data Management, 2/28).

The report said that "in the absence of credible analyses to guide decisions about how to cost-effectively and expeditiously develop the interoperable [EHR] ... VA and DOD have fallen back on the divergent approaches that each department has determined best for it -- VA intends to modernize [its Veterans Health Information Systems and Technology Architecture system,] and DOD expects to acquire a new commercially available system."

The report added that as a result, the agencies are undermining the Interagency Program Office's ability "to serve as a focal point for future collaboration" on the project.

Report Recommendations

GAO recommended that the agencies create a plan that details:

  • A schedule for implementing the interoperable EHR systems at both agencies;
  • A list of potential risks and appropriate responses to the project;
  • How the interoperable EHR systems will clinically benefit patients;
  • The roles of organizations within each agency that are tasked with work related to the EHR systems or to the interoperability project; and
  • How the agencies will track progress on the project (Bowman, FierceEMR, 2/28).

In addition, GAO recommended that the agencies estimate the costs associated with their previous and current EHR efforts. GAO also said that the agencies should ensure that the Interagency Program Office has the necessary authority and resource-control to complete its responsibilities.

According to EHR Intelligence, DOD and VA agreed with GAO's recommendations.

GAO said that it would update its findings after the agencies have taken action to resolve the issues (Bresnick, EHR Intelligence, 2/28).

Source: iHealthBeat, Monday, March 3, 2014

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