Mixed Messages Regarding DOD and VA EHR Interoperability

According to GAO’s research, the Interagency Program Office (IPO) tasked with facilitating interoperability between the two departments’ health records systems, has taken action and predominately worked on near-term objectives such as standardizing their existing health data and making them viewable by both departments' clinicians in an integrated format.  Both departments also have long-term plans to modernize their EHRs.  The IPO has also outlined a technical approach for achieving interoperability.  However, the departments did not meet the October 2014 deadline for certifying that all their health care systems data complied with national data standards.  Both departments said they plan to accomplish this later in calendar year 2015. 

The NDAA calls for full standards-based interoperability and modernized software to support clinicians by December 31, 2016.  But GAO found that the departments’ systems modernizations plans showed a number of key activities scheduled beyond this milestone date.  The interoperability capabilities planned as part of EHR modernization efforts at both agencies indicate completion by 2018.

Conversely, DOD stated late last month that DOD and VA systems are already interoperable.  As part of the announcement of the Defense Healthcare Management System Modernization (DHMSM) contract award on July 29, Frank Kendall, the undersecretary of Defense for acquisition, logistics and technology said, “We are about to certify to the Congress that we are already interoperable.”  “It’s a big misconception that the new health care system we’re buying is about interoperability,” Kendall stated.

The departments are currently achieving interoperability through the Joint Legacy Viewer (JLV), sometimes referred to as Janus.  The JLV allows clinicians to view a patient’s past medical records on one screen even though they are being pulled from the two differing DOD and VA systems.  At VA, JVL now has 13,000 users.  DOD has 1,200 users and plans to add another 9,000 in September.   

The next stage of DOD-VA interoperability is the Enterprise Health Management Platform (eHMP) which will begin rollout in March and eventually replace JVL. One major aspect of the new platform is the ability to incorporate records from private health care providers. 

According to GAO’s findings, the IPO has taken steps to develop process metrics intended to monitor progress related to the data standardization and exchange of health information, but has not yet specified outcome-oriented metrics and established related goals.  These are important to gauging the impact that interoperability capabilities have on improving health care services for DOD-VA shared patients. Additionally, the IPO has not identified a time frame for when it plans incorporate these metrics and goals into its guidance.

GAO made the following recommendations.  DOD and VA, working with the IPO, should 

• Establish a time frame for identifying outcome-oriented metrics 
• Define related goals to provide a basis for assessing and reporting on the status of interoperability  
• Update IPO guidance to reflect the metrics and goals identified.

DOD and VA concurred with GAO’s recommendations.

Although interoperability progress is being made.  More needs to be done to meet NDAA deadlines and to establish metrics to meet prescribed functionality and sharing capability.