DoD and VA EHRs: Is interoperability the answer and will it be achieved?

Earlier this month, GAO released a scathing report regarding DoD and VA’s progress, or lack thereof, toward interoperable electronic health record (EHR) systems.  The February report advises VA and DoD to substantiate claims that developing and maintaining two separate EHRs that share data is the most cost effective solution to achieving interoperability for military and veteran health records.  

DoD and VA started an effort in 1998 to share electronic patient health information.  In 2011, they launched a program to develop a single common electronic health record system (iEHR).  The new system was to be implemented across both departments by 2017.  The iEHR program was to be managed and led by the interagency program office (IPO) that was established in 2008 to facilitate information sharing initiatives across the departments.  The IPO estimated the cost of the iEHR would total $29 billion for 2013-2029, $9 billion for the acquisition and $20 billion for maintenance. 

In February 2013, both departments publically announced they were abandoning efforts to jointly develop a single EHR, due to new cost estimates of $12 billion versus original estimates of $4-$6 billion.  Instead, the departments would acquire, implement, or update their own EHRs, but achieve full interoperability among the two separate systems.  DoD and VA claimed that the new interoperability approach would be more cost effective to achieve the same goals of sharing patient data.

GAO’s recent report states that DoD and VA have yet to demonstrate that the new approach will be more cost effective or timely than the single-system approach.  Additionally, the departments have not developed revised cost and schedule estimates for the new interoperability strategy.  Absent this thorough analysis, VA and DoD have continued to march forward in pursuing new individual EHR systems.  VA has launched a program called VistA Evolution to enhance its current VistA EHR system by adding two enhanced clinical capabilities which are to be deployed at two VA sites by the end of FY 2014 and deployed fully across the department by the end of FY 2017.   

DoD plans to acquire a new EHR to replace its current AHLTA system.  The initial RFP for the DOD Healthcare Management System Modernization (DHMSM) was released in January 2014 and a final RFP is planned for release in July.  DoD plans to reach initial operating capability in the 4^th quarter of FY 2106.  The DHMS Program Executive Officer is to develop a health data-sharing and interoperability road map that is to address interoperability with VA, private health care providers, and patients.  The roadmap will be delivered to DoD management this month.

GAO has been monitoring DoD and VA’s efforts to share patient electronic health information for the past 15 years.  GAO has consistently recommended that both departments address pervasive and persistent management challenges that hinder achieving full interoperable electronic health record capabilities.  Collaboration between VA and DOD has been hindered by long-standing barriers and ineffective implementation of the IPO.

GAO recommends that DoD and VA compile and compare costs for current and former EHR approaches.  Additionally, GAO recommends that both departments develop a plan for interoperability and grant the IPO necessary authority and resources to carry out the initiative.  VA and DoD concurred with GAO’s recommendations.