DoD-VA EHR interoperability efforts lack single point of accountability

The Department of Veterans Affairs has tried to modernize its legacy electronic health record system in four separate attempts over two decades, with the latest initiative already facing serious challenges.

That’s the contention of a Government Accountability Office official who testified on Tuesday before the House Subcommittee on Technology Modernization, which provides oversight of the VA’s planned acquisition of a $10 billion Cerner EHR to replace the legacy Veterans Health Information Systems and Technology Architecture (VistA).

“VA pursued three efforts over nearly two decades to modernize VistA,” GAO’s Director of IT Management Issues Carol Harris told the House subcommittee. “These efforts experienced high costs, challenges to ensuring interoperability of health data and ultimately did not result in a modernized system. VA recently initiated its fourth effort—called the Electronic Health Record Modernization—and the program is already facing serious challenges.”

Also See: Lawmakers voice concerns about VA’s plans for Cerner EHR

In particular, Harris testified that uncertainty remains regarding the governance of the VA’s EHR Modernization Program.

“As we’ve previously reported, the governance plan for this program has not been fully defined nor has the VA fully implemented our recommendation to define a role of the key office in its governance plans,” she said.

While the VA intends to establish a single common EHR system with the Department of Defense by leveraging a shared Cerner Millennium platform, the role and responsibilities of the Interagency Program Office (IPO)—created by law to act as a single point of accountability for DoD-VA interoperability efforts—has not been clearly defined, according to Harris.

“A priority recommendation that we believe VA should implement as soon as possible is defining the role of the Interagency Program Office,” said Harris, who made the case that this single point of accountability is critical to achieving DoD-VA interoperability. “Ensuring that VA fully defines the role of the Interagency Program Office with DoD is the most important action that VA can take to ensure that the EHR Modernization Program is a success.

“The IPO, as it is currently operating, is not an effective office for being that central point of accountability,” Harris added. “You have two departments, VA and DoD, who are unwilling to relinquish control to a third party to make those decisions.”

Rep. Jim Banks (R-Ind.), ranking member of the House Subcommittee on Technology Modernization, told Harris that the IPO is “not living up to Congress’ vision for a single point of accountability” and that, “unfortunately, DoD and VA still have not come to any decisions.”

As a result, Banks announced that the subcommittee is working to finalize draft legislation to force the issue. “The idea is the IPO should be repurposed to organize all aspects of interoperability,” he said. “The departments will have to figure out what level of centralized control they want. But, we need to focus on comprehensive interoperability.”

“If DoD and VA cannot formalize a process for how they are going to adjudicate these really tough issues, they are going to fail again in this fourth attempt at integrating their systems,” concluded Harris. “Having a single point of accountability is crucial, because when the wheels start falling off the bus, we have to be able to identify who is responsible in order to effectively have corrective actions.”