DoD-VA EHR interoperability needs a single point of accountability
Interagency Program Office must clearly define its role and responsibilities, says GAO’s Carol Harris.
If the Departments of Defense and Veterans Affairs are to succeed in creating interoperable electronic health record systems, an Interagency Program Office must clearly define its role and responsibilities.
That’s the contention of members of Congress and a Government Accountability Office official who testified on Thursday before the House Subcommittee on Technology Modernization, created this summer to provide oversight of the VA’s rollout of Cerner EHR at an estimated cost of $10 billion.
Also See: New House subcommittee to hold VA EHR program accountable
While the VA intends to establish a single common EHR system with DoD by leveraging a shared Cerner Millennium platform, GAO’s Director of IT Management Issues Carol Harris told the subcommittee that the Interagency Program Office (IPO)—created by law to act as a single point of accountability for DoD-VA system interoperability efforts—has not come close to fulfilling its objective.
“In June 2017, the VA announced that it planned to acquire the same commercial electronic health record system that DoD has been acquiring,” testified Harris, who added that the VA’s program management office has since been established and drafted high-level plans for governance. However, she noted in her testimony that program officials “have not yet indicated what role, if any, the IPO is to have in the governance process.”
As a result, Harris said the GAO is recommending that the VA “clearly define the role and responsibilities of the IPO within the governance plans for acquisition of the new system” because “focusing on a single point of accountability is critical in moving forward to make sure that interoperability is functional.”
However, John Windom, acting chief health information officer at the VA’s Office of EHR Modernization, told lawmakers that he does not believe that the IPO has decision-making authority over his office.
Likewise, Lauren Thompson, director of the IPO, said her office is not equipped to act as a “single point of accountability” when it comes to DoD-VA system interoperability. “At this point in time, we make recommendations—we do not have the decision-making authority,” she added.
Nonetheless, GAO’s Harris insisted that “according to the law, the IPO is supposed to be the single point of accountability, so that would include responsibility, authority and decision-making.” Further, she pointed out that the testimony of Thompson and Windom on the subject is “in conflict” with the expectation set out by statute. “If the IPO continues the way that it is operating today, we are going to continue to have dysfunction in moving forward,” Harris concluded.
Similarly, Rep. Jim Banks (R-Ind.), chairman of the House Subcommittee on Technology Modernization, made the case that the IPO is “one of the few aspects of EHR modernization that is mandated by law” and “has a very important and permanent role to play in governance.”
Banks said that the consensus of Thursday’s subcommittee hearing is that the IPO needs to do more and live up to its statutory authority. “My hope is DoD and VA will hash out what that looks like and come to mutual agreement,” he added. “I am willing to give them additional time to do that, but I will not wait forever.”
The VA’s planned acquisition calls for aligning the deployment and implementation of its Cerner system with DoD’s ongoing rollout of its own system—called MHS GENESIS, which is in the pilot phase.
However, the initial deployment last year of MHS GENESIS at four military sites in the Pacific Northwest was found to be “neither operationally effective nor operationally suitable,” according to a report from DoD’s director of operational test and evaluation released in May.
“We have learned so many lessons from MHS GENESIS’s early mistakes—there is a great deal, though, that we still do not know,” said Banks. “We do not know in any significant level of detail what will happen—and when—in VA’s EHR modernization. We do not know precisely how the Cerner Millennium system will be structured and configured. The department is still deep in its planning to flesh out its schedule and fill in those blanks.”
That’s the contention of members of Congress and a Government Accountability Office official who testified on Thursday before the House Subcommittee on Technology Modernization, created this summer to provide oversight of the VA’s rollout of Cerner EHR at an estimated cost of $10 billion.
Also See: New House subcommittee to hold VA EHR program accountable
While the VA intends to establish a single common EHR system with DoD by leveraging a shared Cerner Millennium platform, GAO’s Director of IT Management Issues Carol Harris told the subcommittee that the Interagency Program Office (IPO)—created by law to act as a single point of accountability for DoD-VA system interoperability efforts—has not come close to fulfilling its objective.
“In June 2017, the VA announced that it planned to acquire the same commercial electronic health record system that DoD has been acquiring,” testified Harris, who added that the VA’s program management office has since been established and drafted high-level plans for governance. However, she noted in her testimony that program officials “have not yet indicated what role, if any, the IPO is to have in the governance process.”
As a result, Harris said the GAO is recommending that the VA “clearly define the role and responsibilities of the IPO within the governance plans for acquisition of the new system” because “focusing on a single point of accountability is critical in moving forward to make sure that interoperability is functional.”
However, John Windom, acting chief health information officer at the VA’s Office of EHR Modernization, told lawmakers that he does not believe that the IPO has decision-making authority over his office. Likewise, Lauren Thompson, director of the IPO, said her office is not equipped to act as a “single point of accountability” when it comes to DoD-VA system interoperability. “At this point in time, we make recommendations—we do not have the decision-making authority,” she added.
Nonetheless, GAO’s Harris insisted that “according to the law, the IPO is supposed to be the single point of accountability, so that would include responsibility, authority and decision-making.” Further, she pointed out that the testimony of Thompson and Windom on the subject is “in conflict” with the expectation set out by statute. “If the IPO continues the way that it is operating today, we are going to continue to have dysfunction in moving forward,” Harris concluded.
Similarly, Rep. Jim Banks (R-Ind.), chairman of the House Subcommittee on Technology Modernization, made the case that the IPO is “one of the few aspects of EHR modernization that is mandated by law” and “has a very important and permanent role to play in governance.”
Banks said that the consensus of Thursday’s subcommittee hearing is that the IPO needs to do more and live up to its statutory authority. “My hope is DoD and VA will hash out what that looks like and come to mutual agreement,” he added. “I am willing to give them additional time to do that, but I will not wait forever.”
The VA’s planned acquisition calls for aligning the deployment and implementation of its Cerner system with DoD’s ongoing rollout of its own system—called MHS GENESIS, which is in the pilot phase.
However, the initial deployment last year of MHS GENESIS at four military sites in the Pacific Northwest was found to be “neither operationally effective nor operationally suitable,” according to a report from DoD’s director of operational test and evaluation released in May.
“We have learned so many lessons from MHS GENESIS’s early mistakes—there is a great deal, though, that we still do not know,” said Banks. “We do not know in any significant level of detail what will happen—and when—in VA’s EHR modernization. We do not know precisely how the Cerner Millennium system will be structured and configured. The department is still deep in its planning to flesh out its schedule and fill in those blanks.”
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