VA and DoD integration of medical records going about as well as you probably expect

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VA and DoD integration of medical records going about as well as you probably expect

In short, not well.

Now, I've never been involved in a huge multi-Department level integration plan, but if I was, I think the first thing I would do would be to plan it out. I say that because that's how I approach everything from vacation to accomplishing a task at work. I even still follow the troop leading procedures* for just about everything I do:

Step 1. Receive the Mission

Step 2. Issue a warning order

Step 3. Make a tentative plan

Step 4. Inititate movement

Step 5. Reconnoiter

Step 6. Complete the plan

Step 7. Issue the complete order

Step 8. Supervise

* NOTE: Those are the troops leading procedures taught to me in basic.  They are the ones taught to me at Primary Leadership Development Course.   They are the same ones taught in Field Manual 3-21.10 Chapter 2.  Nonetheless, I had a link here to the something called the Army Study Guide which is asserting some sort of copyright claim that by linking to them, I'm violating some intellectual property.  So, I'll be deleting the link, and then working VERY HARD to create a Streisand Effect for them in the near future.  So I took the link down, and am changing "Start Neccessary Movement" with "Initiate Movement" which makes the mnemonic device of "RIMIRCIS easier to remember.  

OK, so let's take the WayBack machine to that magical year, 2006.  Mind you, this was 7 years ago, when the war in Afghanistan had already turned 5.  So, just using that as our start point, look at this passage from a GAO report titled VA and DOD Health Care: Efforts to Provide Seamless Transition of Care for OEF and OIF Servicemembers and Veterans

In April 2004, VA signed a memorandum of agreement (MOA) with DOD that established the referral procedures for transferring injured servicemembers from DOD to VA medical facilities. VA and DOD also established joint programs to ease the transfer of injured servicemembers to VA medical facilities, including a program that assigned VA social workers to selected MTFs to coordinate patient transfers to VA medical facilities. Nevertheless, problems remain in the process for electronically sharing the medical records VA needs to determine whether servicemembers are medically stable enough to participate in vigorous rehabilitation activities. According to VA officials, the transfer could be more efficient if PRC medical personnel had real-time access to the servicemembers’ complete DOD electronic medical records from the referring MTFs.

OK, so, “problems remain in the process for electronically sharing the medical records.”  Things happen, I’m sure the government put its top men and women on remedying the identified deficiency.  TOP MEN AND WOMEN!  Done deal, let’s move on.

Nah, just kidding, they still haven’t accomplished anything on it.  In fact, if you look at the troop leading procedures above, the VA and DoD haven’t even started a Reconnoiter yet, as both admit that neither department has even bothered to take a look at the other Department’s system.  As noted in this Next Gov article:

VA proposed yesterday that Defense adopt its Veterans Health Information Systems and Technology Architecture, known as VistA, which would lead to plug and play compatibility, Baker said.

McGrath said Defense will conduct an analysis of VistA, including costs. VA needs to educate Defense about the strengths of VistA as “they don’t know it as well as we do,” Baker said.

He added that VA has done a poor job in marketing VistA to key audiences, including Congressional staff, to counter what he called canards about the system, such as the fact that it runs on the old MUMPS programming language. Hundreds of commercial companies use MUMPS because “it is very fast and effective,” Baker said.

So there you have it, seven years after identifying an existing problem, the VA and the DoD haven’t even compared or looked at the systems that each have to see if it might work better than what they have. 

Here’s a Congressman from California laying out what would happen if this was done in the private sector:

Bear in mind that this hasn’t been an “out of sight out of mind” type thing.  The Congress has held innumerable hearings on it.  The American Legion has been pushing it at every Washington Conference that I remember attending, dating back years.  It’s not lack of identifying the problem and talking about it, it is a complete intransigence by the two Departments to actually work together.

OK, so moving forward from here, what are we looking at?  Well, that Next Gov article talks about that:

The estimated cost of developing an integrated electronic health record for the Defense and Veterans Affairs Departments spiraled to nearly $12 billion by last September, VA Chief Information Officer Roger Baker said in a press call this morning. The mounting costs led top leaders of the two departments to call a halt to the joint effort on Feb. 5.

Baker said original estimates for the completed iEHR ranged between $4 billion and $6 billion, but by last year had jumped to double the high-end estimate. Elizabeth McGrath, deputy chief management officer at Defense, told members of the House Veterans Affairs Committee yesterday that integration expenses accounted for part of that increase, but did not specify how much.

Though the iEHR effort has been dropped, Baker said Defense and VA will acquire as many as 50 joint and shared medical applications, and pegged the cost of those acquisitions to between $4 billion and $6 billion, the original projected cost of the entire iEHR.

So far we’ve done nothing, it has cost a lot, and the cost is increasing.  And we scrapped the initial plan without really doing anything.

How important is the sharing?  This article makes it clear:

Veterans' advocates argue that a single electronic health records system would ease military members' transition to veteran status, ending the hassle for newly-separated members of having to hand-carry medical records to VA hospitals or clinics. It also could speed processing of VA compensation claims and help to relieve the rising claims backlog.

"A single unified record was something that actually could have made a dent in the process and delivered benefits to deserving veterans faster," Jacob B. Gadd, deputy director for healthcare in American Legion's rehabilitation division, told the veterans' committee.

"The majority of the delay in claims, as we all know, is the collection of medical evidence, which a single unified record could solve…It takes the average claim 257 days to get a decision. Fully-developed claims, when all the information is in place, are averaging just 120 days."

I really wish I had something productive or uplifting to say about this, but it honestly just shocks the conscience.  All I can do is shake my head and think of the line from the movie Office Space: "What is it you would say you do here?"  Maybe the DoD and VA should be asking that of it's "seamless transition" folks, because the answer appears to be "virtually nothing." 

 Actually, it might be better if I end with the Testimony alluded to above by Jake Gadd:

While VA and DOD may still be pursing improved communications, they have abandoned the Integrated Electronic Health Record (iEHR) and that should justly raise an alarm amongst the veterans’ community.  This may save money now, but it wastes a portion of the billion dollars already spent.  Furthermore, as illustrated by the impact of having readily accessible records in the claims process, it’s an abandonment of technological solutions to the difficult problems the claims system faces.

Veterans should be able to expect 21st century technological solutions that are forward looking, not a retreat to the legacy of the past where VA and DOD maintain their own separate camps.  The men and women who serve chose to serve one government, so one government should be able to deliver one healthcare record to them.  This technology should not be out of our grasp.

He's right, of course.  As Commander Koutz said

[O]ur veterans are the real losers in this decision. Without a joint DoD-VA record that is easy to access, veterans have to ask for copies, and those requests often take months to process.

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The Same MUMPS system that required me to provide my insurance information every monthly visit for a year straight as it was entered (and I presume deleted) religiously?

"Well, THIS time it will work.."

How about an interface between the two systems? The 12 Billion Dollar price tag is someone throwing a dart at a dart board. How can you say on one hand you have not looked at it and then on the other hand instantly come up with an estimate? They picked a number that gives them an excuse for status quo.

The VA was one of the original users of MUMPS and have a boat load of emotional capital attached to it and isn't going to change.

Has DoD gone electronic? I'd they have, how are they going to continue to lose/shred/what ever your medical records?

That photo of the TRS(pronounced Trash)-80 brings back memories.

Having worked in the GOV/DOD IT area, I have seen a number of large scale projects fail miserably. In most of these, the people in charge bit off far more than they could chew and then proceeded to choke on it. The IT consulting companies and subcontractors are also really good at promising the world, dividing it up among a dozen or more companies, driving the price up, and delivering peanuts.

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News from the World of Military and Veterans Issues. Iraq and A-Stan in parenthesis reflects that the author is currently deployed to that theater.