Interoperability of VA and DOD Medical Systems not going well

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Interoperability of VA and DOD Medical Systems not going well

This is an issue that goes back at least the 20 years I've been working here, the ability of VA and DOD to share medical files.  And it was a priority at least as far back as 2008 for Congress and others when they created the "Interagency Program Office (IPA)".  

A recent GAO report has some of the history, starting with this:

Since 1998, DOD and VA have relied on a patchwork of initiatives involving their health information systems to exchange information and increase electronic health record interoperability. These have included initiatives to share viewable data in existing (legacy) systems; link and share computable data between the departments’ updated health data repositories; develop a virtual lifetime electronic health record to enable private sector interoperability; implement IT capabilities for the first joint federal health care center; and jointly develop a single integrated system.

Over 10 years later Congress had created the IPA and they were already having problems:

We later reported in January 2009 that VA and DOD had continued to take steps to set up the Interagency Program Office.18 For example, the departments had developed descriptions for key positions within the office. In addition, the departments had developed a document that depicted the Interagency Program Office’s organizational structure; they also had approved a program office charter to describe, among other things, the mission and functions of the office.

However, we pointed out that VA and DOD had not yet fully executed their plan to set up the office. For example, among other activities, they had not filled key positions for the Director and Deputy Director, or for 22 of 30 other positions identified for the office.

And now, ten years later there is this troubling article from NextGov:

The office created to ensure health record interoperability between the Veterans Affairs and Defense departments will cripple the agencies’ latest multibillion-dollar overhaul efforts if it doesn’t change its role, according to a congressional watchdog.

“Based on the [Interagency Program Office]’s past history, I think it’s evident they never had the clout to mediate and resolve issues between VA and DOD as it relates to interoperability,” Carol Harris, director of IT acquisition management issues at the Government Accountability Office, said Thursday. “If the IPO continues the way it’s operating today, we are going to continue to have dysfunction moving forward.”

Backtracking just a little bit, the Secretary, Robert Wilkie addressed the issue when he spoke at our convention:

The departments of Veterans Affairs and Defense will be inseparable as they roll out interoperable modernized electronic health records (EHR) systems over the next decade, VA Secretary Robert Wilkie said Wednesday.

Wilkie served as an undersecretary within the Pentagon until he took over as acting VA secretary in later March. He told a room full of veterans at the American Legion National Convention in Minneapolis that Secretary of Defense Jim Mattis gave him the parting order that “from here on out, DOD and VA will be joined from the hip.”

“I have been given instructions from him to make our new electronic health care system work so that from the time any young American enters the service to take his first or her first physical to the time that he or she first walks into the VA, there will be a continuous, holistic record,” Wilkie said.

But, back to Next Gov:

Projects of this size are only successful if there’s a single “executive-level entity” calling the shots and taking the fall if things go wrong, [director of IT acquisition management issues at the Government Accountability Office, Carol] Harris told lawmakers. That means deputy secretaries should be leading the program, she said, but instead, agencies are relying on a convoluted web of governance boards and steering committees to do so.

“Accountability has been so diffused that when the wheels fall off the bus, you can’t point to a single entity that’s responsible,” Harris said at the hearing. “When everyone’s responsible, no one’s responsible. That’s [what] led us to where we are today.”

This is really not ideal.  And GAO somewhat predicatbly has asked for more money for the IPA:

The responsibilities of the Interagency Program Office have been intended to support the numerous approaches taken by VA and DOD to increase health information interoperability and modernize their respective electronic health record systems. Yet, while the office has led key efforts to identify data standards that are critical to interoperability between systems, the office has not been effectively positioned to be the single point of accountability originally described in the National Defense Authorization Act for Fiscal Year 2008. Further, the future role of the Interagency Program Office remains unclear despite the continuing need for VA and DOD to share the electronic health records of servicemembers and veterans. In particular, what role, if any, that the office is to have in VA’s acquisition of the same electronic health record system that DOD is currently acquiring is uncertain.

I don't know much about interoperability of VA and DOD systems, but it is obviously troubling that 20 years after the Federal Government made this a priority no one seems to know who is in charge, how to fix it, or what it will cost.

Posted in the burner | 2 comments
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If you are a Viet Nam veteran you no longer have any priority in attending the American Legion College. I consider this another slap in the face to Viet Nam Veterans. We are suppose to be equal with no rank among us and as such we should be equal to be able to attend The American Legion College regardless of the ERA one served. The selection committee has this one all wrong. The individual they won't allow to attend is a plus and positive influence to our organization and they should allow him to attend this year. I am very disappointed in the National Organization for putting this policy in place. Variety of war era's is a plus when attending the Legion College. It should be the call of the individual departments as to who they want to send not the national organization.

Drafted 1/1972 but was never sent to the war zone. Did 8 years of service, not counting some reserve time. Not eligible for Service Retirement. So one person in VA says I'm eligible for medical care, one say I'm not. Served with a lot of Nam vets. One thing i noted: the GovMent can't read a different "departments" records or even find it, so they dump the chore on you.
Near the end of his term as President, FDR said one of his major regrets was discovering he couldn't "fix" the VA, and didn't believe anyone could. So that's how we treat our vets.
Why didn't the Legion respond/explain the above by John-Henry? We have never treated our Nam Vets right.

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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.