DOD-VA Modernization of health files does not meet interoperability targets, observers say

New multibillion-dollar e-health programs covering military and veteran populations are failing to achieve the levels of interoperability promised by officials, according to a monitoring report released Thursday.

The Department of Defense and the Department of Veterans have each agreed to use the Cerner Millennium e-health system to cover more than 18 million people. The Ministry of Defense hired Leidos to serve as the integrator of the Cerner system in 2015, and the VA signed a separate contract with Cerner in 2018. Together, the projects are valued at more than $ 20 billion – and the real cost is expected to be much higher. -high.

The two systems are designed to work together as “the only, integrated EHR that has the ability to share accurate and effective patient health information between DOD and VA to ensure interoperability of health records between departments and with external healthcare providers. “, According to a joint report of the Chief Inspector of the VA and DOD.

Interoperability is not just an administrative policy goal – Congress has ordered agencies to use systems that can seamlessly exchange information in the 2015 National Defense Permit Act.

Where DOD and VA failed, according to the reportis in the migration of existing patient information to new systems and in the development of interfaces for moving data from medical devices to the Cerner Millennium health record.

While some basic patient information such as health conditions, allergies, medications, immunization records, and histories of hospital and outpatient procedures were included in the migration to Cerner, extensive information, including patient laboratories, clinical notes, and some diagnostic information was not included in the initial implementation. of the Cerner system from DOD or VA. (DOD is about a third of its deployment; VA has released live with Cerner at three clinical locations and remains the bulk of its efforts.)

The Chief Health Informatics Officer of the Health Defense Agency told OIG auditors that the legacy health data will be migrated to Cerner once DOD completes its full implementation of the new EHR.

According to the VA’s data migration plan, more, but not all, of the legacy data will eventually become part of Cerner’s system, but there is no time frame for this.

DOD and VA rely on the Joint Legacy Viewer, a solution introduced before agencies decided to use the same EHR system to access data for non-Cerner Millennium patients. The Joint Legacy Viewer is a read-only system that does not meet the interoperability requirements required by Congress.

According to the report, DOD and VA have not created interfaces for capturing data from medical devices in the new health record systems. While some devices follow industry interoperability standards, many do not, requiring DOD and VA to devise interfaces to ensure that information from the devices ends up in patients’ health records.

The IG report also notes that the provision of benefits to clinical users is inconsistent in DOD and VA, with many people gaining access levels not required by their roles, potentially putting patient data at risk.

The auditors want the Federal Program Office for the Modernization of Electronic Health Records (FEHRM) to fulfill its role in providing a unified guideline to the VA and DOD on interoperability. According to the report, the FEHRM program office “limits its role to facilitating discussions between DOD and VA on features that would achieve interoperability”.

The report recommends more oversight of the FEHRM than the level of Deputy Secretaries at DOD and VA. He also recommended that FEHRM come up with a definition of a “complete” patient file and develop a plan to migrate inherited health data so that the records meet this definition of completeness. In addition, FEHRM is tasked with planning to maintain seamless interoperability of medical device data with the Cerner system.

In response to comments, FEHRM Director William J. Tinston agreed or partially agreed with the report’s recommendations, but he said his office “will continue to take on greater responsibilities under the FEHRM Charter when funding and resources become available.”

The report states that, according to the FEHRM Charter, Tinston depends on identifying and requesting the necessary resources. Auditors want more information on the resources and bodies needed, as well as plans to address specific interoperability recommendations.