By Sandra Basu

WASHINGTON - A new VA and DoD scheme to deliver a shared electronic health record solution faster than originally planned is drawing the ire of federal lawmakers.

While the agencies originally had planned to build a single integrated electronic health record system from scratch by 2017, it was announced last month that they will now pursue a less costly and accelerated plan that will use already existing technology. The change in plan is expected to provide clinicians with many capabilities in 2014.

Government officials said DoD is working toward an evaluation of their choice of a core of technology on which to base the system, while VA is utilizing the Defense Systems Information Agency.

“This approach is affordable, it’s achievable and, if we refocus our efforts, we believe we can achieve the key goal of a seamless system for health records between VA and DoD on a greatly accelerated schedule,” Defense Secretary Leon Panetta said during a press conference on the effort.

Secretary of Defense Leon Panetta holds a joint press conference with Secretary of Veterans Affairs Eric K. Shinseki at the U.S. Veterans Affairs Building in Washington. — DoD photo by Erin A. Kirk-Cuomo

Lawmakers, however, were less enthusiastic about the change in plans.

“This is a huge setback and completely unacceptable,” Rep. Mike Michaud (D-ME), said in a written statement. “For years we have been told by both agencies that progress was made and that things were on track. I’m disappointed that our nation’s two largest government agencies — one of which is the world’s foremost developer of high-tech machines and cyber-systems — could not come together on something that would have been so beneficial to those that served.”

Rep. Jeff Miller (R-FL) said in a written statement that the decision by DoD and VA “to turn their backs on a truly integrated electronic health record system is deeply troubling.”

Plan Forward

The slow progress up to this point in achieving a joint iEHR has frustrated both clinicians and government officials. Panetta acknowledged those frustrations recently to healthcare providers at Walter Reed National Military Medical Center, Bethesda, MD, in December.

“Part of it is just the technology of doing this,” he explained. “We think because, you know, we all operate on computers and, you know, information flows like crazy, that somehow you can make this all happen overnight. It doesn’t work that way. It takes a lot of work to be able to bring these systems together. It takes a lot of advanced technology to bring it together.”

The announcement of the accelerated schedule comes after Panetta and VA Secretary Eric Shinseki announced in December that they had requested a plan on how to speed up integration of the systems. Under the new strategy, Panetta said the agencies “now have a clear and achievable path to meet the president’s directive to implement the seamless electronic health record system.”

“Our goal had been to complete this effort by 2017. I think over the last few months, [Shinseki] and I both have recognized that, you know, our worry is, how long is it going to take to get to that goal?” Panetta explained last month. “And what is going to be the price tag to get to that goal? And how many times is it going to be delayed? So we asked the managers of the joint program to take a step back and assess whether we could achieve the president's directive much sooner and for much less money than had been budgeted.”

Specifically, the agencies plan to accelerate the exchange of real-time data between VA and DoD by the end of 2013 and allow all VA and DoD patients to download their medical records by May of 2013.

The agencies also approved plans to expand the use of a common interface to seven polytrauma sites and two DoD sites by July 2013. This will allow providers there to see information on a given patient from both DoD and VA.

“These patients are exchanged back and forth between the two systems quite regularly. There is a lot of interaction between them,” VA Under Secretary for Health Robert Petzel explained in an interview with reporters. “There is a lot of movement from the VA for a while and then back to DoD, so we felt that this was one of the best places to demonstrate the utility of having this new graphic user interface that allows us to look at both sets of records at the same time.”

Overall, VA Chief Information Officer Roger Baker explained that, in 2014, VA and DoD healthcare providers throughout the two systems will be able to share the “most important medical information” about every patient. This includes exchanging information on lab results, medications, allergies and clinical notes.

“What this entails is the exchange of information in the most critical, clinical areas between VA and DoD in a computable format so that it is usable by clinicians to appear as a single electronic medical record in those areas to the clinician,” Baker said.

EHR Goals

Assistant Secretary of Defense for Health Affairs Jonathan Woodson, MD, said that what has been mapped out as a strategy “takes into account an increasingly more austere fiscal environment.”

“That’s why we're driving and accelerating the program and reducing risk and accelerating schedule to make sure that we're as efficient in this process as possible,” he said.

Officials told reporters that they expect that, in fact, “hundreds of millions” of dollars will be saved by using existing technology.

Senate Committee on Veterans’ Affairs Chairman Bernie Sanders (I-VT), said, however, he was “deeply disappointed” by the decision “to back away from a commitment to develop and implement a truly integrated, single, electronic health record.”

At a Senate hearing last month, Panetta defended the new plan and denied the agencies had “abandoned” plans to develop a single unified medical record but said the agencies needed an immediate solution.

“We knew that developing that system has taken years. It is going to take more years, it is going to cost a great deal of money as we do that, but in the interim we have to do everything necessary to create interoperability between the Veterans Administration and the Defense Department so that doctors who are dealing with these individuals can bring this information together. We can do that interoperability using existing systems,” he said.