WASHINGTON, DC—As the September 30 deadline for achieving interoperable electronic health records approaches, the Departments of Defense and Veterans Affairs are still lacking in several key areas according to legislators and government investigators. Key positions intended to oversee the effort remain unfilled, and the very definition of what the two agencies hope to achieve in terms of interoperability remains undefined.

DoD and VA are required by law—the National Defense Authorization Act of 2008—to establish an Interagency Program Office and to implement fully interoperable electronic health records by September 30, 2009. According to the Government Accountability Office, while the IPO has been formed and is partially functioning, it has yet to become the point of accountability for the departments’ interoperability efforts that it is meant to be.

VA and DoD continue to fill the office’s key leadership positions—that of director and deputy director—on an interim basis. According to the agencies, at least one of the people they had planned to hire pulled his or her application at the last minute, necessitating that they continue the recruitment process. More importantly though, the IPO has failed to create a set of performance measures against which DoD and VA can judge their efforts.

“The office has not yet performed the tasks that are fundamental to IT management,” explained Valerie Melvin, GAO’s director of information management at a House VA hearing last month. “In particular, the office has not followed through on an earlier recommendation that it establish goals and performance measures. Without a plan that describes the project’s scope, resources and key milestones, VA and DoD lack a key tool with which to measure their ongoing efforts.”

VA and DoD have also yet to create a master schedule—a timeline showing what milestones in their effort will be achieved and when, Melvin said. Legislators were skeptical that the agencies would achieve their goal by the mandated deadline. “This interoperability isn’t going to happen by September 30, obviously,” declared Rep. Phillip Roe, R-Tenn. Melvin did not disagree, but said that some measure of interoperability will be achieved, though the exact nature of that measure remains unknown.

“We have some concerns about the definition of interoperability,” she noted. “They will achieve something. It might be a measure more than what they’ve had in the past. What we have not been able to get from VA and DoD to date has been a clear, quantitative and measureable definition of what it is they will have at that point.”

DoD and VA have been working on the problem of creating an interoperable electronic health record since 1998—a fact that did not go unremarked at the hearing. Rep. Zack Space, D-Ohio, pondered, “If this were a large corporation, and if 10 years ago their IT director was dispatched to achieve interoperability, I wonder how many IT directors in that 10-year period would have been fired for not getting this done.”

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