Even If All Goes Right With Overhaul, Veterans Still Face a Health Records Mess

November 22, 2019

This article by Richard Sisk originally appeared on Military.com, the premier resource for the military and veteran community.

A House hearing Nov. 20 exposed a major roadblock to the $16 billion plan to put in place a single electronic health record system for the Departments of Defense and Veterans Affairs. And it has nothing to do with technological challenges.

The VA and Pentagon have not yet begun to address old bureaucratic turf wars on data sharing that scuttled past efforts to let veterans and doctors have access to their entire health records, according to testimony by VA officials.

Even if the immensely complicated programming, infrastructure and software obstacles to data sharing can be overcome, veterans would still have to make separate requests to the VA and DoD for their complete health records under existing rules and laws, the officials said.

"If a patient needs to go to both the VA and DoD to get their complete record, then we're not meeting the underlying goal of this whole project," Rep. Susie Lee, D-Nevada, chairwoman of the House Veterans Affairs subcommittee on technology modernization, told a panel of VA officials.

Based on their testimony, Lee said she is unsure where the VA stands on solving the jurisdictional problems involving the data. The officials themselves seemed unsure.

Seamless access to records is a main goal of the electronic health record, or EHR, overhaul, said VA Deputy Secretary James Byrne. "That is a capability that we intend to have, if we do not have it already," he said.

Byrne and several other officials could not immediately provide details on the status of the data sharing issues, and took several questions for the record.

The VA is aware of the problem, but a solution is still in the discussion stage, said Dr. Laura Kroupa, chief medical officer for the VA's Office of Electronic Health Record Modernization (OEHRM).

"The laws and regulations were not written at a time when we had the same instance of an EHR," Kroupa said. "There has been a lot of discussion about how to adjudicate that and who has provenance over different parts of the record."

The bottom line is that Congress might have to write new laws to get past the old rules blocking data sharing if the VA and DoD can't come to an agreement, said John Windom, executive director of OEHRM, in response to Lee's offer to consider legislative action.

"To the extent that there needs to be a change in laws and regulations, obviously we would like to understand exactly what needs to happen so we can be of assistance and expedite that," Lee said.

Windom told Lee the VA owed Congress "greater granularity" on the impasse. He added that no one had considered the data-sharing issue when the electronic health record plan was being formulated.

In August, VA Secretary Robert Wilkie said the 10-year, $16 billion contract with Cerner Corp. of Kansas for implementation of the new health records system was "on track," but the VA has since announced several delays.

In September, the VA announced that the scheduled 2023 debut of a Cerner-developed appointment scheduling tool to address the wait-times issue is now expected to launch in 2025.

Also in September, the VA said that the EHR pilot program, planned for March 2020 at three VA medical centers in Tacoma, Seattle and Spokane in Washington state, has been rearranged.

The rollout at the Mann-Grandstaff VA Medical Center in Spokane is still on for March 28, the VA said, but the efforts at the Tacoma and Seattle VA medical centers have been pushed back to October 2020.

[RELATED: MOAA's Health Care Page]

At the subcommittee hearing Nov. 20, Dr. Robert Fischer, director of the Mann-Grandstaff VA Medical Center, said, "The augmentation plan is under execution now," adding that about 40% of the 108 planned new full-time hires to implement the EHR system are already on board.

Byrne said he is "very confident" of a smooth rollout in Spokane but added that the VA is ready to push back the start date should problems arise.

"If anything is going to impact patient safety, that is a no-go," he said. "That rules over everything."

Windom said the VA will be relying on the clinical staff at Mann-Grandstaff to determine whether to delay the rollout.

Even if the rollout in Spokane goes ahead as planned in March, the test will be only a limited version of the EHR, the VA officials said.

The staff at Mann-Grandstaff will still have to toggle back and forth between the new system and the existing Veterans Information Systems and Technology Architecture, or VistA.

Both Lee and ranking subcommittee member Rep. Jim Banks, R-Indiana, urged the VA not to rush the pilot program in Spokane.

"It is so important that the Spokane employees be able to train on the actual production system before go-live, not merely a mock-up training system," Banks said. "If a few more weeks are needed to make the training more meaningful, I urge VA to take it."