In testimony given last week at a hearing before the House Committee on Veterans' Affairs Subcommittee on Oversight and Investigations, Joel Willemssen, GAO's managing director for information technology, said the VA has not been able to establish shared electronic health record (EHR) capabilities with DOD in three key IT management areas--strategic planning, enterprise architecture (i.e., a description of business processes and supporting technologies), and IT investment management. As a result, this weakness in planning could further risk both departments' goal of designing a better healthcare IT network.
The VA and DOD operate two of the nation's largest health care systems, providing healthcare to 6 million veterans and 9.6 million active duty service members at estimated annual costs of about $48 billion and $49 billion, respectively. However, Willemssen said both departments, which increasingly share health information, are unable to articulate explicit plans, goals, and time frames to coordinate the health IT requirements common to both departments' EHR systems.
Willemssen also explained that the VA and DOD had not developed a process for selecting IT investments based on criteria that consider cost, benefits, schedule, and risk factors. That process would help in deciding the best IT systems to meet both departments' common health IT needs.
Willemssen did say that the VA and DOD are working to establish the Virtual Lifetime Electronic Record (VLER), which is intended to facilitate the sharing of electronic medical, benefits, and administrative information between the departments. Both federal departments also are developing joint IT capabilities for the James A. Lovell Federal Health Care Center (FHCC) in North Chicago, Illinois. The FHCC is to be the first VA/DOD medical facility operated under a single line of authority to deliver medical and dental care for veterans, new naval recruits, active duty military personnel, retirees, and dependents.
However, part of the difficulty in coordinating their health IT efforts has been that both departments have invested heavily in modernizing their own separate HER record systems. VA has spent almost $600 million from 2001 to 2007 on eight projects as part of its Veterans Health Information Systems and Technology Architecture (VistA) modernization efforts. In April 2008, VA estimated an $11 billion total cost to complete the modernization by 2018. At the DOD, approximately $2 billion has been spent over the 13-year life of its Armed Forces Health Longitudinal Technology Application (AHLTA).
These efforts have created barriers in developing a joint strategy to designing a modern electronic health record system that address their common healthcare business needs, Willemssen said.
"These barriers resulted in part from VA's and DOD's decision to focus on developing VLER, modernizing their separate electronic health record systems, and developing IT capabilities for FHCC, rather than determining the most efficient and effective approach to jointly addressing their common requirements." Willemssen told the committee. "Because VA and DOD continued to pursue their existing health information sharing efforts without fully establishing the key IT management capabilities described, they may have missed opportunities to successfully deploy joint solutions to address their common healthcare business needs."
Bill Johnson, chairman of the Subcommittee on Oversight and Investigations, expressed his disappointment that both departments waited so long to agree to a joint EHR system.
"A crucial area for VA IT to meet expectations is the establishment of the joint Electronic Health Record, or "EHR", with DoD. Yet another overdue item for our active duty service members and our veterans, the EHR has been pursued separately by the two departments," Johnson said. "The result is billions of dollars spent, much of it duplicative, and no joint EHR. While I commend the secretaries of both departments for finally committing this spring to cooperatively pursue this endeavor, I have lingering concerns that mistakes made in previous IT contracts could be repeated."
To align the efforts of both departments to address their common healthcare business needs, Willemssen made several recommendations. These include:
-- Revise the departments' joint strategic plan to include information discussing their electronic health record system modernization efforts and how those efforts will address the departments' common health care business needs.
-- Further develop the departments' joint health architecture to include their planned future state and transition plan from their current state to the next generation of electronic health record capabilities.
-- Define and implement a process, including criteria that considers costs, benefits, schedule, and risks, for identifying and selecting joint IT investments to meet the departments' common health care business needs.
The GAO also recommended that the Secretaries of Veterans Affairs and Defense strengthen their ongoing efforts to establish VLER and the joint IT system capabilities for FHCC by developing plans that include scope definition, cost and schedule estimation, and project plan documentation and approval.
Willemssen told the committee that both departments endorsed GAO's recommendations and in March the Secretaries of Veterans Affairs and Defense committed their respective departments to pursue joint development and acquisition of integrated electronic health record capabilities.
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