VA/DOD Healthcare Interoperability Can Be Improved | Citizens Against Government Waste

VA/DOD Healthcare Interoperability Can Be Improved

The WasteWatcher

Citizens Against Government Waste has advocated often for improved healthcare data sharing between the Departments of Defense (DOD) and Veterans Affairs (VA).  The Government Accountability Office has also been pushing for this process to be completed, noting in its February 27, 2014 report that these efforts had been ongoing since 1998.  DOD and the VA have spent billions in taxpayer resources trying to develop healthcare systems that are interoperable, so that active military personnel moving over to the VA can get their healthcare information transferred with as little disruption to care as possible.

The most recent effort began in 2017, when the VA decided to adopt the framework being used for the new electronic healthcare record (EHR) system being developed by Cerner for the DOD known as MHS Genesis, and contracted with Cerner for $10 billion over 10 years to build a similar system that would be interoperable with DOD’s EHR.  On July 29, 2019, the VA migrated 23.5 million veteran records from its legacy VistA EHR to the new Cerner Millennium EHR.  This was a hopeful step forward to finally having an interoperable healthcare system at both departments.  To date, DOD and VA have deployed the Cerner Millennium EHR system to 49 DOD facilities and one VA healthcare facility.

However, on May 5, 2022, the DOD and VA Offices of Inspector General (OIGs) issued a joint report reviewing the issues the interoperable EHR continues to face.  The OIGs found that the DOD and VA failed to migrate healthcare information in a consistent manner from legacy systems to the Cerner Millennium to create a single, complete patient health record; develop interfaces from all medical devices to the Cerner Millennium system to automatically update the system from those devices; or ensure users had access to the Cerner Millennium system for only the information needed to perform their duties. 

According to the OIGs’ report, many of these issues were not remediated because the Federal Electronic Health Record Modernization (FEHRM) program office did not facilitate discussions when disputes arose between DOD and VA, and only provided guidance if the departments reported a problem.  The OIGs recommended that FEHRM take action to determine what information is necessary to be considered a complete EHR and implement a plan to develop and implement a migration plan for this information to the Cerner Millennium EHR. 

In its response to the OIGs, the FEHRM program office suggested that additional funding and authorizations were necessary to implement the recommendations, so that the office has the resources it needs.  While funding and authorization allocations for the FEHRM are the responsibilities of the two departments, Congress, as it begins its discussions for the National Defense Authorization Act (NDAA) for 2023, should ensure the resources needed to improve the FEHRM program office are made available.  Otherwise, the latest effort to make healthcare records interoperable between DOD and the VA will fall short of its objectives.