DOD-VA well being report modernization not hitting interoperability targets, watchdogs say

The brand new multibillion greenback digital well being information packages overlaying the navy and veteran affected person populations aren’t reaching the degrees of interoperability promised by officers, in response to an oversight report launched on Thursday.

The Division of Protection and the Division of Veterans Affairs individually contracted to make use of the Cerner Millennium digital well being care system to cowl greater than 18 million people. DOD tapped Leidos to function integrator of the Cerner system in 2015, and VA contracted individually with Cerner in 2018. Collectively, the initiatives are estimated to value greater than $20 billion – and the true price ticket is anticipated to be a lot increased.

The 2 programs are supposed to work collectively as a “single, built-in EHR that has the aptitude to precisely and effectively share affected person well being care info between the DOD and VA to make sure well being report interoperability between the departments and with exterior well being care suppliers,” in response to a joint inspector common report from the VA and DOD.

Interoperability is not simply an administrative coverage objective – Congress ordered the companies to discipline programs that would seamlessly trade info within the 2015 Nationwide Protection Authorization Act.

The place DOD and VA fell quick, in response to the report, is in migrating current affected person info to the brand new programs and in growing interfaces to maneuver information from medical units to the Cerner Millennium well being report.

Whereas some primary affected person info like well being situations, allergy symptoms, medicines, immunization information and histories of inpatient and outpatient procedures have been included within the migration to Cerner, a wealth of knowledge together with affected person labs, scientific notes and a few diagnostic info was not included within the preliminary rollout of the Cerner system by both DOD or VA. (DOD is a couple of third of the best way by means of its deployment; VA has gone dwell with Cerner in three scientific places and has the majority of its effort left to go.)

The Protection Well being Company’s chief well being informatics officer informed OIG auditors that the legacy well being care information shall be migrated to Cerner after DOD completes its whole rollout of the brand new EHR. 

Underneath VA’s information migration plan, extra however not all legacy information will finally develop into a part of the Cerner system, however there isn’t any timeframe for doing so.

DOD and VA are each leaning on the Joint Legacy Viewer, an answer fielded earlier than the companies determined to make use of the identical EHR system, to entry affected person information that’s not in Cerner Millennium. The Joint Legacy Viewer is a read-only system that doesn’t meet congressionally mandated interoperability necessities. 

In accordance with the report, DOD and VA didn’t arrange interfaces for capturing information from medical units into the brand new well being report programs. Whereas some units comply with business interoperability requirements, many don’t, requiring DOD and VA to provide you with interfaces to ensure info from units leads to affected person well being information. 

The IG report additionally notes that the task of privileges for scientific customers has been inconsistent throughout DOD and VA, with many people receiving ranges of entry that aren’t required by their roles, doubtlessly placing affected person information in danger.

Auditors need the Federal Digital Well being Report Modernization (FEHRM) program workplace to satisfy its function in offering unified course to VA and DOD on interoperability. In accordance with the report, the FEHRM program workplace “restricted its function to facilitating discussions between the DOD and VA on the capabilities that will obtain interoperability.”

The report recommends extra oversight of the FEHRM from on the deputy secretary degree at DOD and VA. It additionally recommends that the FEHRM provide you with a definition of a “full” affected person report and develop a plan emigrate legacy well being information in order that information match that definition of completeness. Moreover, the FEHRM is charged with planning to assist seamless information interoperability from medical units to the Cerner system.

In reply feedback, FEHRM Director William J. Tinston concurred or partially concurred with the suggestions within the report, however he mentioned that his workplace “will proceed to imagine better duties in accordance with the FEHRM constitution as funding and assets develop into accessible.” 

The report states that it’s as much as Tinston, per the FEHRM constitution to determine and request wanted assets. The auditors need extra info on wanted assets and authorities in addition to plans to deal with particular interoperability suggestions.