Ever since the Defense Department and the Veterans Affairs Department decided to step back from their approach to building a joint electronic health record earlier this year, DoD has been searching for a new electronic records system. As DoD nears a decision point, VA is making the case that its own system, VistA, would make a great fit for both departments.

The two departments’ original vision was to build a single electronic health record that would follow a service member from the time he or she enlisted in the military to the time they exited VA care. Both agencies say that’s still the fundamental goal, but under a revised program they announced last month, rather than building a record system from scratch, they’ll each begin from separate “core technology” starting points and focus more on sharing data than integrating their systems.

Under the new plan, VA decided to use its existing electronic health record system, VistA, as its core technolgy. DoD wants to scrap its current health record, and hasn’t yet decided what will replace it.

But Stephen Warren, VA’s acting assistant secretary for information and technology, said his department thinks it has an easy answer.

“The organization strongly believes VistA is the tool DoD can use to their best benefit. But they have to embrace that on their own. If you force-feed it, it will never happen,” he told reporters on a conference call Wednesday. “We believe they’ll come to that conclusion, but we have to give them that opportunity.”

DoD doesn’t believe the decision is so simple.

Beth McGrath, the department’s deputy chief management officer, told Congress earlier this month that the Pentagon is currently considering VistA, whose data rights the government already owns, as one option. But it’s also looking at commercial health record products.

“The commercial health IT space has made tremendous leaps in terms of modernization over the years. We want to ensure that we’re assessing all the capabilities the commercial market brings,” she told the House Armed Services Committee on Mar. 13.

DoD issued a request for information to seek out commercial solutions on Feb. 8. VA took the unusual step of preparing a response to that request for information, plugging its own VistA system.

Since it is a governmental agency and not a vendor, the department didn’t make the submission directly. Instead, it posted a 31-page “draft” response on the website of the Open Source Electronic Health Record Agent, the nonprofit group it established to modernize VistA with help from the open source software community.

But in VA’s regularly-scheduled conference call with reporters, Warren was not shy about making the case that if DoD and VA are going to move to a seamless electronic health record system, beginning from a similar starting point would help a lot.

“The more complex a system is, the more moving parts it has, the more dependent systems there are, all of that adds up to a higher probability of failure. One piece will fail somewhere along the way,” he said. “Running a single system ensures you’re looking at the same record. You don’t have to worry about translating data or staging it, or making sure it’s moving across various systems correctly. It’s in one place, it has one source, it has one use. There’s tremendous value there, and that’s why we think VistA is the path we should go down. But I need to make sure that I respect my colleagues across the river to make sure that’s what they need to do to meet their business needs.”

DoD is in the process of deciding what system will best meet those needs. The comment period for its request for information ended in late February. DoD’s Office of Cost Assessment and Program Evaluation is leading the effort to decide whether the Pentagon should adopt a commercial product or use VistA. Per McGrath’s earlier testimony, the decision should be in hand by the end of March.

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