The Defense Department is “way behind” the Department of Veterans Affairs as the government’s two largest bureaucracies push toward the longstanding objective of achieving interoperable health record systems, Defense Secretary Chuck Hagel said Tuesday.
The new defense secretary said he ordered a restructuring of DoD’s approach to the integrated electronic record and delayed a critical solicitation to industry — one that was originally intended to form the military health system’s baseline for sharing data with VA under a revised approach the departments agreed on recently.
The restructuring Hagel described to the House Appropriations Subcommittee on Defense boils down to “internal adjustments on how we manage the program within the department to streamline responsibility as we move forward,” a senior defense official said in an email to Federal News Radio after the hearing.
But in testimony to the appropriations panel, Hagel expressed clear frustration that DoD is not further along in its contribution to the joint effort, four years after President Barack Obama ordered the two departments to integrate their records. “I can’t sit here and defend what we’ve done. I could take you through the program and show you that the money hasn’t been totally wasted, because [some capabilities] have come out of our investment. But I acknowledge we’re way behind. We will do better, and I have personally taken this on,” Hagel said.
Hagel said he has personally inserted himself into the process over the past several weeks and ordered a restructuring that will include direct management oversight from his office.
His comments came two months after DoD and VA said they would revise their approach to health record interoperability. Rather than building a single record system that both departments would use, officials decided to begin from separate “core technology” starting points and focus on making the data in those systems more interoperable.
VA intends to build on its existing VistA health record system. The department unleashed the source code for the government-owned IT product into the open source community two years ago as a way to modernize its own EHR in collaboration with other health care organizations that have already adopted VistA.
DoD has made clear it wants to jettison its current health record, AHLTA. VA would like the Pentagon to simply jump aboard the VistA effort rather than choosing a third party as its new core technology starting point.
DoD was supposed to make a decision and issue a request for proposals by the end of last month. But Hagel said he blocked that RFP.
“I didn’t think we knew what the hell we were doing,” he said. “Until I get some understanding of this and get some control over it, we’re not going to spend any more money on it. But that doesn’t mean we aren’t making progress. We’ve got teams over at VA and we’re doing a lot of good things, but we haven’t completed an integrated health record system, which is what we committed to.”
DoD has not yet settled on a new approach to its health record modernization effort. DoD issued a request for information earlier this year when DoD and VA decided it would be more cost-effective to stay on separate paths than to build a new system from scratch.
But the Pentagon has not yet determined what’s next.
“An internal team within DoD has completed their review of responses from the RFI. The results are currently being reviewed to determine the best way forward,” a senior official said.
Hagel told lawmakers he hoped to have an update about DoD’s approach to selecting a core EHR technology within the next week, but said the department would know its way ahead within the next month.
Hagel has some personal experience with electronic health records in government. He was deputy administrator of what was then the Veterans Administration in the early 1980s when VA still was beginning to build the early incarnations of an electronic health record that eventually produced VistA.
But he said the technology DoD ultimately settles on is far less important than the core issue of whether the two departments can easily and reliably exchange patient data.
“What the president said he wanted when he came into office, and what the Congress funded, was a seamless, interoperable system,” he said. “You can use the word integrated, you can use any word you want. I want it to work. Until I get my arms around this, I’m not going to spend any new money on it. I can’t defend it, but we are making some progress. We’re way behind, but we will do better.”