Leaders in the departments of Defense and Veterans Affairs admit that creating a seamless transfer of electronic health records (EHR) between departments would be a good thing. The problem has been figuring out the best way to do that.

Secretary of Defense Chuck Hagel has now decided that turning to the commercial marketplace rather than adopting VA’s own Veterans Health Information Systems and Technology Architecture (VistA) is the best choice for his department.

Hagel announced his decision in a May 21 memo to Frank Kendall, Under Secretary of Defense for Acquisition, Technology and Logistics, and Jessica Wright, Acting Under Secretary of Defense for Personnel and Readiness.

“A competitive process will allow DoD to consider commercial alternatives that may offer reduced cost, reduced schedule and technical risk, and access to increased current capability and future growth in capability by leveraging ongoing advances in the commercial marketplace,” Hagel wrote.

He went on to say while VA may have good reasons to adopt VistA for its EHR core, it was not a good fit for his department based on DoD’s own market research.

Kendall and Wright led a group of senior DoD officials in a 30-day review of the Integrated Electronic Health Record program.

“Based on the findings of your review,” Hagel wrote, “I am convinced that a competitive process is the optimal way to ensure the best value solution for DoD.”

Even though DoD is turning to the commercial marketplace, its own research showed VistA might still be part of one of the competitive offerings it would receive, Hagel wrote.

In making his decision, Hagel acknowledged the benefits a more interoperable and modern EHR system would have for clinicians and patients in both departments.

Streamlining the handoff of EHR has also been seen as a way to help alleviate VA’s disability claims backlog.

Hagel, however, warned against giving that too much weight as only 4 percent of VA’s current backlog is linked to the transfer or completeness of DoD’s records.

“These EHR efforts should not be conflated with the present VA disability claim backlog,” he wrote.

To expedite the move to the competitive process, Hagel put forward four directives:

• DoD will continue to work with VA “to develop data federation, presentation and interoperability.” This is seen as a primary, near-term goal to be pursued separately from the department’s longer-term goal of modernizing its health record information technology (IT).
• DoD will seek full and open competition for EHR modernization.
• The Assistant Secretary of Defense for Health Affairs will act as the functional sponsor for this capability and Wright’s office will continue to be in charge of coordinating health care with VA.
• Kendall will assume responsibility for DoD’s health care records interoperability and modernization efforts. He shall also take the lead on the technical and acquisition aspects of coordination with VA.

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