As the Defense and Veterans Affairs Departments celebrate the initial launch of the electronic health record in four medical facilities, Congress is keeping a close eye on the continued development of the $4.3 billion program.

Senate Armed Services Committee Chairman John McCain (R-Ariz.) is watching the DoD and VA joint venture, especially when it comes to IT challenges. McCain asked the two departments to update him on best practices and lessons learned by VA that will avoid upgrade challenges.

“VA is working with DoD to assess existing business process and determine what changes may be necessary throughout the contract life cycle,” a letter to McCain late last month from VA Secretary David Shulkin and Deputy Defense Secretary Patrick Shanahan stated. “DoD is making available senior acquisition, testing and project management experts who were instrumental in DoD’s own transformation to assist VA with initial contract implementation.”

The letter goes on to say those resources will allow VA to adopt DoD’s best practices and lessons learned through the requirements and acquisitions phase.

VA established a dedicated program office for EHR, which will be staffed with subject matter experts in contracting, health IT and business innovation, the letter stated.

VA and DoD also assured Congress the project is on track with its timeline. VA is currently standing up its initial program efforts and is developing an acquisition and implementation timeline. The letter stated VA is currently in the midst of “focused negotiations” with Cerner to finalize a contract. Genesis is based on Cerner’s software.

Meanwhile, DoD began deploying MHS Genesis to patient care sites earlier this year, with full deployment scheduled for 2018 and completion in 2022.

The first four sites are now officially live.

At the first four “go-live” sites, Genesis has now supplanted three different aging health IT systems. By the time it’s deployed worldwide, officials say it will have made DoD patient care “seamless” in that it will be interoperable with both private-sector medical providers and VA, and will give clinicians real-time access to the entirety of a patient’s medical history, plus decision-support tools that are far beyond the grasp of the current systems, some of which date to the 1980s.

“We are in the midst of a transformation in health care,” said Vice Adm. Forrest Faison, the Navy’s surgeon general. “Today, because of the miraculous inventions that have surrounded us over the past 20 or 30 years, the volume of medical knowledge in the world is doubling every two years. We are rapidly approaching the point where we can’t make good on the promise of delivering the best health care our nation can offer without driving these clinical practice guidelines to the point of care, and that’s what Genesis is allowing us to do.”

While DoD is excited about its launch, Congress wants to make sure there is proper oversight of the commercial off-the-shelf system, fearing it may fall prey to excessive customization that forces VA and DoD to have completely different record systems as time goes on.

The letter stated VA is adopting DoD clinical workflows to the greatest extent possible, while adding some necessary VA-specific functions that are not performed by DoD.

“This will minimize customization and system differences and ensure consistency of processes and practices. Joint governance will facilitate standardization among the technical and functional components of the EHR system,” the letter stated.

McCain asked specifically if DoD or VA needed any legislative help with the program. The departments stated changes may be required to the law to allow DoD and VA to have a single healthcare record from a privacy and system of record notifications standpoint. The departments stated there also may be differences in title funding between DoD and VA.

Both departments still have a long way to go before they are at full capability.

The VA needs congressional help to reshuffle VA resources and get the project off the ground in 2018.

To foot the bill for the first year of the new contract with Cerner, the department first wants Congress to finish and include funds in the agency’s 2018 appropriations bill. But if Congress doesn’t pass all appropriations bills and develops an omnibus or another continuing resolution for the rest of the fiscal year, VA wants Congress to transfer $782 million from its other appropriations accounts to initiate the EHR modernization project in this year. About $92 million would come from VA’s Office of Information and Technology (OI&T) and the remaining $692 million come from unobligated balances in medical care accounts.

And because of certain funding restrictions under the continuing resolution, VA will ask for a smaller transfer — $373.8 million in fiscal 2018.

On the DoD side, the Pentagon’s independent Office of Operational Test and will conduct assessments of how well the commercial-off-the-shelf software meets DoD’s stated requirements and how it’s performing. All the while, DoD will be harvesting lessons from the first four IOC sites, delivering more training to users, and deciding which business processes the military health system needs to change to get the most out of the new system.

Defense officials expect to make a formal decision to fully deploy Genesis sometime in 2018. Once that milestone is reached, they expect installations at hospitals and clinics to move at a faster pace than they did at the initial deployment sites over the past year.

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