Office overseeing EHR interoperability between DoD, VA not having ‘active role’ in rollout

A central office meant to coordinate how the departments of Defense and Veterans Affairs roll out a common Electronic Health Record does not yet have a plan to ensure the system will be interoperable between both agencies, according to the latest watchdog report on the matter.

A joint report from the DoD and VA inspectors general finds the Federal Electronic Health Record Modernization (FEHRM) Program Office has not yet developed a plan to plan to achieve EHR interoperability, as required under the National Defense Authorization Act, nor did it “take an active role to manage the program’s success.”

“Instead, FEHRM Program Office officials limited their role to facilitating discussions when disputes arose between the DoD and VA, and would only provide direction if the departments reported a problem,” the report states.

DoD and VA agreed to work together to implement a single, integrated EHR that has the capability to accurately and efficiently share patient health care data between both agencies, as well as external health care providers.

The goal of creating an interoperable DoD-VA electronic health record is a massive undertaking and requires the integration of two of the largest health care systems in the world.

DoD provides care to 9.6 million enrolled users and the VA treats 9.21 million enrolled users. The VA alone expects to spend $16 billion to complete the full scope of the Cerner Millenium EHR rollout.

The fiscal 2020 NDAA required the FEHRM Program Office to ensure interoperability and allow “seamless health care” between DoD and VA health care facilities and providers, as well as health care partners outside the federal government.

The FEHRM office includes personnel from the Defense Health Agency, DoD Healthcare Management System Modernization (DHMSM) Program Office, the VA’s Office of Electronic Health Record Modernization and other agencies.

The report finds the FEHRM Program Office’s lack of planning made it harder for DoD and VA to make the Cerner Millennium EHR interoperable.

The IGs found DoD and VA did not consistently migrate patient health care information from the legacy electronic health care systems into Cerner Millennium to create a single, complete EHR.

The IG also found DoD and VA did not take steps to ensure the Cerner EHR granted users access only to information needed to perform their duties, which raises concerns under the Health Insurance Portability and Accountability Act (HIPAA).

“We found that the Cerner Millennium user roles were not always commensurate with the health care provider’s assigned duties and therefore, users had more access to patient health care information than was necessary,” the report states.

The EHR contains a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, lab and test results, and radiology images.

DoD plans to deploy Cerner Millennium at all its 490 health care facilities by 2023. As of December 2021, the agency has deployed it to 49 facilities.

VA plans to deploy Cerner Millennium at 1,454 health care facilities by 2028. At the time of the IG audit, VA had only one go-live of the EHR at its medical center in Spokane, Washington.

A second go-live took place in Walla Walla, Washington in March, and a third go-live happened on April 30 in Columbus, Ohio.

VA Secretary Denis McDonough told the House VA Committee earlier this month that the Cerner Millenium EHR has experienced five shutdowns since March 3, the first of which was so “egregious,” that the company’s chief executive officer issued a signed apology.

An outage last month brought down all federal Cerner systems across the Defense Department, VA and the Coast Guard.

Deputy VA IG David Case told the technology modernization subcommittee of the House VA Committee last month that the VA at this point doesn’t have an integrated master schedule for the rest of the EHR rollout, “so we don’t exactly know what VA’s plans are and how they intend to implement their plans over the 10-year span.”

“It’s more than just identifying dates on a calendar. They have to account for work that has to be done, whether it’s infrastructure updates, IT, physical infrastructure. That training has to be done, and they have to build in a risk assessment with a best-case, a worst-case and the most likely case. And to date, that hasn’t been done, and all that is going to impact budget,” Case said.

VA spokesman Randy Noller said in a statement that the agency”will continue to work closely and effectively with the Federal Electronic Health Record Modernization Office and our DoD colleagues on our joint effort.”

“We consider all opportunities for improvement in VA’s approach to ensuring a complete electronic health record that accomplishes a seamless transition from military service to veteran status,” Noller said.

Congress has been laying the groundwork for DoD and VA to jointly develop an integrated EHR since the 2008 NDAA. Lawmakers included additional provisions in the 2014 and 2020 NDAAs to further refine EHR interoperability standards.

The Defense Health Agency awarded a contract to the MITRE Corporation in September 2021 to conduct an independent evaluation of the interoperability between DoD and VA’s systems, but MITRE has yet to perform its testing because of VA’s delays in deploying the EHR.

The IG report states that achieving interoperability between the DoD, VA and external health care providers through the deployment of a single EHR system is critical, because health care providers will have the ability to securely transfer and share health care information for service members and veterans.

“As the DoD and the VA continue to deploy Cerner Millennium, health care providers at those facilities should be confident that a patient’s EHR is accurate and complete regardless of where the point of care occurred,” the report states.

The director of the FEHRM Program Office told the IGs that the office needs resourcing and appropriate delegations of authority from the DoD and VA to address the report’s recommendations.

The director also told the IGs that the FEHRM Program Office will begin executing actions when funding, staffing and authorities are allocated. However, the IGs said the director should be asking DoD and VA for those resources.

“It is the director’s responsibility to request needed resources and authorities from the DoD and VA,” the report states.

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