The Department of Defense (DoD) says that it has met the interoperability requirements for electronic health records (EHRs) as called for in the National Defense Authorization Act (NDAA) of 2014.
DoD and the Department of Veterans Affairs (VA) have two goals in integrating patients' records and making the information accessible by both agencies, said Chris Miller, the program executive officer for Defense Healthcare Management Systems, speaking at a media roundtable in Arlington, Virginia last week. Those goals, Miller said, are to create a seamless health record, and modernize the software that clinicians and analysts in both agencies use.
Currently, the two departments have different systems for their patient population of approximately 35 million. Initial plans to combine the two systems were nixed in 2013 when it was decided that VA should stick with its VistA platform and DoD should go its own way with a commercial system. Indeed, in late July, it was announced that a team led by Cerner Corp. and Leidos won the bid to modernize the massive Department of Defense Healthcare Management Systems Modernization EHR contract. The new contract is set to cover more than 9.5 million Defense Department beneficiaries and the more than 205,000 care providers that support them. The contract was reported to be in the $9 billion range. However, fully operational capability isn’t planned until the end of 2022, long after what was originally discussed.
What’s more, in 2014, the National Defense Authorization Act mandated that DOD and VA verify that their systems are interoperable. However, In August, a Government Accountability Office (GAO) report found that the departments did not establish that all healthcare data in their systems complied with national standards and were computable in real time by the Oct. 1, 2014 deadline that they were given.
Nonetheless, in a Nov. 16 letter to Congress, Frank Kendall, undersecretary of Defense for acquisition, technology and logistics, attested that DoD has met the interoperability requirements of section 713 of the NDAA. "With this letter, we are certifying that we have not merely met this requirement, but have gone even further to integrate data from other DOD systems, including inpatient, theater and pharmacy, into this process, thereby exceeding the NDAA's requirements," Kendall wrote to the chairmen and ranking members of the House and Senate Armed Services, Veterans’ Affairs and Appropriations committees.
Kendall added, “The VA is currently working to finalize their efforts; once both departments have met their requirements, DoD and VA will provide a joint certification to Congress.” DoD has mapped all 21 domains requiring national standard terminologies, representing nearly 1.8 million unique clinical terms, Kendall said.
According to a DoD news release, the department has met these requirements by using a web-based, integrated system, called the Joint Legacy Viewer, or JLV. The technology combines information from about 300 record systems in real time to give clinicians and benefits administrators in both departments detailed patient histories on clinical interactions as far back as the early 1990s, according to a Federal Computer Week (FCW) report.
"We've done a lot to get this information to a point where it's both shared and it's usable, but we recognize that we're going to continue to have to do more things to actually continue to make it as useful as possible," Miller said at the roundtable. JLV is still in a testing phase, however, he said.
According to the FCW report, there has been skepticism regarding JVL; Rep. Will Hurd (R-Texas), chairman of the House Oversight and Government Reform Committee’s IT subcommittee, complained at an Oct. 28 hearing that JLV is "not real interoperability." To that point, Miller said, "I'm not sure we're clearly able to get to a common definition of what success looks like,” according to FCW.
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