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Is Healthcare IT Interoperability (Almost) Here?

Brian Eastwood | April 16, 2013
This year's Health Information and Managements Systems Society's HIMSS13 conference began with a shocker: The announcement that five leading electronic health record (EHR) vendors were forming a group called the CommonWell Health Alliance that would promote "seamless interoperability" of healthcare data.

The departments represent two of the largest healthcare systems in the United States and two of the earliest adopters of EHR technology: VistA, launched in 1978, helps the VA treats 6.3 million veterans, while the DOD's AHLTA, which debuted in 1997, holds records for 9.6 million active duty service members.

Since the late 1990s, both Congress and the President have urged the departments to achieve varying measures of EHR interoperability. Planning has been absent virtually every step of the way, Valerie C. Melvin, director of information management and technology resources issues for the Government Accountability Office, testified before the U.S. House of Representatives Committee on Veterans' Affairs.

The testimony came after the VA and DOD first said they would abandon the effort to develop a joint EHR by 2017 and then backtracked, saying they were committed to integrated EHR systems rather than a shared system.

Melvin cited several specific examples:

  • The 1998 Government Computer-Based Patient Record project to give each department an interface into the other's EHR suffered, as "basic principles of sound IT project planning, development and oversight" weren't followed and "accountability...was blurred across several management entities." The project was finished in 2005.
  • A joint clinical health data repository, slated for completion in October 2005, was nearly one year late. This initiative, GAO said, lacked a project management plan and an architecture for describing the common interface.
  • While a directive to develop six specific "fully interoperable [EHR] systems or capabilities" by Sept. 30, 2009 was met, the GAO saw none of the "objective, quantifiable and measurable performance goals and measures that are characteristic of effective planning." These were developed seven months after the functionality was in place.
  • The Virtual Lifetime Electronic Record, a way to streamline how patient records move with a soldier who leaves active duty, began with successful pilot programs. However, without "identifying the target set of capabilities that they intended to demonstrate in the pilot projects and then implement on a nationwide basis," the VLER couldn't meet its goal of implementation at all domestic VA and DOD sites by the end of 2012.
  • Lack of planning for an integrated, jointly funded federal health care center left the VA and DOD unable to "estimate the project cost or establish a baseline schedule." The total cost ballooned to $122 million--not including the workarounds resulting from delays in setting up single sign-on, single patient registration and physician order portability.
  • Finally, the fate of the interoperable EHR remains in doubt, the GAO said, and "the extent to which the departments' revised approach to iEHR is guided by a joint health architecture remains to be seen." This in spite of a February 2011 GAO report that recommended putting EHR modernization efforts and IT investments in the context of common healthcare business needs.


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