Electronic Health Record U-Turn: Are VA and DoD Headed in the Wrong Direction?

COMMITTEE ON VETERANS’ AFFAIRS
U.S. HOUSE OF REPRESENTATIVES

OPENING STATEMENT OF RANKING MEMBER MIKE MICHAUD
334 CANNON HOUSE OFFICE BUILDING
 
Electronic Health Record U-Turn:  Are VA and DoD Headed in the Wrong Direction?

FEBRUARY 27, 2013

Thank you, Mr. Chairman.

We, as a nation, have a “sacred trust” to care for those who have served and sacrificed.  To do this, we rely on a “community of support.”

DoD and VA are the pinnacle of that community.  Together you are the front-end and the back-end of the veteran safety-net.  You must come together seamlessly or veterans fall through the space between you.

You have no greater mutual responsibility to those who have served you, and to those you serve, than to ensure a complete and smooth transition from the military back to civilian life.

Key to that smooth transition is the transfer of the health records that document the physical and mental sacrifices of our nation’s heroes.

The Integrated Electronic Health Record (iEHR) initiative is critical to ushering in a more fluid process for our service men and women who transition into the veteran world.  

Ideally, instead of servicemembers hand carrying paper records with them to medical appointments, access to their records would be readily available, electronically, to the providers and health care personnel who care for them when they take the uniform off and continue their lives as civilians.

In transforming the VA into a 21st century agency, we envisioned a seamless record that could benefit the men and women who have served this country honorably.

The idea of VA and DoD being capable of electronic communication was not a new one.  We believed that VA and DoD could accomplish this task.  

For at least a decade the two largest agencies in the government have worked this issue – often taking two steps forward and one step back.  

I was under the impression, and in fact reassured, as late as September 2012 that the development of the iEHR, while challenging, was still on track to becoming the reality we intended.  

So, in early February when we read in the news of the decision that VA and DoD were “modifying its strategy” from the planned iEHR approach and focus, I was disappointed and disheartened.

It seems to me that we have regressed back to 2004 when the Bidirectional Health Information Exchange was the way electronic information was exchanged.  I am hoping this is not the case.

There are questions that must be answered as to the future of the iEHR and plans to move forward.

The original strategy – the intent of iEHR – was to design, build and implement a new, single system “from scratch.”  In revising your life cycle cost estimates, you have determined that approach is too expensive.

So, you “modified your strategy” to use a core set of capabilities from existing EHR technologies.  But rather than selecting one system from those currently available, your modified strategy is for each Department to separately select a core system of choice.  

VistA, the VA’s current system is old and by all accounts replacing VistA with an existing Commercial Off The Shelf package is estimated to be $16 billion dollars, according to a September 6, 2011 letter.  

VA believes that leveraging open source methodologies will increase the rate of improvement within VistA and will be much cheaper.   

DoD is looking to explore commercial options for its core system and won’t have a selection decision until March.

How does this modified strategy live up to the initial intent of iEHR to be a single, integrated system?

I am currently not comfortable with the direction we seem to be heading.

I am sure everyone in here would agree that we cannot afford to continue moving forward and back on this issue.  VA was once a leader in electronic health record keeping – today, it is one that is simply trying to keep up.

This must change.  You – we - owe more to the nation’s servicemembers and veterans.  

I look forward to the testimony today and a frank, open discussion on the way ahead.