House Members Question Unclear Leadership on EHR Interoperability

military healthcare, veterans healthcare

During a congressional hearing today on the Department of Veterans Affairs’ $10 billion electronic health records (EHR) modernization effort and the Department of Defense EHR effort–called Military Health System Genesis–House members voiced concern about who is in charge of interoperability efforts.

While the answer may be clear on paper, the reality of the situation is far from simple, as Thursday’s House Veterans Affairs Technology Modernization subcommittee showed.

“The IPO (Interagency Program Office) was established by law to act as a single point of accountability for DoD and VA system interoperability efforts. Unfortunately, this office has not come close to fulfilling this objective,” said Carol Harris, director of IT acquisition management issues at the Government Accountability Office(GAO). In her statement, Harris detailed how GAO has issued multiple reports on the IPO in the past that have garnered agreement from the VA and DoD, but seen little action result from them.

“The question is, after so many twists and turns over the years … whether the IPO is up to the task. And if not, how do we make it up to the task?” asked Rep. Jim Banks, R-Ind., chairman of the subcommittee.

“At this point in time, we make recommendations, we do not have the decision-making authority,” said Dr. Lauren Thompson, director of the IPO. “The IPO serves in a convening and coordinating role. We facilitate the information sharing from the experiences of the DoD’s MHS Genesis deployment at its initial sites to the VA, and conversely information from the VA as their program is being developed to share with the DoD,” she noted.

John Windom, the acting chief health information officer and the program executive officer for the Office of Electronic Health Record Modernization within the VA, stressed the importance of a governance structure that solves issues early on. “For governance to be successful, things have to be resolved at the lowest level,” he said. “If everything has to be elevated to an executive council or a government integration board, then we’re really not succeeding.” He also shared an organizational chart with the subcommittee, demonstrating how technicians, clinicians, and other professionals from DoD and VA will work with each other to find a solution before elevating the issue.

However, the governance structure gives an even number of seats to VA and DoD. Rep. Phil Roe, R-Tenn., noted his concern that there is no set leader in that structure. “There’s nobody we have as a three- star here,” Roe said, harkening back to the military command structure.

“One of the things that strikes me looking at the organizational chart, there are 16 boxes here, which shows that accountability has been so diffused, when wheels fall off the bus you can’t point to a single entity that’s responsible, and that’s a problem,” said Harris.

While the purpose of the hearing was ostensibly to discuss how the IPO could assert its “single point of accountability” role, the discussion turned towards other solutions.

“Wouldn’t it be better to make a decision, whether by the Congress of the United States or preferably the Executive branch, that would put one of these two players in charge,” asked Mike Coffman, R-Colo. “To say, either its DoD or VA and the other player is certainly going to have input, but it’s going to have to follow.”

“I think that in past situations what we’ve seen historically is that when everyone’s responsible, no one’s responsible,” said Harris, citing the previous failed effort to create interoperable DoD and VA EHR records.

“I would offer that our governance is evolving,” said Windom. “I think we will have a governance structure that works.”

“That still doesn’t define the fact that we don’t have a lead agency in charge. I still think there’s a role for the IPO with a lead agency in charge, but I think we owe it to the taxpayers, our active duty, and our veterans to get this right, and I believe we’ve got to define somebody as the lead agency,” responded Coffman.

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