House VA Subcommittee Questions EHR Progress and Accountability

military healthcare, veterans healthcare

The House Committee on Veterans Affairs Subcommittee on Technology Modernization met today to discuss the implementation of Electronic Health Record (EHR) Systems at the Department of Veterans Affairs (VA) and the Department of Defense (DoD).

Right off the bat, Chairwoman Susie Lee, D-Nev., called out the Department of Defense not providing written copies of its testimony until after the close of business yesterday. Saying, “in providing oversight it’s important that we have the proper time to review documents” and that receiving the testimony so late, “does not optimize our ability to do our job.” She further called out the agencies for “finger pointing” when it comes to taking responsibility for challenges and missteps. Her opening remarks set the atmosphere for most of the Subcommittee questioning VA and DoD witnesses about the status and accountability surrounding the rollout of the new EHR solution.

Lee specifically called out ongoing efforts regarding Federal Electronic Health Record Modernization (FEHRM) joint governance strategy, as well as the FEHRM program office – both of which are currently in development. She said that information currently provided isn’t enough and holes are missing in what was shared with Congress thus far.

Ranking Member Jim Banks, R-Ind., stressed the importance of cooperation between the DoD and VA when it comes to EHR initiatives. Saying that a lack of cooperation has been the “graveyard” of previous efforts. Banks said that he is hopeful that ongoing EHR initiatives at both the VA and DoD will be successful; however, he said “it is not reasonable to expect this Subcommittee to endorse decisions that we have scant details about. Decisions that are the product of a secretive process.”

Banks also referenced FEHRM, and said he understands the desire to make the agreement in private before announcing anything publicly, however, he expressed disappointment that no agreement has been made. With upcoming deadlines and “go-live” dates in mind, Banks said, “the opportunity for FEHRM to have an impact is right now,” he said. Banks also said that there needs to be substantive discussion right now to ensure that FEHRM can ensure that the new EHR systems are able to effectively help service members, veterans, and care providers.

Subcommittee members were especially interested in the structure, reporting hierarchy, and responsibilities of FEHRM. John Windom, executive director of the Office of EHR Modernization at the VA, said that the goal of the FEHRM office is to “promote rapid and agile decision-making.” Further, the structure of the office will “maximize DoD and VA resources, minimize EHR deployment and change management risks, and promote interoperability through coordinated clinical and business workflows, data management, and technology solutions while ensuring patient safety.” Additionally, the FEHRM program office “will be responsible for effectively adjudicating functional, technical, and programmatic decisions in support of DoD and VA’s integrated EHR solutions,” Windom explained. William Tinston, program executive officer for the Defense Healthcare Management Systems, noted that the office will also include “key members of the IPO [Interagency Program Office], as well as DoD and VA program office staff.”

Rep. Connor Lamb, D-Penn., pushed back against how the witnesses described the goals of FEHRM. He referenced a previous Subcommittee hearing which heard from Federal contractors working on the EHR initiative. Saying that the contractors described the decision-making process as “slow,” rather than agile and said that they testified that the number one thing they needed to succeed was a faster decision making process by the DoD and VA.

In terms of the finalized FEHRM plan, Windom said that the DoD and VA will “jointly present the final construct of the plan to Congress, including our implementation, phase execution, and leadership plans.”

Rep. Phil Roe, R-Tenn., questioned whether the new system will be able to evolve as technology changes. Windom responded that ongoing technology modernization is a benefit of the indefinite delivery/indefinite quantity contract the VA has with EHR provider Cerner. Saying that the VA will be able to capitalize on Cerner’s advancements in the commercial sector in the VA’s EHR solution. “We will evolve with the market,” he said. Roe, who is also a medical doctor, explained his own frustration with EHR systems as a practitioner. He said that the tech professionals don’t understand what care providers find important in terms of data, and so they provide so much information it overwhelms care providers. He urged the VA to listen to its medical practitioners and adapt the solution to meet their needs.

Lee also zeroed in on differences between existing medical record keeping between the DoD and VA – primarily how the agencies format their patient identification numbers. John Short, CTO for the Office of EHR Modernization at the VA, explained that the VA has undertaken the lengthy process of moving over to the DoD’s style of patient identification. Currently, the VA has assigned all veterans it has ever served new numbers and is shortly going to undergo testing of the new numbers and system. He stressed the importance of achieving interoperability between the two systems to ensure seamless patient care.

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