A joint report released this week from the Offices of Inspector General for the Departments of Defense and Veterans Affairs found that the agencies had not taken all necessary actions to achieve interoperability of patient care information when they deployed the Cerner electronic health record system and launched the Joint Health Information Exchange.
"Achieving interoperability between the DOD, VA, and external healthcare providers through the deployment of a single EHR system is critical because healthcare providers will have the ability to securely transfer and share health care information for the nation’s 9.6 million DoD armed forces members, dependents and retirees, and 9.21 million enrolled users," read the report.
"VA appreciates the recommendations," said VA spokespeople in response to requests for comment from Healthcare IT News. "We consider all opportunities for improvement in VA’s approach to ensuring a complete electronic health record that accomplishes a seamless transition from military service to veteran status.
"We will continue to work closely and effectively with the Federal Electronic Health Record Modernization Office and our DOD colleagues on our joint effort," the spokespeople continued.
Requests for comment from DOD and the FEHRM Program Office were not returned by press time.
WHY IT MATTERS
As outlined in the audit report, Congress directed the DOD and VA to enable interoperability of patient health information between the departments as part of the FY 2008 National Defense Authorization Act. Additional requirements were instituted as part of the FY 2014 NDAA and the FY 2020 NDAA.
To meet those interoperability requirements, the agencies contracted with Cerner in 2015 (for DOD) and 2018 (for VA), with plans to deploy its EHR throughout healthcare facilities over the next decade.
The DOD and VA also established the FEHRM Program Office to provide direction and oversight to organizations rolling out the Cerner EHR.
"The FEHRM Program Office’s primary mission is to work closely with the DOD and VA to implement a single, interoperable federal EHR and develop and maintain a complete patient record that would enhance patient care and healthcare provider effectiveness," read the joint audit report.
"Furthermore, the FEHRM Program Office implemented the Joint Health Information Exchange to enhance the ability of the Departments to securely exchange healthcare information with more than 15,000 external healthcare providers," noted the auditors. However, the watchdogs found that the DOD and VA "did not take all the actions needed to achieve interoperability."
Specifically, said the OIGs, the agencies did not:
- Consistently migrate patient healthcare information from the legacy electronic health care systems into Cerner to create a single, complete patient EHR
- Develop interfaces from all medical devices to Cerner Millennium so that patient healthcare information will automatically upload to the system from those devices
- Ensure that users were granted access to Cerner Millennium for only the information needed to perform their duties
The OIGs pointed the finger at FEHRM for this, saying that it did not develop and implement a plan to achieve interoperability requirements or take an active role to manage the program's success.
"Instead, FEHRM Program Office officials limited their role to facilitating discussions when disputes arose between the DOD and the VA, and would only provide direction if the Departments reported a problem," said the report.
"Because the FEHRM Program Office limited its role, the DOD and the VA took separate actions to migrate patient healthcare information, develop interfaces and grant user access to Cerner Millennium," it continued.
The OIGs recommended that the FEHRM Program Office develop processes and procedures in accordance with its charter, along with:
- Determining the type of healthcare information that constitutes a complete EHR
- Implementing a plan for migrating legacy patient healthcare information needed
- Implementing a plan for creating interfaces that would allow medical devices to connect and transfer patient healthcare information to Cerner Millennium
- Implementing a plan to modify Cerner Millennium user roles to ensure that users are granted access to only the patient healthcare information necessary to perform their job responsibilities
"The Deputy Secretary of Defense and Deputy Secretary of Veterans Affairs agreed with the recommendation to review the actions of the FEHRM Program Office and direct the FEHRM Program Office to develop processes and procedures in accordance with the recommendations," said the auditors.
"In addition, the Deputy Secretary of Defense and Deputy Secretary of Veterans Affairs stated that they would ensure the FEHRM Program Office complies with its charter and applicable NDAA requirements," they continued.
THE LARGER TREND
The EHR modernization effort at the VA has been the subject of several OIG reports over the past year, which raised concerns about cost estimates, training deficiencies, scheduling systems, medication management, ticket-process concerns and care-coordination deficiencies.
But the DOD's new EHR implementation also faced its fair share of watchdog scrutiny about its rollout timeline and its handling of patient security.
ON THE RECORD
"As the DOD and the VA continue to deploy Cerner Millennium, healthcare providers at those facilities should be confident that a patient’s EHR is accurate and complete regardless of where the point of care occurred," said the joint OIG report.
Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.
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