DOD, VA did not do enough to make new electronic health record system work, IG audit finds
Stars and Stripes May 16, 2022
WASHINGTON — A joint inspector general audit of the Defense and Veterans Affairs departments found the agencies did not do enough to exchange electronic health records information because interagency program officials did not direct or develop a clear plan for the system to work.
The new electronic health record system is designed to connect the VA's medical centers and clinics with the Defense Department and the Coast Guard. The connection allows providers more information on a veteran's medical history and provides a smoother transition from active duty to veteran status. Thus, the VA and Defense Department acquired Cerner Corp.'s electronic health record platform, Cerner Millennium.
The Defense Department signed a $4.3 billion contract with Cerner in July 2015. The VA signed a $10 billion contract with Cerner in May 2018 to overhaul its health record system and make it compatible with the Defense Department. At the time, Capitol Hill lawmakers expressed concerns about the project because of previous failed attempts by the VA and DOD to merge their systems.
However, the inspector generals found the VA and DOD took separate actions to move patient health care information, develop a connection and interaction between hardware, software and users, and grant user access to the Cerner platform. The audit, led by the DOD inspector general, was conducted from February 2020 through February 2022. During the audit, the Cerner records system was implemented at 49 DOD health care facilities and one VA facility — the Mann-Grandstaff VA Medical Center in Spokane, Wash.
The Cerner system launched in Spokane in October 2020. Since then, records issues have plagued the facility. VA Inspector General Michael Missal said in a video in March that his office received wide-ranging complaints to its hotline and from Congress members since the records system was launched at the Spokane VA. Complaints included unauthorized and inaccurate medication orders, errors in patients' name and genders, issues in scheduling primary care appointments, misdirected links to video medical appointments, and lost referrals.
The 2008 National Defense Authorization Act, a law passed annually by Congress to set guidelines on the defense budget and cover military-related programs led by other agencies, ordered the Defense Department and VA to have their electronic personal health information systems operate jointly. In the 2014 NDAA, lawmakers cited the agencies' efforts were unsuccessful and again required the DOD's and VA's electronic health records systems to exchange patient information with outside health care providers. The 2020 NDAA required the agencies to take an active role in managing the electronic health record to successfully exchange, use and move patient information from medical systems, devices and applications.
To meet the NDAA requirements, DOD and VA officials established the Federal Electronic Health Record Modernization Program office in December 2019. The office works with DOD, VA, Coast Guard and other federal agencies to expand the electronic health record system.
Officials for the Federal Electronic Health Record Modernization Program were tasked with coming up with a comprehensive strategy for the VA and DOD to share patient data seamlessly with each other, other agencies and external health care providers.
According to Federal Electronic Health Record Modernization's charter, its responsibilities include providing oversight and direction for the joint function execution, analyzing opportunities for collaboration and advocating for implementation efficiencies, and supporting interoperability across the federal and private sectors in conjunction with the VA and DOD.
The inspector general report said the FEHRM office did develop a strategy for the electronic health system to work, but it did not take an active role in managing the program's success. Moreover, the program office limited its part to aid in the DOD and VA disputes. The Federal Electronic Health Record Modernization only provided direction if the Defense Department or the VA reported an issue.
This led the two agencies to take separate actions. And the two agencies did not take all necessary actions to migrate patient health care information from the legacy electronic health care systems into the new Cerner system to create a single complete record. Additionally, they did not develop connections from medical devices to Cerner for patient information to upload into the system nor ensure users were granted access to the system to perform their duties.
The inspector general recommended the DOD and VA secretaries review the Federal Electronic Health Record Modernization's actions and oversee the program office's development of processes and procedures in accordance with its charter and the National Defense Authorization Acts. The inspector general also recommended FEHRM officials coordinate with Defense Department and VA officials to determine the type of health care information that makes a complete electronic health record.
Additionally, FEHRM leaders must also develop and enforce a plan for a transfer of patient health care information to the new electronic health record system.
In March, the VA inspector general released three reports focused on the complaints and failings within the electronic health record system's medication management, care coordination and the ticketing process, which the staff utilizes to request help and report issues. Officials for the inspector general reviewed allegations between January 2021 to June 2021.
Last year, the VA completed a review of the Cerner records system to overhaul it after hearing concerns from staff in Spokane, where the electronic record system was first implemented.
Last month, House lawmakers told VA officials to halt their launch of the agency's new electronic health records system at any other facilities until the problems that caused outages at the first two medical centers to use the new system are fixed. During the House hearing, the VA medical centers at Walla Walla and Spokane, both in Washington state, experienced an outage.
The VA launched its electronic health record system at the VA Central Ohio Health Care System in Columbus on April 30. It was the first VA health care facility outside of the Pacific Northwest to launch the Cerner Corp. records system.
The inspector general audit stated the DOD plans to deploy the Cerner system at 490 health care facilities by 2023. The VA plans to deploy the system at 1,454 health care facilities by 2028.
The VA is scheduled to launch the new system at Roseburg and White City, both in Oregon, on June 11, Boise, Idaho, on June 25, and Anchorage, Alaska, on July 16. Other VA facilities in the Puget Sound region of Washington state are expected to launch the system on Aug. 27.