Military Update: Civilian furloughs expected to hit hard

The Obama administration pared back its plan to develop a single integrated electronic health record system for the departments of Defense and Veterans Affairs due to shrinking defense budgets and rising costs.

If the single system were built "from scratch," as planned, it would cost up to $12 billion, double the estimate given to Congress two years ago.

These details came to light last week during a hearing of the House Veterans Affairs Committee where VA and Defense health officials had uncomfortable moments explaining the new plan.

They also heard the Government Accountability Office criticize the DoD-VA electronic record integration effort as plagued "by long-standing project management and planning weaknesses, inadequate accountability and poor oversight, which often has led to changes in the departments' priorities, focus and time frames for completing the initiatives."

VA and DoD officials testified that, while they will not adopt a single e-record health system, they are accelerating plans to make those two systems operate like one, at least from the view of clinicians and patients.

"I would like to assure members of this committee that, press reports not withstanding, the DoD and VA remain committed to achieving the goals of the (integrated electronic health record) program: that is common data, common (software) applications and a common user interface," said Roger W. Baker, assistant secretary of VA for information and technology.

"We are looking to achieve those goals through a lower-risk, lower-cost path than we were on," Baker added.

Maintaining separate health record systems adds challenges for making them behave as truly seamless for users.

Something called a graphical user interface, for example, is needed to make two different records look the same. Having separate systems also make developing common software applications more difficult.

But VA officials sounded relieved to be able to keep their own health records system, known as Vista. Defense officials, meanwhile, said they are shopping for an e-records system from among commercial sources. They also have not yet ruled out using Vista as the "core" e-record system if ways could be found to modernize it and adapt it to military-unique needs.

Rep. Jeff Miller, R-Fla., committee chairman, said he and colleagues were surprised and disappointed by the decision. He listed several occasions over the past year, most recently last December, when senior VA and DoD officials gave assurances that progress toward rollout of an integrated health record was steady and its launch in 2017 was on schedule.

"I am concerned that this new approach is a step backwards towards the model that had been previously tried and failed — namely maintaining two different systems between two different departments and wishfully thinking that the two systems will eventually talk to one another," Miller said.

Veterans' advocates argue that a single electronic health records system would ease military members' transition to veteran status, ending the hassle for newly separated members of having to hand-carry medical records to VA hospitals or clinics. It also could speed processing of VA compensation claims and help to relieve the rising claims backlog.

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at:

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