Who's minding the store on DOD-VA health systems collaboration?

When the Pentagon and the Department of Veterans Affairs abandoned plans to develop a joint electronic health record in 2013, the responsibility for creating standards of data interoperability between the VA's Vista system and the multiple legacy systems at DOD fell to the small Interagency Program Office.

The IPO, initially created at DOD in 2009 to develop requirements for a joint system, took on the role of handing data interoperability issues in 2013 as VA modernized Vista and DOD embarked on a commercial health record procurement. That role led to the development of the much reviled Joint-Legacy Viewer, a read-only system that allows clinicians inside VA and DOD to look up health records of patients across both systems. It is also available to some extent to private-sector providers.

Now that VA and DOD are both on the road to implementing health record software from health technology vendor Cerner, the current role of the IPO is unclear.

At a Sept. 13 House hearing, IPO Director Lauren Thompson said that her office was not staffed or resourced to act as a decision-making authority to deal with governance conflicts that will inevitably arise between the DOD and VA electronic health record modernization projects.

"I don't believe today we are configured to support a single point of accountability as is being suggested here today," Thompson said.

Carol Harris, who leads IT acquisition management issues at the Government Accountability Office, said that one solution might be for Congress "to relieve the IPO of the legislative requirement to act as the single point of accountability" when it comes to health record interoperability.

"The IPO, based on history, has demonstrated that they have not had the clout to mediate and resolve the issues between the two departments," Harris said. "The performance of the IPO has been relatively lackluster."

Harris and some members of the newly formed Technology Modernization Subcommittee of the House Veterans Affairs Committee are looking for a high-level executive body, perhaps at the deputy secretary level of one of the two organizations, to take the leading role in ironing out disputes and conflicts in the implementations before they lead to technical failures or cause cost overruns or project delays.

John Windom, the program executive officer who leads the VA's Cerner implementation and who played a leading role in developing the DOD's solicitation for a electronic health records system, urged members to be mindful of the complexities involved and the need for people on the ground to manage issues like data standards, workflow and other governance processes.

"Governance has to be successful at the lowest possible level," Windom said. "Things can't rise to the superior level on every matter."

House Veterans Affairs Committee Chairman Rep. Phil Roe (R-Tenn.) said, "There needs to be a buck-stops-here person in this organization" to take responsibility for the success of the overall DOD and VA modernization system, jointly budgeted at more than $20 billion over 10 years.

Rep. Mike Coffman (R-Colo.) said he wants a lead agency to be designated to manage the implementation process.

"I think from Day One we made a terrible mistake -- the prior administration continued by this administration, in not saying to both of these major players that ... one of you is in charge," Coffman said. "By not doing that, we've created this consensus situation where we hope that it's going to get done, but we don't know that it's going to get done."