Despite a presidential task force and a presidential commission, the Department of Defense and Department of Veterans Affairs continue to slowly creep along in their effort to build a streamlined information system around electronic health records (EHRs). According to a recent Government Accountability Office (GAO) report, the DOD and VA lack a documented strategy for measuring outcomes and performance.
In the latest round of governmental pressure to modernize, the GAO is auditing efforts of both agencies to integrate their health record systems by the fall of 2009. In their second review of the department's IT marriage, the GAO reported missing links in achieving interoperable systems bliss. In sum, the DOD and VA failed to jointly outline and document performance measures or ‘results-oriented measures' that gauge their progress.
Success in Baby Steps...
Currently, the VA and DOD are sharing pharmaceutical information across over 21,000 patient records. The shared data repository - the Clinical Health Data Repository (CHDR, pronounced "cheddar") - is used to safeguard against medical errors. These errors include drug interactions and potential allergic reactions to prescribed regimens.
The agencies have also outlined a new strategy for integrating their health information systems - although they've been trying to do this for the better part of a decade - including the creation of an inter-agency office that would oversee and implement the massive EHR project. VA and DoD officials have consistently testified before Congress that the data partnership is underway and that they've even received EHR certification from the Certification Commission for Healthcare Information Technology, an independent, non-profit oversight group for EHR products.
How to Measure Success? Um, How About a Deadline?
While one would think that these governmental giants would have seen the memo on results-oriented goal setting and performance measures (Vice President Al Gore, 1996), one cannot mock their enormous task...too much. Bridging different systems - many of them legacy - in order to reach the accepted level of interoperability as advised by the Department of Health and Human Services is a monumental task. However, few milestones have been set. The GAO reports that the strategy lacks clear dates and deliverables for task completion.
"Another activity calls for the review of national health IT standards, but does not provide a tangible deliverable to determine progress in achieving the goal," says the GAO in their January report.
As critiqued by watchdog groups, the DOD and VA have spent over $1 billion dollars and began their EHR project over a decade ago. Unfortunately, the bureaucratic giants are far from reaching full EHR interoperability by their mandated live date of September 2009.
Hey Private Sector, Are You Paying Attention?
To enhance understanding of the importance and challenge behind interoperable EHR systems, the GAO report presents a simplistic and helpful typology. Seemingly in line with the PC vs. Mac catch phrase battle, the GAO introduces the line: "I am interoperable and computable-are you?" to highlight EHR interoperability levels and their benefits. For example, reaching the highest level of interoperability (i.e. computable electronic data) is vital for providing decision support and alerts for clinicians regarding a patient's health. Clinical note taking, however, may not need to reach the highest level of interoperability. A PDF-style readable (unstructured viewable data) can suffice.
The VA/DOD project is a cautionary tale for practices of every size that are contemplating EHR systems as a result of the stimulus package. Determining what level of interoperability that a practice needs in order to meet both government criteria and the needs of its patients is a vital step prior to implementation. Undertaking a massive interoperability project that involves older and newer systems is daunting, as evidenced by the VA/DOD attempt at information sharing. The lesson learned is that determining specific benchmarks that isolate needed results is an important strategy in reaching an acceptable level of success. In short, don't try to get a 100 percent solution right out of the gates. Start simply and build from there. Of course, those lacking any electronic healthcare record system have the advantage of the newer, more seamless technology solutions - an unfortunate reality for DoD and the VA.
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