Since 1982, the Department of Defense (DoD) and the Department of Veterans Affairs (VA) have been trying to create a simple, interoperable system that could transfer patient information for service members transitioning from the DoD into the VA health care system. This process has been anything but smooth, starting with paper medical records being attached to gurneys each time a patient was moved to the squandering of hundreds of millions of dollars on numerous attempts to create an electronic health records (EHR) system that could work in both agencies.
Until June 2017, the VA used the same EHR system for nearly 40 years, the Veterans Health Information System and Technology Architecture (VistA). It is an open source platform that permits modifications by health care information technologists based on the perceived needs of each clinic or medical center. Unfortunately, this led the VA to customize the VistA EHR system in each facility without any centralized planning. It also caused difficulties for the VA and the DoD to provide interoperable health care management to service members and veterans.
The VA finally decided to phase out the VistA EHR and adopt the DoD’s new EHR system, known as MHS GENESIS. This 10-year, $10 billion process to house all patient data for both the VA and the DoD in one common platform will help enable seamless care between the two agencies.
In a sign of progress in this efforts, on July 29, 2019, the VA transferred 23.5 million veteran patient records to the shared Cerner Data Center, a critical milestone that will enable the transition of these records into the new EHR system. But, like many other well-intended federal programs, all is not well with the interoperability of all veterans’ health records.
On Aug. 21, 2019, the VA Office of Inspector General (VAOIG) released the results of an audit regarding the digitization of medical records for veterans at Veterans Health Administration (VHA) facilities. The OIG found that as of July 19, 2018, there was a significant backlog of “paper documentation that measured approximately 5.15 miles high and contained at least 597,000 individual electronic document files dating back to October 2016.” The scanning of medical documents was not always subject to the proper reviews, including quality and legibility. This failure to provide up-to-date information puts “continuity of care at risk” and “makes it challenging to ensure [patients] receive accurate diagnoses and timely care.”
The OIG recommended that the VHA take steps to improve the management of scanning activities with sufficient resources and staffing to ensure “appropriate quality assurance monitoring.” That includes the creation of an adequate training program for personnel who scan and index medical records.
Under the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act), veterans are now allowed to seek medical care not just through VA medical facilities, but also through telehealth virtual options and community health care providers. This was a welcome and much-needed change to the delivery of health care to veterans, but the additional treatment options have also made the transfer of EHR information more complex.
The VHA has both a massive backlog of medical records and insufficient resources to ensure the accuracy of the medical records that have been and are waiting to be transferred. Unless patient information is 100 percent accurate, there is no assurance that the care veterans receive as they transition from DoD healthcare to VA healthcare will be what they need and deserve.
VA officials should take the advice of the VAOIG and move quickly to resolve the issues raised in the report. Otherwise, the lengthy and expensive process to move all patient data to the Cerner Data Center will become much longer and more costly, to the detriment of the nation’s veterans and taxpayers.
Deborah Collier is director of technology and telecommunications policy for Citizens Against Government Waste.
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