House committees on armed services and veterans affairs held a joint hearing Wednesday to review details of President Obama's plan to improve the Transition Assistance Program (TAP) for separating and retiring military members, with a kind of five-to-seven-day "reverse boot camp" available by late 2013 to smooth transition to civilian life and employment.
But lawmakers were more interested in asking their witnesses -- the secretaries of defense and of veteran affairs -- for progress on some older initiatives that so far have fallen short of helping veterans.
One such initiative is the integration of separate VA and Department of Defense electronic health record systems, a key component to achieving Obama's promise of a Virtual Lifetime Electronic Record (VLER) that would capture full health care histories on individuals, including private sector care.
Committee members said they were disappointed to learn that full integration of the VA and DoD health record systems won't occur until 2017. And Defense Secretary Leon Panetta and VA Secretary Eric Shinseki didn't sound confident about meeting that deadline.
"This is not easy," Panetta said. "So the way we're approaching it is to try to see if we can complete this process at two places, San Antonio and Hampton Roads (Va.). And then try to expand it to every other (VA and DoD) hospital. It's tough. But if we can achieve this, it would be a very significant achievement that I think could be a model not only for hospitals that we run but for hospitals in the private sector as well."
Shinseki acknowledged the two departments for 10 years have been discussing and taking interim steps toward an integrated Electronic Health Record (iEHR) system. He described as "ground breaking" the fact that he and Panetta agree now on what the system will be and are moving toward it.
"The way forward for us is a single, joint, common, integrated electronic health record" that will have "an open architecture, not proprietary in design. That is a significant change from previous discussions" focused on possible arrangements with a "proprietary contractor."
But Rep. Bill Johnson (R-Ohio), chairman of the VA subcommittee on oversight and investigations, told Shinseki and Panetta not to be satisfied with a 2017 deadline to give health care providers access to all VA and military electronic medical records. Johnson said he had a 30-year career in information technology, including at one point as staff director to the chief information officer on U.S. Special Operations Command.
"I know what it takes to get this stuff done and five years, gentlemen, is totally unacceptable," Johnson said.
He blamed VA, telling Shinseki his department lacked "an overall information technology architecture. You and I have talked about this before, and it still doesn't exist."
"I understand that you can't account for the last 10 years, Mr. Secretary," Johnson said. "And I understand that you've got two bureaucracies that don't necessarily like to be told what to do and (don't) get along all the time. But I will submit to you that another five years is unacceptable (and) ought to be unacceptable to you."
"I'll work with you," Shinseki promised Johnson. "We believe we have a good mark on an architecture. Obviously we haven't satisfied you. We will come back and work it again."
Rep. Jeff Miller (R-Fla.), chairman of the House Veterans Affairs Committee, contrasted progress integrating VA and DoD health records with the far more challenging effort in the '60s to land a man on the moon. "Why is it taking so long?" he asked.
Shinseki described two large departments with "maybe the two best electronic health records in the country and trying to bring that culture together to say 'We are going to have one and it's entirely possible.' "
"And I agree with you," Shinseki said, "it's not technology. It's leadership."
He and Panetta met four times in the past year to discuss this and other collaborative efforts. He held earlier meetings with Robert Gates, Panetta's predecessor. It took a total of 17 months to reach an agreement.
In April 2011, the departments announced that a preliminary version of the iEHR would be deployed by 2014 to medical facilities in San Antonio and Hampton Roads. Last November they re-chartered an Interagency Program Office (IPO) to serves as the single point of accountability for integrating health IT capabilities. But it wasn't until February this year that they hired Barclay P. Butler as IPO director.
In an interview last month, Butler, an information technologist with 31 years' experience supporting delivery of health services, including as chief information officer for the Army Medical Department, said VA and DoD continue to test "portability of information" across their separate systems at the James A. Lovell Federal Health Care Center in North Chicago as staff there treat veterans, military members and even military families.
"We are taking lessons learned (at Lovell) and applying them to the single integrated electronic medical records we are building in the IPO," Butler said. The big effort, he said, is building an infrastructure "runway on which we will land our clinical capabilities" as they readied to run as an integrated system in San Antonio and Hampton Roads areas where at least two services have hospitals and the VA runs polytrauma centers.
"There is so much more we can do to provide the clinician more complete information, more longitudinal data or more population health data so they can better care for their patients. It's all about improving quality of care at a reduced cost," Butler said.
The ultimate goal is a continuous health record that builds from the day a member enters service to "final honors" as a veteran. And regardless of where the service member is assigned, or the veteran lives, Butler said, the clinician would have "visibility into a complete and lifetime record."
Like his bosses, Butler mentioned the 2017 deadline to achieve full operational capability but he didn't bang that drum very hard.
"It certainly is a complex undertaking. I don't want to minimize that," Butler said. But the effort is "leading the nation in developing an electronic medical record that follows the patient throughout their lifetime."
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