March 20, 2014

By Leo Shane III
Military Times Staff writer

After being jilted again and again by the Pentagon in pursuit of a common digital health records system, the Veterans Affairs Department is hoping a new makeover will finally get its own system noticed — and perhaps get defense officials to commit to a long-term relationship after all.

The Pentagon and VA spent a decade and $1 billion developing plans for a common digital health records system, only to have the military step away last year. So VA officials are taking a new approach: using outside companies to sell the system as the perfect match for the military’s every desire.

Last week, VA Secretary Eric Shinseki told lawmakers he wants “to be in the competition” for the new defense records system, even though Pentagon planners haven’t expressed much enthusiasm for VA’s plans in the past.

At issue is the Veterans Health Information Systems and Technology Architecture, or VistA, VA’s longtime health records system. VA officials released their source code to commercial developers last year with an eye toward making it more interoperable with outside medical programs.

That’s led to a number of improvements in VA’s system, officials said, while creating a stronger private-sector base for it. Several private companies plan to bid to build the Defense Department’s new digital health records system, a multiyear, multibillion-dollar endeavor.

This means DoD could end up buying a new system that is compatible with VA’s records, based on VA’s software — the original, long-delayed goal — but with a commercial firm acting as a go-between.

That irony has befuddled lawmakers who wonder if troops and veterans will ever get the seamless, lifelong electronic medical files the Obama administration promised five years ago.

“Everybody seems to be protecting their own turf,” said Rep. Phil Roe, R-Tenn. “That might work well for them, but it’s not working well for troops and veterans.”

Roe puts the blame squarely on the Pentagon, saying VA “has done its job” in updating its records system, while DoD still contemplates its path ahead.

Decades-old goal

The idea of seamless military-to-veterans records has been a goal of the two departments for decades, but President Obama made it a formal promise in 2009.

Veterans’ advocates have long lamented the process of dragging hefty paper medical files from doctor to doctor to make sure service-connected injuries and past physician visits aren’t overlooked.

VA and defense officials had planned to solve that problem by upgrading their separate electronic medical records into a common digital system. But they abandoned that plan last spring, citing a $28 billion cost estimate.

At the time, defense officials considered switching to VA’s VistA system but instead opted to see if better, more compatible commercial options were available.

VA officials privately disagreed but publicly backed other plans to integrate the departments’ separate records in other ways. Officials in both VA and DoD say that despite their still-different systems, they have common displays for most digital medical files — allowing physicians from either department to see the same information about patient prescriptions, treatments and illnesses.

But lawmakers are still frustrated that DoD abandoned plans to share a single back-end software system and confused by DoD’s indifference toward VistA.

Many stories have been cited of missing and incompatible records leading to duplicate treatments, unnecessary operations and a host of headaches for veterans. Roe said his greatest fear is that “10 years from now, we’re still going to be here dealing with the same problems.”

DoD hopes to put a new records system fully in place by 2019. It has been soliciting input on its proposal request for months, gauging commercial firms’ interest and ideas before a formal bid process later this year.

Defense Secretary Chuck Hagel has publicly stated he is open to the idea of a VistA-based system, if the coupling would be beneficial to the military.

But a final decision might not come for years.