healthcarereimagined

• Robert Huckman
• Maya Uppaluru

Leaders of most internet-based businesses have realized the critical importance of using open application programming interfaces (APIs) to expand the reach of their organizations. If the health care industry followed suit, the impact on the quality and cost of care, the patient’s experience, and innovation could be enormous.

APIs are programming routines or protocols that allow software applications to share data. Organizations such as Amazon, IBM, Salesforce.com, Facebook, and Google, have all engaged in substantial API “releases” that permit developers to access information so they can build new applications or businesses. For many of these organizations, there is massive potential to create new value. Ultimately, this type of innovation serves the end customer — creating better functionality and experience for the user.

The impact of open, standardized APIs in health care would be even more significant. In a health care market where APIs are commonplace, patients could have easy, efficient access to their own data, which would help them understand their own health and make more informed choices. Providers would be empowered by innovative user interfaces and analytics platforms that could support their clinical decision making. Researchers could have easier access to detailed clinical and claims data to create hypotheses and identify trends — and create a better experience for individuals donating their data for science. Finally, the availability of data would lead to the development of an entirely new group of health care innovators: developers who do not have particular expertise in health care but, when given secure access to clinical data from the industry, could create tools of significant value. Together, these benefits could allow the health care system to tap the true potential of its massive data resources.

Efforts to “liberate” health care data for third-party applications have progressed slowly, because the sector lacks the robust APIs and app developer programs common in other industries. This creates major challenges with respect to care quality, safety, and cost. For example, consider the case in which a stroke patient is prescribed a clot-busting medication in the ER, but the record of her dosage does not follow her seamlessly to other units within the same hospital. Even worse, the full record of her ER stay may not follow her back to her primary care provider. Similarly, the parents of a child with diabetes may not be able to get access to their child’s records, impairing their ability to monitor their child’s condition effectively.

In the United States, the American Recovery and Reinvestment Act of 2009 introduced the Medicare and Medicaid EHR Incentive Program, which is administered by the Centers for Medicare and Medicaid Services (CMS). This program provided financial incentives to adopt certified EHR technology systems and includes requirements that specific providers “meaningfully use” these systems. As a result of this program, 97% of reported hospitals had certified EHR technology in 2014, up from 72% in 2011.

Their success in meeting meaningful use requirements affects the level of Medicare reimbursement that they receive. Among other objectives, meaningful use includes the requirement that providers enable their patients to (1) view, (2) download, and (3) transmit their health data to a third party (known as the “VDT” requirement). The most-recent meaningful use regulations — the widespread implementation of which is currently due to occur in 2018 — add a fourth requirement that patients be able to access their health information through an API via the application of their choice. This new functionality would not only enable EHR systems to share data with patients but would also help to create system-wide interoperability between different providers and EHR systems.

For patients and their caregivers, the benefits of interoperability and easier access to data via APIs are obvious. Today, patients often have to deal with a different patient portal for each provider they visit. Open APIs will make it easier for both vendors and start-ups to create web and mobile applications that retrieve patients’ clinical data from various EHR portals and aggregate the information in a single location.

For providers, who often report difficulty with using EHR technology, APIs represent an opportunity for internal innovation. Open APIs can allow provider systems to build their own custom user interfaces in-house or shop around for a better solution than the interface that comes standard with their EHR system. EHRs could eventually become a platform on top of which other companies could build more tailored applications and improve usability for clinicians.

For researchers, a less-obvious benefit of open APIs in health care is the potential created for a wide range of individuals or organizations to engage in “citizen science” by performing analysis of trends in utilization, cost, or outcomes using a large population of aggregate, anonymized medical records. The Stanford Children’s Health system in the San Francisco Bay Area has developed an open source, analytics platform for diabetes management, leveraging its EHR’s API and Apple Healthkit, which can be implemented by any physician to improve understanding of patient trends over time. The Stanford team works with the DexCom blood-glucose-monitoring device, which has an app that sends continuous patient data into the EHR, allowing patients and their providers to make shared decisions about treatment.

Other projects like the Personal Genome Project are aggregating individually donated genome, health, and trait data from thousands of participants to help citizen scientists interpret genetic variants. PatientsLikeMe, an online clinical-research platform driven by individual data donation, aims to deliver real-time patient insight into many diseases and conditions. In some cases, it has raised questions about established approaches to treatment. In 2011, a patient-initiated observational study using the PatientsLikeMe platform was published, refuting a 2008 study claiming that lithium carbonate could slow the progression of amyotrophic lateral sclerosis (ALS). With easier access to clinical data, authorized and mediated by the participant, open databases like this could become powerful tools for fueling precision medicine and data-driven, individualized care.

Given their significant potential to improve value in health care, the immediate question is how we can accelerate progress toward broader use of open APIs within the industry. We see four main needs in this regard:

1. Financial incentives for providers need to encourage the data exchange necessary to deliver better outcomes. The health care industry is in the midst of a massive shift away from fee-for-service models to value-based care that ties reimbursement to better outcomes, lower costs, and higher patient satisfaction. Payments under Medicare’s new merit-based incentive payment system (MIPS) as well as new incentives for professionals participating in alternative payment models will go into effect starting in 2019. Both these programs contain requirements for providers to leverage certified EHR technology to improve care delivery. When providers face an incentive to exchange data to support better outcomes, the business case for implementing APIs becomes much clearer.

2. The concerns of both patients and providers around privacy and security must be addressed. There are legitimate security issues that arise with exchanging data. However, the rest of the consumer and business internet has adopted and extensively deployed standards for the secure exchange of sensitive data like OAuth 2.0 and Open ID Connect to facilitate authentication and authorization using APIs. While the health care industry and health data is certainly subject to unique security and privacy considerations, providers can benefit from leveraging these standards and safeguards to support patient access, while preserving privacy, security, and patient preferences.

3. Vendors should implement open standardized APIs with transparent terms of use, policies, and developer fees. Today, integration with EHR vendors’ varied and proprietary APIs can be costly and resource intensive. No standard has yet been adopted across the market, although promising work is being conducted by Project Argonaut to support emerging standards for health care APIs. Further, there is little transparency into the anticipated costs and policies associated with each unique API. In this environment, small start-ups don’t know what to expect and can be priced out or limited in their partnering options with different EHR vendors.

4. Cultural and workflow issues within health systems must be addressed. Providers often fear being paralyzed by a deluge of data when APIs are implemented that allow patient-generated data to enter the system — or fear that releasing data may cause them to lose patients. When APIs are implemented in practice, however, these fears are rarely realized. To the contrary, modern technology and analytics have the potential to add value to the decision-making process for providers and patients; in other industries we’ve found that making systems interoperable improves both the user experience and retention of customers. At Ochsner Health System, a pilot program to prevent heart failure and hypertension used an API to collect body weight and blood pressure data from over 500 individuals’ connected devices, leading to significant reductions in hospitalizations and improved blood pressure control. Despite initial provider concerns, the results from these and other pilots across the country have shown the potential of APIs to improve care and create a better experience for patients and providers alike.

To truly build a health care system that can evolve at the rapid pace of technology and science, we must tackle these formidable challenges head on. Open APIs provide massive potential for increased patient empowerment and shared decision making between providers and patients that may transform the delivery of health care.

This article is the result of independent research and does not represent the views of the White House, the Office of Science and Technology Policy, or any other entity of the U.S. federal government.

Article link: https://hbr.org/2015/12/the-untapped-potential-of-health-care-apis?utm_content=buffer83c58&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

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Robert Huckman is the Albert J. Weatherhead III Professor of Business Administration at Harvard Business School and is the current faculty chair of the HBS Health Care Initiative.

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Maya Uppaluru is a policy advisor at the White House Office of Science and Technology Policy and has also served in policy and innovation roles at the Office of the National Coordinator for Health IT and the Federal Communications Commission. She previously led communications and outreach for Grameen Foundation. She is a graduate of the University of Maryland School of Law and the University of California at Irvine.

By Joseph Conn  | April 17, 2015

American tax payers have spent billions funding our current healthcare computer systems.

“Cash for Clunkers,” he calls it.

“[The legislation] gave $30 billion,” says technology entrepreneur Jonathan Bush, “to buy the very pre-internet systems that all of the doctors and hospitals had already looked at and rejected.”

And, he’s right. We’re using clunkers. Paid for by the U.S.A.

The reason for this is simple. These government subsidized and heavily regulated software systems were never designed for the physician end-user. They were built to satisfy thousands and thousands of pages of federal regulations. And, they’ve essentially achieved two things: (1) to create privilege for some, and (2) to politicize everything for the rest of us.

I use these software systems every day. I constantly make reasonable requests to health IT for their improvement. But, nothing changes. And, why should it? The success of the product is not intimately tied to the experience of the one using it. It’s backwards economics.

Every medicine I try to order in this one system requires four clicks and three inputed letters to override some illogical electronic “alert” that pops up. The alert message is supposed to be protecting patients. But, it’s another regulation that does nothing of the sort in this system. No physician even pays attention to these alerts anymore. We just click, type, type, type, click, click, and click. Done.

For three years, I’ve been trying to get them to fix this problem. The alerts are like a perpetual beep that never stops. Ultimately, you just ignore it, and the intended purpose is dead.

Well, physicians have been ignoring these alerts for years. Evidently, it’s the same amount of time they’ve been ignoring my request to fix it. You might enjoy my actual message to them this week:

Dear Mark [name changed to protect the innocent],

You must help me, friend.

Either you and I fix this together, or we might as well both throw in the towel and retire. Medicine, all of medicine, depends on you and me. It depends on us now. We are its last frontier.

Mark, I order just one medicine.

One.

Aspirin 81mg by mouth daily.

It’s the most common dose we order these days. It is the only medicine my patient is getting. The only one. For the record, my patient can buy it over-the-counter himself.

I sign off on the medicine, and then, BEEP!

An alert.

Imagine that.

I get an alert.

It’s a DDAD alert, whatever that means. Wonder what it might say…?

It says, “The daily dose of 81 mg is below the usual dose of 324 mg to 4000 mg.”

Click here… type, type, type, click, click, and click, to override.

Mark, we work in dung every day, but this is the worst of it.

Get them to turn this off. All of it. All of the nonsense alerts. Send this message to someone at central authority who might actually care about doing something right. Actually make something better.

I’m going to keep pacing back and forth staring at the screen.

Onward.

-Rocky

They call physicians like me complainers. Non-conformists. They say improving medical care depends on us doing it their way. If I object, I’m against “quality,” they say.

Yet, their model of data entry has no data proving it’s better. In fact, those that practice within it–along with the patent experience because of it–frequently say otherwise.

Telling you where medical providers hang out at the hospital these days is redundant. You already know. They are in the same centralized room or workspace. Typing and clicking and overriding one illogical alert after another. The patient is somewhere metaphorically far away.

This is our medical system.

The bureaucracy keeps ticking to its own heartbeat, while an apparent flat line awaits.

Hopefully, it will be for the current system and not its patients.

Article link: http://bilhartzmd.com/?p=3441&utm_content=bufferd2222&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

Secretary McDonald has initiated “12 breakthrough priorities” as the near term focus for modernizing VA. Try this on for size. By the end of this year, the Department of Veterans Affairs plans to transform the Office of Information and Technology and implement a “holistic Veteran data management strategy.” In business terms, that tech speak translates into “seamless care.”

It means that any Veteran can simply walk into any of our facilities and get care. Soon thereafter, personnel at the facility can immediately call up patients’ data on the screen, regardless of geography or the kind of facility. “Our goal is to make sure…that our systems recognize you as a veteran. You should be able to get care wherever you walk in to get care,” said Dr. David Shulkin, VA’s undersecretary for health. This Electronic Health Management Platform will integrate all records from all providers across the entire VA network.

Health care executives can probably appreciate the enormity of this task. Matching Electronic Health Records (EHRs) with the right patient is still a challenge for the private sector. According to a recent article in Modern Healthcare, error rates can be as high as 50 percent. And remember, most hospital systems are a fraction of the size of VA’s 152 medical centers, the largest integrated health care system in the United States.

Consequently, VA gives you the opportunity to manage health care on the leading edge, where vast amounts of changing information empower your direct providers to make good decisions. Isn’t that why you got into health care management in the first place?

There are a lot of opportunities available at VA – and not just in the health care field. This is a significant IT challenge, and VA has additional information technology goals to tackle as well. Regardless of your profession, take an opportunity to research your job options and Join VA.

Article link:http://www.blogs.va.gov/VAntage/26051/help-turn-va-into-one-of-americas-most-advanced-medical-systems/

Read this blog as Secretary McDonald discusses his transformation plan, MyVA.

M. Gregg Bloche, M.D., J.D.

N Engl J Med 2016; 374:1001-1003March 17, 2016DOI: 10.1056/NEJMp1502629

Audio Interview

Interview with Dr. Ashish Jha on lessons from the recent Veterans Health Administration crisis and future directions at the VA. (4:55)

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In 2014, Americans reacted with outrage to reports that personnel at Veterans Health Administration (VA) medical centers had schemed to feign compliance with targeted waiting times for appointments. Whistle-blowers outed miscreants, alleging that clinical delays had caused scores of avoidable deaths. Political leaders blamed bad actors — and each other. Investigations led to firings — and congressional fury that not enough heads were rolling. The prevailing narrative was one of breakdowns of character and culture: dishonesty, callousness, and ineptitude.

Several years earlier, a similar scenario played out in Britain’s National Health Service (NHS), which had set waiting-time and quality-of-care targets that many facilities struggled to meet. The struggles of one facility, in the county of Staffordshire, became a scandal.

When, in 2008, an inquiry was opened into elevated mortality rates at Mid-Staffordshire’s main hospital, its chief executive ascribed these numbers to a coding glitch. But patients, family members, and physicians told horror stories of neglect. Over the next 5 years, investigations showed pervasive clinical lapses and gaming of systems to meet targets at this and other NHS hospitals. As with the VA scandal, politicians blamed individual perpetrators and one another, and the prevailing narrative highlighted lapses of character and culture.

But closer scrutiny reveals another parallel, with important implications for cost-control efforts. In both cases, performance standards often proved incompatible with resource constraints. Yet the gap between the two remained unmentionable amid pressure to make care both better and cheaper. Outbreaks of dishonesty resulted, as personnel tried to finesse failures with fakery. The fakery was discovered, and perpetrators were punished. But the truth that trade-offs between quality and cost were embedded in budget constraints remained submerged.

The gap between the care the United States promises veterans and the care it provides dates back a century: complaints about clinical overcrowding and corruption beset the Bureau of War Risk, the VA’s predecessor, from its beginning.1 Ousters and reorganizations were repeatedly followed by new revelations of shortages, neglect, and duplicity. The most recent cycle of revelation and outrage peaked in April 2014, when CNN reported that the Phoenix VA had shunted more than 1400 sick patients to an off-the-books list to hide failures to meet wait-time targets. Some patients had died without seeing a doctor. Others were put on the official list only when appointments could be scheduled within the 14-day-maximum wait time.

Anger over this deception dominated the public response. But inquiries by the VA inspector general (IG)2 and the White House3 showed large gaps between demand and clinical capacity. Wait-time targets failed to account for shortages of specialists, clinic space, and other resources, investigators concluded. Better administrative practice couldn’t fully bridge these gaps.

The IG found similar problems at many VA facilities. By August 2014, a total of 93 sites were under investigation for allegedly manipulating wait times.2 Congress quieted the outrage by giving the VA $16.3 billion to hire more clinicians and pay for private care as a stopgap. But it neither offered a long-term plan to align resources with demand nor conceded the need to weigh therapeutic benefit against costs.

The Mid-Staffordshire scandal similarly grew from a gap between resources and expectations. Annual deficits and NHS funding cuts forced Mid-Staffordshire to begin borrowing in 2003–2004 to cover costs.4 Downsizing ensued. Specialized hospital units were replaced by merged units with less-specialized staff.

Meanwhile, the British government adopted market-style reforms meant to reward frugality. Local health care networks were invited to bear risk, as “Foundation Trusts,” in return for enhanced autonomy and a share of savings. Waiting-time and other performance targets were introduced. Mid-Staffordshire’s leaders aggressively pursued Foundation Trust status, pressing clinical managers to slash spending to meet approval standards.

A government-commissioned inquiry by Sir Robert Francis revealed how these circumstances combined to create a major health care scandal.4 Francis’s report describes how Mid-Staffordshire’s leaders imposed cuts without assessing risks, then intimidated staff into suppressing their concerns. Overwhelmed clinicians, Francis concluded, couldn’t remain conscientious and still keep up. Receptionists performed emergency department triage. Meals were left out of reach of bedridden patients. Drug doses were missed. Incontinent patients weren’t cleaned. And impossibility engendered emotional disconnection. One physician told Francis, “What happens is you become immune to the sound of pain” — or “you walk away. You cannot . . . continue to want to do the best you possibly can when the system says no to you.”

Meanwhile, management insisted that NHS performance targets be met, punishing breaches even when compliance did more harm than good. Emergency department nurses told of delaying the start of antibiotics, pain medication, and other needed treatment to attend to less-needy patients within the 4-hour wait-time limit. Staff who missed targets feared being fired. This fear, Francis found, led to premature discharges and falsification of records.

Francis’s investigation showed how failure to address conflict between pursuit of quality and thrift begets frustration, neglect, and worse. Both scandals, moreover, spotlight the limits of deceit. Outraged caregivers, patients, and family members exposed gamesmanship and maltreatment. Impossible expectations led to abuses that proved impossible to hide.

“There’s a defined pot of money,” Francis told me last year. “But there’s a public expectation — there’s also a professional expectation — I should be allowed to do everything that’s in my patient’s interest . . . . Politicians promise the same. When that doesn’t work, it’s the fault of the [institution’s] leadership.” The result is a “toxic atmosphere” that “prevents those who are running the show from telling the truth” — and signals caregivers to keep quiet.

This analysis doesn’t let clinicians off the hook for dishonesty or neglect. But it underscores that these scandals are sentinel events — indicators of the risk that caregivers will move from frustration to insensitivity to corruption when put in an impossible bind between demands for frugality and demands for excellence.

Some institutions do better than others at achieving thrift while limiting ill effects. Identifying management practices that maximize clinical value within budget constraints is a vital policy priority. But management methods are blunt tools. They leave room for gaming. They encounter “bounded rationality” — psychologists’ term for people’s finite abilities to understand and respond to complex reward-and-sanction schemes. Rules and incentives, moreover, often corrode intrinsic motivation to avoid shirking and self-dealing.

Cost–quality trade-offs pervade medicine. Studies of the relationship between cost and clinical outcomes at many hospitals, including VA facilities,5 show correlations between higher spending and better results, especially when spending variation arises from different levels of care. The myth that we can control costs without forgoing therapeutic benefit is belied by mounting evidence.

As cost pressures build, failure to admit the need for trade-offs will make scandals more likely. Yet we’ve not begun a public discussion about how to make them. Policymakers keep silent lest they be accused of “rationing.” Professional leaders prefer to cast quality and cost reduction as complementary. They often are, as the Institute for Healthcare Improvement’s Triple Aim initiative has shown. But when they’re not, clinicians find themselves in a trackless wood.

Accountable care organizations (ACOs) are a case in point. Medicare’s Shared Savings Program, which rewards ACO physicians financially for restraining spending, claims both quality improvement and cost control as goals, but the latter is its main aim. Rewards are reduced for subpar scores on 25 clinical quality targets, but high scores yield no payoff without financial savings. The 25 metrics, moreover, track routine care and standardized outcomes; complex, individualized treatment courses are ill-represented. ACOs can therefore game the system by pursuing high scores while stinting on complex, high-cost care. Proliferating bundled-payment schemes multiply the possibilities for such gamesmanship, by rewarding providers for hitting cost and quality targets. The VA and NHS scandals underscore how such targets can misdirect us.

Outcome and process metrics that more broadly reflect what clinicians do can shrink the space for gamesmanship. But open discussion of how to make real cost–quality trade-offs is essential to stopping the progression from impossibility to the breakdown of professionalism and compassion — a progression that leads to scandal.

Touts success of Meaningful Use, but continued struggles with interoperability

In its annual report on the state of HIT to Congress, the Office of the National Coordinator looks back at the progress it made in 2015 and at the barriers that still need to be overcome.

The ONC says throughout 2016, it will continue to “build the economic case for interoperability,” coordinate with industry stakeholders to increase enhance consumer access to data, and to care and discourage health information blocking, among other goals.

Efforts that the agency highlights in the report made last year include broad, sweeping initiatives like the Health IT Strategic Plan 2015-2020 and its Interoperability Roadmap, as well as its growing role in areas like patient engagement, delivery system reform and precision medicine.

ONC also points to steps made in the Meaningful Use program, including publishing the requirements for Stage 3 of the program.

In addition, the agency touts successes from the MU program seen last year–such as the 482,000 healthcare professionals and 4,880 hospitals and critical access hospitals that received payment for adopting or implementing MU as of December 2015.

Of the barriers ONC will seek to address in the coming years, one of the key ones it lists in the report is interoperability. The agency says it will continue to work Congress “to determine ways to advance policies and practices that support provider-focused, person-centered interoperable health information exchange that advances health information exchange and deters information blocking.”

“Looking forward to 2016, we will continue to work in concert with our federal colleagues, Congress, and our private-sector partners to achieve a truly learning health system where electronic health information is available when and where it matters most,” National Coordinator Karen DeSalvo, M.D., and Matthew Swain, senior strategy analyst for ONC’s Office of Planning, Evaluation, and Analysis, write in a post at the Health IT Buzz blog.

ONC also recently announced a new initiative to help healthcare organizations “adapt and evolve ONC’s standards and technology work processes,” FierceHealthIT previously reported.

The ONC Tech Lab “will provide internal and external stakeholders with common connection points to ONC’s standards and technology efforts,” according to Steven Posnack, director of the agency’s Office of Standards and Technology.

To learn more:
– here’s the report (.pdf)
– read the blog post

Related Articles:
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Updated federal HIT strategic plan focuses on person-centered care
HHS releases updated Meaningful Use rules
ONC pushes adoption, evolution of standards through new initiative
ONC: Patient comfort levels with EHRs, data-sharing on the rise
CHIME, HIMSS, Cerner, Allscripts among health IT orgs jumping into precision medicine

March 2, 2016 | By Pam Baker

Given sweeping changes in healthcare ranging from the Affordable Care Act to precision medicine, most healthcare organizations find traditional health IT leaders insufficient for adeptly shifting the organization from volume to value-based payment models. That’s because the traditional CIO has plenty of technical skills but rarely has clinical skills or experience. Enter the new clinical IT executive to flip the IT model from tech-centric to patient-care-centric. And, yes, these new executives have mad tech skills, particularly in big data.

HIMSS, a nonprofit focused on improving health through information technology, just released its 27th annual leadership survey which is designed to identify generalized trends within U.S. healthcare IT. Seventy-one percent of the 282 IT executives and professionals in U.S. hospitals and health systems surveyed reported they employ a clinical IT executive. The researchers found that, based on analysis of a multitude of issues, that approach is working.

“The presence of a clinical IT executive in a healthcare provider organization appears to have a notable impact on the organization’s orientation towards health IT,” according to the report.

Check out the infographic with that report for an overview of other findings. Suffice it to say that most health organizations find it critical to have a clinical IT executive onboard – not to replace the CIO but to better align technology use to business goals through an executive with equally strong clinical and technical knowledge.

“Clinical IT executives clearly possess a unique and valued perspective regarding the criticality of health IT on an organization’s patient care focused efforts, and this orientation appears to be gaining traction in many organizations” said Lorren Pettit, vice president, research for HIMSS, in a statement to the press.  

“And while clinical IT executives are part of the overall executive team in many healthcare organizations, their presence is not universally true.  We will definitely continue to explore and track these issues in future HIMSS research studies.”

Specific areas respondents found health IT to be critical, as opposed to simply supportive, include:

• Clinical integration (74%)
• Primary care provider efficiency (72%)
• Mandated quality metrics improvement (68%)
• Care coordination (67%)

And, yes, big data and small data too are the very backbone of these efforts. Thus we have a new breed of big data specialists.

While the position of clinical IT executive grew organically in response to pressures in meeting mandates and profiting in spite of them, don’t be surprised if other industries follow suit and add executives primed to flip the IT model.

For more:
– see the press release
– see the report
– see the white paper

Article link: http://www.fiercebigdata.com/story/move-over-health-it-cio-rise-big-data-wielding-clinical-it-executives/2016-03-02?utm_medium=nl&utm_source=internal&mkt_tok=3RkMMJWWfF9wsRokua7Bce%2FhmjTEU5z14ugrX6K3lMI%2F0ER3fOvrPUfGjI4ETcpnMK%2BTFAwTG5toziV8R7LMKM1ty9MQWxTk

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By Frank Konkel March 2, 2016

Five years ago, Congress mandated the creation of the first medical center to be operated by both the departments of Defense and Veterans Affairs as a model for joint delivery of health care across both agencies.

In its short history, however, the Chicago-based Federal Health Care Center has struggled with costly IT and planning issues, according to a new Government Accountability Office report.

The report suggests IT infrastructure problems, first identified in 2012 when a $122 million project went over budget, have not been mitigated.

Both VA and DOD share resources at the facility, but to accommodate the agencies’ different network security standards, they share resources over three networks — not one. The resulting complexity has “impeded efficiency” for staff of both agencies to consistently access VA and DOD’s electronic health records system, according to the report.

Through upgrades and expanded data sharing support, DOD and VA have tried to improve the health care center’s IT infrastructure reliability. Aside from using a single network, there seems to be no clear-cut solution.

In responses to the GAO report, officials said a single-network IT infrastructure is not going to happen.

The problems uncovered in GAO’s latest report is, in one sense, a physical manifestation of the massive struggle between VA and DOD to seamlessly share electronic health records. The two agencies’ respective systems each manage some 10 million beneficiaries. Pentagon officials believe they are ready to certify health records interoperability required by the 2014 National Defense Authorization Act, but Congress and its watchdogs contend such interoperability is years away.

Last year, the Pentagon awarded Leidos and its partners a $9 billion contract to develop its next-generation electronic health records system. By 2022, Pentagon officials expect its commercial system to be “interoperable and running” with VA and other commercial platforms.

Article link: http://www.nextgov.com/defense/2016/03/it-problems-still-bedevil-dod-va-health-care-center/126378/?oref=nextgov_today_nl

March 4, 2016 | By Molly Bernhart Walker

The Captain James A. Lovell Federal Health Care Center in North Chicago is the first attempt to fully integrate the Veterans Affairs and Defense departments’ healthcare facilities, but officials told the Government Accountability Office they have no plans to find common ground on a single-network IT infrastructure at the facility.

Difficulties managing network connections and providing seamless access to software applications stemmed from the facility’s complex IT infrastructure, according to a GAO report published Feb. 29.

User credentials are a recurring problem, said auditors. For example, clinicians must access both VA’s Veterans Health Information Systems and Technology Architecture, or VistA, and DoD’s Armed Forces Health Longitudinal Technology Application, or AHLTA, to view complete patient prescription information.

Staff who do not routinely see both VA and DoD patients are less likely to regularly log in to both systems, but user credentials expire after different lengths of time for VistA and AHLTA due to differences in VA and DOD policies. Logins expire every 90 days for VistA and every 60 days for AHLTA, said the report.

“When access to VistA or AHLTA is lost, patient orders and test results may be incomplete, delayed or not transmitted, potentially impacting patient care and impeding staff efficiency,” said GAO.

IT infrastructure at the facility is actually comprised of three networks to accommodate differences in VA and DOD network security standards, and GAO found the departments spent approximately $17 million from 2011 to 2015 to troubleshoot the hospital’s network infrastructure, local IT capabilities and other IT issues.

Defense officials interviewed for the report said they are working with VA to upgrade the infrastructure, but both departments said there are no plans to resolve differences in network security standards or stand up a single-network IT infrastructure.

“According to VA officials, this is due, at least in part, to the departments’ different missions,” said the report.

The report, which made eight recommendations to the departments overall, also highlighted organizational challenges, such as VA and DoD’s struggles to select facility leadership.

“VA and DOD did not use – and have not yet developed – FHCC specific criteria to select individuals for the facility’s director (from VA) and deputy director (from the Navy) positions to ensure that they would be well suited for a collaborative environment,” said the report.

The departments also had a hard time making decisions regarding the integration of the civilian and active duty personnel at the facility. That’s in part because the facility did not conduct comprehensive, data-driven staffing analyses – considered a federal human capital management best practice.

“In December 2015, FHCC officials told GAO they had developed an initiative in the interim for reviewing staffing until VA and DOD conduct a more formal, comprehensive, data-driven review of the FHCC’s workforce,” said the report.

For more:
– download the report (.pdf)

Article link: http://www.fiercegovernmentit.com/story/va-dod-refuse-find-common-ground-it-infrastructure-joint-hospital/2016-03-04?utm_medium=nl&utm_source=internal&mkt_tok=3RkMMJWWfF9wsRokuanIe%252B%252FhmjTEU5z14ugrX6K3lMI%252F0ER3fOvrPUfGjI4ET8JmNK%252BTFAwTG5toziV8R7LMKM1ty9MQWxTk

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IT workarounds at VA-DoD health facility costly

March 4, 2016 | By Molly Bernhart Walker

The Veterans Affairs Department has taken a “step back” from its work evolving its open source electronic health records to review whether the program is on the right track and to instead focus on interoperability with the Defense Department’s forthcoming commercial electronic health records.

During a March 2 hearing before the House Appropriations subcommittee on military construction, Veterans Affairs and related agencies, VA Chief Information Officer LaVerne Council said the department had not yet decided if it might replace VistA with a commercial off the shelf solution.

VA is reviewing the program to consider what sort of capabilities will be needed for a healthcare tool “we can grow upon,” she said.

Despite the president’s fiscal 2017 budget request for VA including a $40 million reduction in funding for VistA Evolution, Undersecretary for Health at the Veterans Health Administration David Shulkin said “We are not slowing down anything on VistA. We have millions of dollars to enhance this.”

Shulkin said the VistA Evolution pause showed the department undertaking a careful review, to ensure BA is being a good steward of taxpayer dollars.

“We came into these roles to make sure this is the right plan for veterans and the right plan for the American public,” he said.

In recent years, VA has worked to modernize, and then “evolve” its Veterans Health Information Systems and Technology Architecture, known as VistA, to improve its capabilities and better enable it to share information with the Defense Department.

Council said the millions of dollars put toward VistA Evolution thus far have not been a waste.

“The dollars that were in the VistA Evolution were primarily focused not only on interoperability but also the sustainability of VistA in allowing it to grow,” she told lawmakers.

VistA Evolution investments included networking, infrastructure sustainment, the continuation of legacy capabilities and capability upgrades. It has also funded clinical terminology standardization, “which is a key part of being able to have care in the community or interface with care outside of the VA,” said Council.

While the business case review for VistA has halted further development of the platform for now, Council used the hearing to tout recent wins – such as surpassing 35,000 clinicians using the system’s Joint Legacy Viewer.

Council said the VA is on schedule to define clear interoperability with DoD in March and have key capability between VA’s Electronic Health Management Platform and DoD’s Defense Healthcare Management System Modernization platform by August.

Article link: http://www.fiercegovernmentit.com/story/future-vista-evolution-uncertain/2016-03-04?utm_medium=nl&utm_source=internal&mkt_tok=3RkMMJWWfF9wsRokuanIe%252B%252FhmjTEU5z14ugrX6K3lMI%252F0ER3fOvrPUfGjI4ET8JmNK%252BTFAwTG5toziV8R7LMKM1ty9MQWxTk

For more:
– go to the hearing page (includes archived webcast and prepared testimony)

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