OIG Finds Health Data Migration Inconsistencies in VA, DoD EHR Project

An OIG report revealed that data migration and end-user access challenges have hampered the joint DoD and VA EHR implementation.

The Department of Defense (DoD) and Department of Veterans Affairs (VA) did not consistently migrate patient health data from legacy EHR systems when implementing a common Cerner Millennium EHR, according to a joint DoD and VA OIG report.

The DoD and VA set out to achieve interoperability of patient health information across DoD, VA, and external healthcare providers by deploying the Cerner EHR system at 49 DoD facilities and one VA healthcare facility.  

However, according to the report, the departments did not take all actions needed to achieve interoperability.

Specifically, DoD and VA did not consistently migrate patient healthcare information from the legacy EHR systems to create a single, complete patient EHR.

The departments also failed to develop interfaces from all medical devices to the new EHR to automatically upload patient health data to the system from those devices.

Additionally, DoD and VA did not ensure that users were limited to accessing EHR data specifically for their job duties.

The OIG report noted that a lack of involvement from the Federal Electronic Health Record Modernization (FEHRM) Program Office contributed to these interoperability issues.

“The DoD and the VA did not take all action necessary to achieve interoperability because FEHRM Program Office officials did not develop and implement a plan to achieve all FY 2020 NDAA requirements or take an active role to manage the program’s success as authorized by its charter,” the report authors explained.

“Instead, FEHRM Program Office officials limited their role to facilitating discussions when disputes arose between the DoD and the VA, and would only provide direction if the Departments reported a problem,” the authors added.

Due to a lack of management from the FEHRM Program Office, DoD and VA took separate actions to migrate patient health information, develop interfaces, and grant user access to Cerner Millennium.

“We recommend that the Deputy Secretary of Defense and the Deputy Secretary of Veterans Affairs review the actions of the FEHRM Program Office and direct the FEHRM Program Office to develop processes and procedures in accordance with the FEHRM Program Office charter and the National Defense Authorization Acts,” the OIG report suggested.

Additionally, the report called on the FEHRM Program Office director, the Defense Health Agency director, the program executive director of the VA Office of EHRM Integration, and the program manager for DoD Healthcare Management System Modernization to determine the type of health data that constitutes a complete EHR.

The OIG audit also suggested the FEHRM Program Office develop and implement a plan to modify Cerner Millennium user roles to ensure that users only have access to patient health information necessary to perform their job responsibilities.

The deputy secretary of defense and the VA deputy secretary agreed with the recommendation to review the actions of the FEHRM Program Office and direct the FEHRM Program Office to develop procedures based on OIG advice.

The deputy secretaries also stated that they would ensure the FEHRM Program Office complies with its charter and applicable NDAA requirements.

The FEHRM Program Office director agreed with the recommendations to determine the health information that constitutes a complete EHR and implement a plan to migrate that patient information to Cerner Millennium.

However, the director stated that the FEHRM Program Office needed resourcing and appropriate delegations of authority from the DoD and VA to address the recommendations.

The director also stated that the FEHRM Program Office was prepared to begin executing actions when allocated funding, staffing, and authorities.

“Although the Director agreed, we consider the recommendations unresolved because the Director made any actions contingent upon the DoD and VA providing additional authorities and resources,” the OIG authors wrote.

“It is the Director’s responsibility to request needed resources and authorities from the DoD and VA; therefore, we request that the FEHRM Program Office Director provide additional comments describing the actions the FEHRM Program Office plans to take to identify the resources needed to execute its mission and request the authorities needed to address the recommendations,” the report noted.

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