DOD, VA Cerner implementations stumbling on their raison d’être–interoperability. Those of us with pre-Covid memories recall that the Department of Defense and the Department of Veterans Affairs had separate and ancient EHRs that didn’t speak well with each other. Going back to the Federal FY 2008 National Defense Authorization Act (NDAA), both DOD and VA had to become interoperable. Thus Cerner became the one-stop-shopping solution for both, after attempting to modernize their warhorse systems (AHLTA and VistA, respectively). DOD went first in 2015 and rolled it out through the Military Health System (MHS). The VA awarded it in 2018 and started to roll it out in 2020. (No one said that the US government works quickly.) This would also include the US Coast Guard, which is under the Department of Homeland Security.

Earlier this month, a joint VA and DOD audit by their respective Inspectors General (IG) found that both departments, plus the FEHRM (Federal Electronic Health Record Modernization) Program Office established by DOD and VA to oversee the process, as well as the joint health information exchange (HIE) established in 2020 by the FEHR, did not ensure interoperability between their systems. Specifically, they did not:

• Consistently migrate patient healthcare information from the legacy electronic health care systems into Cerner to create a single, complete patient EHR
• Develop interfaces from all medical devices to Cerner Millennium so that patient healthcare information will automatically upload to the system from those devices
• Ensure that users were granted access to Cerner Millennium for only the information needed to perform their duties

Most of the audit pointed responsibility at the FEHRM for not taking an active role in the program, instead acting as a facilitator. The IGs recommended a review by DOD and VA of FEHRM’s procedures, develop processes and procedures to ‘comply with its charter’ and the recommendations of the audit, as well as the NDAA.

VA’s problems with the first implementation at Mann-Grandstaff VA Medical Center in Spokane, Washington in late 2020 blew up embarrassingly last year before the Senate Veterans Affairs Committee [TTA 28 July 2021]. GAO further barked at them in a ‘watchdog’ report published in January. It followed VA’s own “mea culpa/go forth and sin no more” reorganization plan in December. Healthcare IT News, Healthcare Dive