Defense, VA hit by health IT cost overruns

Electronic health record and medical management system efforts may fail or be delayed despite federal investments worth billions of dollars.

By Charles Fiegl amednews staff — Posted Aug. 19, 2013

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Several federal health information technology projects may be delayed, cost more than anticipated or fail, according to a recent audit of major spending initiatives.

The federal budget for health IT, including some electronic health record systems, and other high-tech programs is expected to reach $82 billion in 2014. The Government Accountability Office studied investments in new systems and concluded that several stalled or delayed projects place $10.4 billion at risk. The projects include health IT programs at the Dept. of Defense and Dept. of Veterans Affairs.

Since 2003, the GAO counted 15 failed investments. For example, the VA ended a program to upgrade an outpatient scheduling system after spending $127 million over nine years in 2009. The department began a new effort to replace the 25-year-old system in May 2010.

The VA also had spent $1.9 billion to transition to a new EHR system but terminated the program in October 2010. Weaknesses in its earned value management processes were projected to lead to cost overruns.

The GAO warned that 17 projects could be in danger of failing or costing taxpayers more than forecast if significant challenges were not addressed. For example, the Defense Dept. is spending $2 billion on an EHR initiative called the armed forces health longitudinal technology application, or AHLTA. The EHR has met expectations for outpatient and dental care documentation, but other capabilities have been scaled back, and users of the system have complained about its performance. The Defense Dept. is working to improve AHLTA because it will help transition to a new system with greater functionality as a real-time EHR in 2015.

Plug pulled on joint EHR

The Defense Dept. and VA together have pursued the common goal of developing an integrated EHR at a cost of $25 billion. The EHR would allow the departments to share health information as well as consolidate resources. But in February, the secretaries for both departments said they would pursue diverging plans, with the VA modernizing its system and the Defense Dept. purchasing its new EHR.

“The secretaries offered several reasons for this new direction, including cutting costs, simplifying the problem of integrating DOD and VA health data, and meeting the needs of veterans and service members sooner rather than later,” the report stated. “Nevertheless, the departments' recent change in the program's direction and history of challenges to improving their health information systems heighten concern about whether this latest initiative will be successful.”

The initiative was restructured to pursue separate but related health IT efforts, said Maureen Schumann, a spokeswoman for the Defense Dept. However, the departments still have the goal of a shared EHR system.

VA officials noted that they are continuing to work toward making health data interoperable between the two departments in 2014. They also will launch a clinical tool allowing departments to view health data simultaneously.

“While the immediate focus is on accelerating data interoperability between the two departments, the end goal remains the same — to make certain that VA and DOD are creating a seamless health record integrating VA and DOD data and modernizing the software supporting DOD and VA clinicians,” VA officials wrote in a joint statement for a July 10 hearing before the House Armed Services Committee and the House Veterans Affairs Committee.

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