VA, DOD must improve exchange of medical records

Two years have passed since a Washington Post news story revealed some instances of inadequate treatment of soldiers at Walter Reed Army Medical Center.

The resulting public outcry and concern for our nation’s veterans led to a number of investigations and inquiries on what should be done to support wounded servicemembers. Among the numerous recommendations that followed was a consistent call for the smooth exchange of information between the Department of Defense (DOD) and Department of Veterans Affairs (VA) disability systems.

While such recommendations were an epiphany for some, many members of Congress, including myself, had long ago realized that our two largest federal agencies were failing to provide a seamless transition from military to civilian life. Doing so is especially important for those enduring the military’s medical discharge process. The cornerstone of seamless transition should be a real time, bi-directional, and interoperable electronic exchange of medical and personnel information.

This issue was personified for me during congressional oversight trip to Iraq in August of 2006. While there, I marveled at the advances in medical science that were saving the lives of soldiers, who in previous wars, would have perished from comparable levels of trauma. But as wondrous as these life-saving techniques were, I was stunned when I saw the method being used to transfer vital medical information: Severely injured servicemembers had their medical records taped to their chests!

The contrast was remarkable: Had the same government that made such marvelous advances in medical technology not recognized the importance of electronic information exchange?

I was obviously deeply concerned that the continuity of care for these injured heroes hinged on the adhesive quality of the tape being used to secure medical records to their chests.

Upon my return to Capitol Hill, I immediately began working on legislative efforts to reform these outdated methods that were jeopardizing the care of our veterans. I successfully amended H.R. 1538, the Wounded Warrior Assistance Act, which was later included in the National Defense Authorization Act for Fiscal Year 2008 (P.L. 110-181). The amendment directed the VA and DOD to take the following steps to improve the transition process:

• Development of a comprehensive policy on the care and management of members of the armed forces, including the development of a system that allows for fully interoperable electronic exchange of personnel health information;

• A uniform separation examination and evaluation that VA could use for rating decisions; and

• An electronic DD-214.

As both chairman and ranking member of the House Veterans Affairs Committee, I have continued efforts to eliminate the barriers between VA and DOD that hinder the continuity of medical care. The committee has held dozens of hearings on this issue and I believe that there is positive momentum on this important issue, but much remains to be accomplished.

I was initially encouraged by the announcement that the Obama administration intends to implement a single DOD and VA electronic medical record, and was hopeful it might finally become a reality after 20 years of bureaucratic infighting. However, a Veterans Affairs Subcommittee on Oversight and Investigation hearing on July 14 indicated that stagnation is occurring.

Congress mandated, in the National Defense Authorization Act of 2008, the VA and DOD to establish an interagency office to act as a single point of accountability for the development and implementation of an electronic health record system.  The electronic health record system would allow for the full interoperability of personal healthcare information between the two departments.

The deadline for the interoperable health record system is Sept. 30, 2009. But the Government Accountability Office (GAO) testified that failure to appoint key leadership positions precludes any accountably for an interoperable system. The office is also not accomplishing other essential functions necessary to fulfilling its responsibilities.

Three years ago the Great Lakes Naval Training Center in Illinois was held out as the example of integration, interoperability, and bidirectional capabilities and now it is reportedly experiencing stagnation. It is unacceptable to allow this to happen.  I intend to visit Great Lakes to examine — first hand — the restrictions to the free flow of medical information between VA and DOD. I cannot emphasize enough that this goal should be among our nation’s highest priorities.

The men and women of our armed forces have served valiantly in the face of battle, and their healthcare providers should have complete access to all medical treatment records without unnecessary gaps between VA and DOD.

We are well beyond the need for further studies and commissions. It is time for the departments to make it happen, and nothing less than significant progress is acceptable.

Buyer is the ranking member of the House Committee on Veterans Affairs and serves as a colonel in the Army Reserve.