With most veterans waiting nine months for the Department of Veterans Affairs to process disability claims, a congressional panel Wednesday chastised the VA and the Department of Defense for each breaking four years of vows to merge all troops’ medical records into a single electronic system to help crack that backlog.
A senior defense official admitted to the House Committee on Veterans' Affairs that while “looking down the barrel” of Friday’s sequestration-mandated budget cuts, DOD recently opted not to simply link with the VA’s existing electronic health-record system but to instead seek a more cost-effective computerized tool to catalog and track its service members' medical files.
That explanation, however, sparked committee members to slam both agencies for protecting their individual turfs rather than fixing the lengthening wait for troops' claims to be seen and for disability checks to be cut. Further complicating that human math: Another 34,000 service members will return from Afghanistan during the next 12 months.
“Dammit, it’s time to get over the excuses and get this fixed!” said Rep. Jeff Denham, R-Calif., a veteran of Operation Desert Storm. “We have brave men and women that are coming home in huge numbers right now. We don’t want to see these backlogs of benefits continue to escalate. What we need is you guys (VA and DOD) to work together.
“You’ve been given a directive by your President to get this done. My belief is you don’t have the will to do it,” Denham said. “Those who have volunteered at a time of war ... if they come home tomorrow, they ought to be in the (electronic-record) system tomorrow, knowing what benefits they will receive ... and that it doesn’t take a 5-day or a 50-day system. Get it right or we’re going to force you to get it right.”
On Tuesday, VA Secretary Eric Shinseki acknowledged in a speech to the American Legion that effectively slashing its ballooning benefits backlog hinges, in part, on the full installation of an electronic record system. As of December, that backlog had reached more than 270 days, according to a VA website.
In a separate but related move, Rep. Jeff Miller, R.-Fla., chair of the House Veterans’ Affairs Committee, urged VA leaders to fire “problematic employees” rather than to continually transfer them from one regional VA office to another — a bureaucratic shell game that “has contributed to major benefits backlogs at a number of VA regional offices across the country.”
“It’s time to end that culture of complacency that has developed among some VA employees and replace it with a culture of accountability,” Miller told Shinseki and others Tuesday at the same American Legion gathering in Washington, D.C. “If a VA employee doesn’t want to do their job, the answer isn’t to move them to another VA office. The answer is to remove them from VA altogether.”
The committee hearing Wednesday was held to ask the two largest federal agencies to explain why they are — according to Miller, "doing a U-turn" — failing to honor a promise made to Congress as recently as last July to build a single, universal, electronic health-record system.
VA leaders testified they prefer their current electronic system, called VistA — on which, according to Congress, the VA already has spent hundreds of millions of dollars to install, and potentially billions more to improve. VA has been using VistA for decades. Miller said military “doctors in theater” have told him they prefer using the VA’s electronic-health-record system. In addition, more than 100 non-VA hospitals have implemented that technology.
Following the hearing, VA officials emailed a statement to NBC News reaffirming that the Department of Veterans Affairs and DOD remain “committed to a single, joint, electronic health record.” They also revealed that Shinseki on Tuesday called new Defense Secretary Chuck Hagel to congratulate him on his Senate confirmation and that during the phone chat “both leaders emphasized their desire to meet soon and build on the strong partnership between the two departments on common priorities for troops, veterans, and military families.”
“In short, VA and DoD are seeking to achieve the same program goals: common data, common applications, and a common user interface, but we look to achieve them with less cost and less risk and accelerate the availability of needed functionality,” read the VA’s emailed statement.
DOD chiefs, meanwhile, testified they are exploring several electronic health-record options — including "commercial" systems — to replace its current set-up, called Ahlta. And while the Defense Department said it is considering VistA as one option, its assessment found that system may be too clunky and costly to build across the entire armed services.
"There is no infrastructure really right now for us to bring VistaA into 56 hospitals and 700 clinics and be able to configure it," testified Jonathan A. Woodson, assistant secretary of defense for health affairs and director of TRICARE Management Activity. "The good news about VistA is it was ahead of its time ...
"(But) it's important for this program to skate to where the puck will be. What I mean by that is: The current VistA system is a generation 1-plus-2, in terms of how we look at electronic health records. Industry is already at a generation 3 and moving to a generation 4," Woodson said. "We would need to assess what's required for us to bring VistA over, modernize it, and (calculate) what the total cost of ownership would be over time."
One veteran, who listened Wednesday to the techno-speak and budget explanations offered by the VA and DOD, urged the two agencies to find common ground fast.
"Veterans are not getting the single system they were promised. As long as VA and DOD remain in separate camps, pursuing their own individual systems, it's the veterans that will be short-changed," said Jacob Gadd, deputy director for health care at the American Legion.
"Getting all the information into one place can be the key to finally breaking the back of the backlog. But we don't have it," added Gadd, a former Navy hospital corpsman. "VA and DOD have spent four years and close to a billion dollars to develop this and we're in the same place we were in four years ago ... Until they fulfill the promise made to veterans of a single, seamless, unified record, the veterans of this country will remain skeptical of their government's ability to deliver on all of the promises made to them."