iEHR would get a shorter leash, under House NDAA amendment

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An amendment to the National Defense Authorization Act for fiscal 2014 (H.R. 1960), which passed June 14, would impose reporting requirements on the Defense and Veterans Affairs departments' integrated electronic health record project, as well as stand up an advisory panel to provide additional oversight.

Amendment 164 (.pdf), sponsored by Reps. Buck McKeon (R-Calif.) and Adam Smith (D-Wash.), was agreed to by voice vote on June 13. The amendment was developed in collaboration by the House Armed Services, Veterans Affairs and Appropriations Committees, said Rep. Jeff Miller (R-Fla.) during a July 10 hearing.

If the bill is enacted into law, the secretaries would be required by Jan. 31, 2014 to give appropriate congressional committees a plan on the iEHR. This plan would include program objectives, organization, responsibilities of the departments, technical system requirements, milestones (including a schedule for industry competitions), system standards the program will use, metrics to assess the program's effectiveness, and funding levels needed for fiscal years 2014 to 2017 in order to execute the plan.

The departments would not be allowed to use more than 25 percent of the funding authorized under NDAA, until the plan is submitted to the committees, says the amendment.

Within 60 days of submitting the plan to Congress DoD and VA would also be required to present the committees with a commissioned, independent assessment of their plan.

The amendment also stands up an advisory panel--no later than 60 days after the enactment of the act--that would "certify to the appropriate congressional committees that such record meets the definition of 'integrated.'"

The 14-member advisory panel would be comprised of two co-chairs appointed by each secretary, the DoD and VA chief information officers, one member from the DoD acquisition community and one from the VA acquisition community, two members of the academic community appointed by Defense Secretary Hagel and two academics appointed by VA Secretary Shinseki, and two members of industry appointed by Hagel and two members of industry appointed by Shinseki. The panel would be required to report to congressional committees quarterly on the iEHR's progress.

"I am concerned that language in the House FY14 NDAA and in the House FY14 MilCon and Veterans Appropriations Act may overly restrict both VA and DoD's options going forward as well as impose significant oversight burdens on the program," said DoD Undersecretary for Acquisition, Technology, and Logistics Frank Kendall during a July 10 joint hearing of the House Veterans Affairs and Armed Services Committees.

"We would like to work with the Congress on less restrictive language that would both address your concerns and allow for efficient program execution," said Kendall.

The amendment sets requirements for what the final iEHR should look like and says it should be deployed no later than Oct. 1, 2016.

The iEHR should adhere to open architecture standards, including "modular designs based on standards with loose coupling and high cohesion that allows for independent acquisition of system components," agreed-upon technical standards, enterprise investment strategies that leverage proven designs and "aggressive life-cycle sustainment planning," among other requirements.

"By the point of full deployment decision, such a record must be at a generation 3 level or better for a health information technology system," says the amendment.

If enacted, DoD and VA would also be required by Oct. 1, 2014 to make AHLTA and VistA healthcare data "available and actionable in real-time through shared technology." Until that is achieved the departments cannot spend more than 10 percent of the funding authorized under the act, says the amendment.

A congressional source speaking on the condition of anonymity said the committees are fleshing out definitions for some of the terms used in amendment 164, such as "single core technology" and "interoperability," so they are used consistently by the departments. These definitions will be added to the report language so it can be incorporated when the bill goes to conference, said the source.

During the recent joint hearing, Kendall noted the confusion around iEHR terminology.

"All of these terms, like 'integrated record,' carry an awful lot of weight and are interpreted differently by different people. My view is that by 2014 we will have integrated records that we share with VA," said Kendall. He later added that integrated records and healthcare management software are different things.

For more:
- download the amendment (.pdf)

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