E-health problems in the military frustrate lawmakers

Defense and VA have ad hoc processes in place if there is an immediate need to provide data on the severely wounded, but those only cover small numbers of patients.

At the third hearing on the topic this year, lawmakers on Wednesday struggled to understand why the departments of Defense and Veterans Affairs continue to have problems electronically sharing information necessary to treat service members and veterans.

"I hope and I expect that DOD and VA will tell us today that, by no more than a year from now, clinicians in DOD and VA will have full electronic access to the medical information they need to treat their patients, whether that information resides in computers owned by DOD or by VA," Arizona Democrat Harry Mitchell, chairman of the House Veterans Affairs Oversight and Investigations Subcommittee, said at a hearing.

According to findings released at the hearing by the Government Accountability Office, the departments have ad hoc processes in place if there is an immediate need to provide data on severely wounded service members to VA centers that specialize in treating such patients. The manual workarounds, like scanning paper records, are generally feasible only because the number of such patients is small.

Also, GAO said the departments have made some progress on a test project that allows for live, two-way views of certain outpatient data from existing systems at all VA and Defense Department sites.

In general, GAO found that the departments have made progress in their long-term ambition to modernize their health systems and in piecemeal initiatives, like the test, but much work remains to achieve electronic medical records that can be transmitted seamlessly. There is no overall plan that incorporates all of the ongoing activities.

Rep. Tim Walz, D-Minn., a retired member of the Army National Guard, asked GAO official Valerie Melvin for her assessment of the departments' timeline for implementing a comprehensive, two-way system.

"I am not able to say when the departments will be at the point of having a longitudinal bidirectional health system," she said. "Both agencies have told GAO they do not have a date."

Subcommittee ranking Republican Ginny Brown-Waite of Florida questioned whether the GAO had sensed reluctance on Defense's end to share information because of security concerns about the VA's computer system. Melvin said she is not aware of that problem.

But when Brown-Waite asked Brig. Gen. Douglas Robb, who served as the command surgeon for the U.S. Central Command until June, if the use of a proven life-saving information tool is being discouraged at some sites, Robb said, "There were some locations that did not support it as much as others."

That tracking application was used by surgeons in Landstuhl, Germany, to view the X-rays of an Army soldier impaled by a still-live grenade in Afghanistan before the patient arrived at the hospital. The man was at the hospital less than 24 hours after being injured.

Without the application, "you can imagine that the paperwork might not keep up with the patient," Robb said.

Veterans Health Administration official Gerald Cross said in written testimony that VA and Defense are working to expand two-way exchanges of radiology images, a capacity now being tested in El Paso, and "are on target to document a plan to share digital images enterprise-wide by March 2008."