Weak coordination hampers efforts on medical databases

Efforts by the Defense and Veterans Affairs departments to create a medical database that works across their jurisdictions have been hampered by weak interagency coordination and the lack of a broad vision for the health network, an expert said Wednesday.

Valerie Melvin, the assistant director of information management issues at the General Accounting Office (GAO), testified that while she has been encouraged by recent agency presentations on their progress, overall the agencies have been "severely challenged" in creating a virtual medical-records system as part of their Health-e-People e-government initiative.

Other witnesses who spoke to a House Veterans Affairs subcommittee added that the creation of an e-records system for the healthcare industry is necessary to reduce costs and eliminate preventable medical errors by caregivers.

"[Veterans Affairs] and [Defense] continue to lack a clearly defined architecture and technological solution for developing the electronic interface and associated capability for exchanging patient health information between their new systems," Melvin said. "Moreover, the departments remain challenged to articulate a clear vision of how this capability will be achieved and in what time frame."

Melvin said the initiative lacks a "fully established project-management structure," with relationships among managers not clearly established and no lead entity for final decisions.

Meanwhile, agency officials told GAO that they are moving ahead with an electronic pharmacy system, which GAO questioned given the lack of an overall strategy for the initiative.

"Until these critical components have been put into place, the departments will continue to lack a convincing position regarding their approach to and progress toward achieving the Health-e-People goals and, ultimately, risk jeopardizing the initiative's overall success," Melvin said.

Jonathan Javitt, chairman of the health subcommittee of the President's Information Technology Advisory Committee, said creating an electronic system is vital to reducing death and injury from medical errors.

"It is time we stopped delivering 21st-century care using administrative methods that were well established when Hippocrates entered practice more than 2,000 years ago," he said. "There are simply too many bits of information for the human computer to track perfectly, particularly when patients are cared for by multiple doctors."

He estimated that electronic systems already cut between $80 billion to $350 billion in costs annually, but the lack of comprehensive national studies makes calculating such savings unreliable.

Jonathan Perlin, acting undersecretary for health, demonstrated a prototype electronic-records system for the subcommittee and touted its benefits.

And James Reardon, chief information officer with the Military Health System, described ongoing information-sharing efforts among the Defense Health Technology Program and other departments and agencies.