What’s Brewin: No More Excuses

Retired Army Lt. Gen Terry Scott, chairman of the Veteran's Disability Benefits Commission described in testimony before the Senate Veterans' Affairs Committee this week a bit of peculiar bureaucratic logic that, in his opinion, seems to impede development of compatible electronic health record systems for the Defense and Veterans Affairs departments.

While officials from both departments announced this January that they plan to develop a joint inpatient electronic health record, neither has come up with a completion date for the project, Scott said. In a weird way, that gets them off the hook for ever developing the joint record.

Scott told the Senate hearing, "We understand why the departments are so reluctant to establish planned completion dates since they will be expected to achieve those goals." [My emphasis added.]

The government could grind to a halt of this kind of thinking spreads outside Defense and VA.

Oh Well, They're Only Two Years Late

Former Army Secretary Togo West pointed out at the same Senate VA hearing that the 2003 report from the President's Task Force To Improve Health Care Delivery for Our Nation's Veterans says to "develop and deploy by fiscal year 2005, electronic medical records that are interoperable, bidirectional and standards based."

The lack of such a system, West said, has resulted in a "systematic breakdown" of a seamless and smooth transition of war veterans from Defense health care systems to VA health care systems. Some of these war veterans are seriously wounded, with a number suffering from post-traumatic stress disorder and traumatic brain injury.

But, a top VA official had a great idea to fix this problem. (Read next item.)

"OIPT" It

I bet you thought forming an overarching integrated project team was so 20th century, but not for Patrick Dunne, assistant secretary of policy and planning at VA. He told the Senate hearing that the department has formed an OIPT to address myriad ills surrounding the poor treatment of the latest crop of war veterans, including data sharing with Defense and improved treatment of PTSD and traumatic brain injuries.

I don't know how OIPTs fit in the bureaucratic scheme of things with task forces, but hopefully Dunne's OIPT can address a key problem with the current VA task force on compatibility between Defense and VA health care information systems.

The disability commission's Scott told the senators that particular task force will not advance information sharing by much, only submitting a report next January, which will provide an analysis of alternatives on the road to compatible Defense and VA systems.

Then, someone will have to form another task force (or OIPT), which will produce more reports and require additional analysis, and then more Senate and House hearings. The poor veterans will still be lost in a baffling maze of substandard care.

Veterans Tracking Application Inches Along

The Veterans Tracking Application is a nifty tool that shares health information between Defense and VA. It's based on the Defense Joint Patient Tracking Application, but is still not widely used by VA health care professionals, according to Dr. Edward Huycke, VA's chief defense coordination official.

Huycke told me this week that while VTA is available to VA clinicians on the department's Veteran Health Information Systems and Technology Architecture Web portal, use has been slowed by the requirement that end users engage two sign-on processes: one to get onto VistA and another to access VTA. Huycke said VA is working to develop a single sign-on process for both VistA and VTA.

He added VTA has been deployed to 1,200 program managers for care coordination nationwide and since VTA can draw on Defense and VA information, it is definitely helping meet the "seamless transition" requirement.

Huycke said VA has hired CTA to help it with requirements definition for the next generation of VTA - and hopefully, once the requirements are in, VA will not need to form another OIPT.

The Top Line

I'm a grateful recipient of Defense health care -- including an all-expenses-paid medevac flight as a Marine from South Vietnam to Guam -- and an unabashed fan of VistA.

But in my view, it's time to stop forming task forces and OIPTs, and do whatever it takes to provide the best care possible for those this society sends into harm's way.

Let's focus on the top line: the wounded warrior. End bureaucratic games, stop turf battles between Defense and VA and speed development of a compatible health care record with as little folderal as possible.

We need results. Not more OIPTs, commissions, or reports.