Making The Transition: What the iEHR Failure Means for Veterans

This article was written by Lt. Dan,who writes for HIStalk Connect and provides daily headlines on HIStalk.

After eight years of service — during which I traversed seven countries across three continents, lived in three states, and had the privilege of working alongside the very best, brightest, most dedicated, honest, and sincere men and women I have ever known — the time finally came in November 2009 for me to walk away. I signed my discharge papers on November 11 (Veterans Day), got in my car, and drove off base for the last time. I was sad, scared, and very excited.

Fast forward three months. I am sitting in a doctor’s office, about to have a physical from my new PCP. The office was clean; the staff was polite. This was nothing like sick call, where all ailments were treated universally with a prescription for Motrin 800 and a return-to-work slip. During the appointment. my doctor told me to send him my medical records from the Army.

I tracked down the clinic on the base I’d been assigned to and asked for my medical record. They told me it had been forwarded to the US Army Human Resources Command. I called them. They said that they didn’t have my records, didn’t know where my records were, were not responsible for processing requests to access said records, and suggested that I call the VA.

Undaunted, I did call the VA. They told me that US Army HRC was probably misinformed because they should have my records, but to be certain, I would need to fill out some forms, mail them in, and wait for an estimated 90+ days.

At this point, it was beginning to sound like my medical records were having a far worse go of it in civilian life than I was. I told them never mind, the whole thing seemed pointless since I knew everything that was in them and could just tell my PCP the history myself the next time I saw him.

When I went for my first civilian dental exam and was asked if I had a dental record, I was smart enough to just say no. To date, I still don’t have my military medical records and probably never will.

Transitioning out of the military is not easy. It’s moving long distance back to your home town and finding a new job. It’s changing the way you talk so you don’t accidently swear in a business meeting, or call a 22-year-old co-worker “ma’am.” It’s learning to make friends with people you don’t have something intimately in common with. It’s a good bit of doubting yourself and whether you are going to be good at this very different new life.

This stress is exacerbated by an estimated 35 percent prevalence of PTSD in returning veterans, and an estimated 20 percent prevalence of traumatic brain injury, which along with more traditional disabilities, has resulted in nearly 50 percent of departing veterans requiring disability services from the VA.

When that 50 percent of discharged veterans leave the military, their healthcare is transitioned from DoD facilities to VA facilities. The hope is that this will one day be seamless. For now, before the VA will provide services, soldiers submit a disability claim to receive approval to start receiving benefits.

Herein lies the problem. It takes an average of 277 days from the time a claim is submitted until the time a decision is made, much higher than the VA’s stated goal of 125 days. During this waiting period, veterans are left in limbo without access to services or entitlements. There is new policy in place that will allow a departing soldier to submit a disability claim with the VA prior to exiting the military, but currently they can only submit 180 days prior to their discharge date. Helpful, but another example of the needs of the veterans getting lost in translation with the policy makers.

The enormous disability claims backlog has made national news for more than a year now because it is larger than it has ever been in our nation’s history, approaching 1 million claims. Veterans who are leaving the service are usually dealing with a new job, a long distance move, and basic emotional transitions and simply do not have the energy to tackle another exhausting problem in their lives. But the VA’s disability claims process has become exactly that, an exhausting problem in the life of veterans who need services.

Over the last several years, the VA has put in place a plan to correct the disability claims backlog. It was a two-tiered technology implementation plan that involved developing iEHR, which would reduce the time it takes for veterans’ medical records to make their way to disability claims processors. A new disability claims automation system was expected to reduce the time and resources required to process a claim. These two projects were expected to solve the backlog, and so they were heavily funded and highly prioritized.

The disability claims system, called the Veterans Benefits Management System or VBMS, was a $500 million system that began its implementation this past summer. It hit the ground with a loud thud despite the fact that a significant portion of its allocated funding was spent.  The implementation has been mired in delays and functional issues that have repeatedly sent engineers back to the drawing board.

In June 2012, VA CIO Roger Baker acknowledged the issues in an interview, saying, “In mid-December, the volume of VBMS usage grew rapidly as users from the 18 [regional offices] were added. VBMS began to experience dramatic slowdowns in response time for some users, especially during peak usage hours. A root cause analysis determined that the issues were due to the way data is being read from disk storage. Since the impact was considerably more read/write work for each transaction, it had a greater impact as more users attempted to perform work on VBMS.” The initial recommendation was to halt any non-critical tasks, but the permanent fix will require a significant redesign.

VBMS was initially scheduled to complete its implementation across all VA processing centers by the end of 2012. At the close of 2012, just 5 percent of claims processors were using the new system. The implementation timeline has now been pushed out until the end of 2013.

iEHR was also conceived as a way of tackling the benefits backlog. The overriding goal of iEHR was to bring all stakeholders in the transition of veterans’ healthcare under one system to allow for a fundamentally more streamlined process for both soldiers and benefits processing for the VA. Summarized best by California House Representative Jeff Dunham during a recent hearing, “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.”

iEHR was halted on February 5 after officials within DoD and the VA realized that the total cost to develop the system had grown to more than $12 billion, more than double the original $4-$6 billion estimate CIO Baker quoted at the onset of the program. Following the announcement, the VA and DoD went back and forth over whether it would be feasible for DoD to implement the VA’s VistA EHR as a Plan B that would allow both organizations to operate within one EHR and maintain the overall goal of a unified system that could streamline the transition process for veterans.

In response to this idea, the Assistant Secretary of Defense for Health Affairs said “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. 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." On February 8, DoD announced that it was launching a vendor search, ending any hope that iEHR would be revived.

Within the past 30 days, CIO Baker along with VA CTO Peter Levin have been called before the Veterans House Services Committee multiple times to answer to outraged representatives over delays, cost overages, and systematic failures within both programs. For four years, the disability claims backlog grew with no improvement in the pace at which the VA processed new claims. Baker and Levin were the project owners for the two projects that were targeted to address the disability backlog issue. They drafted their plans, spent the money, the projects failed, and all that was left for them to do was resign, which is ultimately what they both did.

Now we have a growing disability claims backlog weighing down the VA. The proposed solutions have failed and the money is spent. Further complicating matters, the government is staring down the barrel of a federal budget sequester that is going to further limit the VA’s options to fix the disability claims backlog.

Meanwhile, a veteran population dealing with almost 10 percent unemployment and an unprecedented 22 suicides a day is going without disability benefits because the system that was designed to support them is fundamentally broken and programs intended to fix these problems are back to square one.