The demonstration sites evaluated four major IT solutions: the Laboratory Data Sharing Initiative; a DoD/VA credentials-sharing interface; the Bi-directional Health Information Exchange; and digital image sharing (DoD/VA, 2008, p. 5).
According to the final report from the DoD and the VA, there were a number of barriers to sharing. Some were amenable to policy changes, such as the different hiring authorities of the two departments, the need for procedures for paying for shared services and transferring funds, and limits on data sharing. The projects also demonstrated the importance of buy-in by all relevant local parties; the need for continuous education and training to overcome cultural differences; the problems presented by different business practices in such areas as staffing, procurement, funding, construction standards and timelines, and credentials; and the information-sharing limitations imposed by different information management (IM)/IT systems (DoD/VA, 2008, pp. 64–66).
Joint Incentive Fund
As part of the NDAA 2003, Congress also established the Joint Incentives Program to enable more collaboration between the VA and the DoD. The two secretaries were directed to contribute a minimum of $15 million per year each to a DoD-VA Health Care Sharing Incentive Fund and to use the funds to “carry out a program to identify, provide incentives to, implement, fund, and evaluate creative coordination and sharing initiatives at the facility, intraregional, and nationwide levels” (DoD/VA, 2004, p. 1). Known as the Joint Incentive Fund (JIF), the program was extended until September 30, 2015, by the NDAA 2010, the law that established the Captain James A. Lovell Federal Health Care Center (FHCC).
The JIF is administered by the VHA “under the policy guidance and direction of the HEC [Health Executive Council],” and its chief financial officer provides financial status reports to the Health HEC and to the chief financial officer of DoD’s TRICARE Management Activity (AMEDD, 2012). The HEC uses the funding to promote local VA/DoD sharing by paying for initial start-up costs of a project that is expected to become self-sustaining after several years. In some cases, the projects permit existing joint venture sites to expand their collaborative activities; in other cases, the JIF projects are awarded to encourage potential joint ventures. The VA/DoD partners submit proposals each year. The Joint Facility Utilization Resource Sharing Working Group (JFURSWG) is charged by the Joint Executive Council (JEC) to review the proposed sharing activities. In its ninth year, the JIF has funded 130 projects totaling $420.6 million (Interviews).