use the FY 2010 funding, but the DoD could not because its appropriations bill had not been passed and the DoD was operating under a CR. This delayed DoD funding of work on orders portability until January 2010. DoD funding was further held up by a congressional committee pending submission of a report on joint medical IT.
By early 2010, it was evident that orders portability for laboratory, radiology, pharmacy, and consultations and referrals were probably not going to be ready by October, and that a “Plan B”—a workaround solution—was going to be necessary for the pharmacy to assure patient safety. In February, the VA’s chief information officer told Congress that single patient registration, single sign-on, and orders portability for laboratory, pharmacy, and radiology would not be ready until the end of November 2010 (and orders portability for consults not until later in 2011), which would delay the move of the Navy’s outpatient clinics to the ACC (U.S. House of Representatives, 2010, p. 39). At that time, “significant concerns regarding the ability to deliver IT capabilities in such a compressed time frame were elevated to the Deputy Secretaries of Defense and Veterans Affairs” (VA/DoD, 2011, p. 41). They assigned the Interagency Program Office (IPO) to oversee and coordinate the Lovell FHCC IM/IT development effort. The IPO developed a joint interagency master schedule and established an executive committee of top national and local VA and DoD IT officials that met biweekly. The VA and the DoD controlled the funding, however, and proceeded to develop the interoperability capabilities on parallel tracks, which made it difficult for the IPO to coordinate the development process (Filippi, 2011). The IPO reported later that it encountered long lead times because of the separate review processes within each department and the need to adjudicate differences (IPO, 2012, p. 6).22
The main stumbling block in developing orders portability for pharmacy was the need to have sequential prescription numbers that are the same in both EHR systems, which could not be achieved without making changes in AHLTA and VistA. The departments, however, had agreed that no changes would be made in those legacy systems. This left a gap in IT capability, because the orders in VistA would not be consistent in AHLTA, and vice versa. “This gap created several unacceptable patient safety risks that could only be overcome by having licensed pharmacists manually input the necessary functions that will be performed automatically when the IT solution is deployed” (VA/DoD, 2011, p. 57). The departments agreed to provide $1 million through the JIF to fund up to seven pharmacists for a year as a workaround until orders portability for pharmacy could be de-
22 The DoD and the VA revised the Interagency Program Office charter in October 2011 to make it “the single point of accountability for [i.e., have the authority to manage] the development and implementation of the integrated electronic health record” (DoD/VA, 2011).