veloped, which was estimated to be ready by the last quarter of FY 2011. This arrangement has been extended beyond 1 year until the pharmacy capability of the joint VA/DoD integrated EHR (iEHR) system is developed, currently scheduled to occur in 2014 (the iEHR, the next generation EHR system being developed jointly by the VA and the DoD to replace VistA and AHLTA, is described at the end of this section).

Meanwhile, the schedules for the other capabilities proved to be too ambitious and were not met. Each department was developing solutions for its own system and testing them in laboratory conditions rather than in a live environment (GAO, 2011, p. 21). In some cases, the two department solutions did not work well together when field-tested in North Chicago. For example, each department selected a different commercial program for single sign-on with context management, and it proved to be difficult for the two programs to work together through DoD’s firewall and server. Mostly, it just took longer than expected to develop the various capabilities and then longer than expected to implement them because of unexpected glitches. As Lovell FHCC IT leaders put it, “integration was dependent on the computer systems functioning as planned” (Poulin et al., 2012). Unfortunately, things did not always go as planned.

The single patient registration and single sign-on with context management capabilities were delivered to the Lovell FHCC on December 13, 2010, and were operational by the end of the month, except for delays in access to single sign-on for some users and limitations on context management because of inconsistent family member codes between the DoD and the VA and other problems. Because of continuing problems with using two single sign-on with context management programs at Lovell, the IPO recently decided to use just one of the two programs for use in the iEHR system (Brewin, 2012).

Orders portability for laboratory and radiology were also delivered in December 2010, but user testing found that additional testing and development were required (IPO, 2011). Limited use of orders portability for radiology and laboratory was deployed in March 2011, but the Lovell FHCC decided to delay implementation of orders portability for laboratory until radiology was running smoothly—that is, achieving a rate of 90 percent matching of patients with images—which was achieved by the end of 2011 (GAO, 2011). Orders portability for laboratory was deployed initially in a few clinics in January 2012, after remaining software defects, complete user account and laboratory test mapping, and patient registration issues were resolved.



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