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By Brian Robinson
Despite persistent criticism of the pace of efforts to share electronic patient records between the Defense Department and the Veterans Administration, the two will be sharing all essential data by the end of this year, according to executives heading development of a new DOD/VA inter-agency program office (IPO) that will oversee those efforts.
What happens after that will depend on what the DOD/VA Joint Clinical Information Board says is needed to move towards an interoperable electronic medical record, said Lois Kellett, director of integration and communications at DOD’s Tricare Management Activity, and acting director of the IPO.
“We know pretty well what we’ll be doing with sharing to the end of 2008,” she said. “To get from there to a fully interoperable EMR by Sept. 2009 we’ll ask the board to prioritize what else they feel is needed, and that will drive what work we will be doing.”
The IPO, which was stood up on April 17, is the result of a congressional mandate detailed in the National Defense Authorization Act of 2008. The goal is to create a single point of contact that Congress can refer to rather than have to query both the DOD and VA separately about data sharing issues.
But the new office should also help improve on the work the DOD and VA have done on records sharing since 2001, Kellett said.
“There’s a lot to be said for having one office that will be doing all of the management and oversight and making sure the work is being done,” she said. “As we go forward it doesn’t help much if both sides are not doing testing at the same time, or if an interface is being built on one side but not on the other.”
It will also provide a continuity of expertise, rather than having to rely on people who are assigned by the DOD and VA and who change over time, she said. That group will also have a better grasp of the various cultures in both the DOD and VA and be able to grasp when each side are talking past each other.
Both Kellett and the IPO’s acting deputy director Cliff Freeman, director of the VA/DOD Health IT Sharing Program Office, have so far been focused on the mechanics of setting up the IPO, and deciding on staffing and contractor requirements. They’ve also been looking for separate office space for the new organization.
A large part of their job has been to write the position descriptions for the permanent director and deputy director, who will be appointed by the DOD and VA respectively. They should be in place sometime this Fall, though both Kellett and Freeman said they will not be candidates for those positions.
In the meantime, they said, the pace of current sharing activities has not slackened.
As far as outpatient data is concerned, the DOD has now deployed its Armed Forces Health Longitudinal Technology Application (AHLTA) globally and is already sharing a great deal of the data collected with the VA, Kellett said.
For inpatient data sharing, things are a little more uncertain. The DOD will be looking to see what it can do with AHLTA’s inpatient module, Kellett said, while Freeman said the VA is currently re-engineering and re-hosting its Veterans Health Information Systems and technology Architecture (VistA) for use in its My HealtheVet system. “So it makes sense for both organizations to see what we can do as we move forward,” he said.
Currently, according to Kellett, data such as inpatient discharge summaries, operative reports and inpatient consultations from those larger hospitals that are using electronic records systems are being shared with the VA, accounting for about 15 percent of all inpatient bed stays.
The VA is most concerned about getting data from hospitals such as Walter Reed Army Medical Center, the Bethesda Naval Hospital and the Brooke Army Medical Center since they are the key for patients coming from war zones in Afghanistan and Iraq and transitioning in to the VA system.
To that end, Kellett said, it was also essential to get an electronic records capability installed at the Landstuhl Regional Medical Center in Germany, often the first stop for wounded warriors on their way to the US. That was completed in December 2007.
One thing that apparently won’t be happening, however, is that VistA will become the template for the DOD/VA interoperable EMR, as has been suggested by some people.
“I sincerely doubt that,” Kellett said. “There is currently no strong economic or sharing reason for the DOD to go and rip out AHLTA and install VistA in its place.”
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