In Hampton Roads, Va., the departments of Defense and Veterans Affairs are staging the most far-reaching military health information mash-up ever attempted.

Taking place in southeastern Virginia's Tidewater region, an area with a dense concentration of military personnel, the project will bring together defense and veterans medical centers, as well as local providers Sentara Healthcare, Riverside Health System and Bon Secours Medical Group in an unprecedented test of health information-sharing across the military-civilian divide.

The project is planned as a leap forward in the military's effort to create a single Virtual Electronic Lifetime Record (VLER) for its members. VLER health communities will test electronic health information-sharing among the Department of Defense, the Department of Veterans Affairs and private provider networks.

The network that evolves from the pilot will help cement the Obama administration's vision for establishing easy access by armed services members and veterans to their complete medical and administrative personnel records.

The first VLER pilot, already underway in San Diego, involves the exchange of medical information between the Veterans Health Administration and the private Kaiser Permanente health network.The Hampton Roads project will build upon what was started in San Diego, according to Dr. Stephen Ondra, VA's senior policy adviser for health affairs. The new pilot will attract double, perhaps triple, the 450 patients participating in the San Diego project, he said.

The pilot will also represent DoD's first official participation in the VLER community project. By enabling information exchange among purchased care providers of both DoD and VA patients, the Hampton Roads project will involve more complex hand-offs and therefore a greater number of datasets than in the San Diego VLER.

The project is also likely to tap the capabilities of an existing Virginia health information exchange, MedVirginia Inc. The Richmond, Va.-based HIE is currently working with the Social Security Administration to provide to SSA claims examiners the electronic health records of Social Security benefits applicants."[Hampton Roads] is important to DoD because we expect to have the opportunity to exchange information with private sector providers in the Tidewater area," said DoD spokeswoman Cynthia Smith. "In San Diego, Kaiser Permanente is not a DoD contract provider and we found no shared patients between DoD and Kaiser Permanente." The southeastern Virginia area was chosen for its "high volume of beneficiaries, large volume of purchased care and strong support for health information exchanges from the governor's office," said Smith.

Purchased care refers to the healthcare services provided to government beneficiaries by private organizations under contract. "DoD and VA both encourage our contract providers to participate since much of the care provided to our beneficiaries comes from contract providers," said Smith. "DoD and VA need access to private sector information to create a true lifetime electronic healthcare record for our service members and veterans."

Purchased care connections
The multilateral information exchanges among private medical networks envisioned in Hampton Roads, "will provide an impetus to get a full health information exchange going in the Hampton Roads area," said Dr. Charles Frazier, vice president for clinical innovation at Riverside Health System. From there, "we can connect to a Virginia exchange and ultimately a national exchange." Frazier and his team have been in touch with Sentara, a not-for-profit provider serving southeastern Virginia that operates more than 100 sites, and Bon Secours, the fourth-largest provider in Virginia, about participating in the pilot. "Being able to share medical information among us and with DoD and VA is the right thing to do for the patient," he said.

"Sentara is excited to be among the Hampton Roads civilian providers collaborating with the VLER project," said Bert Reese, Sentara's chief information officer.

The VA's Ondra expects the Hampton Roads VLER project to adopt a number of enhancements over its San Diego predecessor. "We will be expanding the dataset that we will be exchanging and will also be adding some lab capabilities," he said.

The Hampton Roads project also will emphasize online sign-up and consent forms and benefit from sharper patient correlation capabilities to ensure exchanged data are attached to the right patient.

The San Diego project experienced challenges with several data fields which will be corrected in Virginia. "We had cases of standard ambiguity with respect to two data fields in San Diego," Ondra said. The data fields in question were patient allergy information and date formatting.

Standard ambiguity refers to an overly flexible data definition. "In the vast majority of data fields the standards held," said Ondra. "But in these two cases, different organizations defined the data slightly differently. We have since tightened up the data definition. You really don't know how a data standard will perform until you test it on a live environment."

At least one DoD hospital will begin exchanging information with the Hampton Veterans Medical Center and private providers around July 31. Expansion to the other DoD facilities in the area will follow, according to DoD's Smith.

"The clock will start running on July 31," said Ondra. "We plan on doing an assessment six months later, at which point we'll look at lessons learned and will develop solutions to any problems that emerge." Those enhancements, in turn, will be applied to the next set of pilots.