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VA CIO Roger Baker shared intentions to begin using the joint DoD-VA iEHR at two military facilities within two years – and offered a glimpse of what that early iteration will look like.
Baker sketched out the scenario VA is aiming to create within two years: A patient should be able to leave a VA facility after getting treatment, walk across the street to a DoD or private hospital, and the clinician there should see the patient's VA records. That means seamless care for patients – with the clinician not having to think about whether that data actually resides in the VA’s VistA or the DoD’s AHLTA electronic health records systems.
“The phraseology I’ve been using is the Wizard of Oz,” Baker said, during his monthly call with reporters on March 28. “In two years we may be saying, ‘Don’t look at what’s going on behind the curtain,’ because we’ve had to do some things to make it work that won’t be in the final system.”
Indeed, with the full iEHR version still being sculpted, and still four to six years away, Baker was careful to point out that the VA is deploying an initial build that will comprise VistA, AHLTA, and other pieces.
The VA looked for geographical areas with significant populations of both veterans and current service members, as well as ties to various non-military facilities nearby, and came up with Hampton Roads, because it’s one of the pilot sites for the Nationwide Heatlh Information Network (NwHIN), and San Antonio, for its base.
For those facilities, “We can’t do the entire iEHR in two years so the design we’ve laid out, in the architecture there are 4 layers, the data layer, the services bus, the applications, and the graphical user interface,” Baker added. “Three of those layers we install in those facilities will be brand new.”
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Those are the data layer – for which Baker said the DoD and VA agreed on a common health data dictionary – the enterprise services bus, for which Harris won the contract last week, and the GUI, which has been piloted in Hawaii since last year.
In the applications layer, the system will encompass existing VistA or AHLTA applications that clinicians need to access, Baker said, and in the future iEHR will utilize applications from both.
“There’s no way we can field all 127 apps by then,” he added. “We will field a number of new ones in that time but we’ll also integrate with existing AHLTA and VistA applications to make sure we’re fielding an entire EHR.”