DOD, VA recalibrate the model for health records

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Departments' move to open source seeks to deliver one record for service members' entire career -- from active duty to veteran

The jewels in the government health IT universe have long been the Defense Department’s Armed Forces Health Longitudinal Technology Application (AHLTA) and the Veterans Affairs Department’s Veterans Health Information System and Technology Architecture (VistA), both of which have decades of development behind them. They’ll eventually merge to become a single military electronic health record, by far the largest EHR in the country.

Along the way, they’ll also break other ground. The new, integrated EHR (iEHR) will be the first major government health IT project to be developed as an open-source project, though traditional software acquisition approaches could still be used for some elements of the EHR.

Both of the current DOD and VA EHRs use a lot of proprietary and custom components, so trying to merge them as they are would be a nightmare. Going the open-source way will get around that and also produce something that should be much easier to maintain and scale for future needs.

“Moving to an open-source model invites innovation from the public and private sectors,” said Eric Shinseki, VA secretary, in announcing the start of the program in June. “It is an important element of our EHR collaboration with the Department of Defense and an important part of our strategy to ensure that VA clinicians have the best tools possible, and that veterans receive the best health care possible."

The Open Source Electronic Health Record Agent was launched at the end of August to be the governing body for the open-source community that will help develop the iEHR.

The goal is to provide service personnel with a single health record that will follow them from the moment they enter the military to the end of their lives. The trick will be to provide a single architecture for the EHR while still enabling both the DOD and VA medical people to work with the AHLTA and VistA components they still find useful.

To that end, the VA issued a request for information in September to gather ideas from industry on what the graphical user interface and associated Web services might look like for the integrated EHR.

There is an interim joint EHR of sorts. The Virtual Lifetime Electronic Record (VLER) was launched after President Barack Obama ordered in April 2009 that DOD and VA create a single, lifetime EHR for the armed services. However, the VLER focuses on sharing medical information between the two, building on previous data sharing initiatives between VA and DOD. However, it doesn’t use the single architecture envisioned for the iEHR, so it is limited in what it can do.

Still, what it will do is provide DOD and VA with the experience of operating a joint EHR, in addition to giving service members and veterans an idea of how the iEHR will work for them. In September, VA said it was expanding its VLER pilot and was on track to implement a health information exchange at 11 of its VA medical centers and to partner with both DOD and private health care entities by the fall 2011.

VA said its goal is, by the end of the fiscal year, to have 50,000 veterans who are VA patients authorize the sharing of their records.

It might not be all smooth sailing. Apart from the technical complexities of merging the two EHRs, how easy it becomes may depend on how well both DOD and VA convince congressional committees that they’ll be able to pull off the move to the new record.

The House Military Personnel Subcommittee, in its May markup of the 2012 National Defense Authorization bill, held back all but 10 percent of the money the Military Health System had requested for the iEHR work, saying it first wanted to see a transition plan that detailed how the transition would be done in an efficient and cost-effective way.

That followed a report in February from the Government Accountability Office that criticized both VA and DOD for not having specific plans, goals or time frames for their joint health IT needs.

Nevertheless, both DOD and VA seem committed to the iEHR. As was noted at the time in early 2011 when Shinseki and then DOD Secretary Robert Gates agreed on the concept for the integrated record, 90 percent of the medicine used by DOD and VA is the same, so why not have a single EHR and have taxpayers pay to build it once?


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