Office to oversee sharing military health records behind schedule

Delay could make Defense and VA miss 2009 deadline to share patient files.

The creation of a joint program office to oversee sharing of electronic health records between the Defense and Veterans Affairs departments might not meet a congressionally mandated deadline to begin exchanging records by September 2009, according to the Government Accountability Office.

Comment on this article in The Forum.Valerie Melvin, director of human capital and management information systems, told the Senate Veterans Affairs Committee on Wednesday that a Defense-VA interagency program office will not be fully operational until the end of 2008. It then will have only nine months to meet the deadline for full interoperability. Top positions have yet to be filled and a charter has not been established yet because the office's responsibilities were broadened to include sharing personal and benefit information.

Because of these factors, Defense and VA "may be challenged in meeting the required date for achieving interoperable health records and capabilities," she said.

The two departments recently completed developing an information interoperability plan, which details the hurdles they must overcome to achieve full interoperability, said Ward Casscells, assistant secretary of Defense for health affairs. Problems to solve include:

• Incompatible legacy computing and communications infrastructure;

• Lack of a robust, joint architecture to facilitate interagency data sharing;

• Existing data in unstructured formats, which make it difficult to discover and access;

• Undefined standards and maturing standards.

Top information technology officials at the Military Health System and VA told Nextgov this week that they were developing a new joint information architecture, but the blueprint for the architecture will not be completed until the end of 2009.

Patients treated at facilities operated by the Military Health System and VA, clinicians now can view electronic data from the two departments, Casscells said. Michael Kussman, VA undersecretary for health, told the hearing that records on more than 4 million veterans have been transferred from the Military Health System to VA.

The two departments have started exchanging some data at the "highest, most complex level of interoperability," which is drug information in a standard data format that a computer can act on, Casscells said. The pharmacy information exchanged between the two systems warns clinicians of a potential dangerous interaction between drugs prescribed by providers in either the Military Health System or VA.

Even though the exchange of computable information has been applied to only 19,000 patients, Melvin hailed it as a breakthrough not widely achieved in other health care systems.

One key problem that inhibits data sharing is that while all VA records are electronically based, MHS operates a hybrid electronic paper system. At a hearing of the Military Personnel Subcommittee of the House Armed Services Committee in March, Casscells said the Military Health System "will not have a completely paperless medical record for many years."

Kussman told the Senate hearing that the Military Health System has started a pilot project to test a capability to scan paper documents and associate them with a specific patient and then transmit that information to VA.

Casscells and Kussman said the Military Health System and VA can meet the September 2009 deadline.