Pentagon will be the primary provider of IT for integrated health records

Sergej Khakimullin /

Defense will offer the baseline architecture, identity management, storage and data dictionary.

The integrated electronic health record the Defense and Veterans Affairs departments are planning to launch within two years will rely heavily on Defense systems and services, with VA playing second fiddle, according to a report the Pentagon submitted to Congress in April.

The EHR Way Ahead Architecture the Military Health System started developing in 2009 will serve as the baseline for the integrated system, for instance. The Defense Manpower Data Center will provide identity management services and the Defense Information Systems Agency will store the electronic health records in its data centers, Dr. Jonathan Woodson, assistant secretary of Defense for Health Affairs, said in an April 3 report to the Senate and House Armed Services committees.

In the 55-page report, “Department of Defense Enterprise Architecture to Guide the Transition of the DoD Electronic Health Record and Related Matters,” Woodson said both departments agreed in early 2011 that the EHR Way Ahead Architecture “would be the ‘presumptive’ architecture. It has since evolved into the target iEHR based on identified joint functional details.” The report did not define or explain those details.

The federal information technology dashboard pegged total costs for the EHR Way Ahead Architecture at $48.3 million and said Defense still needed to complete a more detailed analysis of the planned architecture.

The report said integrated electronic health record development will focus on a “best of breed approach that includes a mix of [service-oriented architecture]–compliant capabilities, open source and custom systems.”

Commercial software tops the list for the iEHR, according to the report. “First, purchase commercially available solutions for joint use. Second, if available, adopt a department-developed application solution. Third, approve joint application development on a case-by-case basis,” the report said.

The report also makes it clear the Defense/VA Interagency Program Office headed by Barclay Butler, a former Harris Corp. executive who served as the chief information officer for the Army Medical Department while on active duty, will run the joint health record operation. The interagency program office will serve as the “single point of accountability for the iEHR,” the report said.

Butler will make all capital investment decisions for the iEHR, the Pentagon told Congress. Investments will focus on broader priorities and not on the needs of individual programs, the report emphasized.

The report said a graphical user interface for clinicians is key to developing an integrated health record system, but did not identify which interface the departments planned to use. Mary Ann Rockey, program executive officer of Joint Medical Information Systems/Clinical at MHS, displayed a sample during a triservice medical symposium in February.

VA Chief Information Officer Roger Baker told a press briefing in May 2011 that the two departments had selected the JANUS GUI developed at the Tripler Army Medical Center and the co-located VA Medical Center in Honolulu as the clinical interface for the iEHR. In her presentation, Rockey said the joint Defense/VA hospital in Chicago also will use JANUS.

The two departments have set up a joint Interagency Clinical Informatics Board to guide development of more than 30 functional capabilities for the iEHR, starting with a pharmacy system, the report to Congress said. The pharmacy system will include inpatient and outpatient orders and an inventory management system, according to Rockey.

She said other systems the Interagency Clinical Informatics Board identified include a patient portal, operating room and medical device management, patient consent and education, and global medical image access.

Woodson told Congress that VA has agreed to adopt a unique number assigned to all Defense personnel to tag patients’ records. “VA has agreed to adopt the [electronic data interchange person identifier], allowing information systems in both departments to access beneficiary records and assign access controls,” the report said. Joint use of the identifier is “essential for combining data from disparate systems in DoD and VA.”

Electronic health records will be stored in DISA data centers based on “cost and service-level agreements,” the report stated. Rockey said VA signed an agreement in September 2011 to consolidate its data centers into DISA data centers. Baker told Nextgov in January that VA will move its electronic health records to DISA within a year.

VA also has agreed to use the Defense health data model, allowing the two departments to “seamlessly access and aggregate that data into a single, logical data store,” the report said. The Pentagon finalized an agreement to use a Defense Health Data Dictionary in a pilot project at the VA Salt Lake City hospital in January, Rockey said. Government Health IT reported in April that the dictionary, developed by 3M, will be a “cornerstone of the iEHR.”

The report to Congress does not contain any cost estimates for the iEHR, saying these “will continue to be refined as the program matures.” The report did say joint Defense-VA use of the system will “help to contain health care costs and provide higher value-based health care delivery systems.”

When the two departments complete the iEHR deployment, it will stand as the largest electronic health record system in the world, serving 7.8 million veterans and 9.7 million military personnel through 59 military hospitals and 152 VA hospitals with a combined staff of more than 350,000.

(Image via Sergej Khakimullin /