The Defense Department notified lawmakers this week it has met congressionally mandated requirements for health records interoperability requirements with the Department of Veterans Affairs.
In a letter addressed to Rep. Harold Rogers, R-Ky., chairman of the House Appropriations Committee, Defense Undersecretary Frank Kendall said the Pentagon has surpassed requirements established in the 2014 National Defense Authorization Act for sharing outpatient data of millions of military personnel with VA to improve patient care for soldiers and veterans alike.
“With this letter, we are certifying that we have not merely met this requirement, but have gone even further to integrate data from other DOD systems, including inpatient, theater and pharmacy, into this process, thereby exceeding the NDAA’s requirements,” Kendall said.
VA’s effort to ensure information contained within millions of patient electronic health records is interoperable with the Pentagon’s systems – and viewable through an integrated display of data in secure systems – will come shortly, said David Waltman, senior adviser for information strategy at the Veterans Health Administration.
“We are not very far behind,” Waltman said on a call with reporters, adding VA planned to certify its capabilities in the second quarter of 2016 .
Move Follows Close Congressional Scrutiny
DOD and VA use fundamentally different health records systems – the Armed Forces Longitudinal Technology Application and the Veterans Health Information Systems and Technology Architecture, respectively. Officials scrapped plans to integrate them in 2013 citing cost overruns.
Even as the Pentagon moves toward a next-generation Defense Healthcare Management Systems Modernization awarding a $9 billion contract to defense IT firm Leidos and EHR vendor Cerner earlier this year, the effort to integrate existing data between the two agencies didn’t subside.
Over the summer, Pentagon officials, including Kendall and Chris Miller, program executive officer for DOD’s Healthcare Management Systems Modernization, defended the interoperability efforts in both departments.
“I offer this to anybody,” Miller said. “We share more information between DOD and VA than any two large health systems in the world. I can take any provider today, put them in front of a computer anywhere and I can pull up the entire longitudinal health record between [a DOD beneficiary] and a veteran. I’ve done this on the Hill, I’ve done this with a number of senior people in government because they don’t believe me.”
Yet, GAO has been skeptical, and a report released in late October claims VA and the Pentagon are “still years away” from fully interoperable electronic health records.
What Does ‘Interoperability’ Mean?
Miller, speaking to reporters during yesterday's demonstration of VA-DOD health records sharing, somewhat reconciled both points of view by explaining the complexities involved with the term “interoperability.”
“I wish we wouldn’t talk about interoperability sometimes because it’s a very hard term, a very technical term,” Miller said. “But I think when you talk to our users and understand what their struggles are, what their problems are, we can really apply technology and solutions to make sure those things get better. Success here really isn’t about technical terms or levels, it’s really about use cases and how well our providers are able to do those jobs. We’ve done a lot to get this info to a point where it’s shared and it’s usable. This data does a lot to help people.”
Using the Joint Legacy Viewer, a Web-based system that provides an integrated longitudinal view of a soldier or veteran’s health record, Miller and a cadre of Pentagon and VA officials demonstrated how the agencies share health records data.
Approximately 30,000 users across the DOD and VA – mostly clinicians and benefits analysts – can use the JLV to pull patient data in real-time from close to 300 disparate database sources.
Access to the system requires a Personal Identity Verification card, and record logs monitor who views and accesses data to ensure stringent privacy standards, Waltman said.
The JLV itself provides a detailed look at a veteran or soldier’s entire health history, including everything from allergies, health summaries, past vital signs and immunizations, to theater data stores and technical medical data, said Brian Jones, user integration physician lead at the Defense Health Agency.
JLV also offers the ability to compute basic structured data, which allows a clinician to do something like graph a patient’s vital signs over time. The computing feature “helps us lead nationally” in health records sharing, Jones said. JLV also makes use of unstructured data sets, like doctor’s notes, and makes them viewable via plain text.
A user can view “how the doctor thinks of you and put together a story,” Jones said. “The rest of the story comes in the unstructured data. The intent of the system is to take as much data as we can from both instances and provide the best, most seamless care.”
Beyond the Joint Legacy Viewer
Importantly, the record-sharing improvements extend to commercial health providers – millions of vets and soldiers use private health providers – but records must be requested and are delivered in consolidated clinical document architecture.
Miller recently said DOD and VA clinicians are able to view combined records of more than 7 million patients who received care from both departments, but the Pentagon’s road to interoperability isn’t stopping here.
On Thursday, Miller said JLV is “a transitional product, but a very important product,” not only for its current uses, but also in DOD’s future migration to its next-generation EHR system.
However, it’s unclear to what extent greater use of JLV between the Pentagon and VA will assuage congressional critics who view expanded use of the tool as a Band-Aid measure.
“The Joint Legacy Viewer, the JLV, is not real interoperability,” Rep. Will Hurd, R-Texas, the chairman of the House Oversight and Government Reform Committee’s special IT panel, said during a hearing last month. He added, “the ability to view patient data and the ability to access and use in real time patient data are two profoundly different things.”