Defense and VA to Congress on Health Records: It's the Data, Not the Software

Top officials at the Defense and Veterans Affairs departments said Wednesday they will create a system to exchange standard clinical health data, which will allow the departments to develop a single, shared electronic health record without the need to build a joint system from scratch. The officials spoke at a joint hearing of the House Armed Services and Veterans Affairs Committees.

President Obama directed the two departments to develop an integrated electronic health record in April 2009, but the effort foundered earlier this year due to spiraling cost estimates, which had soared to $28 billion, Frank Kendall, Defense undersecretary for acquisition, technology and logistics, told lawmakers.

Instead of pursuing an integrated health record, Kendall said Defense and VA will focus on developing and deploying a data management service to give clinicians from both departments access to patient health information viewable through a graphical interface by January 2014.

Kendall also disclosed that Defense has established a new office to purchase core systems to replace aging military health software, including the department’s primary electronic health record system, known as the Armed Forces Health Longitudinal Technology Application.

“It is crucial to note that a seamlessly integrated and interoperable electronic health record with full data exchange and read/write capability can be achieved without DoD and VA operating a single healthcare management software system,” Kendall said in his prepared testimony.

Robert Petzel, VA’s undersecretary for health, said data standardization, not a single software system, is key to the exchange of healthcare information between the two departments. Illustrating the extent of the challenge, he noted that the department’s current systems use different names for blood glucose, making it “impossible to integrate and track blood sugar levels for diabetics across the two systems,” for example.

Petzel agreed with Kendall that data standardization would eliminate the need for VA and DoD to use the same electronic health record software. “Health record data integration and exchange is possible regardless of the software systems. In fact, as private sector experience has shown, using the same system does not guarantee that information can be shared. The important thing is that both systems use national standards and a common language to express the content and format of the information they share,” he said.

Rep. Jeff Miller, R-Fla., chairman of the House Veterans Affairs Committee, did not buy into this new approach. “The two departments are, once again, moving on their own tracks, with promises we’ve heard before about making two separate systems ‘interoperable.’ Pardon my frustration, but it seems the only thing interoperable we get are the litany of excuses flying across both departments every year as to why it’s taking so long to get this done,” Miller said.

Petzel said the joint data management service will retrieve patient information from systems currently operated by both departments in seven critical clinical areas:  medications, problems, allergies, lab results, vitals, immunizations, and note titles. Those represent the vast majority of patients’ clinical information.  

This information “will be mapped to open national standards -- the same as those being adopted by the private sector -- making the data computable and supporting health information sharing not only across DoD and the VA, but also with private sector providers,” Petzel said.

Both Kendall and Petzel said their respective departments need to enhance or replace their existing EHRs, with the VA planning to modernize its decades old Veterans Health Information Systems and Technology Architecture (VistA) and Defense planning a series of acquisitions for what Kendall repeatedly referred to during the hearing as healthcare management software, not an electronic health record system.

Kendall said Defense plans to competitively acquire new clinical software to replace AHLTA, an outpatient EHR; Essentris, an inpatient EHR provided by CliniComp Intl. of San Diego; the Composite Health Care System, develop by SAIC and used by clinicians for scheduling appointments and procedures; and a new EHR for use in combat to replace the current Theater Medical Data Store Systems by 2017.

To manage these acquisitions, the Pentagon has created the Defense Healthcare Management Systems Office, which will report to Kendall. David Bowen, currently the chief information officer of the Military Health System, will serve as the new office’s program executive officer, FierceGovernmentIT reported Wednesday. Bowen previously served as CIO for both the Federal Aviation Administration and Blue Shield of California.

Verlin Hardin, currently director of the Military Health System Office of Transition Management and former CIO of the Navy Bureau of Medicine and Surgery, will serve as program manager for the Defense Healthcare Management Systems Modernization program, FireceGovernmentIT reported.