Shinseki and Gates clinch deal on common health record

Veterans Affairs Secretary Eric Shinseki said Thursday he and Defense Secretary Robert Gates agreed on March 17 that their departments would develop a common electronic health record system.

A former high-ranking federal health information technology official, who declined to be identified, said the agreement ultimately could save the two departments billions of dollars in development and maintenance costs.

Shinseki, speaking at a hearing of the Military Construction and Veterans Affairs panel of the Senate Appropriations Committee said he and Gates had agreed to "merge our capabilities to come up with a common platform," but provided few details.

He disclosed the agreement with Gates well over an hour into the hearing in a back-and-forth dialogue with ranking member Mark Kirk, R-Ill. Kirk at one point asked if the Defense Department was ready to "surrender" on the continued use of its AHLTA electronic health record system and go with VA's decades old Veterans Health Information Systems and Technology Architecture, known as VistA.

Defense, Shinseki said, "understands its current system [AHLTA] is not what it needs in the future." He then disclosed the agreement with Gates to develop a common system, and added the two departments will work on details between now and May.

Congressional staffers, who declined to be identified, said beyond the high-level agreement between the two secretaries few details on development of the common record have been worked out. But, they added, it most likely will use the open source approach to development of the next generation of VistA announced by VA last month.

Beth McGrath, deputy chief management officer at Defense, told Nextgov that Gates and Shinseki met March 17 "to discuss the next generation of the electronic health record. [As] a result, DoD and VA will continue to synchronize EHR planning activities for a joint approach to EHR modernization. The departments have already identified many synergies and common business processes, including common data standards and data center consolidation, common clinical applications, and a common user interface."

Kirk pressed VA Chief Information Officer Roger Baker on what role commercial software would play in development of the new common record. Baker said VA cannot do all the work on its own, and intends to incorporate commercial software into the new EHR.

Last month, five members of the Wisconsin congressional delegation asked VA and Defense to consider using a single commercial system for their new electronic health records, a move that could benefit one of the state's largest employers, Epic Systems Corp., one of the most successful EHR companies in the country.

Congressional sources said the information technology staff at the Military Health System continue to resist the idea of a common record and to interpret the high level agreement between Shinseki and Gates narrowly. An industry source said MHS views the agreement as covering common data elements and the presentation layer, which define how data is passed from one computer to another, such as a request from a browser to a website.

This source said Gates already has chopped the AHLTA development budget, however, and expects to realize $2 billion in savings from working with VA on a common electronic health record.

The 2010 report of the Defense-VA Interagency Program Office sent to Congress last week shows that nine of 13 core functional capabilities for an EHR -- such as inpatient and outpatient documentation, pharmacy and laboratory systems, imaging and radiology -- are common to both departments.

This leaves three unique Defense requirements -- third-party billing for TRICARE insurance, readiness, and theater/shipboard systems; and one unique VA requirement -- long-term care, which the industry source said can be handled as modules to the core common system.

The former high-ranking federal heath IT official said it also would make sense to involve the Indian Health Service in development of the common record because IHS' electronic health record is an offshoot of VistA. Sen. John Hoeven, R-N.D., noted in many Indian tribes half of the men are veterans.

Kirk asked Shinseki about the possibility of the Centers for Medicare and Medicaid Services adopting the common record. Shinseki said he had discussed the issue with CMS officials, but did not elaborate.

Kirk said he wants both Gates and Shinseki to detail their plans for the common record at a hearing in May.

The common electronic health record would be the largest such system in the world, serving 7.8 million VA patients and more than 9 million Defense patients. MHS operates 59 hospitals and 354 health clinics around the world, served by 53,198 military personnel and 53,278 civilians. The Veterans Health Administration operates 153 hospitals, 135 nursing homes, 50 residential rehabilitation facilities and 15 clinics supported by a staff of 252,925.

Kaiser Permanente, the largest private health care provider in the United States, serves 8.3 million people with 35 hospitals, 431 medical offices and a staff of 167,000 employees. Kaiser spent $4 billion during a six-year period from 2003 to 2009 to deploy its electronic health record system, which Epic Systems developed.