14 organizations are looking to join federal electronic health record program

More than a dozen U.S. government agencies are in various stages of joining the federal electronic health record modernization program, or FEHRM, which is seeking to make health data exchanges seamless and move to cloud-based infrastructure.

“At least 14 different federal partners are in some stage of negotiations with us to join the federal EHR program. Some are just inquiries. Some are just asking, and some are more serious. Some of them actually are in the stage of developing functional requirements documents,” said Lance Scott, chief technology officer for the FEHRM Office.

“We’re really really happy to see it expanding,” he said at the GovCIO Media & Research Health IT Summit Wednesday.

The FEHRM office, chartered jointly by the departments of Veterans Affairs and Defense in December 2019, guides agencies in implementing a common federal EHR to digitally store and share patient information. The office has helped the VA, DOD, National Oceanic and Atmospheric Administration and the U.S. Coast Guard deploy the federal EHR, which is commercially known as Oracle Health Millennium.

Scott declined to name new agencies interested in deploying the federal EHR but said his office is “very close” to launching several partnerships. At least two agencies — Immigration and Customs Enforcement and Customs and Border Protection — are actively searching for new EHRs. 

Talk of expanding the federal EHR program came the same day that lawmakers on the House Veterans’ Affairs Committee lambasted VA officials for moving to balloon the size of an Oracle contract to roll out the federal EHR at VA medical facilities. They also voted unanimously to subpoena Oracle officials to testify on the expanding costs.

Interoperability, cloud focus

The FEHRM office is looking to make health data exchanges between the federal EHR and other EHRs seamless by preparing to connect to the Trusted Exchange Framework and Common Agreement, or TEFCA, said Scott. 

The office is choosing the Oracle Health Information Network as its connection point to other TEFCA Qualified Health Information Networks, he explained. Through the Oracle network, providers using the federal EHR will be able to securely exchange health information with providers using other EHRs, so long as they are connected to a Qualified Health Information Network.

Scott said there will be a period of waiting for providers to connect to TEFCA but, when they eventually do, “it’ll just see an astronomical shift in data exchange.” TEFCA currently connects more than 23,000 organizations, including clinics, hospitals, post acute care facilities and federal agencies, according to the nonprofit contracted to manage its implementation.

TEFCA connectivity builds on the FEHRM’s previous interoperability efforts, such as the creation of a joint health information exchange, or HIE, in 2020. 

The federal EHR is gradually migrating functionalities to Oracle Cloud Infrastructure, Scott noted.

“We've got one tranche in the bag. We've got another one that's going to go live again this month, and that one's going to be the whole health data intelligence sector, including health data registries,” said Scott. 

The FEHRM office has enabled more than two dozen registries to help clinicians make better care decisions for patients with diabetes and other health conditions, Scott explained. But clinicians used the registries too much, which led to a replatforming of the functionality along with a move to the Oracle Cloud Infrastructure, he continued.

Scott said he expects the move to the cloud will be complete over the next 18 to 24 months.

Scaling AI

The FEHRM office is also working on scaling a longitudinal natural language processing system that helps clinicians make sense of a flood of patient health data, according to Scott.

The office first tested the system with the Military Entrance Processing Command, or MEPCOM, which uses it to search key words from military candidates’ sprawling medical records, he explained.

“It boils the ocean to come down to, ‘hey doc, you need to look at these 27, 35, 46 documents because these contain the terms that you're looking for?’” he said.

The system reduced military candidate processing times from 10 days down to about five hours, according to Scott. Nearly 20 other organizations have sent the FEHRM office requests for MEPCOM-like buttons that can turn on the longitudinal natural language processing system.

“Twelve months from now, the federal EHR ecosystem won’t look remotely like it does today,” said Scott.