VA, DOD prom­ise up­grades to cur­rent EHR sys­tems

VA, De­fense De­part­ment scrap uni­fied EHR sys­tem

Modern Healthcare - - NEWS - Joseph Conn

Car­di­ol­o­gist Dr. Lewis Coul­son, a Veter­ans Health Ad­min­is­tra­tion physi­cian for the past 42 years, works with one of the best elec­tronic health in­for­ma­tion sys­tems in the world—the VA’s VistA.

But when a re­cently dis­charged veteran walks into his of­fice at Jesse Brown VA Med­i­cal Cen­ter in Chicago and he calls up the health record, he gets only a care sum­mary from his or her days in the mil­i­tary.

The sum­mary con­tains im­por­tant items such as the pa­tient’s med­i­ca­tions, past di­ag­noses and ap­point­ments, but not rich and some­times equally im­por­tant de­tail.

It’s nowhere near the com­pre­hen­sive record avail­able to older veter­ans through VistA, or the spe­cial­ized sum­mary avail­able through the VA’s com­put­er­ized pa­tient record sys­tem (CPRS), VistA’s main user in­ter­face, which in­cludes car­diac catheter­i­za­tion data, dig­i­tized X-ray and other imag­ing and de­tailed physi­cian notes. “It’s more of a gen­eral sum­mary,” Coul­son said of the ver­sion seen at the VA from the mil­i­tary. “I can see they’ve been seen by a heart doc­tor” but “it’s not as good as CPRS, or if I could see the whole thing di­rectly.”

Last week, De­fense Sec­re­tary Leon Panetta and VA Sec­re­tary Eric Shin­seki an­nounced they were scrap­ping a five-year ef­fort to build a new com­mon elec­tronic health record sys­tem—a plan once touted as the best so­lu­tion to the decades-old in­ter­op­er­abil­ity prob­lem plagu­ing med­i­cal record trans­fers be­tween the mil­i­tary and the VA. Now, they said, the VA and DOD will pur­sue fur­ther im­prove­ments in the in­ter­op­er­abil­ity of their cur­rent EHR sys­tems.

By De­cem­ber, health­care data used by the VA and the Mil­i­tary Health Sys­tem should be stan­dard­ized and data will be ex­changed in real time, Shin­seki vowed. Also, of a Web­based in­ter­face called Janus, devel­oped in 2003 by the VA and DOD, would be up­graded and its use ex­panded. Janus al­lows clin­i­cians in ei­ther sys­tem to peer into each other’s EHRs.

Success in build­ing a uni­fied sys­tem wouldn’t come a moment too soon for veter­ans’ ad­vo­cates such as

Adrian Ati­zado, the as­sis­tant na­tional leg­isla­tive di­rec­tor for the Dis­abled Amer­i­can Veter­ans. His group has been frus­trated by years of failed ef­forts to achieve in­te­gra­tion be­tween the two sys­tems. “The se­verely in­jured

ser­vice mem­bers, who have to hop be­tween the VA and the DOD, they have to be im­pacted the most,” he said. “The mean­ing­ful shar­ing of health in­for­ma­tion has a di­rect im­pact on the cost of health­care, the qual­ity of health­care and the pa­tient’s health out­come.

“It has to be com­putable to be mean­ing­ful to a clin­i­cian,” Ati­zado said. “If I’m a physi­cian and I have 20 min­utes to see a pa­tient, I don’t have time to read 20 PDFs. You can­not view DOD’s health data in the VA’s world. Not be­ing able to com­pare MRIs, or spec­trom­e­ters or X-rays, VA providers have to ac­com­mo­date for that lack of mean­ing­ful in­for­ma­tion, which puts more bur­den on the ac­tual provider.”

The mil­i­tary and VA brass ad­mit­ting de­feat in their ef­forts to build a one com­mon EHR sys­tem

is only the first step in achiev­ing the in­ter­op­er­abil­ity goals sought by VA physi­cians, veter­ans and their ad­vo­cates. While Panetta and Shin­seki out­lined an ag­gres­sive timetable last week, the two agen­cies have a his­tory of miss­ing dead­lines.

The ini­tial dis­con­nect be­tween IT sys­tems of the VA and DOD dates to 1988. That’s when soft­ware de­vel­oper SAIC won a bid­ding com­pe­ti­tion to build the mil­i­tary its own EHR, bas­ing the new sys­tem on free soft­ware code from the VA, which had been work­ing on its own EHR since at least 1977. About $1 bil­lion later, re­calls pro­gram­mer

Tom Mun­necke, who worked on both sys­tems, the mil­i­tary de­ployed its Com­pos­ite Health Care Sys­tem, a “turnkey op­er­a­tion, hard­ware, soft­ware, main­te­nance and train­ing at 750 sites all over the world.” The big flaw, though, was that the mil­i­tary’s new EHR could not com­mu­ni­cate with its VA fore­run­ner.

Ef­forts to con­nect the sys­tems be­gan in 1998 with only par­tial suc­cesses. By April 2009, full in­ter­op­er­abil­ity was still so dis­tant that the White House an­nounced that the two de­part­ments had taken only a “first step” to­ward cre­at­ing what Pres­i­dent Barack Obama called a “joint vir­tual life­time elec­tronic record” that would en­able “a stream- lined tran­si­tion of health­care records be­tween DOD and the VA.”

That hasn’t hap­pened yet, not com­pletely. Last week, Panetta ad­mit­ted the “frus­trat­ing” in­ter­op­er­abil­ity strug­gle had gone on for years with­out success.

“We can and must do bet­ter,” he said. “It’s been in­ef­fi­cient for ser­vice mem­bers to have to hand-de­liver records from one sys­tem to an­other when they get out of the mil­i­tary. Our ser­vice mem­bers of­ten have ex­ten­sive records. The last thing they need is to worry about their doc­tors hav­ing all the in­for­ma­tion that they need in or­der to pro­vide them the care that they de­serve.”

How much pa­tient care has been af­fected by the decades of only par­tial in­ter­op­er­abil­ity be­tween the two sys­tems is any­body’s guess, Ati­zado said. “It would really take a re­searcher to de­ter­mine that,” he said.

Veter­ans are gen­er­ally very happy with the care they get in VA, he said, be­cause clin­i­cians find ways to work around the in­for­ma­tion bot­tle­necks with the mil­i­tary.

Coul­son, the Chicago VA doc­tor who is also a med­i­cal in­for­mati­cist, agreed. The elec­tronic pa­tient sum­maries the VA re­ceives from the mil­i­tary are a vast im­prove­ment over a decade ago, when dis­charged veter­ans might en­ter his of­fice with pa­per records.

He is hope­ful this lat­est surge by the brass will fi­nally achieve the long-de­layed goal of full in­ter­op­er­abil­ity. “Go­ing from mil­i­tary life to civil­ian life and mak­ing it seam­less ought to be the goal,” he said. “I think, the more in­for­ma­tion we have the bet­ter.”


De­fense Sec­re­tary Leon Panetta, left, and VA Sec­re­tary Eric Shin­seki scrapped a plan last week to cre­ate a sin­gle-shared EHR sys­tem.

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