The Defense and Veterans Affairs departments will use existing DoD facilities in Richmond, Va., and on Hawaii’s island of Maui to develop and test components of a new $4 billion integrated electronic health record (iEHR) system.
The centers, to be opened at DoD’s joint information technology centers there by Oct. 1, are a key step in the departments’ effort to make active-duty military members’ electronic health records accessible to VA doctors, and to have vets’ records accessible to VA and other health care providers.
VA, DoD and contractors at the centers will test how parts of the new system interact with each department’s legacy electronic health record systems — VA’s VistA and DoD’s AHLTA, once known as the Armed Forces Health Longitudinal Technology Application.
This includes testing a critical portion of the new health record, called the enterprise service bus, which will allow components of the future system to communicate with each other and with VA and DoD health information stored in data centers.
Replacing the department’s existing systems will take another five years. But, if everything works as planned, clinicians won’t notice any degradation in service, said Karen Guice, principal deputy assistant secretary of Defense for health affairs, and acting Military Health System chief information officer.
Guice spoke at the Healthcare Information and Management Systems Society conference in Washington last week. Once DoD and VA start to roll out portions of the iEHR system in 2014, “we need to make sure that something doesn’t break,” she said.
The iEHR will include four layers — a graphical user interface for clinicians to see health data, 127 applications to submit and retrieve medical data, the enterprise service bus, and DoD and VA health information co-located in data centers managed by the Defense Information Systems Agency.
One of the first capabilities available in the new system will be pharmacy and immunization applications, which will be rolled out in 2014 in San Antonio and Hampton Roads, Va. Initially, a mix of new and old systems will work together on the back end, but clinicians will be able to view information in a single record without toggling between different systems.
As director of the VA-DoD Interagency Program Office (IPO), Barclay Butler oversees development of the iEHR and other joint initiatives.
He equates his role to a company’s CEO. He answers to an advisory board, co-chaired by Elizabeth McGrath, deputy chief management officer at DoD, and Roger Baker, VA’s CIO. He also works with clinicians to set development priorities.
Butler, a former Harris Corp. executive and CIO for the Army’s medical department, was appointed director in February, following congressional hearings that raised concerns about the interagency office’s lack of oversight authority.
“The secretaries of both departments have been very clear in driving their own departments to say that the IPO is that single point of accountability,” Butler told reporters at the conference.
He’s confident that authorities outlined in an October charter give his office sufficient authority over joint programs, including iEHR and the Virtual Lifetime Electronic Record Health program, an administration initiative to ensure service members’ health records are easily accessible once they become veterans.
Butler said in the past, deciding which capabilities clinicians need has come too late in technology development.
“This is a health care transformation effort that IT enables,” he said. “This is not an IT effort where IT guys make decisions on priorities and order of efforts.”
“Too often, we have been a little bit late in our delivery schedule,” she said. “We want to make sure that whatever we do, we speed to market and get something in the hands of providers.”
But the development process varies at VA and DoD.
“That’s where you have two cultures that are very different,” Butler said. The IPO has its own acquisition strategy to quickly develop components of the iEHR.
There are also budgetary and technical challenges.
For example, DoD’s flying intensive care unit cannot capture all the data from monitoring devices and other equipment used to keep service members alive while flying from theater to the United States, Guice said.
Automatic budget cuts that could take effect in January would also hinder development of the iEHR.
Unlike VA, DoD hasn’t fully committed to using open source software to develop the iEHR. Butler said both open source and commercial software will be used for the new system.
However, all of VA’s 2013 budget request for the iEHR — $169 million — will go toward open source software, Baker said.
Butler said DoD is prioritizing which applications can be put into the open source repository, because some of the applications are part of commercial systems and the code cannot be released publicly.
Last month, DoD announced that an open source version of the military’s electronic health record software used for troops on the battlefield is available to download, but that is just a start.
Butler said DoD has more than 100 commercial-based systems combined that make up its electronic health record system.