Barclay P. Butler is director of the DoD/VA Interagency Program Office. (Thomas Brown / Staff)
The Defense and Veterans Affairs departments have until 2017 to consolidate under one electronic system the complete health records of military service members — from their active-duty days through their veteran years.
Overseeing development of the $4 billion system is Barclay Butler, director of the DoD/VA Interagency Program Office. Butler’s office is responsible for the design, evaluation and deployment of the integrated electronic health record, or iEHR.
“We’re on track,” Butler said about the departments’ progress.
But meeting milestones hasn’t come without challenges, and Butler expects the same will be true over the next five years.
Federal Times spoke with Butler about those challenges and what’s ahead for the iEHR. Following are edited excerpts:
Q: What are the main challenges in migrating to an integrated electronic health record?
A: Change management is the biggest challenge. … It all comes down to making sure that the [medical facility] site that we are deploying [the system] to is ready, that the infrastructure is ready, that the training is ready, that we have worked with the clinicians with their business processes.
It took eight years to develop the DoD Composite Health Care System, CHCS, [the foundation of DoD’s electronic health record system], and it took about that many years to develop the initial version of VA’s system, VistA [Veterans Health Information Systems and Technology Architecture].
There are similar development and deployment times out in industry, somewhere between six and eight years to get an integrated electronic health record, and we’re pushing that to be a five-year window [for the iEHR].
Q: What are the unique challenges of developing a system that will serve more than 18 million people worldwide?
A: We design it to be able to manage that many patients. ... We will plan on about nine data repositories that span the globe, likely five in the continental United States and then a couple in other areas, and we will have … 24 virtual sites [that require less hardware] closer to our hospitals.
Overall, we will be taking somewhere around 229 data centers and condensing those into the nine regional centers and the 24 virtual centers, and that reduction in complexity allows us to be able to manage this very large patient population.
Q: What iEHR milestone will be achieved in 2014?
A: The 2014 date is a tremendously important date for us in that we will have created everything that is necessary, to include [sharing across departments] a few early clinical capabilities of immunization, laboratory and pharmacy, and we now have a platform to add in the other 54 joint applications that we will be doing in the subsequent three years.
Q: How will the patient experience change once the iEHR is in place?
A: It means a continuous record for their entire service through their veteran status. … When the DoD and VA beneficiaries go out into the private sector and receive care, VLER Health is used to authorize that care and, most importantly, to bring that care record back into the longitudinal record.
Q: What is VLER (Virtual Lifetime Electronic Record) Health, and how does it work?
A: VLER Health is like that communications system that allows the iEHR to communicate with other hospital networks in the private sector, as well as doctors’ offices in the private sector. ... When a patient, say, at Fort Drum, needs to have inpatient care, Fort Drum doesn’t have an inpatient facility; [the patient has] go to Syracuse, N.Y., and get care down there. VLER Health can be used to send the request to that hospital and then, in a secure way, get the results of that treatment ... back into the iEHR.
VLER Health is software and adapters and gateways that allow the iEHR to exchange data in a standard way with hospitals and doctors’ offices [and] share benefits data with the Social Security Administration.
Q: Will VA and DoD continue sharing data through other means in 2017, and will paper records still be used?
A: For the most part, the information exchanges that we currently have will be replaced by the iEHR, in that the clinicians will have access to the complete longitudinal record, and I won’t have independent systems from the DoD and VA that will need to continue to exchange data. We expect that those systems will go away.
There may be still a case for some paper records, but I think the goal here is to have a completely electronic record, and I can only think of a few instances where you might want to add paper, [such as] if there were an outage — you would still need to continue care. You may capture that on paper, but then that would be soon put back into the record.
We will be providing the patient a personal health record that they will not only be able to see their patient data, but they will be able to contribute data into that record.
Q: How many iEHR contracts have been awarded so far?
A: We probably let more than 50 contracts of all shapes and sizes and kinds over the last year. We’ll probably continue that rate over the next year.
Q: What is your office doing to increase electronic information sharing with private partners?
A: That is really the backbone of our VLER Health efforts. Our Joint Executive Council gave us a go decision to further deploy VLER Health out in areas that have a large patient population that are going out into the private sector, [in areas where] the health information exchanges in the states or in the regions are mature.