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Defense Health shoring up IT ahead of EHR move

February 6, 2015 (Photo Credit: Alan Lessig)

As the Defense Health Agency moves forward in pursuit of a new electronic health records system, officials there also are overhauling IT to become a more agile, responsive organization.

Top priorities for the 2015-2016 time frame include the EHR, enterprise consolidation, interoperability with the Veterans Administration, application rationalization and the standardization of enterprise activities, according to Dave Bowen, DHA CIO and director of healthcare IT.

"We're continuing to consolidate across the enterprise; having consolidated our central units we're now looking at treatment facilities…and trying to bring them into fold in a more standardized fashion," Bowen said Feb. 4 at AFCEA Army IT Day in Vienna, Va. "We're continuing to work with the Veterans Administration for more interoperability. This has been a topic that's gotten a lot of press – I can tell you we send massive amounts of data to the VA each and every day, millions and millions of fields of data."

Bowen said DHA has been establishing methodologies to further standardize interaction between the two agencies – a move that's critical as DoD and VA pursue different paths toward new EHR systems.

To date, the agencies have jointly standardized more than 46,000 medical terms and are continuing to work on standardizing more activities.

DHA officials also have been re-engineering business processes to achieve better efficiencies and cost savings, according to Col. Chip Terry, Air Force Medical Service CIO.

That work includes three different business cases that Terry gave as examples. The first centers on bringing together management staff, including three service CIO shops, operational commands and the former TRICARE Management Activity office, Terry said.

The other business cases are IT-focused: DHA is consolidating its IT infrastructure, standardizing IT "all the way down to the desktop," Terry said. The agency also is going through an application rationalization process to eliminate duplicate applications and processes.

"For example, in [the Military Health Service] we had 26 applications for e-learning, and we're in the process of going down to one," he said. "It's extremely tough work; you don't just go in and turn it off. You have to communicate with the end user and have an exit strategy and plan for how to take care of their needs."

If the IT-centered efforts sound familiar, it's because much of the work is in line with broader Defense Department efforts to streamline and centralize IT operations. That includes aligning DHA with the Pentagon's Joint Information Environment through a "community of interest" that allows for rapid, online collaboration between DoD healthcare stakeholders.

"As we look for infrastructure improvement, the key is that we are pursuing a medical community of interest enclave that nests within JIE," said Col. Andrew Smith, commander of the Army Medical IT Center.

Smith said that the JIE alignment also improves security and helps move information more quickly. "Being nested below JIE through the joint regional security stacks allows us to collapse our network, reduce infrastructure and increase throughput data across our enterprise."

Smith also noted that the goal is to have in place a new, consolidated directory services capability in time for a pilot run of the new EHR system. It's one of five major lines of effort that also include seamless networks with a single security architecture, desktop-as-a-service offerings, compute and storage management capabilities and a global service center.

With a massive, multi-billion dollar procurement for the new EHR system on the line, the IT work is figuring in heavily, according to DHA Director Lt. Gen. Douglas Robb.

"This is an $11 billion procurement. When you think about that, this infrastructure piece is huge," Robb said. "So we have to think about what we're going to do to make sure we get the best performance out of that EHR."

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