Secretary of Veterans' Affairs David Shulkin's decision to adopt MHS Genesis as the department's electronic health record system has brought the discussion of interoperability full circle.
Shulkin acknowledged as much in his June 5 press conference at the White House, talking about how the VA and Department of Defense have tried, failed and tried again to develop an EHR system that could transfer the medical records of active duty personnel between departments with fluid ease when they become veterans.
"And when I went back and looked at this issue very carefully since becoming secretary, I was able to trace back at least 17 years of congressional calls and commission reports requesting that the VA not only modernize its system but work closer with the Department of Defense," he said.
"But actually, to this date, the Department of Defense and the Department of Veterans Affairs have gone separate ways. We each have separate systems, and each are supporting separate electronic systems. And while we've been able to advance interoperability at the cost of hundreds of millions of dollars to the taxpayers, today we still have separate systems that do not allow for the seamless transfer of information."
In announcing the move, VA telegraphed its intention to abandon a standalone EHR system, a position it — and Shulkin — have held to be integral to the agency’s health care plans since 2013.
Back then, both agencies had spent millions to try and develop a shared in-house health care system, only to see the plan bog down in favor of exclusive systems that can talk to each other.
What’s the difference now? It appears to be the ease of a commercial-off-the-shelf system to manage the records can accomplish what the agencies hoped to do 17 years ago.
David Norley, communications director for the Defense Healthcare Management Systems, said that Cerner — the health information technology company operating the system — would be working on both DoD and VA adoption at the same time, aided by the same executives that helped the current stand-up of the system, without impacting the rollout.
"The big thing with it is that the data is all going to be in the same place," he said. "MHS Genesis with the DoD and MHS Genesis with the VA should be the same substantiation.
"But more importantly, the data hosting is going to be at the same place with the same cybersecurity features that the DoD has already put in place. It’s going to be the same data source for Sgt. Or Mr. Smith going forward. So that seems to be something that knocks down a lot of the barriers that were there before."
The DoD still plans a full rollout of MHS Genesis by 2022, while the VA’s schedule for adoption remains to be determined.
But now that the VA will be adopting the DoD’s system, what happens to the interoperability tools that agencies developed to work with their previously separate systems?
It turns out, not that much.
The Joint Legacy Viewer, the prime interoperability conduit designed to share EHR between DoD’s MHS Genesis and VA’s Veterans Information Systems and Technology Architecture — or VistA — system, doesn’t appear to be going anywhere.
"It will still be a major player in what we do, but it won’t necessarily be a major player between DoD and VA, not in the active system," Norley said.
The JLV was implemented as a way for DoD, VA and private health providers to share EHR information through their disparate IT systems in a readable format. Agency officials have leaned on the JLV as the instrument of interoperability ever since they abandoned a shared EHR system in 2013.
MHS Genesis went live on Feb. 7 at Fairchild Air Force Base outside of Spokane, Washington, the first step in a wave rollout DHA officials have planned for 2017, with three other Washington installations set to get the system this summer.
Norley said that while MHS Genesis is currently operational through its pilot program, it communicates with both private and DoD legacy systems through the JLV, making it the prime interoperable conduit for the near future.