DoD and VA back down from iEHR development


The Defense and Veterans Affairs departments will forego development of an integrated electronic health record system and instead focus on data interoperability, officials from both departments said.

In a Feb. 5 joint press conference with Defense Secretary Leon Panetta, Veterans Affairs Secretary Eric Shinseki said the two departments will choose a "core set of iEHR capabilities no later than March of 2013" and will agree on a set of standardized healthcare data no later than this December.

"Rather than building a single integrated system from scratch, we will focus our immediate efforts on integrating VA and DoD health data as quickly as possible, by focusing on interoperability and using existing solutions," Panetta said.

In a follow-up press conference (.pdf) with other officials from both departments, Roger Baker, the VA chief information officer, said data selected for standardization this year will cover just seven informational domains pertaining to immediate patient needs such as prescriptions or lab results. Not until 2017 will the two departments standardize all medical information domains--for which there exist "well more than 40," Baker said--such as images and notes.

By 2017 "the system that we operate on, the software that we use, will be highly common at that point," Baker also said.

Despite officials' repeated use of the word "common," however, it is unclear what that DoD-VA commonality will entail, whether it means DoD and VA EHRs will be based on a common set of software modules.

"DoD must follow its processes to make a selection of a core technology," Baker said in a Feb. 6 statement. He also said the two departments will have "shared applications." One outside observer, speaking on condition of anonymity, said this and other mentions of a common solution are references to the Virtual Lifetime Electronic Record, a joint health data exchange program. The likelihood of DoD adopting elements of the VA EHR, the Veterans Health Information Systems and Technology Architecture--known as VistA--is practically nonexistent, the observer added.

"'Anything is better than VistA,' that's the mentality in DoD," he said.

Elizabeth McGrath, the DoD deputy chief management officer, suggested her department may be in the market for an EHR system. "There's probably a better way, again, looking at commercial--what's happening in industry," she said during the Feb. 5 follow-up press conference. McGrath has been a proponent of a lightweight approach toward jointness, stating in 2011 that the departments should utilize a "common architecture, common data services and data centers." Defense officials have also often said they favor purchase of a commercial system.

Also among the changes announced by the two secretaries is an additional rollout of the Janus graphical user interface that allows care providers to look at the two departmental electronic health record systems on a single monitor.

According to a September Government Accountability Office report, Janus is a read-only tool, meaning that any user who wants to enter data back into a health record must do it outside Janus. Care providers have complained that Janus has stability issues and that it's cumbersome, as well.

Additional locations Janus will be deployed to include five VA polytrauma centers and two DoD polytrauma centers, as well as the DoD's Joint Base Elmendorf-Richardson and the VA medical center in Anchorage, both in Alaska, said Randy Petzel, DoD undersecretary for health affairs.

For more:
- go to the Feb. 5 press conference transcript
- download the follow-up press conference transcript (.pdf)

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