The Defense and Veterans Affairs departments' integrated electronic health record--or iEHR, as it's being called--will be housed in a cloud computing environment hosted by the Defense Information Systems Agency, said VA Chief Information Officer Roger Baker.

"One of the things the two secretaries, of Defense and Veterans Affairs, have agreed [to] is we'll utilize DISA data centers as part of our joint electronic health record system," said Baker, while speaking at a May 4 event in Washington, D.C. sponsored by TechAmerica.

The iEHR will have "all the data in a single place so that for the military member it's seamless for them," Beth McGrath, chief management officer at DoD, said earlier at the same event.

Already VA is moving all electronic health record systems out of hospitals and into regional data centers, said Baker, referring to the transition as "cloud VistA." VA hospitals often don't know where their VistA system is actually located "and they really don't care," said Baker

Meanwhile, DoD is preparing data collection for a joint EHR so it can "lock the data elements" from the beginning and connect processes, said McGrath. "You have to say, 'when do we first capture that individual?' And it is in the accessions process. So I want to be sure that I've defined the data element that I want to use to track that military member throughout his or her lifecycle at the very, very beginning," said McGrath. "This is everybody in, and it's end to end, and we're going to do it right."

According to McGrath, the departments have agreed to a data-driven, standards-based approach as well as a joint, common architecture. The iEHR aims to have a "light footprint and the right security controls," and data center consolidation is part of that, she said. The joint system will also have a common presentation layer and common business practices, for example pharmacy processing and recording for active-duty and veteran records will be the same, she said.

As McGrath and Baker revealed the extent of sharing between VA and DoD, it remains unclear how health record modernization fits into a joint system. The modernization of the Military Health System is underway and will be wrapped into iEHR efforts, said McGrath; similarly, VA officials have said they are modernizing VistA and will "refactor" MUMPS as much as possible. Until now VistA and MHS modernization efforts have been characterized as separate VA and DoD efforts housed under the umbrella of a joint EHR's development.

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