iEHR aims to be agile and open


Agile techniques have gained importance as the Defense and Veterans Affairs departments try to quickly launch the integrated electronic health record, or iEHR. With more than 100 scrum teams working at once, it's a lot to coordinate, said Barclay Butler, director of the DoD-VA interagency program office.

But the iEHR is still a unified effort that won't be launched piecemeal, he said while speaking Oct. 18 at the AFCEA Bethesda Health IT Day in Bethesda, Md. If the departments unveiled it now, "it would sit on a shelf" until the common interoperability framework, enterprise service bus and master services list were ready.

"When I've got all those pieces running--not completely but just enough to turn it on--then I can light up the graphical user interface," said Butler.

Open source technology and open standards are also central to deploying a highly functional iEHR quickly, said Tim Cromwell, director of standards and interoperability at the Veterans Health Administration's office of informatics and analytics.

Seventy percent of veterans receive some portion of their care from the private sector, "so, there's a real business case to share information in a standards way out to the private sector and to acquire that information back," said Cromwell.

Fortunately, there aren't many standards gaps that will affect the iEHR's initial operating capability, he said. For the IOC, much of the standards will come from mapping the VistA terms to the health data dictionary--a product 3M contributed to open source, said Cromwell.

"In healthcare we're approaching that tipping point where you're going to see an explosion of open source efforts," said Butler.

Butler said vendors must see the business case for open source if they want to work with the IPO on any of the iEHR modules.

Vendors should see "that the combined power of both the DoD, VA and that market will put them in such a position that they will then be almost immediately looked on as market leaders in this space," he said.

Then that technology could extend to the public and private health space, where they can provide professional services, he said.

The panel discussion offered a glimpse at iEHR project milestones. According to Col. Joseph Grebe, program manager for the iEHR within the IPO, the iEHR will have by Nov. 1 "increment one" of the clinical data repository. He also said that during the first week of November "we'll be out in San Antonio with single sign on and context management."

The IPO is also reassessing its joint medical infrastructure, taking notes from "a lesson learned" from the North Chicago, Ill. James A. Lovell Federal Healthcare Center, said Butler.

"DISA along with the services and both departments have signed up to create a logical network that will ride on a global grid," said Butler. "This logical grid is going to be called Med COI, the medical community of interest. The single network will make it simple for a DoD doc to talk to a VA doc."

Related Articles:
IOM: No more DoD-VA integrated medical centers until iEHR
iEHR time frame 'optimistic and uncertain'
VA shifting focus to patient-centered EHRs