A joint, integrated electronic health record between the departments of Defense and Veterans Affairs should be in place 4 to 6 years from now, said VA Chief Information Officer Roger Baker during a May 27 press call.

VA Secretary Eric Shinseki announced an agreement between the two departments to merge their separate EHR systems into one new system, since dubbed the iEHR, earlier this year.

iEHR will be a combination of shared code and standards, Baker said. Some applications will definitely be utilized by both departments, such as pharmacy software, laboratory software, and an enterprise service bus, Baker added.

"I believe the intention is to get to the point where there is a single repository for all the data related to an individual's medical record, whether that data was generated in DoD or in VA," he said.

VA and DoD have yet to work out how they'll get to a single database, however, he said. The two departmental secretaries are set to discuss the matter during their next scheduled meeting on June 23.

Meanwhile, implementation of a single graphical user interface for the existing systems--VistA in the VA and AHLTA in the DoD--has started with a limited number of users in the Tripler Army Medical Center in Honolulu; Tripler is also the site of the Honolulu VA Medical Center. Baker said the GUI will roll out in pilot mode this summer in the James A. Lovell Federal Health Care Center in North Chicago, Ill., which is unique in that it's a DoD/VA medical facility operating under a single line of authority,

As for the role open source will play in the iEHR--the VA is currently in a procurement for an open source "custodial agent" to moderate an open source ecosystem for EHR development--Baker said his department has spent six months "walking through" the advantages of open source with the DOD and Congress.

DoD officials have emphasized that they want "commercial" products incorporated into the iEHR, which some reports have interpreted to mean "proprietary." But, DoD and other officials have said many times in the past decade that open source software almost always meets the definition of commercial items under federal procurement regulations.

One advantage to open source, Baker said, is that it would greatly facilitate "our ability work with the private sector and private sector products as part of the joint EHR."

For more:  
- listen to Baker's May 27 press call
- download a  2009 DoD memo (.pdf) on open source software

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