North Chicago's James A. Lovell Federal Health Care Center, the remodeled Illinois hospital which has served as a pilot for Veterans Affairs- and Defense-department facility collaboration, began pushing the limits of AHLTA and VistA interaction before the integrated electronic health record project began. But the bits and pieces of progress at Lovell will form the bedrock of iEHR, said Col. Claude Hines, program manager of the Defense Health Information Management System.

"The foundation [for the iEHR] is already there," said Hines while speaking Aug. 9 at an AFCEA NOVA event in Vienna, Va.

"We have to move data back and forth in real time, not like the normal data that we share with the Bidirectional Health Information Exchange. But we have to use two [enterprise service buses] to move data back and forth between both departments because it's transactional to support the healthcare," said Hines.

DoD and VA have some substantially different work processes, such as pharmacy, noted Hines. And with varying processes, culture can be a major obstacle.

"Sometimes it doesn't matter if the leader says, 'this is the way we're going to do it.' You have that one person that is a major stakeholder and a major player at a facility for a long time and you have to figure out how to overcome that person to get things moving forward in a positive direction," he said.

But as progress continues in North Chicago and as iEHR requirements are revealed, it will become easier to work through those differences, he added.

"The good news, though, is that we are less about saying 'we're unique,'" said Col. Hon Pak, the Army medical department's chief information officer. "That's where we are going, but obviously it's a journey."

Pak said he's encouraged by the promise of openness with the forthcoming iEHR.

"We planned, as part of this EHR framework, to release all the documents, architecture, all these things. It will no longer be, 'you figure it out, you tell us a solution,'" he said.

"The open-source custodial agent, largely a VA-led effort but we also participate, really gives you an opportunity in ways that we've never had before," said Pak. "Having that venue now equalizes the playing ground so that small, innovative organizations can come and help us figure things out."

Opening the door to nimble, innovative technologies is a core focus for Pak, who said DoD is looking for more modular capabilities. All the services "have pretty much bet the farm" that patient-centered medical home will change healthcare, but he said they need the right tools to get there.

"This idea around [health information exchange], telehealth, mobile health, patient-centered medical home are really going to be the necessary ingredients that have to be formulated to drive some of the transformation," he said.  

Related Articles:
Spotlight: VA awards contract for iEHR open source custodial agent 
iEHR will use DoD enterprise architecture 
iEHR will be in place 4 to 6 years from now, says Baker 
VA, DoD to deliver iEHR user interface by July