Both the Department of Veterans Affairs and the Department of Defense manage massive healthcare delivery networks with the help of advanced, comprehensive electronic medical records that are accessible from virtually every facility within each health system.
Although federal officials say 750,000 Americans are dually eligible for care through the Veterans Health Administration and the Military Health System--and 250,000 receive care from both systems in any given year--their records are only minimally compatible, since each EMR has its own standards.
Connectivity is coming, however.
The two departments have plans for a joint, interoperable health record. The timetable, approved by the Bush administration, calls for the next-generation VA and MHS records systems to be fully operational by 2005.
"At that point we will be able to exchange information and do the necessary checks and know what medications each vet is taking," says Robert Kolodner, M.D., acting VHA chief health informatics officer.
On March 21, the VA, DoD and the Indian Health Service of HHS announced the first set of communication and data standards for clinical information as part of the administration's Consolidated Health Informatics strategy (see April, page 2). The program calls for a governmentwide EMR standard and transmission channel, dubbed the Federal Health Information Exchange.
"We don't want to lose the compatibility of the data" so the EMR can trigger alerts and reminders and check to see if the patient has had recommended tests elsewhere, says Army Lt. Col. Bart Harmon, M.D., chief medical information officer at Tricare, the managed care division of MHS. "The computer is becoming an active participant in healthcare and not an alternative to paper."
Today, members of the military no longer must get one health assessment at the time of discharge from active duty and another exam at the time of entry into the VA--an expensive duplication of services funded by taxpayers.
"For several years now, at the time someone separates from the military, we do one assessment and we pass that electronic information on to the VA," says Harmon.
"We're putting a very big focus on making the information available as quickly as possible."
Since early this year, VA physicians have been able to call up MHS laboratory notes, radiology reports, discharge summaries, medication histories and patient allergy information with a single click on the VHA Computerized Patient Record System, without having to wait for the Pentagon to send the data. But they still cannot write notes to records stored on MHS computers.