The news was welcomed by members of the open-source software communities that have grown up around the VA's VistA EHR.
Formal, concerted efforts by the VA and the DOD to swap patient records go back at least to 1998, but have achieved only sputtering success and meanwhile earned a decade of criticism from Congress and the watchdog General Accountability Office.
In 2008, for example, Congress set a deadline to achieve “full interoperability of personal healthcare information between the two departments” by Sept. 30, 2009. It didn't happen. In 2009, then newly elected President Barack Obama set a goal for creating what he described as a virtual lifetime electronic health record by 2012 that could follow active-duty military personnel through to veteran status. That hasn't happened, either.
But the president's call for a lifetime record still remains the goal, said Roger Baker, assistant secretary for Information and Technology at the VA.
“In fact, one of the 'quick wins' that VA and DOD are accelerating is the sharing of the seven most important clinical information 'domains' in a standard data format between the two organizations,” Baker said in an e-mail.
The two departments “remain committed to shared, standard data, shared applications and a shared common user interface,” Baker said. “The strategy change is to look to existing EHR technology as a starting point on which to build those shared items. VA will use its award-winning VistA EHR as the core technology for its part of the EHR. DOD must follow its processes to make a selection of a core technology.”
By summer, the two departments will pilot a common computer interface between the two systems for physicians at seven joint rehabilitation centers across the country and expand its use at existing centers so that all of them will be interoperability the end of July 2013. In addition by January 2014, data at the VA and the Defense Department will be standardized so that beneficiaries at both organizations will be able to download their own health information, creating “a clear and achievable path directive to implement the seamless electronic health record system for our troops and for our veterans.”
Baker said it “matters greatly that the data that VA and DOD have on patient care be combinable, along with private sector information, into a single health record for an individual. This is a vital part of the president's direction to create a lifetime electronic record for each service member and veteran. This is why the secretaries have focused on the data and the 'quick wins' announced yesterday.”
The idea of one EHR system for both departments' healthcare services is as old as IT development at both, which, at the VA, dates to the late 1970s. In effect, achieving interoperability would undo a schism between the two EHRs that was created by design at the cost of more than $1 billion in the 1990s when the Defense Department's initial EHR was created as a derivative of the VA's system, but interoperability between the two was not maintained.
In 2009, consultants hired by the government determined it was feasible for the two departments to work together and come up with a common EHR system to achieve interoperability.
Consultants Booz Allen Hamilton and Gartner came up with figures ranging from $1.4 billion to $5.2 billion, but other estimates placed the final price tag at closer to $15 billion. The two departments had been marching in the direction of a single system ever since.
Together, the VA and the DOD operate nearly 100 hospitals and 1,000 clinics and provide healthcare services to more than 15 million people, including 1.1 million who receive care from both organizations. They have achieved measures of interoperability, but systemwide exchange has eluded them.
“There have been many different attempts, and different attempts have served some limited purposes, but when they've tried a more global effort to support more of the functionalities, they haven't been able to scale up,” said Seong Ki Mun, president and CEO of the Open Source Electronic Health Record Agent, a not-for-profit organization founded by the VA in 2011 to spearhead an open source development project to improve the VA's VistA EHR and work with the Defense Department on the joint EHR development effort.
“I think we'll be able to make a real, significant contribution toward this newly directed effort,” Mun said. “I applaud the decision that the secretaries made. As an open source community, we feel very comfortable with that.”
Dr. Nancy Anthracite, president and chief medical officer of WorldVista, a not-for-profit organization formed in 2002 to promote the use of an open source version of VistA outside the VA, expressed no regret at the demise of the joint development effort.
“The previous plan was going to be extremely expensive and it would not have worked,” Anthracite said. “I do not know what they have planned now, but I am hopeful it will be better. I would like to see them migrate the military system to VistA while doing the work to enhance VistA to support the additional needs of the military and the military dependents. We already know that VistA provides 90% of the capability that the military needs. There is no technical reason this cannot be done cost effectively.
“VistA is already being adapted and modernized without replacing the existing system,” Anthracite said. “It will happen a lot faster if the funds and manpower that were being put into this ill-conceived plan were directed to enhance this already excellent system.”
