DOD And VA Finally See Need To Develop Joint Electronic Medical Records SystemDOD And VA Finally See Need To Develop Joint Electronic Medical Records System

In the wake of much-publicized shortcomings in medical care provided to returning soldiers, the U.S. departments of Veterans Affairs and Defense are launching a project to develop a joint inpatient electronic medical records system. But don't expect substantial progress for years.

The departments were among the earliest adopters of digitized patient records, leaving many wondering why they're so far behind in sharing data. Their EMR systems, which evolved separately, don't interoperate, and the DOD even has problems sharing data among its own facilities. This was an annoyance for peacetime medical care, but with the wave of injured soldiers returning from Afghanistan and Iraq, delays in accessing physicians' notes and other information are compromising their care when they're moved from one medical facility to another.

The VA and the DOD are able to exchange electronically some inpatient information--including lab, prescription, and radiology data. But Defense facilities still use a lot of paper records, making it difficult to transfer physicians' notes and other important information when a soldier is moved. The project's goal is to "evolve and modernize to share data more widely," says David Schroeder, the deputy director in charge of interagency data sharing for the DOD's Military Health System.

EMR PIONEERS

Since the 1970s, the DOD and the VA have been using EMR systems originally built on a common system. However, they went off on separate paths over the years. The VA developed its Veterans Health Information Systems & Technology Architecture, or Vista, a system for inpatient and outpatient facilities with decentralized data repositories. Defense developed the Armed Forces Health Longitudinal Technology Application for outpatient care. AHLTA is used in 70 DOD hospitals and 400 clinics worldwide, handling 120,000 encounters with outpatients a day, says Chuck Hume, deputy CIO and chief of program analysis and evaluation for the Military Health System. AHLTA was designed with a centralized database because military patients and doctors move around every two to three years. "We have a unique need. It's very nomadic--so the practical solution was a centralized database" for outpatient records, Hume says.

The DOD also uses an application that tracks patients from combat to the medical facility they end up at in the United States. In its U.S. facilities, however, the DOD uses a variety of EMR systems.

When a patient is moved from a Defense hospital to a VA facility, not all records go along. Instead, a discharge summary is sent, Schroeder says. However, a "fair amount" of allergy, pharmacy, lab, and radiology data is transferred through a bidirectional data sharing system, he says, and physician notes will be added to that system this fiscal year.

One-way gateways have been built through which data from larger Defense medical facilities--such as Walter Reed Hospital and Bethesda Naval Medical Center--can be sent to the four VA facilities where many of the most seriously injured people are sent after they're discharged from the military. All electronic data, along with paper records and radiology images, is transferred in a view-only format through this system, which has no interactive capabilities.

The new project will look at all the existing systems and determine the best way for the VA and the DOD to develop a joint inpatient EMR system. The agencies plan to issue a request for proposal next month to hire a company to assist them in the initial assessment. It will be several years before VA and Defense facilities are on the same systems, Hume says.

"There's a lot of work to do," he adds. "It's not easy. There's no model out there. We're inventing the model. It's easy to identify everything we should do, but we can't wave a magic wand." But with so many eyes trained on them, the Defense Department and the VA will need to work as fast as possible to address this problem.