DOD, VA Agree On Joint EHR ArchitectureDOD, VA Agree On Joint EHR Architecture

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In a report that the Department of Defense (DOD) recently submitted to Congress, the DOD said that it and the Department of Veterans Affairs (VA) had made "significant progress" on their project to create an integrated electronic health record (iEHR).

This assessment echoes a recent announcement by Roger Baker, CIO of the DOD, that the first version of the iEHR would be ready in two years, instead of the four years earlier allotted for development.

The Congressional report stated that the two departments had agreed on a wide range of topics, including common data standards, data center consolidation, common clinical applications, a common presentation layer, and a governance structure for the iEHR. The Defense Department's Information Systems Agency will run the data centers, and its Manpower Data Center will handle identity management, the report said.

The two departments also have agreed on how iEHR functionalities will be developed. Their goal is to use "a coordinated, 'best-of-breed' approach that includes a mix of existing SOA (service-oriented architecture)-compliant capabilities, commercial-off-the-shelf, open-source and custom systems."

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In addition, the two departments will acquire "commercially available components for joint use whenever possible and cost effective." Only if those are unavailable will they adopt a "Department-developed application solution." Also, open source will be an option, although not the main development method. "To foster innovation and expedite the delivery of products to the user, the EHR will leverage both open source and traditional approaches to software acquisition," the document says.

What this language makes clear is that the DOD fully agrees with the VA about the need to use the latest software developed by the private sector to modernize their legacy information systems. Peter Levin, CTO of the VA, told information last September that the departments would move in this direction. That interview took place just after the VA and the DOD established the Open Source Electronic Health Record Agent (OSEHRA) to act as the governing body of a new public-private open source community.

The DOD report to Congress is strong evidence that the departments finally have their ducks in a row, said Mary Lamb, COO of Suss Consulting in Jenkintown, Pa., in an interview. She cited not only the decision to rely on private-sector solutions, but also the plan described in the document for transitioning from the departments' legacy systems to the iEHR.

The VA already is piloting a separate summary record called the Virtual Lifetime Electronic Record (VLER), designed to give clinicians access to key patient data whether they're in military or VA facilities or the private sector. The Congressional document said that the VLER and iEHR programs would be merged.

The report also states that the DOD and the VA have adopted a common framework for semantic interoperability that eventually will encompass standard terminologies such as SNOMED and LOINC. Initially, however, the framework will be based on the DOD data model, and data will be mapped both to systems that adhere to national standards and those that don't, such as the VA's VistA EHR.

"They want the data to be in a common format so that when a clinician looks at the record, they can find all the key pieces they need to treat that patient," Lamb explained.

Finally, the Congressional report presents a roadmap for the development of iEHR functionality. The current set of capabilities includes inpatient and outpatient pharmacy, immunization, and dental care. Next up will be ER care, laboratory, PHR, consultation and referral management, and care management. In the future, the report said, the iEHR will add inpatient and outpatient documentation, anatomic pathology, and disability evaluation.

Referring back to the priority list for acquiring new applications, Lamb said, "For all these capabilities, they'll follow that process. This is an efficient and effective way for the departments to modernize their information systems together."

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