The Departments of Defense and Veterans Affairs are revamping their plan to integrate the electronic health records used by their two large medical systems, promising the new approach will deliver capabilities sooner and for less money.

Defense Secretary Leon Panetta and VA Secretary Eric Shinseki announced the revised program and revised timeline following one of their regular meetings on the topic of better integrating services for veterans and military members. Under the new approach, Panetta said, the integrated electronic health record originally scheduled to reach full capability in 2017 will offer up at least partial functionality by early 2014.

“Rather than building a single integrated system from scratch, we will focus our immediate efforts on integrating VA and DoD health data as quickly as possible, by focusing on interoperability and using existing solutions,” he said. “This approach is affordable, it’s achievable, and if we refocus our efforts, we believe we can achieve the key goal of a seamless system for health records between VA and DoD on a greatly accelerated schedule.”

Focus on ‘quick wins’

The new plan still calls for VA and DoD to merge toward a common software platform by 2017, but in the short-term, they’ll focus more on standardizing the data their present-day systems use than on standardizing software.

Roger Baker, VA’s chief information officer, said the departments decided to focus on “quick wins:” By 2014, VA and DoD plan to be able to exchange the most important types of data — seven different “data domains” that are accessed by clinicians in the two departments on a day-to-day basis, including lab results, drug information, allergies and clinical notes.

“It will be exchanged on all patients, and most critically, it will be in a standard data format so that the data looks exactly the same between the two systems by 2014,” he said. “In 2017, the goal is that we’re exchanging all patient information, and there are more than 40 domains when you think about everything to make common between the two organizations. Probably even more critically when you think about 2017 is that the software we use will be highly common at that point.”

Another change — by the end of this year, the two departments will begin sharing a common graphical user interface in clinical settings each of them operate. Dr. Jonathan Woodson, the assistant secretary of Defense for health affairs, said the 2013 rollout will begin with seven DoD and VA wounded warrior polytrauma centers.

“These patients are exchanged back and forth between the two systems quite regularly. There’s a lot of interaction between them, so we felt this was one of the best places to demonstrate the utility of this new graphical user interface that allows us to look at both sets of records at the same time,” he said.

Scrapping plan for new system built from scratch

Officials said the reason the two departments will be able to deliver capability sooner at a lower price is that they’ve jettisoned their original plan to build a new, joint system from the ground up, an approach they originally estimated would cost $4 billion by 2017.

Instead, Baker said, they’ve agreed that each department would use an existing “core technology” as their starting point. VA will build from its existing VistA health record system, but DoD has yet to select the technology that will form its core.

“Our goal though is to make certain that we’re creating a single medical record for all patients, so that a clinician seeing a patient from a DoD or VA system has all medical information available to treat that individual from the moment they raise their right hand to the moment they’re honored on one of our national shrines,” he said.

But for the most part, the departments say the new approach won’t involve throwing the work they’ve already done out the window.

Beth McGrath, DoD’s deputy chief management officer, said most of the work to date has involved creating common requirements and data standards, developing a shared “enterprise service bus” that all health IT applications will eventually connect to, and bringing their IT networks closer together. Those are all efforts that will still come into play between now and 2017.

“The VA, for example, agreed two years ago, and has moved out quite smartly on moving their systems and their data into the (Defense Information Systems Agency) data centers, to make sure we’ve got interoperability across the enterprise,” she said. “It’s important to remember that the approach we’re taking remains fundamentally consistent.”

One foundational aspect of the data standardization effort will be a common system for identity management. Baker said the two secretaries have agreed to create a single set of standards for identity across the health care systems. It will be based on the vast storehouse of personnel information DoD currently operates through its Defense Manpower Data Center, but customized to fit VA’s business processes.

“We had a significant discussion with the secretaries about how fundamental it is for two large organizations like this to merge their identity management systems,” he said. “It’s a key piece of what we’re doing to make certain that we’re always talking about exactly the same patient and that we agree on the attributes of the individuals as we go forward.”

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