As the Defense Health Agency prepares for the initial launch of a new electronic health record in the next few months, the Pentagon said it was broadening its definition of interoperability.

Rear Adm. Raquel Bono, director of the Defense Health Agency, said she’s “widened her aperture” on what interoperability means, and DHA’s approach to the new EHR reflects that definition.

“I’d been so narrowly focused on DoD and [Veterans Affairs,] she said in an Oct. 12 speech during AFCEA Bethesda’s Health IT Day. “I started realizing that interoperability meant being able to share in a bi-directional manner … health data information with our commercial and private hospitals that help take care of our beneficiaries.”

For Bono, interoperability starts within military medical treatment facilities and hospitals.

“I realized that if I can’t move to that greater interoperability between what I’ve got within my hospital walls, it’s going to be a lot harder for me to do that interoperability beyond my hospital walls,” she said.

To that end, DHA is making sure that the hundreds of programs and devices military hospitals use  speak the same language as the forthcoming electronic health record, Bono said. The new EHR must be able to interface with forward-deployed elements within the military health system and within different combatant commands, in addition to medical centers at VA or private facilities.

“When we’re looking at interoperability within the hospital walls, I need to make sure that our medical devices can interface with our electronic health record,” she told Federal News Radio. “As we’re looking at our portfolio and we’re rationalizing it — whether they’re applications, programs or medical devices — what’s first on the chopping block or the first consideration is how well they’re going to interface with our interoperable medical record.”

This comes as DoD pushed back to February the much-anticipated roll out of its new commercially derived electronic health records system, MHS Genesis. The EHR is set to go live at one facility in the Pacific Northwest, with three more scheduled for later in the spring.

Work on the EHR also involved a shift in thinking — from customization to one that emphasizes standardization and configuration. It’s one of 14 principles DoD is using to guide its work on the EHR.

DHA wants military medical programs and devices to configure its systems to comply with the DoD EHR, said Capt. James Ellzy, deputy program executive officer with the Functional Program Executive Office for Defense Healthcare Management Systems at DHA. And if certain devices or programs do need a custom solution, DoD is taking a harder stance.

“What is it that your system allows us to easily change?” Ellzy said. “Those are the things we want to tackle. And if it is customization, we’ve asked our partnership to tell us its customization. Don’t sugar-coat it; let us know up front that it’s customization. Sometimes we might push back.”

The Pentagon said it’s confident it will meet its goal to deploy the full EHR by 2022. Bono said the delays give the Defense Health Agency an opportunity to get the initial deployment right the first time and make technical corrections along the way.

“In moving to the right a little bit, it gives us a chance to understand what some of the challenges are going to be, and we’ll have more complete solutions,” Bono said. “With those more complete solutions, we feel that will allow us to keep on track with our overall deployment schedule.”

DoD has also started to train military doctors and professionals and update clinical workflows to comply with the new EHR, Bono said.

“Some of our biggest transition efforts have to do with changing the practice of a few people,” she said. “We’re looking at the community that are the primary end-users of the electronic health record.”

Those end-users will eventually include doctors and medical professionals with the Veterans Affairs Department, other federal partners and the private sector.

But creating full interoperability with the VA and industry will certainly take more time.

“From an interoperability perspective, we are not where we need to be with respect to ubiquitous system for care,” said Dr. Lauren Thompson, director of the DoD/VA Interagency Program Office. “Part of that has to do with the fact that there are multiple networks in play in industry, the exchange of data and using different specifications and even in some cases the same specifications at a different level of granularity that get implemented differently.”

Thompson said she’s beginning to see some success points by holding roundtables with industry and other major stakeholders. She said that approach has helped DoD develop the initial capabilities for the new EHR.

But real sustained progress on broader interoperability will only come if and when top leadership gets on board.

“Ultimately, it comes down to people and incentivizing people to take action,” Thompson said. “We have a lot of plans. We’ve done a lot of analysis. We’ve made recommendations and identified potential solutions, but ultimately someone needs to do something.”

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