Military Update: DOD, VA take lead in health-record sharing
November 29, 2008
Dr. Ross Fletcher, chief of staff of the VA Medical Center in Washington D.C., asked a recent patient, a war veteran, how many times he had been exposed to the blast of an improvised explosive device. Answer: about 11.
“This particular one,” Fletcher said, “had ruptured his tympanic membrane and also caused -- not severe but some --traumatic brain injury.”
To review the veteran’s medical history, Fletcher didn’t need to consult a bulky file of paper documents. On his computer screen was VA’s medical record system and the display for this patient showed a small blue flag in the upper right corner with the words “Remote Data Available.”
With a click, Fletcher called up an extensive list of DoD reports on the patient. The links on allergies and pharmaceutical history, including drugs dispensed recently at nearby Walter Reed Army Medical Center, had been delivered to VA as “computable data.” That meant Fletcher would be warned by the system if he prescribed a drug that would put the patient at risk.
Other DoD information viewable by Fletcher included military inpatient discharge summaries, procedures performed, outpatient encounters, patient vital signs, lab test results, notes on medical problems, family history, social history and even clinical data that had been gathered in the war theater.
It was all the essential healthcare information a clinician would need. For this patient, Fletcher read outpatient notes from the field hospital in Afghanistan after the patient’s most recent IED attack. It said he was taken to an operating room where shrapnel was removed from his right side scalp.
“I can see exactly what the doctor saw when he first saw this patient, which is really quite beneficial,” said Fletcher.
Two decades after the bugle first sounded, a revolution is well underway in the sharing of electronic health records between the departments of Defense and Veterans Affairs. Their progress also is serving as the cutting edge of a nationwide effort to make electronic health records transferable between any hospital, clinic or caregiver across the country.
Accelerants to some stunning recent gains have been: mounting casualties of war from Iraq and Afghanistan; the scandal of bureaucratic neglect found at Walter Reed in 2007, and vigorous prodding by Congress.
The National Defense Authorization Act of 2008, for example, directs DoD and VA to have their electronic personal health information systems “fully interoperable” by Sept. 30, 2009. The law also ordered a DoD/VA interoperability program office established to be the single point of accountability for reaching the ’09 goal.
Lois Kellett, acting director of the office, said the congressional deadline will be met, in part because lawmakers left it to a committee of DOD and VA clinicians to define “fully interoperable.”
Kellett and Dr. Fletcher were among a half dozen senior healthcare officials at a Nov. 24 Pentagon press briefing to discuss progress between the two departments in the sharing of electronic patient health information.
DoD-VA information sharing takes several forms. For several years, for example, there has been a monthly transfer of historical electronic health information from DoD to VA on all separating service members. This health data now covers 4.5 million former military patients and is accessible for reading by VA providers when one of them seeks VA medical care.
A more sophisticated system for sharing real-time, readable electronic health information is available when service members or severely wounded veterans need care from both DoD and VA. For them a Bidirectional Health Information Exchange sends text data between any DoD and VA sites.
For severely wounded warriors transferred from one of three military medical centers to one of four VA polytrauma center, a new capability exists to send electronically their radiology images such as x-rays and MRIs. A pilot program is testing ways to share such images, which need massive amounts bandwidth, more routinely between other VA and DoD facilities.
DoD and VA first were authorized to share electronic patient records by a law passed in late 1980s. The only began doing so in 2001. A study completed in September this year, by the consulting firm Booz Allen Hamilton examined whether VA and DoD should be forced to use the same electronic health record system, either one of the two now in use or a whole new one.
The study recommended that VA and DoD continue to operate separate systems but to make them more “service-oriented” for doctors and patients with changes to improve their compatibility. For example, Kellett said, care providers can have trouble understanding files they open because VA and DoD haven’t standardized all their codes or abbreviations or even how patients are identified.
“We’re already interoperable,” Kellett said. “But some of it requires some translation or mediation, to go back and forth, so each side clearly understands.” The proposed solution, which DoD and VA have embraced, is to adopt a “common service-oriented architecture,” she said.
To meet the ‘09 deadline, Kellett said her office sets priorities based on recommendations of a board of DoD and VA clinicians. One goal for ’09 is to have discharge summaries transferred to VA from 70 to 80 percent of military inpatient hospital beds, excluding only the smallest facilities. VA now gets such information from about 50 percent of military inpatient beds.
Another goal set by the board to reach full interoperability is to equip all DoD health facilities with document scanning capability so that when patients are referred to private sector specialists those records can be entered into the DoD system and be viewable by any military or VA provider.
Records of such private sector encounters aren’t viewable electronically now beyond the referring military facility, Kellett said.
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