Pentagon Plays Catch Up on Digital Health Records

The Pentagon is developing a multi-billion dollar electronic health record system at a time the military and the Department of Veterans Affairs face increased scrutiny regarding their ability to share electronic health information.

The Defense Department's new program is trying to leverage commercial technology to ensure health records can be shared with both private hospitals and the VA, Pentagon officials said.

The DoD Healthcare Management System Modernization program plans to create an electronic system and database that facilitate access to medical records for more than 9.6 million troops and their families.

The new effort should be welcomed by critics who have expressed concerns over the years about the inability of Defense Department and VA health records systems to work together.

Lawmakers and government watchdog groups have slammed the Pentagon and VA in recent years for using different databases for medical information that are not compatible and lag behind industry standards for electronic medical records.

"The VA has been doing this for a long time and I don't see a reason why the VA and DoD have not made more progress. It does not appear that there is yet a system that allows for a seamless transition from military resources to VA resources both in terms of benefits and health care," said Mike Viterna, president of the National Organization of Veteran's Advocates.

A GAO report from February said the military and VA need to improve collaboration; develop interoperability plans for electronic health records; and create cost-effective and timely solutions.

"The Departments of Veterans Affairs and Defense abandoned their plans to develop an integrated electronic health record (iEHR) system and are instead pursuing separate efforts to modernize or replace their existing systems in an attempt to create an interoperable electronic health record," the report states.

"The VA and DoD have not substantiated their claims that the current approach will be less expensive and more timely than the single-system approach."

The report points out that the respective individual efforts of the DoD and the VA need to be better integrated and coordinated as well.

"The departments have yet to update their joint strategic plan to reflect the new approach or to disclose what the interoperable electronic health record will consist of, as well as how, when, and at what cost it will be achieved," the report states.

The new Pentagon effort, which began in January 2013, is designed to replace a range of existing military healthcare systems including the Armed Forces Health Longitudinal Technology Application, or AHLTA, and the Composite Health Care System, or CHCS, said Navy Capt. John Windom, DHMSM program manager.

"The product is going to be more usable, more expandable, more robust -- all of the things that our clinicians deserve. We're seeking to leverage the technological advancements that are taking place out in the commercial medical world," Windom said.

For example, the AHLTA and CHCS have difficulty sharing information -- something this new integrated system plans to correct, he added.

The new Pentagon program will seek to provide an integrated, global network of electronic health care information to more than 55 medical centers and hospitals, 361 ambulatory care clinics, 249 dental clinics and 300 ships, Pentagon officials said.

The new database will include the full range of health information from medications to test results, check-ups and even injuries sustained while deployed.

These advancements include building a system which is fully interoperable with the VA system and the private sector by using common interfaces and common internet protocols, Windom explained.

The DHMSM program is working closely with the Department of Health and Human Services' Office of the National Coordinator to ensure the IT standards and protocols allows the various systems to work with one another and share information as needed, Windom added.

"If we follow the same inherent interface protocol, we will be interoperable with VA and private providers," he explained. "We are aligning with commercial standards."

The Pentagon plans to award a single contract to a winning proposal sometime next year, Windom said.

The Pentagon's new program is being developed to work seamlessly with the VA's new health records system called Veterans Health Information Systems and Technology Architecture, or VistA. In fact, it is conceivable that VistA could be among the technologies offered in response to the Pentagon's request to industry about the new program, Windom said.

The first deployment of the new electronic health records system will be in the Puget Sound, Wash., region, he said.

Ultimately, the new Defense Department database will be deployed at military treatment facilities worldwide to include operational environments, forward deployed locations, Navy ships and submarines.

While this new effort unfolds, Defense Department officials are also working at increasing the ability of the Pentagon to share key health information of transitioning service members when they leave active service. Both Pentagon and VA officials said they have made progress digitizing medical records and increasing accessibility of information between the two organizations for transitioning service members.

David Bowen, director of health information technology for DoD's Defense Health Agency, told Military.com the Pentagon has made substantial progress passing information to the VA.

In particular, Bowen cited an initiative beginning in 2002 to pass along key information from departing service members called the Federal Health Information Exchange.

"We went back to 1989 and started moving data on those service members forward, moving that data over to the VA. Every month, we send data on our newly separated service members over to the VA," Bowen said.

To date, the Pentagon has electronically sent health data on 6.2 million service members, including 95 million lab results, 15 million radiology results and almost 100 million pharmacy records, he added.

At the same time, the Pentagon says its digital Health Artifact Imagery Management System, or HAIMS, provides an electronic record of a service member's treatment. Medical treatments, X-rays, hospital visits and combat injuries from theater and deployments all get uploaded into the system, said Pentagon spokeswoman Lt. Col. Catherine Wilkinson.

Since January, all separating service members have been required to add their medical information into HAIMS, a system which can be accessed by a segment of the VA called the Veterans Benefits Administration, Wilkinson added.

"There is a mandate that every separating service member's records get uploaded into HAIMS. We've uploaded more than 50,000 records and approximately 5,000 have filed claims with the VA. The Veterans Benefits Administration can query HAIMS," said Wilkinson.

One analyst said the presence of a number of different electronic systems underscores the need for the Pentagon to establish technology able to achieve greater commonality and integration.

"We've seen a lot of health information exchanges and collaborative work; there's still a need to agree upon common standards. There's still a lot of work that needs to happen to standardized formats. There is a lot of exchange going on, but there needs to be better integration with different systems," said Harry Rhodes, director of HIM Practice Excellence for the American Health Information Management Association.

Meanwhile, VA officials say that they are making progress on a joint DoD-VA effort to create a single, secure electronic record called Virtual Lifetime Electronic Record, or VLER, according to a written statement from VA spokeswoman Ndidi Mojay.

VLER catalogues prescription information on patients as well as details on allergies, past medical procedures and lab results. The VLER program, which was started in 2009, is available to service members and veterans at many locations including Madigan Army Medical Center in Tacoma, Wash., and the Naval Medical Center at San Diego.

VLER is designed to allow caregivers, clinicians and benefits providers to view all relevant information about the veteran securely, regardless of where it was documented, in a single, secure, electronic record, she added.

Senior Pentagon officials acknowledge that, while much progress has been made, there are still paper records that need to be digitized.

"There are still paper records. Back in the Vietnam, era the health records were paper. Until HAIMS came along, we would physically send that paper record over to the VA. Now, with HAIMS, we scan that paper into an electronic system. We have Guard and reserve service members who still have paper records," Bowen said.

-- Kris Osborn can be reached at Kris.Osborn@monster.com.