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Giants Join Forces

March 1, 2007
by Kathryn Foxhall
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Bringing together the VA's inpatient system and DoD's outpatient EMR may serve as a prime example of cooperation.

Largely responsible for dealing with conflicts, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) are acting like models of cooperation as the two government entities plan to integrate their electronic medical records systems over the coming years.William winkenwerder, jr., m.d.

"Both VA and DoD believe that a joint system will make inpatient medical records instantly accessible to clinicians in both departments. VA clinicians will have immediate access to their patients' military health records, allowing doctors and others to make faster and better treatment decisions," a VA statement said.

In his announcement at the Jan. 23 American Health Information Community (AHIC) meeting, VA secretary Jim Nicholson said, "The potential that this joint effort holds for the nation's healthcare community is probably immeasurable. A successful, vibrant and dynamic VA/DoD model can be synthesized and reproduced in healthcare systems both large and small."

Although the two departments have worked toward closer cooperation on electronic medical records (EMRs) for years, staff members of both agencies expressed surprise they are getting "married," as William Winkenwerder, Jr., M.D., DoD's assistant secretary for health affairs, described it.

He indicated that the VA probably has the largest collections of inpatient EMRs in the country, and DoD probably has the largest outpatient collection.

HHS Secretary Michael Leavitt, calling the announcement a "monumental event," noted both systems are "committed to migrate" toward standards endorsed by AHIC, the panel of high-profile leaders that advises the government and has fostered the Certification Commission for Health Information Technology (CCHIT) and other efforts.

Winkenwerder said, "has a great impatient system, VistA. We have a great outpatient system, AHLTA."

The VA, he said, had planned to upgrade its system to a new platform for some time. On the other hand, Winkenwerder said, DoD has some inpatient electronic capability, but, "It is not a sophisticated system. So we were faced with the prospect of having to develop our own, or to contract with some private entity to do this."

When the technical staff in the two departments brought the possibility of a merger to the leaders' attention, Winkenwerder said, "It did not take us very long to just say, 'Absolutely. Amen. Let's go do this.'"

He also said AHIC, which has existed since 2005, has helped to bring the two departments together on the issue. The assistant secretary emphasized that currently the DoD and VA systems "talk" to each other, sending information on a weekly, sometimes daily, basis. But the new configuration, he said, will allow computable information to move in "real time and be accessible to the providers from either system, appropriately guarded for authentication."

Winkenwerder said the departments will be studying the issue for 60 to 90 days. After that, the system may take several years to develop and implement. The two departments will have a joint working team, he said, but they have not decided whether team members will be in one office.

DoD, Winkenwerder said, does "have some different requirements for hospitals that operate overseas, in Iraq, for example, or Afghanistan - different requirements than you would for a DoD hospital here in the United States or a VA hospital in the United States."

He also noted that the VA medical providers will be more familiar than DoD providers with the workings of the new system, "because it will be principally based on the look and feel of the current VistA system." But the new platform, he said, will allow records to be moved anywhere in the world.

Winkenwerder said the departments hope to have a further announcement soon on exactly how they will proceed.

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Kathryn Foxhall is a contributing writer based in Hyattsville, Md.