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Military's 'Joint Virtual Lifelong Electronic Record'

April 20, 2009
by David Raths
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To help us assess how difficult it will be to link the entire nation’s electronic health records in five years, one place we can look for lessons is the U.S. military.
The Military Health System and the Veterans Health Administration have been working for close to 10 years on making their two systems interoperable. Although they have made progress, it hasn’t been easy and some work still remains—for instance, on sharing administrative as well as clinical data.
At last week’s World Healthcare Congress in Washington, D.C., I attended a presentation by Chuck Campbell, CIO of the Military Health System, on efforts to create a “joint virtual lifelong electronic record” for members of the military.
Between MHS’ AHLTA and VA’s Vista EHRs, these two large entities keep health information on 14 million beneficiaries and record 1.7 million outpatient encounters each week. Their goal has been creating a way to seamlessly share data between the two organizations. From the outset they decided not to rip and replace any system or to develop one new system for both entities, but instead to work on ways that data can be shared, in much the same way that the National Health Information Network is envisioned.
In 2002 the work began on a federal health information exchange, which sent data on separated or retired military personnel from MHS to the VA. A few years later they created a bidirectional health information exchange, because 3.3 million people are eligible to be seen in both systems.
Now, at the click of a button on the provider’s screen, DoD clinicians can see VA data and VA clinicians can see DoD data.
“We’re sharing a tremendous amount of information between the two organizations,” Campbell said. There are about 60,000 queries a week sent between the two, he added. What’s next? Besides the formidable tasks of working on a new service-oriented architecture and introducing a customizable graphical user interface, MHS plans to team up with one of its Tricare partners on an NHIN pilot project this summer. “To connect to other federal healthcare partners and to civilian healthcare partners, we are going through the NHIN,” Campbell said. “We have participated in two demonstrations. It works. That’s where we’re headed.”
When you combine the VA, MHS and Indian Health Service, they represent a lot of patients. Will those federal organizations be able to play a major positive role in development of the NHIN? Or will their size and bureaucracy levels work against them? What do you think?



David, I also appreciate this post. The VA is a wonderful exemplar for what's possible in the civilian world. (MHS' AHLTA has impressively solved a very different challenge, at a different degree of data granularity, with different trade-offs. I've seen some very impressive presentations of both systems.)

My question: Did Chuck Campbell discuss the distinctions between interoperable, sharable records from the HIE perspective, and interoperable transactions from the process automation perspective? For example, at their new, joint hospital, will doctors be able to place in-patient orders on Vista and AHLTA, and have them transacted on a common order management system? Or, is there some other unifying approach to the transaction side of data capture and workflow?

Thanks for your comments, Kate and Joe. In answer to Joe's question, he did describe some examples of the use of a clinical data repository connecting the two clinical systems in a "computable" way. For instance, he said, if a patient goes to a VA facility to fill one prescription and the MHS for another, the system automatically searches both databases to ensure there is no negative drug interaction. So far, they don't have a common order management system, but that is the direction they want to move in. Campbell said he also wants the service-oriented architecture to change the way they do procurement. They don't want to buy big, expensive systems that take four years to implement. They want to create standards to allow people to develop smaller web services that can be deployed across both systems.

David, I'm so glad you touched in this subject. I was about to blog about it myself

The idea of creating a system that will include administrative and medical information from the day recruits enter military services to the day they leave is one that has enormous implications, both for current and former troops and for the health systems that treat them.

The big question, as you stated, is how this is going to happen, and further, where the funding is going to come from. Don't get me wrong, I applaud all of the parties involved for bringing this critical issue to light, but I really hope the government isn't making a promise it can't back.