Requirements identical for Defense, VA health record system

Development of a joint inpatient electronic health records system will satisfy almost all the requirements of the Defense and Veterans Affairs departments, according to a long sequestered report obtained by Nextgov.

The report, prepared by Booz Allen Hamilton in January, said Defense and VA share a common definition of an inpatient electronic health record and both share similar functional requirements to manage patient care. Booz Allen analyzed more than 1,800 functional requirements and determined that 97 percent of them were similar and only 3 percent were specific to each department. The differences primarily involved admission, discharge and transfer capabilities.

"This overwhelming level of jointness confirms the main hypothesis of this study that DoD and VA care for patients in a similar manner and thus have similar functional requirements," the report concluded.

Defense is working with VA to develop a system architecture to manage both inpatient and outpatient electronic health records, Charles Campbell, the chief information officer at the Military Health System said in September. The fiscal 2009 Defense Authorization Bill requires Defense and VA to adopt technology-neutral guidelines and standards so the two agencies can share electronic health records and soldiers' health records can move seamlessly with them from the battlefield to hospitals and clinics run by VA.

Defense operates an outpatient electronic health record system called the Armed Forces Health Technology Longitudinal Application, but it does not operate an inpatient system. VA has an inpatient record system called the Computerized Patient Record System, which is a component of an electronic health care system called the Veterans Health Information System and Architecture. Booz Allen reported that VA needs to modernize this latter system.

The need to update CPRS and the requirement to deploy an inpatient electronic health record in the Military Heath System presents a "unique opportunity" for both departments to investigate the feasibility of a common system, the Booz Allen report noted.

Even though Defense has unique requirements for battlefield or theater medicine that VA does not have, the study determined there were few differences in the kind of system needed to help care for a patient at the Walter Reed Army Medical Center in Washington or on the battlefields of Iraq or Afghanistan.

Booz Allen interviewed military theater health experts and concluded that there were few differences in the functional requirements for a battlefield health system and a system used at Walter Reed. "The main functional differences are actually features that are not needed in theater," the report noted.

Booz Allen received input on its study from 24 commercial organizations, including electronic health record companies. The industry urged Defense and VA to shift from building a customized in-house electronic health record systems to one based on commercial systems.

The IT consulting firm Gartner, working on Booz Allen's behalf, examined electronic health record systems from seven vendors and said only health system developers Epic Systems Corp. and Cerner Corp. have fully integrated systems that support all Defense's and VA's requirements. Epic fielded a $3 billion electronic health record systems for Kaiser Permanente, the nation's largest private hospital company, and Cerner won a contract in 2005 to deploy its laboratory information system to Defense hospitals and clinics worldwide.

Joseph Dal Molin, founder of e-cology Corp. in Toronto and who works on deployments of electronic health record systems, said instead of looking to commercial sources for a joint inpatient electronic health record, Defense and Veterans Affairs should upgrade VA's inpatient system, which meets a key requirement of the Booz Allen study, user satisfaction.

Steve Arnold, chairman of the global electronic health record task force for the Healthcare Information and Management Systems Society, said Defense and VA should develop a converged electronic health record system that can follow a patient through the continuum of care from a battlefield aid station to care in a VA hospital.

Arnold said such a converged system should be developed on commercial electronic health record systems because VA's system aging. Dal Molin disagreed, and said it would be less expensive to upgrade VA's Veterans Health Information System and Architecture than to build one from scratch.

Booz Allen estimated it would cost between $1.4 billion and $5.2 billion to develop the joint system and take from six to 17 years to deploy.

Booz Allen recommended that Defense and VA conduct a cost/benefit analysis of various options to integrating electronic health record systems, including maintenance of the present systems as is, procuring and deploying commercial systems, and leveraging the capabilities of existing Defense and VA systems.

In July, S. Ward Casscells, assistant secretary of Defense for health affairs said he favored a "converged evolution" of the Veterans Health Information System and Architecture and the Armed Forces Health Technology Longitudinal Application into one system.

A spokeswoman for the Military Health System said Defense and VA have not decided how to adopt the Booz Allen recommendations and does not expect a decision until January.