What is Defense-VA Interoperability?

The Defense and Veterans Affairs departments will achieve full interoperability of electronic health records by Sept. 30, Rear Admiral Gregory Timberlake, acting director of the Defense and VA interagency program office, told a House VA Committee hearing on Tuesday.

Timberlake, testifying before the Subcommittee on Investigations and Oversight of the House VA Committee, quickly added this achievement is based on the definition of interoperability, developed by a critter called the Defense/VA Interagency Clinical Informatics Board, which at least from my perspective, erects a rather small fence around an all-encompassing term. As defined by Timberlake, interoperability of Defense/VA electronic health record systems means that within 79 days they can:

• Exchange social history data, i.e. information on patient use of alcohol and tobacco, for example.
• Share physical exam data.
• Share information from patient questionnaires and self-assessment tools.
• Expand use of the Defense inpatient medical records system. (AHLTA, the Defense health record system, only serves outpatients.)
• Demonstrate the ability of Defense to scan paper medical records and then transfer them to VA. (As Timberlake, whose Naval career started in 1972, pointed out, folks in uniform for a long time have an equally long tail of paper records used before anyone even thought up electronic health records, hence the need for scanning.)
• Develop secure gateways with increased bandwidth to facilitate health record sharing.

Timberlake told the hearing that some of the above -- including the document scanning operation -- are still works in progress.

Roger Baker, the VA CIO, had his own definition of interoperabilty. In his prepared testimony, Baker told the panel that the two departments have made a commitment to ensure clinicians "have the information they need from each other to treat our common patients. This is not to say all electronic medical data will be shared; only to emphasize that everything deemed essential by our clinicians will be shared." He then invoked the guidelines from the Interagency Clinical Informatics Board critter.

Valerie Melvin, director of information management and human capital issues at the Government Accountability Office, said that while Defense and VA will achieve some measure of interoperability by Sept. 30, they will not meet the mandate of full interoperability required by the 2008 National Defense Authorization Act.

The departments are engaged in a slow, rather than expeditious process, she said. In her prepared testimony, Melvin said expansion of the Defense in-patient electronic health record system, based on commercial software from CliniComp International, will require "substantial additional work" beyond the Sept. 30 deadline. Ditto for the document scanning project.

Timberlake, who returned from active duty in November 2008 to run the interagency program office on an interim basis, said the real work on interoperability was stymied by difficulty in recruiting and hiring staff, and getting the machinery in sync.

Timberlake took on a thankless task, and he should not be faulted for what I know has been a herculean effort to get Defense and VA to work together, a mission almost as daunting as "peace in our time."

That said I have to agree with Rep. Phil Roe, R-Tenn., who described progress on Defense and VA electronic health record interoperability as "dismally glacial."