DOD, VA told to use common software

“HAC Military Quality of Life and Veterans Affairs 2007 Appropriations Bill”

The departments of Defense and Veterans Affairs would need to adopt identical software, data standards and data repositories for their electronic health record (EHR) systems if a fiscal 2007 spending bill recently passed by the House Appropriations Committee survives the remainder of the budget process.

The committee’s Military Quality of Life and Veterans Affairs Subcommittee said in its spending bill report that its members feel strongly that the two departments should use identical technology as much as possible to make it easier to share EHR data.

The report directs the VA and DOD to update Congress on their plans for data-sharing systems and standards no later than December.

If the VA and DOD follow the committee’s direction, the two largest health care systems in the country, which collectively served more than 14 million beneficiaries last year, would use the same systems. The electronic records for military personnel would cover them from enlistment to death.

A common EHR platform is the rational answer for data sharing, said Dr. Stanley Saiki, director of the Honolulu-based Pacific Telehealth and Technology Hui, a partnership between the VA and the Army’s Telemedicine and Advanced Technology Research Center.

That view is not universal, however. Dr. Harold Timboe, assistant vice president for research administration and initiatives at the University of Texas Health Science Center in San Antonio, said the VA and DOD do not need to adopt identical systems to share data.

But Timboe said he believes that they do need to adopt common standards. The Department of Health and Human Services wants health providers to do that nationwide, and Timboe believes the VA and DOD can help lead the way.

Timboe, a retired Army major general, commanded the Walter Reed Army Medical Center from 1999 to 2002.

Because DOD and VA beneficiaries receive treatment at private and federal facilities, Timboe said facilities operated by the two departments should become the anchors of regional health information organizations in specific geographic areas to spur data sharing throughout the entire health care system.

Creating common standards for the VA and DOD EHRs could foster economies of scale, said Dr. Kevin Fickensher, executive vice president of health care transformation at Perot Systems.

DOD operates 70 hospitals and 411 clinics. The Military Health System covers slightly more than 9 million beneficiaries, including active-duty and retired military personnel and their families.

The VA operates 154 hospitals, 875 clinics and 136 nursing homes. It treated 5.3 million VA beneficiaries, including veterans and eligible family members, last year.

Paul Grabscheid, vice president of strategic planning at InterSystems, whose Cache software sits at the heart of the VA’s Veterans Health Information Systems and Technology Architecture medical record system, said he supports data sharing between DOD and the VA. But he argued that a mandate for identical software is the wrong approach.

Data sharing can be done through the use of standards-based systems, Grabscheid said. Replacing the two systems at the VA and DOD is not a good strategy, he added.

Saiki said that although the VA and DOD have made some progress on data-sharing initiatives since 1998, it has been slow going.

“Heaven here is a common platform built from the bottom up, with the clinicians dictating the design, not the bean counters,” he said.