VA completes first phase of daunting health records program, CIO says

The Veterans Affairs Department has completed work on the first phase of the Lifetime Virtual Electronic Record and is now preparing to put the records on a national health exchange platform, VA Chief Information Officer Roger Baker said today.

Baker also said that the department is "making good progress" on evaluating, and in some cases restarting, the 45 information technology projects he temporarily halted in June, but he avoided going into detail.  He spoke at a breakfast hosted by market research firm Input.

President Barack Obama officially announced the lifetime record program in April to develop a comprehensive digital medical record for every military service member. The record will contain information from both Defense Department health services and VA health services. A DOD/VA interagency office has been developing interoperability between those medical record systems since 2007.

Baker said the interoperability work is finished and described it as the first of three phases for the lifetime virtual record project. “Phase One is done,” Baker said. “We have the best interoperability between two health systems in the country.”

In the second phase, DOD and VA health records for about 15 million people will be made available for secure exchange with public and private organizations, including health care providers and insurers through the Nationwide Health Information Network (NHIN), Baker said.

The NHIN is a pilot project sponsored by the Health and Human Services Department to demonstrate national-level secure exchange of health data. The system currently is used by several federal agencies, state and local health agencies, and private providers and insurers.

Moving the data to the NHIN is significant because it allows for exchange of medical information with private hospitals and doctors, Baker said. For example, if a veteran receives treatment by a private doctor, eventually that record will be included in the lifetime record, he said.

“A true lifetime virtual electronic record has to include the private sector,” Baker said.

The third and final phase for the system will be developing protocols to securely provide the DOD-VA patient's medical information at the point of care, Baker said. For example, if a veteran who goes to a private hospital, the goal is that the hospital doctor will be able to access all, or parts of, the veteran's health record.

Establishing an exchange at the point of care that can make the medical information available, while still honoring the patient’s privacy and consent agreements, securing classified information, and maintaining tight security, is a highly complex problem, he said. 

Speaking before about 600 industry executives, Baker joked that in four months on the job, he has already worked “10 months' worth of billable hours” to transform the agency and is beginning to see the results.

“We are going to get a lot better,” Baker said. “IT is essential to making the transformation happen.”

Faltering IT projects get new start

He said several of the 45 faltering VA IT projects he temporarily halted in June have been restarted, but he declined to give details or to name the programs. The projects that have restarted have the resources to succeed and “all will be managed to tight milestones,” he said.

Baker said the VA’s IT projects are now being evaluated under the Program Management Accountability System that includes planning, management, spending plans and metrics.

Baker said he and his deputies are currently evaluating the projects to determine their priority, resources and progress, and are focusing most of their attention on troubled projects. “We are dealing with problem communications now,” he added.

He hinted that several “below-the-line” and low-priority programs are among the 45 IT programs that will be eliminated, and said he was learning how difficult it was to terminate contracts. “The issue at the VA is that the VA tried to do three times what it had the capacity to be successful to do,” Baker said.

Processing backlogs and the cloud

Baker also said one of his top priorities is reducing the backlog for benefits processing and he's getting input from front-line VA employees on that effort. Baker revealed that he has started an in-house blog on a social media Web site available only to VA employees. The Web site has several wikis, including one that is generating ideas for improving customer service and benefits management. So far, about 7,000 users have generated 6,000 comments and 3,000 ideas for improvements, which are being evaluated by VA executives, he said.

Asked about cloud computing, Baker said he is a big supporter of the technology and will move VA programs to the cloud, but he is still examining when and which programs, and considering the privacy aspects.

“We are going to get there, but I don’t know when or where,” Baker said. “My biggest concern at the VA in functioning day in, day out, is protecting the privacy of the veterans. It is very important to be very careful how you move into the cloud.”