Joint DOD-VA Medical Center Will Be Major Test for Electronic Health Record Interoperability

The joint effort to deploy a single, interoperable electronic health record for the Defense and Veterans Affairs departments will soon get its most visible test since the program began six years ago: deploying at the Captain James A. Lovell Federal Health Care Center, a joint facility used by both agencies.

The Pentagon has been working to deploy a commercial-based electronic health record system since 2015, when it signed a contract with the Leidos Partnership for Defense Health to deploy a Cerner EHR platform dubbed the Military Health System Genesis. Officials opted to deploy a commercial system in order to finally create a seamless flow of digital records between the military branches and veterans transition to the VA, which signed its own contract with Cerner in 2018.

Both versions of the Cerner software—which operate off the same baseline but have been configured separately to account for clinician workflows at DOD, VA and the Coast Guard—will be deployed at the Lovell Health Care Center in North Chicago, Illinois, in the near future, though the exact timeline is not set.

“The actual schedule for doing that is something we’re still working on,” Federal Electronic Health Record Modernization Director Bill Tinston said Thursday on a call with reporters. The FEHRM Program Office coordinates rollouts at DOD, Veterans Affairs Department and Coast Guard facilities and ensures the combined system is interoperable. “But the FEHRM, DOD and VA are working together to make sure we bring the right solution to that location at the same time to create success there.”

Tinston noted the facility is unique, as DOD and VA clinicians and support staff work as a single team.

“There are other joint sites that we’re looking at similar things,” he said. “But, without question, the most integrated facility is that facility.”

While DOD and VA use two versions of the Cerner platform—MHS Genesis and Cerner Millennium, respectively—Tinston said the EHR operates as one system and each patient has one record, no matter which facility they go to. That said, the two versions of the system have been configured to conform to the different workflows of DOD and VA clinicians.

The Lovell Health Care Center will be the first facility to merge those workflows and test the interoperability of the system.

That will take some effort and planning but isn’t impossible, Tinston said.

“There have been a lot of steps taken up there to make sure the IT—the supporting IT elements of that—work together right now,” he said. “They already deliver care there; they know what they need to do. It’s how do we make sure the workflows are effective across the two organizations. We can’t bring them something that works for only a portion of the organization. We have to bring them workflows that work with the integrated operations that they work within there.”

He said a joint DOD-VA team, led by the FEHRM, is already looking at workflows and business processes at the center to make sure the rollout meets everyone’s needs.

The true goal, Tinston said, is to ensure IT is not a factor in how clinicians deliver health care.

With the Lovell Health Care Center deployment, the FEHRM hopes to “take the IT out of the decision loop for the administrators for these two health care systems so that they can make the decisions they want to make about how to collectively deliver health care without IT driving that decision or limiting their decision space,” he said.

The full MHS Genesis rollout is now 30% complete and the system is on track to be running at all DOD medical facilities—at home and abroad—by 2023, officials said.

Holly Joers, program executive officer for the Defense Healthcare Management System, or PEO DHMS, noted the April deployment dubbed Wave Carson-plus “more than doubled our footprint,” from 20 medical treatment facilities to 47. The jump also increased the breadth of the system to 16 states and added another 10,000 users, bringing the total in the neighborhood of 42,000.

After successfully launching at multiple sites at once, the MHS Genesis team and FEHRM office have gained the confidence to go for more concurrent rollouts.

“Every deployment we take stock of lessons learned and identify the things that can make us more efficient,” Joers said. After the Carson-plus wave, which combined two previously separate waves, “We feel very confident going forward.”