VA and DOD make strides in health IT

If a 747 airliner crashed every week for a year, the fatalities would still be a fraction of the number of people who die annually from medical mistakes.Roughly 98,000 people die each year because of mistakes by physicians and hospital staff, according to the Institute of Medicine.The Health and Human Services Department wants to use its influence as the nation’s biggest health care buyer to reduce medical mistakes by promoting the use of IT by hospitals, physician practices, nursing homes and insurance providers.HHS may have an example to follow elsewhere in government as it pursues this goal in the coming year. The Defense and Veterans Affairs departments have made significant strides in expanding and integrating their electronic health records, portals and prescriptions.The departments are increasing the amount and types of data they share with each other through back-end systems.The nation’s health care industry is moving toward standards for sharing data too, said Dr. Robert Wah of the Navy Medical Corps and director of information management for DOD’s Tricare Management Activity, which administers military health care.“That allows us to buy systems that fit our business processes and [VA] to buy systems that fit their business processes yet still extend the safety net for our patients,” Wah said.DOD and VA recently launched the Bi-directional Health Information Exchange, which will let the departments’ organizations transfer clinical information in near real time. It is being used first at Madigan Army Medical Center in Tacoma, Wash., and Puget Sound VA Medical Center in Seattle.“If we have people being treated at one or the other’s sites, clinicians will be able to start pulling the information about the patient from the other electronic system,” said Dr. Robert Kolodner, VA’s acting deputy CIO for health.Information entered in one system is readable at the other. The departments are implementing this system by specific sets of data, starting with outpatient pharmacy and allergy data.By October, VA and DOD will be able to exchange pharmacy data in real time. “The data exchange will allow us to detect any drug or allergy interactions from medicines prescribed from anywhere in VA or DOD,” Kolodner said.VA will begin to populate and use its updated health data repository in coordination with the pharmacy data domain rollout. The repository, an Oracle Database 10G, will bring together, domain by domain, all the clinical data about a person.Previously, VA had 128 systems for 157 hospitals. VA’s database could find information in the systems, “but it often was not computable and could not be used for decision support because the vo-cabulary was not standardized,” Kolodner said.DOD’s clinical data repository, part of the Composite Health Care System II, checks almost 400,000 pharmacy transactions daily and can track all medications prescribed to its patients from military pharmacies, local civilian drugstores or mail order.Through the Pharmacy Data Transactions Service from Web- MD Corp. of Elmwood Park, N.J., DOD can check a database of commercial pharmacies, Wah said. “I don’t believe there is another organization this large that has this many patients covered with a system that checks a central database before pills are dispensed,” Wah said.As a doctor is entering an order, the system can identify potential medication problems for the patient, said Dr. Bart Harmon of the Army Medical Corps, chief medical information officer for Tricare.“We’ve taken advantage of something that exists in commercial pharmacies, purchased the right to use that and integrated it with our own electronic health record on the back end,” Harmon said.DOD will give its physicians access to patients’ electronic health records through Tricare’s portal. It will also give patients the ability to refill prescriptions online.Tricare Online has 9.1 million beneficiaries. It provides information on drug interactions and other health content. Users can make appointments, similar to booking airline reservations, said Lt. Col. Dave Williams, Tricare’s chief of e-health requirements and operational architecture.