VA set to test new-look health record interface

VA's pending system helps solve the agency's internal interoperability problems, while extending data to the DoD.

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The lack of interoperability between the health records systems serving veterans and active duty military personnel is so notorious that it was even fodder for a Jon Stewart riff on the "Daily Show" in 2013.

Since that time, efforts to bridge the gap have been underway on multiple fronts. At the Department of Veterans Affairs, interoperability is a big part of the push to modernize its homegrown VISTA health record. VA is set to begin testing a spiffy new interface called the Enterprise Health Management Platform (EHMP). It's designed to share data with DOD's current health records, and to be ready to operate in conjunction with a new commercial system the Pentagon is expected to announce this summer.

But more than that, EHMP also looks to solve an interoperability issue within the department, to allow VA caregivers to have access to all of their own patient records across facilities in such a way that allows for the use of all of the advanced computational tools to operate on patient data, irrespective of the location of the patient and the physician.

"What we have not always done, and we are creating now, is a system for providers at the point of care taking care of veterans that natively integrates all of the data from both sides," said David Waltman, a senior advisor to the undersecretary for health on IT issues.

Under the current Computerized Patient Record System (CPRS), patient records are tethered to individual facilities. While caregivers across the VA system can see patient data on a viewer, the computer doesn't work on remote data with the exception of a few functions, such as providing drug interaction warnings, Waltman said during a demo of EHRP for reporters held at VA headquarters June 11.

The EHRP is a web-based viewer that uses modular applets or widgets that provide data on clinical encounters, patient vitals, medications, lab results, allergies and medical conditions. The view is customizable by health providers, and flexible enough to allow for doctors to track specific conditions, and to get short-term and long-term views of patient care. This is useful, noted Neil Evans, a physician who sees patients in the Washington, D.C., VA facility and is co-director of the VA's Connected Health office, because a caregiver in an office visit might want to chart a patient's history over the past few years, while a hospital patient will have multiple streams of data accumulating quickly that needs to be understood and acted upon.

Like other VA software efforts, EHMP was developed in-house on an open source basis. It is a big part of the ongoing VISTA Evolution project to modernize the VA's health record. The system features a search function that runs queries across structured and unstructured data in documents that is powered by the open source search software Lucene, which was developed by the Apache Foundation. The VA is releasing a software development kit so developers can build apps to run on EHMP. Already, Waltman said, a hackathon produced an application that delivered data from FitBit fitness trackers into the system.

The design of EHMP is similar to the Joint Legacy Viewer developed by the DoD and VA as a bridge to full interoperability between DOD and VA systems. Heavy JLV users are going to be among the first to have access to the EHMP system. This is especially useful for VA clinicians who treat "active dual consumer patients," -- people who receive concurrent and overlapping care at VA and DoD facilities, including many military retirees.

After laying the groundwork with pilot projects this summer in Hampton, Va., and early testing in San Antonio, San Diego and elsewhere, Waltman hopes to have a live version in place in the first half of 2016, with the ability to do certain tasks across systems, with full access inside the VA by the end of 2017.

During this phase-in, the CPRS will continue to function, and probably will remain most useful for connections between VA systems and outside commercial providers -- a growing category of veteran care as a result of the Veterans Access, Choice and Accountability Act of 2014, which gives vets who live far from VA facilities the ability to use VA benefits to pay for private care. CPRS is expected to be phased out by 2020 -- about a year after the DOD expects to have its own new health record system fully installed.

Whether this schedule is fast enough for critics of DOD-VA interoperability remains to be seen. Sen. Dean Heller (R-Nev.) wants to tack on an amendment to the fiscal 2016 defense authorization bill that would require the two departments to submit a report with a timeline on health record interoperability to Congress within a year of the law's enactment.

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