Pentagon official: DoD-VA info sharing improving, but work remains

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Sharing of electronic health records between the military and Veterans Affairs is improving, but there is still room for improvement, according to the Defense official in charge of making the disparate systems work together.

"I view success through the eyes of our clinicians and our users. And that's who I'm listening to right now. They seem happier than they've been. I don't think we're ever completely done here. I think we've got work to do. But they are able to see and access more information than they had been previously," said Christopher Miller, who heads the Pentagon's efforts to acquire a new commercial health record while serving as the acting director for the joint DOD-VA Interagency Program Office designed to promote interoperability between electronic health records.

According to Miller, real time data transactions between VA and DoD are growing, and have expanded to include the Veterans Benefits Administration. Clinicians at VA and DoD can use the Janus Joint Legacy Viewer to access data on 5.9 million shared patients, Miller said at a March 25 hearing of the Senate Defense Appropriations Subcommittee.

Janus is installed at 270 sites across the military. DoD and VA have teamed up to map standard medical codes and clinical domains across the two systems, to pave the way for more integrated interoperability that includes data exchange, and not simply viewing records across systems. DoD is also planning a series of tests on the system in April, to rate the effectiveness, usability, and cybersecurity of the system.

Miller said that DoD is also tracking how much use the system gets. Clinicians at the VA and the DoD and benefits adjudicators at VA draw on Janus about 250,000 times per week. But it may be that more education is needed to ramp up usage. "One of the challenges of these complex systems is whether or not the people actually understand that some of the information is available," Miller said.

People and processes

The planned DoD electronic health record is also starting to take shape. A new program office has been set up to deploy the software to theaters of military operation, ships, submarines, and aircraft. The full system is scheduled to be deployed worldwide by fiscal 2022.

According to Miller, the deployment is going to occur in waves of about three hospitals and 15 locations, with each wave lasting about a year. An award in the Defense Healthcare Management System Modernization procurement is expected by the close of fiscal 2015. The program is expected to cost $10.5 billion during its 18-year lifecycle, according to the most recent estimate. Miller expects more updates to cost estimates prior to the award. The Pentagon is seeking $527.5 million to run the program for fiscal 2016. Overall, the Pentagon's medical budget totals $47.8 billion.

Miller couldn't offer much of a progress report on the DHMSM procurement, which is underway. But he did say that the success of the program is less about which commercial health record software was selected than it is execution on training and deployment.

"My problem isn't a technical problem. The hard challenges are really about people and processes. I think the more important factor is, how are we training our people, how are we getting the culture right, how are we making sure we are getting them ready for this," Miller said. "I've visited a number of facilities that have gone through this, and their message routinely is, it's all about the change management and the training. It's not about the tool. It's about how you use that tool," he said.