Electronic Health Records

Integration & Interoperability News

VA Continues Pursuit of EHR Interoperability with DoD

VA is seeking subject-matter expertise on EHR interoperability and health data exchange.

By Kyle Murphy, PhD

- While the Department of Veterans Affairs (VA) continues to face questions about EHR interoperability between itself and the Department of Defense (DoD), the federal agency is also seeking answers to its own questions.

EHR interoperability at VA

Back on June 30, VA issued a presolicitation for health information sharing professional and technical services aimed at improving EHR interoperability between VA and DoD to which it continues to make modifications.

In particular, the federal agency is seeking subject-matter expertise in the areas of interoperability and innovation by August 11, 2016.

According to the modified solicitation, the contract awardee will provide the VA Interoperability Office with a total of eight deliverables relative to EHR interoperability and health information exchange between VA and DoD:

(1)  improving the exchange of medical images;

(2) addressing enhancements the continuity of care process for external DoD care;

(3) enhancing the clinician user experience with current Graphical User Interfaces (GUIs);

(4) improving the exchange of anesthesia information for interagency cases involving surgery;

(5) improving interagency clinical processes where patients are cared for simultaneously by VA and DoD;

(6) examining the impact of data quality for interoperable Electronic Health Records;

(7) evaluate commercial best practices for interoperability in large health care settings; and

(8)  perform an expert review of the published scientific literature on the current use of an interoperable electronic health records (EHR).

The solicitations via FedBizOpps may come as a surprise following the May attestation by VA CIO LaVerne Council that the federal agency had met interoperability requirements set in the 2014 National Defense Authorization Act through the use of the Joint Legacy Viewer.

Council celebrated the department's EHR interoperability achievement in a contribution to FedTech Magazine:

More than 100,000 VA users are using the JLV at 1,700 VA facilities across the country to access patient data from DoD, VA, and community health partners. That number grows by thousands each week, already outpacing the platform’s projected growth for 2016. With JLV users at every VA Medical Center and every Veterans Benefits Administration Regional Office, more than one million patient records have been viewed by VA staff in JLV.

The Joint Legacy Viewer, however, has attracted criticisms considering that it provides a read-only display of patient health information rather than a true exchange of health information. VA officials admitted as much in June hearing called by the Senate Committee on Veterans' Affairs.

"JLV has been a critical step in connecting VA and DoD health systems, but it is a read-only application. Building on the interoperability infrastructure supporting JLV, the Enterprise Health Management Platform (eHMP) will ultimately replace our current read-write point of care application," testified VA Undersecretary for Health David J. Shulkin, MD.

(During that hearing, VA officials also hinted at the possibility of a commercial EHR technology replacing its homegrown VistA EHR platform.)

The limitations of read-only health IT applications and systems were the subject of recent Congressional criticisms of the VA's work on VistA.

Senators Mark Kirk (R-IL) and Jon Tester (D-MT) criticized the federal agency’s lack of EHR interoperability in being unable to exchange diagnostic images like x-rays or CT scans and therefore incapable of enabling providers to view a patient's longitudinal record and provider the most appropriate care possible. Additionally, Kirk and Tester were dismayed at VA’s lack of EHR progress in comparison to private technology vendors.

At that hearing, the Government Accountability Office's Valerie C. Melvin testified that VA was years away from full EHR interoperability.

“A modernized VA electronic health record system that is fully interoperable with DOD’s system is still years away,” she said. “Thus, important questions remain about when VA intends to define the extent of interoperability it needs to provide the highest possible quality of care to its patients, as well as how and when the department intends to achieve this extent of interoperability with DOD.”

The emergence of a VA contract for information sharing expertise more than likely indicates a growing need for a clear definition of interoperability as the healthcare industry and its use of health IT evolves.

Dig Deeper:

VA EHR Interoperability Still Lagging, Senate Hearing Finds
VA Shares Vision for EHR Interoperability, Modernization



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