The Department of Defense (DoD)/Department of Veterans Affairs (VA) Interagency Program Office (IPO) leads and coordinates the adoption of and contribution to national health data standards to ensure interoperability—the ability of two or more systems or components to exchange information and to use the information that has been exchanged— among the DoD, VA, and private sector providers worldwide. Since its re-charter in 2013, the DoD/VA IPO works with the DoD, VA, the Office of the National Coordinator for Health Information Technology (ONC), and various Standards Development Organizations (SDOs), to identify, implement, and map appropriate national standards associated with both Departments’ electronic health record (EHR) systems. In April 2016, the Departments reached this goal and certified their status as interoperable to Congress in compliance with the Fiscal Year 2014 National Defense Authorization Act.

In Susan Sharer’s recent interview with Dr. Lauren Thompson, Director of the DoD/VA IPO, we explore the progress that has been made to enhance health data interoperability between the Departments, the DoD/VA IPO’s ongoing efforts to coordinate and collaborate with external partners across the Health IT landscape, and the Departments’ recent EHR modernization milestones.

The Value of Interoperability

Providing world-class healthcare to service members, Veterans, and their families is of the utmost importance to both the DoD and VA. Together, the Departments represent two of our nation’s largest healthcare systems, with more than 16 million beneficiaries and over 2,500 care locations.

A key component of serving the unique needs of our beneficiaries, regardless of their status, location, or provider, is ensuring their health data is secure, accurate, and ultimately interoperable. Furthermore, the DoD, VA, and DoD/VA IPO work to establish the seamless integration of health data between the Departments and their private sector partners.

This integration further reduces medical errors and streamlines administrative functions to improve clinical decisions. While the 2016 interoperability certification marked a significant achievement for both Departments, the DoD, VA, and DoD/VA IPO recognize the Health IT landscape is constantly evolving and their efforts must remain ongoing to ensure our beneficiaries receive the best care available.

Data Sharing Today

The DoD and VA currently use several tools to support health data sharing. For instance, since 2006, the DoD and VA share medication and allergy data through the Clinical Data Repository/Health Data Repository (CHDR) interface, a tool that exchanges medication and allergy data between the Clinical Data Repository and the VA’s Health Data Repository. The DoD also utilizes the Health Artifact and Image Management Solution (HAIMS) interface, an enterprise-wide data sharing capability that allows the DoD and VA healthcare providers to access artifacts and images generated during the healthcare delivery process.

The Joint Legacy Viewer (JLV) provides care teams with an integrated, read-only display of health data from the DoD, VA, and private sector partners in a common data viewer. With JLV, more than 410,000 DoD and VA clinicians can view in real-time records of more than 16 million patients receiving care from both Departments. JLV reduces the need for patients to carry hard copies of their health records when they visit different facilities. Additionally, complete access to a patient’s medical history leads to more informed decisions about patient care. This increase in user activity has garnered tremendous support from care teams, proving JLV as an invaluable resource to our patients and providers.

Currently, the DoD shares electronic health data with private sector partners through eHealth Exchange, while the VA utilizes both eHealth Exchange and Direct Messaging. eHealth Exchange is the nation’s largest health data sharing network, comprised of Federal agencies and private sector partners that share information under a common trusted framework to improve and advance patient care and public health reporting through a secure, trusted, and interoperable health information exchange(HIE). As a provider-to-provider messaging product, Direct Messaging allows authorized VA clinical staff to share health information between trusted community healthcare partners. The DoD and VA developed external partnerships with many private sector HIEs and continue to add new partners each year. Together, the DoD and VA maintain access to more than 120 private sector partners, with additional HIEs being tested and onboarded.

Collaboration is Key

One of the DoD/VA IPO’s top priorities is to encourage and enable collaboration across the DoD and VA by serving as a central resource for modernization and health data interoperability.
One of the DoD/VA IPO’s top priorities is to encourage and enable collaboration across the DoD and VA by serving as a central resource for modernization and health data interoperability.

While the DoD/VA IPO serves as the single point of accountability to enhance health data standards to improve data sharing between the DoD, VA, and their private sector partners, we cannot work alone. To facilitate collaboration, the DoD/VA IPO and the Departments collaborate with ONC, various SDOs, and other public and private sector partners in health to identify, implement, and map the appropriate national standards associated with both Departments’ EHR systems.

Throughout the last two fiscal years, the DoD/ VA IPO, in collaboration with the DoD, VA, and other partners in health, have conducted several Joint Exploratory Team (JET) initiatives, to identify, investigate, and coordinate consensus on valuable information to assist the DoD/VA IPO and the Departments in enhancing health data interoperability. Focusing on topics including relevant emerging standards, services, as well as other interoperability challenges, these JETs provide a forum for collaboration, an opportunity to address common interoperability challenges, and conclude with technical reports and core technical guidance providing lessons learned and suggested next steps for the departments and their partners in health.

Due to the constantly evolving landscape of Health IT, we also hold regular stakeholder meetings to share information, highlight recent accomplishments, and address common interoperability challenges.

Working alongside leaders in Health IT, the DoD/ VA IPO hosts monthly Town Halls, quarterly Joint Program Synchronization Workshops, and semi-annual DoD/VA Industry Interoperability Roundtables, bringing together hundreds of Health IT experts from across the Federal Government and private sectors. As our DoD/VA Industry Interoperability Roundtables provide an excellent open forum to discuss the current and future state of healthcare information technology, HIE, and health data interoperability, we strongly encourage external participation from interested stakeholders. As the DoD and VA continue to build on their successes and pursue their respective modernization strategies, the DoD/VA IPO looks forward to expanding these collaborative relationships and working together to advance the interoperability capabilities of today and to solve the technological challenges of tomorrow.

Momentum with Modernization

In July 2015, the DoD awarded a $4.3 billion contract to Leidos, Inc. to deliver a modern, interoperable EHR. Leidos is the Prime Contractor that, in contract execution, utilizes its Leidos Partnership for the Defense Health team, which includes Cerner Corporation, Accenture, and Henry Schein Inc.

MHS GENESIS is a state of the market commercial off-the-shelf solution consisting of Cerner Millennium, an industry-leading EHR, and Henry Schein’s Dentrix, a best of breed dental module.

Throughout 2017, the DoD achieved major milestones, deploying MHS GENESIS at Fairchild Air Force Base, Naval Clinic Oak Harbor, Naval Hospital Bremerton, and Madigan Army Medical Center. The DoD plans to deploy MHS GENESIS to more than 9.4 million beneficiaries and 205,000 medical personnel and staff by the end of 2022.

On June 5, 2017, Dr. David Shulkin, Secretary of the VA, announced his decision to adopt the same EHR as the DoD. This decision will ultimately result in a single software baseline and enable seamless care between the Departments without the manual and electronic exchange and reconciliation of data between two separate systems. This decision will, over time, fundamentally solve the problem of transitioning patient health record data between the DoD and VA by eliminating the need for moving data between the two Departments—there will be a single common clinical system.

With this announcement and the DoD’s ongoing deployment efforts, the need to enhance health data sharing is more vital than ever before.

As the DoD and VA continue with their modernization strategies, the DoD/VA IPO facilitates collaboration with Health IT leaders to ensure the DoD and VA are at the forefront of emerging standards and trends in health data sharing. Specifically, the DoD/VA IPO is working alongside the ONC, Health Level Seven International, the Advanced Technology Academic Research Center, the Institute of Electrical and Electronics Engineers, and other public and private sector partners. Advancements in health data interoperability are the future, and will ultimately lead to better health outcomes for our service members, Veterans, and their families.

About Dr. Thompson: Dr. Lauren Thompson is Director of the DoD/VA IPO, which is charged with setting health data standards for the DoD and VA for overseeing the adoption of and mapping to national and international standards aimed at interoperability and Health IT solutions between the Departments and private sector partners. Previously, Dr. Thompson served as Associate Director for Initiatives and Coordination in the Office of Standards and Technology at ONC.

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