Recently, FedHealthIT’s Executive Vice President, Susan Sharer, had the opportunity to speak with Colonel John Scott, Data Manager at Defense Health Agency, about the challenges of interoperability, EHR adoption and the ultimate advantage of MHS GENESIS. Part One of the Interview focuses on challenges, change management and what the Military Healthcare System will be able to do better with MHS GENESIS. Part Two focuses on collaboration, preserving the old information and sharing for improved patient care between departments.
This is an important contribution to Healthcare system collaboration, and the way that DoD and VA develop this can be a cornerstone of further development. We have a mandate to move forward with a joint project to combine data from DoD and VA enterprise data warehouses in order to develop predictive analytics and improve our ability to provide services to separating service members at risk. Our work to design this around the way we have defined the medical record will be pioneering a model of two Government agencies working together; a model that will be expendable to NIH, HHS and beyond. And the standardization of the record systems around the common EHR, MHS GENESIS, which is being done with ONC awareness, will significantly improve the power of the data collection.
Moving forward we want to ensure we are not just exporting bits of data but instead, we’re talking about partnerships conducting analytics inside and under our HIPAA-covered environment.
VA is further along in some aspects with the VA Informatics and Computing Infrastructure and with their project using a supercomputing environment in collaboration with the Department of Energy. Our latest project, called the Interagency Collaboration for the Advancement of Predictive Analytics, will have DoD collaborating on that effort, adding DoD data to the existing environment to keep growing and building synergistically.
Preserving the Information in the Old Record Systems
We’ve done some important work on how we store the record that I am glad to tell you about. It was only recently, in 2014, that we moved from paper to electronic in terms of the official copy of the Service Treatment Record. You may have seen that providing a complete copy of the record to the VA was a real challenge; creating an electronic storage instead of paper and transferring that to the VA was our solution. Today we use this technology to make a copy of every member’s record as they leave the Service, storing in one place everything that might have been on the old paper record along with a “human readable” copy of everything that’s been created and stored in our EHR system. Now, when a Veteran makes a claim with VA, the VA systems signals the DoD system, and that whole set of files is copied into the VA system overnight, where it is available for the adjudicator to review and annotate. To do that, we leveraged the capability of scanning paper-based documents into an electronic filing cabinet integrated with the EHR that we were already planning. And it has come a long way in the 5 years since we turned that on. Part of our requirement to store all the information in our health records will be met using that technology.
We also have legal requirements to save some information separately from individual record storage for tracking purposes and we are planning for that as well. In addition, there will probably be a “cold storage” component of this. All of these strategies will help us ensure that all of the information we have been collecting is accounted for as we consolidate data systems and transition to a new EHR.
An important modern additional requirement to our information storage comes from expectations for continuity of care in the EHR. We want to have immediate access to all of the data points of past health issues that will matter when decisions are being made. Migrating data from the old systems into storage systems that will be well integrated to the new systems and its work flows is an additional driver moving all of this forward.
We have tried to articulate the details of what is important – how far back we need routine labs, individual notes and so on, and the requirements are reasonably well articulated and now just need further refinement.
A final category of information drivers is the analytics community who will need all of the past health information to be available to discover new associations that improve preventive Healthcare. It is not enough to have it stored or printed; it must also be codified so that it can be “computable”. There is still a significant challenge to be met to bring together disparate central data systems into an integrated data platform. But this part is the key to being able to meet the “big data” and “precision data” of modern Healthcare. And we expect to make important contributions, especially as we join our data with the VA’s toward these ends.
Much of the determination of what will be accessible and by whom is still in the planning stages and there are a whole lot of peripheral interests still competing for attention. There will be crossing of boundaries with what has been collected in the various military systems, not just in terms of health information but also in terms of deployment history and medical readiness.
Sharing a Common EHR for Improved Patient Care between the Departments
The policy behind the EHR is based on combining the core record purpose of giving beneficiaries a good functional health record and that includes both medical readiness and the readiness of forces with the need to ensure that record information will be available long term. And supporting the accessibility of the information to the patient will play a big part in meeting the long term goal. To that end, we are working with our VA colleagues who developed MyHealtheVet. We have meetings focused on the strategy behind delivering the capability of the beneficiary to truly own a copy of their own data for the benefit of their own health. That capability will be integrated within the common EHR, and as in our other efforts, we are seeking the input of the Office of the National Coordinator to ensure our strategy complies and reinforces their recent rules that strengthen such patient engagement.
About COL John S. Scott, MD
Colonel Scott is a pediatric cardiologist and board certified clinical informatics specialist with 29 years of experience in military medicine. His positions have included leadership roles in direct care pediatrics and pediatric cardiology, quality management, and information management. He was the Program Director for Clinical Informatics Policy in the Office of the Assistant Secretary of Defense for Health Affairs from January 2012 until July of 2017. Since then he has served as Data Manager in the Defense Health Agency, working to improve data governance and enterprise data management for the Military Health System.