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Renewed Interest in Joint iEHR for DoD-VA Interoperability

By Kyle Murphy, PhD

- Congress will again consider proposed legislation with the purpose of streamlining the exchange of health information between the Departments of Defense and Veterans Affairs.

On March 23, Representative David Roe (R-TN) reintroduced the Integrated Electronic Health Records for Military and Veterans Act (HR 1590), a prize program for the development of an integrated EHR system to connect the two departments. The proposed bill currently sits with the Committees on Armed Services and Veterans' Affairs.

"In fiscal year 2014, the VA completed more than 1.3 million claims. Unfortunately, it appears the VA is still not on track to keep their promise to completely eliminate the backlog in claims in 2015. This has gone on for far too long," Rep. Roe said in a public statement earlier this week.

Although a copy the proposed bill is not yet available, its precursor (HR 2055) is. That bill failed to pass the 113th Congress, making it as far as the Subcommittee on Military Personnel in June 2013. According to a copy of the text, the bill will have made $50 million available in the form of a cash prize assigned by the secretaries of both the DoD and VA.

Prior to making the award, the DoD and VA would be required to convene a joint panel to "establish the criteria for the development of a fully-integrated electronic health records program eligible for an award and contract."

Previous attempts at developing joint EHR platform, let alone a iEHR, came to a screeching halt in early 2014 when the DoD unveiled its plans to modernize its EHR system through a request for proposals as part of the DoD Healthcare Management System Modernization (DHMSM) Program.

The DoD's decision not to choose the Veterans Health Information Systems and Technology Architecture (VistA) EHR — it is not a finalist for the DHMSM contract — and instead opt for a commercial EHR solution effectively ended the joint development of iEHR over the past few years which cost more than $1 billion when all was said and done.

Despite the failure to develop a joint iEHR platform, interoperability between the DoD and VA is approving according to Program Executive Officer for the DHMSM program Christopher Miller. In an interview with FCW, work is still continues but progress is being made.

"I view success through the eyes of our clinicians and our users. And that's who I'm listening to right now," he maintained. "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."

The data exchange between the DoD and VA health systems occurs through the Janus Joint Legacy Viewer, which  has enabled access to the health data of 5.9 million shared patients.

With the deployment of the DoD's replacement EHR technology scheduled for 2022, the ability to achieve EHR interoperability between the two departments is intimately tied to the DoD's choice of a new EHR platform.

Until that occurs, legacy ad-hoc health IT solutions remain the most common mechanism for health data exchange. The reintroduced legislation to develop a joint iEHR would likely lead to more time and energy being expended on an outdated plan as the private sector is already in the process of leveraging application programming interfaces (APIs) and third-party solutions to realize true interoperability.

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