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VA Digital Health Platform to Improve EHR Interoperability

VA is implementing a new Digital Health Platform (DHP) intended to leverage health data access and health information exchange.

- The Department of Veterans Affairs Digital Health Platform (DHP), a cloud-based technology, will equip providers with real-time access to patient health data from VA, military, and commercial electronic health records (EHRs), applications, devices and wearables.

VA plans to implement new digital health platform for EHR interoperability

The program will employ open health IT standards — specifically, HL7 — in combination with cloud-based technologies in order to present a holistic view of veteran digital health records. DHP will rely on application programming interfaces (APIs) to merge military and commercial health data, unify VA data stores, connect patients and providers instantly, and improve patient care.

Currently, VA operates across a variety of disparate systems each housing different records, making it challenging for veterans to exchange information between providers. DHP will connect this health data in a closed-loop system programmed to continuously collect and analyze data. 

The primary goal of DHP is to ensure that all available health data on a veteran — from personal devices and wearables to provider-generated data at annual physicals — is available in one easily-accessible digital location that can follow that individual anywhere.

Because DHP is a cloud-based service focused on connecting a network of existing systems, it will not be dependent on any singular system to function. Were VA to replace its existing VistA EHR technology with a replacement EHR, the process would not have an adverse effect on DHP.

"The digital health platform will be a system of systems," David Shulkin told the Senate Committee on Veterans' Affairs in a June 2016 hearing.  "It is not dependent on any particular [electronic health record], and VA can integrate new or existing resources into the system without sacrificing data interoperability. One of the digital health platform's defining features will be system-wide cloud integration, a marked improvement over the more than 130 instances of VistA that we have today."

Officials with VA stated instead of focusing on building VistA 4, the latest iteration of its EHR evolution scheduled for delivery next year, they are more concerned with modernizing its current EHR system and improving health information exchange.

Critics questioned a new platform replacing VistA after more than $510 million in IT development funds have already gone toward developing the platform since 2014, but Shulkin assured skeptics the resources poured into VistA will not go to waste. 

Shulkin stated that "regardless of whether our path forward is to continue with VistA, a shift to a commercial EHR platform as DoD is doing, or some combination of both."

DHP will prove particularly helpful for a variety of special cases, including veterans with chronic diseases (e.g., congestive heart failure) who require care pathways and monitoring to prevent the worsening of existing medical conditions.

In his written testimony, Shulkin stressed the need to consider special cases in the future:

Due to the expansion of care in the community, a rapidly growing number of women Veterans, and increased specialty care needs, the need for more agility in our EHR has never been greater. We are looking beyond what is delivered with VistA 4 in FY 2018, and we are evaluating options for the creation of a Digital Health Platform to ensure that we have the best strategic approach to modernizing our EHR for the next 25 years. To prepare for this new era in connected health, VA is looking beyond the EHR to a digital health platform that can better support Veterans throughout the health continuum. These factors drive the need for continuous innovation and press us to plan further into the future.

On top of EHR interoperability, DHP will facilitate care coordination, claims processing, and medical records management. 

Dig Deeper:
What is EHR Optimization, How Does It Start?
Why a Thin Line Separates EHR Optimization, EHR Replacement