Healthy Records

Lt. Col. Vic Eilenfield says the latest developments means that DOD will be sending health care data to VA in monthly installments.

TRICARE's Lt. Col. Marie Charles says that standards and requirements were not clearly defined in earlier attempts to connect VA and DOD health databases.

Olivier Douliery

The Veterans Affairs Department's data sharing plan with the Defense Department needs to follow the latest medical information standards.

'VA Senior Adviser Gary Christopherson

Henrik G. DeGyor

VA and DOD re-energize long-stalled plans to share health databases

The Veteran Affairs and Defense departments have mapped out a new route to interoperable health databases and applications, more than five years after they first conceived the plan.

The two departments hope by 2005 to link DOD's Composite Health Care System II clinical data and VA's HealtheVet-VistA repositories for simple, real-time swapping of patient health records.

A big milestone last July made DOD health records for 3.7 million veterans and separated military personnel accessible to Veterans Health Administration clinicians.

DOD can now send information down a one-way path to VA in monthly installments, said Lt. Col. Vic Eilenfield, deputy program manager in the Clinical Information Technology Program Office of the TRICARE Management Activity. TRICARE is overseen by the assistant Defense secretary for health affairs.

'That was the first major IT collaboration that we did,' said Gary Christopherson, senior adviser to VA's health undersecretary.

In 1997, the departments launched their first interoperability attempt with Government Computer-based Patient Records, which they had hoped to deploy by Oct. 1, 2000.

'Neither DOD's nor VA's core systems were built to handle something like that,' Christopherson said. 'It sort of lost momentum.'

In 2001, discussions began again. The renewed effort, dubbed the Federal Health Information Exchange, came after DOD started upgrading its Composite Health Care System I to CHCS II, and VA began improving its VistA health program, now HealtheVet-VistA. The Indian Health Service also began upgrading its Resource and Patient Management System.

By 2005, when all the upgrades are expected to be complete, the interoperability door could finally open.

'The goals we had were very ambitious, and we decided to take, essentially, baby steps,' said Lt. Col. Marie Charles, director of interagency program integration and external liaison at the TRICARE Management Activity. 'The standards and requirements were not clearly defined between the two departments.'

GAO gets involved

A General Accounting Office audit in 2001 made the departments look harder at their plan.

'Expanding time frames and cost estimates, as well as inadequate accountability and poor planning, have raised doubts about GCPR's ability to provide its expected benefits, prompting the agencies to refocus their approach,' the audit said.

Another GAO audit released last September listed the retooling of the project as an example of 'important progress toward improving [VA's] management of information technology.'

Today, the two departments deliver health care to 12 million people at an annual cost of $34 billion. A new records interoperability plan calls for common data and communications standards, two-way information sharing, and joint IT application development and procurement.

A separate plan would set up a single database for determining veteran and active personnel eligibility for benefits and services.

Calling the interoperability strategy HealthePeople, officials said 20 partner agencies and health organizations, including the State Department and Social Security Administration, will begin adopting national standards in the next decade.

They invited private-sector cooperation to help them align with the privacy, security and administrative requirements of the Health Insurance Portability and Accountability Act.

A Joint Executive Council, which includes high-ranking officials from VA, DOD, the Health and Human Services Department, and the Office of Management and Budget, endorsed the plan for common data and security standards, Christopherson said.

In September, the latest versions of three standards were chosen for the information-sharing project: Logical Observation Identifier Names and Codes, Health Level 7 and the Accredited Standards Committee's X12N health informatics model. HHS is reviewing the first two standards and has already adopted the last through HIPAA.

Since then, the Joint Executive Council has also proposed adopting the latest medical standards from three more bodies: the National Council for Prescription Drug Programs, Digital Image Communications in Medicine, and the Institute of Electrical and Electronics Engineers.

'More will come,' Christopherson said. 'We're now doing all the work it will take to pull this agreement off.'

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