System will link health data

System will link health data

Interagency product is designed to share military, American Indian records

By Patricia Daukantas

GCN Staff

An interagency project to share military and American Indian health records will have a Web search system on top of a distributed-object backbone.

The goal of the Government Computer-based Patient Records project is to build a permanent, confidential, flexible system that will not require an overhaul as computing platforms and standards evolve. Although the Defense and Veterans Affairs departments and the Indian Health Service each maintain automated patient-records systems, the three have had no way to share the records electronically.

Of more than 25 million veterans, VA treats about 3 million in any given year, said Peter Groen, GCPR project manager and deputy assistant chief information officer at the Veterans Health Administration.

More than one

IHS treats about 1.5 million people from more than 550 federally recognized tribes, and the armed forces have nearly 1.4 million personnel on active duty. A number of these records might overlap because some individuals have received treatment from more than one agency.

'You're depending on the patients' memory for where the information might be or where they were when they received treatment,' said Dr. David Kentsmith, GCPR's chief clinical officer at the VA Medical Center in Omaha, Neb.

In GCPR parlance, a longitudinal patient record consists of all the medical data ever collected about an individual. Depending on the person's medical history, the record could be a single page or thousands of pages.

The three agencies will continue to keep the original records in their present databases. What the GCPR middleware will do is search for, retrieve and display them in a standard format.

'We want to use what we've already got, only tie it together so we can share information in a meaningful way,' said Lt. Col. Janet T. Martino, an Air Force physician who serves as GCPR's deputy project manager at DOD.

'The GCPR framework acts as a conduit to move information around to where it's needed at the time it's needed,' Martino said. 'We are not planning on building a massive data warehouse in the sky.'

Commercial parts

GCPR planners want an architecture independent of individual component vendors and systems integrators. It must be based on off-the-shelf components as much as possible to make future component and vendor substitutions easier, said the Public Health Service's Capt. James McCain, GCPR's chief technical officer and an IHS health information systems analyst in Tucson, Ariz.

GCPR's foundation will be the Common Object Request Broker Architecture/Object Management Architecture distributed-object standard. The CORBA middleware will intercept user requests at DOD, VA and IHS and carry them out across the agencies' networks.

The CORBA backbone puts scalability into the project, McCain said. 'It fits in well with the requirements to be able to communicate and interact with systems that are distributed globally rather than just locally,' he said.

GCPR users will access data through a standard Java Web browser, McCain said. Through the Internet's Inter-ORB Protocol, the browser can communicate with the GCPR framework regardless of client platform.

'Because we're dealing with health records, security was one of the paramount considerations,' McCain said. GCPR planners are studying how to use 128-bit encryption, public-key certificates and robust firewalls to ensure confidentiality of patient information as it passes around the system.

'I think the most sensitive information of all, probably even beyond national security information, is personal data that people do not want to have shipped around,' Kentsmith said.

In the project's early stages last year, Groen said, the Louisiana State University Medical Center was a full partner, but federal acquisition rules forced the state-run center to drop out of the project.

In April, Litton PRC received the prime contract under a DOD program known as the Defense Medical Information Management/Systems Integration Design, Development, Operations and Maintenance Services II.

The GCPR team hopes to start testing a proof-of-concept system sometime around March. 'Whether and how quickly we move into Phase 2 will depend on the results of Phase 1,' Martino said. If the three sponsoring agencies are satisfied with the prototype, each will carry out a live test in at least one of its facilities before the framework's worldwide deployment.

'Many of us feel that the GCPR framework, even though it has a particular focus in terms of sharing between the partners, certainly can be a model and possibly engage other federal entities to use the same technology and policies,' McCain said.

If the fully deployed GCPR framework works as hoped, researchers could even mine the three agencies' databases for long-term health trends.

'Once you start compiling a longitudinal patient record on an individual, then it's just one more step, and well within the scope of GCPR, to start applying that technology to studies of populations,' Martino said. 'We have the ability to collect information on people over a very long stretch of their life span, which is not typical of many civilian health care organizations because people move around a lot.'

Groen noted that the GCPR project got its start in the wake of the controversy over Gulf War syndrome, a collection of chronic health symptoms exhibited by some veterans.

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