Enterprise Care: MHS Launches Integrated Health Record Initiative

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At the 2012 meeting of the Healthcare Information and Management Systems Society (HIMSS), held February 21-24 in Las Vegas, Nevada, the US Department of Defense (DOD) and the Department of Veterans Affairs’ Veterans Health Administration debuted, for a standing-room-only audience, their initiative to create a single, integrated health record for the military health system (MHS). “This really is a new era for us,” said David Wennergren, deputy chief information officer for the DOD. “The power of Web services and service-oriented architecture are changing the way we can deliver IT capabilities.”
David Wennergren“We can no longer afford to spend millions of dollars and wait years for capabilities to be delivered. Nor can we be bound to solutions that don’t work in the service-based world.”
—David Wennergren, deputy chief information officer, DOD



As Wennergren illuminated in his remarks, the MHS’ transition to a single, integrated, interoperable electronic medical record mirrors the struggles health systems across the country are facing. The scope of the project is ambitious, the need for change is obvious, and funding is in short supply. “We can no longer afford to spend millions of dollars and wait years for capabilities to be delivered,” he said. “Nor can we be bound to solutions that don’t work in the service-based world.” Patient-focused Data Robert Petzel, MD, undersecretary of health for the VA, observed that the MHS is “in the midst of a tremendous transformation in the way we deliver care.” That transformation, he explained, is toward a patient-centered system with an emphasis on care teams—changes that mirror those happening elsewhere in US health care in the wake of reform. His vision of what the MHS is calling its integrated health record, or IHR, is of more than just an informatics platform: he describes it as a patient management platform. The MHS is a powerful use case for the transition, now under way at health systems nationwide, from informatics solutions aimed at streamlining workflow to interoperable, enterprise-wide patient management enabled by IT. With 18 million geographically disparate patients ranging from aging veterans to newborns in military families, the DOD and VA have been challenged to provide the best possible care at their facilities worldwide while maintaining continuity as patients go from being active duty personnel to veterans. With an increase in the use of reserve and National Guard members, there’s an even greater interplay between the VA and DOD patient populations, Petzel explained. As the number of interoperable facilities continues to grow—Petzel cited the James A. Lovell Center in Chicago, which is jointly run by the VA and DOD, as an example—case-by-case exchanges of patient health information are becoming inefficient and burdensome. “We’ve proven that it’s very difficult to do this kind of integration without a singular medical record,” he said. The MHS has set for itself a “quadruple aim” in its initiative to improve patient care through health IT, said Karen Guice, MD, acting CIO of the MHS: optimizing patients’ experience of care, managing population health, paying for value rather than for procedures, and integrated governance. “We need to keep the most important thing in focus, and that is taking care of patients,” she said. Creating the Platform To accomplish this fundamental shift to an integrated health record, the MHS is doubling down on open architecture and modular approaches, Wennergren explained. “That’s the shift we’ve seen happen as we’ve come along this journey,” he said, adding that 18 million patients are “a force that can move markets.” As Wennergren observed, the service-oriented approach is a comparatively new one in health care informatics, although it is not without precedent. The MHS’ approach will begin with a single patient identifier that will stay with its beneficiaries as they move from the DOD to the VA and, sometimes, back again. “There are already agreements in place” between the two departments regarding this common identifier, he said. “It’s manifesting itself in the VA moving into DOD datacenters, so we can co-locate on our way to developing this model.” The IHR will pair patient-provided data with clinician-provided datasets, and will make this information accessible to caregivers through a single graphical user interface to deliver a common presentation approach between the DOD and VA, Wennergren said. He emphasized the MHS’ commitment to developing a common platform, analogizing their vision with the common data model and open architecture employed by consumer computing devices such as iPhones and Androids. “That’s the reality we face, and that’s the future we’re going to build together,” he said. Provider-driven Approach Although greater patient centricity is the primary goal of the MHS’ overhaul, its approach to change will be provider-driven—beginning with a revised governance model aimed at making the DOD and VA more agile when responding to providers’ needs. “We have a shared decision-making algorithm that starts at the level of the Secretary and comes down through councils between the two departments for making the critical decisions that influence what the two will do in the future,” Guice said. “It all starts with what our providers need to improve care.” By applying modular solutions to an open source architecture, the MHS will maintain the level of flexibility needed to get providers the solutions they say they need, said Stanley Lowe, interim deputy director of the Interagency Program Office. “The private sector is going to be critically important to the success of the IHR,” he noted. “We’re not the central repository of all knowledge related to this. We need to adhere to standards, and we know that the standards are lacking in some areas. In the short term, expect to see us embrace private sector products that adhere to those standards—and to see the IHR drive those standards that don’t already exist.” The MHS plans to have the IHR up and running within four years, Wennergren said. “I’m so happy to see this progress being made,” Petzel said. “It will enable us to get the best of both worlds—to share, without barriers, our information, creating a single, continuous health care record. This will be a new generation and a tremendous step forward.” Cat Vasko is editor of HealthIT Executive Forum.