Defense and Veterans Affairs department officials will meet June 23 to approve a major step in a four-to-six year marathon to have a joint electronic health record.
Secretaries Robert Gates and Eric Shinseki, of DoD and VA respectively, will review the plans to implement the initial part of the EHR at a joint medical facility in Chicago.
VA and DoD co-developed a new graphical user interface (GUI) that will bring together data from both agency’s systems.
“We took six VA clinicians, six DoD clinicians and we put them in a room with a blank piece of paper and asked them what a good GUI looks like,” said Peter Levin, VA’s chief technology officer in an interview after a recent conference. “No one had asked them that before. There was one criteria that qualified anybody to be in the room, I wasn’t allowed to have heard of them before. I wanted people who normally wouldn’t participate in the process to sit down in this very user centric way, with a trained facilitator, a guy who has designed hundreds of user interfaces in the past. And we drew it out on a white board. We have now demonstrated to the secretary a prototype implementation, a live implementation, with all the consents, all the privacy, all the security, it was all there.”
Levin said a recent demonstration showed how the interface would work, providing patient data including labs, x-rays, prescriptions and other information to doctors and nurses no matter if they were at a VA or DoD medical facility.
“All these things now are presented in a much more intuitive, I would say, conventional, Google-like modern architecture,” he said. “This is one step in a very long process.”
DoD and VA expect to launch the GUI July 1 in a few selected clinics in Chicago.
“What we are hoping this will be an example of agile development, Program Management Accountability System-like implementation, robust testing, automated testing and showing the user very quickly what it is they’ve asked for, do they like this? Do you want to it green or red? Should the name be in the bottom or the top? Do you like the font?” Levin said. “All the things we are used to now in almost every other application except for health records. Now we will start seeing in it health records in this joint common platform at this joint facility.”
He added the interface isn’t just the basic information about the patient, but their full-health record.
“Everything a clinician would see today in VISTA or in AHLTA will be available to them in the joint common platform,” Levin said.
The demonstration of the GUI will come about two months after VA and DoD formalized their relationship through a memo to implement a joint electronic health record.
VA would not release the memo, but Josephine Schuda, an agency spokeswoman, said in an e-mail, the agreement addresses how to merge business processes, how to use of open-source and a high-level governance structure.
Roger Baker, VA’s assistant secretary for information and technology and chief information officer, said at a recent press briefing that VA is “whole-heartedly embracing open source” while DoD sees it as a tool in the toolbox.
“When looking for a software package if I see a package that already is integrated with open source and APIs, that will be a competitive advantage for the vendor,” Baker said. “I hope commercial vendors will build wrappers that allow proprietary products to talk to open source systems.”
Baker said he meets twice a week for 90 minutes with DoD deputy chief management officer Beth McGrath and others on the senior coordinating group to work on the joint EHR.
“We will implement a single common EHR to defined standards so that we can allow for maximum compatibility with commercial products and products that come from the open source side for utilization for inside DoD and VA,” Baker said. “The key phrase is a single common EHR.”
Baker said behind this joint system will be at least a virtual single database, if not full on data warehouse.
Levin said the database will reside within the Defense Information Systems Agency data centers. He said the goal is to have a centralized database using common data standards and implementation procedures.
“It’s our job now how to figure out now how make it happen,” he said. “What do you mean when you say service level agreements? What do you mean when you say volume, performance levels?”
Levin said the move would happen soon, but was reluctant to put an actual date on when the database would be running.
“We’ve come up with an encapsulation methodology so in the case of VISTA, which is much more fragmented, we will put wrappers around them and start virtually integrating them, so you would call that a federated model with a very deliberate, structured goal of putting this into an openly sourced, nationally standard information model,” he said. “We’ve got the plans in place to do that too.”
At the same time as VA and DoD are working on the database, the two agencies will try to bring their business processes closer together.
Levin said a recent analysis found DoD and VA have many similarities in their applications and data standards.
“Something like 85 percent of apps are exactly the same,” he said. “So rather than come up with a customized way of doing things…we are going to look at corpus of things we can do in common, that we do almost the same, and instead of making them custom, we will make them configurable. The same is true on the data, 90 percent of the data is exactly the same.”
But Levin warned the changing of business processes will be among the most difficult areas to bring together.
“We’ve got the culture right, we’ve got the technology on its way here, but the middle piece, that piece that talks about changing the business process, is really the focus of our attention,” he said. “It will keep me pretty busy for many months.”
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