Dr. Barclay Butler, Director, DOD/VA Interagency Program Office

Since rebooting efforts nearly a year ago to merge their electronic health care management and record keeping systems, the Defense Department and the Department of Veterans Affairs have made what top officials described as considerable progress after the program was in danger of slipping its schedule.

A lot is riding on merging the systems because the DOD and VA operate some of the world’s largest health care management systems. Jointly, the two departments serve more than 18 million patients, use 400,040 medical service providers, and manage 280 million annual outpatient visits. Behind the scenes, they also support 229 data centers.

Combining the information technology architectures underneath these systems would streamline the ability to track the medical records of military personnel from the time they enlist, throughout their military careers and as veterans move into their civilian lives.

But merging DOD’s and VA’s massive systems, both known for their complexity, has proven enormously challenging, despite years of collaboration between the two departments to reach this goal, according to officials with the DOD/VA Interagency Program Office (IPO), who spoke in recent days at AFCEA’s 5th Annual Warfighter IT Support Day.

So much so that the program office created to bring the two systems together was rechartered and its mission was refocused in October 2011 and a joint DOD and VA team was brought together to help move the process forward, said Dr. Barclay Butler, the office’s director.

Instead of upgrading and integrating VA’s VISTA and DoD’s AHLTA health care record systems, both departments decided to take a different approach, starting with the creation of a joint integrated electronic health record (iEHR) as one of the centerpieces of a combined information technology and records managements system.

The infrastructure supporting the systems will also be streamlined, with the number of data centers ultimately to be reduced to nine centers through consolidation and virtualization, said Butler.

The idea behind the iEHR is that it could be developed and launched in a short time frame, said iEHR program manager Susan Perez.

The program has until the end of 2014 to develop an initial operating capability supporting two sites and which includes two major medical capabilities as well as a variety of supporting systems, she said.

That still puts the delivery of a fully integrated system a long way off because both departments must still develop business processes and supporting electronic systems that talk to each other and share data. A common infrastructure, a variety of system tools and unified workflows are also being developed, Perez said. Full deployment of the VA/DOD iEHR isn’t expected before 2017.

The final product will have a common enterprise data center with a shared data capability, Perez said, but the architecture and supporting systems will have to be built in layers to create a unified whole.

In fiscal year 2012, the program office defined its baseline state and awarded an underlying enterprise service provider contract. Work is beginning on system virtualization as well on identity access management and control. The VA is also mapping its business systems to mesh with the DOD’s systems, she said.

In 2013, work will begin on single sign-on and context management capabilities. Additional roll-outs will take place at 16 VA and DOD facilities, setting the stage for additional contracts and deployments, she said.

Perez also reached out to industry to provide suggestions and help with the program. She noted that there will be many requests for information coming out in the next year or so to help merge all of the systems necessary to get the architecture into place. “We want the best products and have them work together to meet the needs of the medical community,” she said.

Defining The IPO’s Mission

The notion of an integrated health record for the DOD is fundamental to taking care of warfighters, said Butler. But he added that putting together an integrated system is challenging because of the complex technical and cultural issues involved in creating it.

Consequently, Butler said the IPO has three primary missions: delivering the iEHR; developing the virtual lifetime electronic health record; and tweaking, managing and overseeing those things related to the iEHR.

These capabilities include medical registries serving a specific part of the patient population. Clinician developed treatment protocols for these patient groups are plugged into the iEHR, Butler said.

Another mission of the IPO is oversight and health information technology services. One example of this is the five-year demonstration program which combined the Chicago Veterans Affairs Medical Center with the Naval Health Center, Great Lakes into the Captain James A. Lovell Federal Health Care Center. The IPO’s role is to provide medical IT services to the center, Butler said.

Among the lessons learned from working at the center is that there were multiple IT enclaves, in this case, VA, Navy and DOD, which had to be made to work together.

“It’s much more important for a doctor at the VA to talk to a doctor in the DOD than for them to independently talk to their chains of command,” he said.

Another part of the process is the adoption of an agile software development process to speed the development of enterprise class systems.

Butler noted that adopting an agile process has greatly improved the delivery times of systems, which a considerable contrast to traditional project development and delivery processes.