Both DOD and the VA are involved in several interagency electronic health data sharing activities according to Dr. Jo Ann Rooney, Acting Under Secretary of Defense for Personnel and Readiness appearing before the Senate Committee on Veterans Affairs. As she explained, several systems are transferring information between the agencies.
For example, when a retired or separated service member leaves active military status, currently the Federal Health Information Exchange (FHIE) provides the only one-way electronic exchange of historic healthcare information from DOD to the VA.
On a monthly basis, DOD sends inpatient and outpatient laboratory results, radiology reports, outpatient pharmacy data, allergy information, discharge summaries, consult reports, admission/discharge/transfer information, standard ambulatory data records, demographic data, pre-and post-deployment health assessments, and post-deployment health reassessments via FHIE. To date DOD has transmitted health data on more than 5.8 million retired or separated service members to the VA.
To help shared patients being treated by both DOD and the VA, DOD maintains the jointly developed Bidirectional Health Information Exchange (BHIE) implemented in 2004. Unlike the FHIE, which only provides a one-way transfer of information; the two way BHIE interface enables clinicians in both DOD and the VA to view health data in text form from DOD’s existing health information systems.
Use of the data from BHIE continues to increase. As of January 2012, data from BHIE is available on more than 4.3 million shared patients including over 293,340 theater patients. Recent 2011 improvements to BHIE include the completion of hardware, improvements to the operating system, and performing security upgrades.
The exchange of pharmacy and allergy data is accomplished through the Clinical Data Repository (CDR) and the Health Data Repository (HDR) interface referred to as CHDR. CHDR supports interoperability between AHLTA’s CDR and the VA’s HDR enabling bidirectional sharing of standardized computable outpatient pharmacy and allergy data. So far, both DOD and the VA have exchanged pharmacy and allergy data on over 1.4 million patients receiving healthcare from both systems.
The transferring of images for the most severely wounded and injured is very important especially when service members are transferring to the VA Polytrauma Rehabilitation Centers for care. Today, DOD is able to send radiology images and scanned paper medical records electronically to the VA.
Both departments are focused on sharing health data with the private sector through the Nationwide Health Information Network (NwHIN) and the Virtual Lifetime Electronic Record (VLER). NwHIN will enable the departments to view a beneficiary’s healthcare information not only from DOD and the VA but also from other NwHIN participants.
DOD and the VA are working jointly on the Integrated Electronic Health Record (iEHR). Both departments anticipate that iEHR capabilities will evolve from existing service oriented architecture compliant capabilities and from commercial off-the-shelf, open source, and custom systems.