DoD and VA still working out how to create single EHR

The Departments of Defense and Veterans Affairs are still trying to figure out how to best align their agencies’ respective plans to create a common Cerner electronic health record system.

Speaking on Wednesday at the HIMSS19 conference in Orlando, DoD and VA program officials said coordinating their activities to ensure interoperable EHR systems is a work in progress, emphasizing that the agencies continue to discuss an optimal organizational design that will facilitate coordinated decision-making and oversight when it comes to governance.

Toward that end, the DoD and VA Interagency Program Office is working to establish joint EHR modernization governance bodies to foster coordination and improve communication between the departments.

“We can’t talk enough about the work that the Interagency Program Office has done to ensure that the DoD and VA are aligning around commercial standards and to also be able to provide a consolidated input between basically the two largest federal healthcare providers,” Stacy Cummings, program executive officer for Defense Healthcare Management Systems, told a HIMSS audience.

Cummings noted that late last year Defense Secretary James Mattis and VA Secretary Robert Wilkie signed a joint statement committing to the implementation of a single, seamlessly integrated EHR that “maximizes commercial health record interoperability” by sharing data between the two agencies as well as community healthcare providers.

Also See: DoD-VA EHR interoperability needs a single point of accountability

The purpose of the document signed by Mattis and Wilkie was to “demonstrate the commitment of both the DoD and the VA to the success of this electronic health record deployment,” according to Cummings. To make decisions and execute them jointly, she added that the agencies have put together a working group to create synergies and efficiencies.

“We’re making great progress—we’re looking at risk and technical and programmatic functions,” she said. “Having greater synergy will reduce the risk to both of our programs.”

While DoD and VA have “spent a lot of time” sharing information and lessons learned, Cummings acknowledged that the two agencies “can benefit from being even closer than we are today.”

Last year, the VA awarded Cerner a $10 billion EHR modernization contract—one of the largest IT contracts in the federal government—to replace the agency’s decades-old Veterans Health Information Systems and Technology Architecture. In 2015, DoD awarded a $4.3 billion contract to prime contractor Leidos to modernize the military’s EHR system with Cerner’s Millennium platform.

According to Cummings, the two agencies will share a data center hosted at Cerner’s Kansas City headquarters in a “single instance” enclave, with the VA taking advantage of investments DoD has already made in that commercial data center.

DoD’s Cerner system—called MHS GENESIS—has so far been deployed at four military sites in the Pacific Northwest. The VA’s planned acquisition calls for aligning, as much as possible, the deployment and implementation of its EHR system with ongoing DoD rollout activities in order to achieve efficiencies.

“In our deployment schedules, we’re looking to be as coordinated as possible where it makes sense,” said Cummings. “But, at the same time, I don’t think either one of us is interested in slowing down our plans to deploy on our timelines.”

In December, DoD authorized MHS GENESIS to proceed with six “waves” of deployment, starting in the fall of 2019. Wave 1 sites include Naval Air Station Lemoore, Travis Air Force Base, Mountain Home Air Force Base and the U.S. Army Health Clinic Presidio—all of which are the first military facilities to field the standard baseline of MHS GENESIS.

Cummings observed that one of the biggest lessons learned from DoD’s deployment of MHS GENESIS to initial operational capability sites was that “this is not an IT implementation—this is a change management program.”

“DoD has already gone live at facilities—we are still educating our clinicians, and that’s a tough chore,” said John Windom, executive director of the VA’s Office of EHR Modernization, at the HIMSS19 conference. “We want to make sure we’re judicious in the way we move forward such that our change management strategies that we’re both employing will take hold as appropriate. This is about the end user—the person that’s required to use Cerner Millennium.”

“It’s a hard sell because people are used to what they’re used to, regardless of how arduous it may be to use or how cumbersome,” added Windom, referring the VA’s legacy VistA system which is popular with the agency’s clinicians.

At the same time, Windom pointed out that DoD and VA have “two different patient populations” that the agencies are trying to both serve using a single, seamlessly integrated EHR. “That’s a tremendous challenge that we don’t take lightly,” he concluded.