VA and Defense agree to build joint electronic health system

After nearly a decade of attempting to exchange information stored in separate systems, the Veterans Affairs Department and the Pentagon have agreed to join together to establish an updated electronic health records system.

While details remain sparse, the Defense Department announced Wednesday that the two agencies would jointly acquire and use a new in-patient electronic health system. The VA developed its current system, known as VistA, in 2001. Work began on the Pentagon's Armed Forces Health Longitudinal Technology Application, or AHLTA, in 1997. Both systems are in need of an upgrade.

The agencies have agreed to study their clinical processes and requirements and assess the benefits and the potential effects on their timelines and costs, before making a final decision on a joint acquisition strategy for the upgraded system.

Until now, the VA and Defense have been working independently on enhancing and improving their existing systems. They have made various attempts to share health information. According to Defense, millions of records and data messages are regularly moved electronically between the agencies.

William Winkenwerder, assistant secretary of Defense for health affairs, said he is excited at the prospect of adopting a common, mutually beneficial solution for the agencies' in-patient health documentation needs.

"DoD and VA manage two of the largest health care systems in the world," Winkenwerder said. "By working together, we can share medical data sooner and more seamlessly than we could on our separate paths."

VA Secretary James Nicholson, who announced plans for the joint venture Tuesday at a meeting of the American Health Information Community, called the agreement "groundbreaking" and said that "it has the potential to further transform the way we care for our nation's veterans and active duty service members."

A joint system for documenting in-patient health information will smooth the process of transferring active duty service members to veteran status, according to the Pentagon. The system will also make the inpatient health care data on shared beneficiaries immediately accessible to both Defense and VA health care providers.

The joint acquisition and development of the system could result in significant cost savings, the Pentagon said in a statement.

The two existing systems have diverse missions. Defense needs its system to support patients in its combat theaters, and pediatric and obstetrical patients. The VA's system supports domiciliary care. But both agencies "believe that the similarities in clinical and business processes may make the adoption" of a joint system a viable option, according to the Pentagon.

Sen. Larry Craig, R-Idaho, ranking member of the Senate Veterans' Affairs Committee, said the announcement is a "major step forward."

"This is long overdue, but a very good sign for America's veterans," he said. "What I think is significant is that the work is under way. That's what our committee and this Congress has insisted upon."

In a committee hearing Tuesday, Under Secretary of Defense David Chu said the development will take time and he does not want to be "naïve about what's required."

"Do we mean a summary of a patient's diagnoses? That's fairly straightforward," Chu said. "Do we mean the clinical notes that the clinician may have recorded, which of course historically were written down, which will have to be transcribed? Do we mean the actual x-ray images? That's a much more significant data requirement."

Robert McFarland, former VA chief information officer, said it made no sense for the two organizations to have separate systems.

The two agencies have more similarities than differences, he said, and should have combined their efforts a long time ago. He predicted that hundreds of millions of dollars could be saved as a result of the joint effort.