Web-based military health records system called bureaucratic, not technical, challenge

Commercial vendors who develop and manage Web-based health record systems say a recommendation by a presidential commission to develop such a system for soldiers and veterans would be a relatively easy task.

In its recently released report, the Commission on Care for America's Returning Wounded Warriors said the departments of Defense and Veterans Affairs must be able to transfer health and benefits information and "move quickly to get clinical and benefits information to users." The panel was appointed by President Bush in the wake of reports of poor treatment of wounded soldiers at Walter Reed Army Medical Center.

Defense and the VA have been working for at least five years to integrate their systems, but they remain "fragmented and compartmentalized," and a simpler one needs to be developed to handle health data interchange, the commission recommended.

The panel, co-chaired by former Sen. Bob Dole, R-Kan., and Donna Shalala, secretary of the Department of Health and Human Services in the Clinton administration, recommended that Defense and VA develop within a year a Web-based portal to present all health care and benefits information from the two departments. The system also should provide patient records to recovery coordinators (who work directly with wounded soldiers in military clinics and hospitals), clinicians and other health care professionals in both departments.

Craig Froude, executive vice president and general manager of WebMD Health Services, the market leader in Web-based health records systems, said such a system already exists in the commercial health care market. What the commission envisions is what WebMD provides to more than 100 hospitals and health care networks through its private portal business, Froude said.

WebMD manages health care plans for large employers such as American Airlines, Dell and IBM, as well as major insurers including WellPoint, Froude said. These private portals integrate health care and benefit information onto Web-based systems or dashboards customized for patients, clinicians, plan coordinators or other users, Froude said.

WebMD's portal also can make pharmacy information available to patients and clinicians and display radiological images on the clinician dashboard. This "unified interface" can link to benefit information, Froude said.

Froude said WebMD private portals serve 30 million people and the public WebMD site processes 40 million visits a year. That scale is larger than the one that Defense and the VA manage each year. Defense's Military Health Care System manages records for more than 9 million beneficiaries, and the VA treated 5.5 million patients in 2006. Froude said it would be daunting to develop a complete health care portal to integrate all health and benefits data from the two departments within the commission's 12-month time frame. "This is a huge undertaking," he said, and it would take more time. But, Froude said, using a phased development approach, some functionality could be up and running within a year.

Chakri Toleti, co-founder of Galvanon, a health care Web-portal developer owned by NCR, called the job of stitching together Defense and VA health information systems "relatively easy" and said his company could easily meet the deadline set by the commission. Toleti said Galvanon has set up the portal framework for health care systems with 20 or more hospitals serving hundreds of thousands of patients in four months. Galvanon uses Web services that find and expose data to a portal well, a technique established in the banking and health care industries. He said since Defense and VA have developed electronic health-record systems, it would not be difficult to build interfaces that can locate, package and display the data on a portal.

In less than a year, Intermountain Health Care in Salt Lake City, which serves more than 1 million patients in 21 hospitals and clinics, developed portals to serve clinicians and patients, said Belle Rowan, director of clinical channels for the Intermountain e-business division. Intermountain used Enterprise Java Bean technology from Sun Microsystems to integrate data from back-end systems into the Web portals. The project required about nine months of coding. "It was time-consuming but not difficult," Rowan said.

Robert McFarland, who served as the VA's assistant secretary for information and technology and chief information officer from January 2004 to April 2006, agreed that the technical challenge of building the Web-based system is not a problem. Application interfaces and digital hooks can tie together the disparate data structures and incompatible health systems of the VA and Defense. He said automating benefits would prove more of a challenge for the Veterans Benefits Administration, which "is in the nineteenth century" when it comes to handling claims because it primarily uses a paper-based process.

The bigger challenge, McFarland said, will be the political and bureaucratic environment, in which Defense and the VA have stridently independent business units. "Sharing information [between Defense and VA] has been the right thing to do for the past 20 years, and it's not rocket science," McFarland said. "But there has to be a desire on both sides to make it happen."

Based on his experience, McFarland said that only Congress can force the two departments to meet the commission's recommendation by passing laws that leave little wiggle room.

But companies like WebMD and Galvanon may find the federal government a frustrating place in which to work, having to deal with the bureaucracy, turf wars, infighting and politics evident in Defense and VA organizations, McFarland said. That means the battle over the Web portal contract would most likely go to "the Beltway Bandits, who have played this game for years," he said.