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Measuring DoD-VA records sharing proves hard

The Pentagon and the Department of Veterans Affairs are making “great strides” in the ability to electronically share the medical records of troops and former troops under their care who are transitioning between the health care systems of the two departments.

However, they can’t accurately quantify overall progress because, officials say, the measuring sticks for progress are a moving and evolving target.

“DoD and the VA are already making very great strides in sharing health care data — which is to say, we’re on target to meet the requirements” of the 2008 Defense Authorization Act, said Gerald Cross, VA’s principal deputy undersecretary for health, in a Pentagon news conference Monday. “DoD and VA are now sharing almost all essential health information that’s available electronically in a viewable format.”

The Defense Authorization Act requires that both departments achieve “full interoperability” of their electronic health record capabilities and systems by September 2009.

But the problem is that “full interoperability” has yet to be defined.

“I think we’re all learning as far as the benchmarks we want to use … and how do we determine what progress is being made,” said Stephen Jones, principal deputy assistant secretary of defense for health affairs.

DoD and VA clinical priorities, including consideration of future items to share beyond September 2009, are set by a joint “clinical informatics board” — a group of DoD and VA physicians — said Lois Kellett, acting director of the DoD/VA Interagency Program Office.

“They’ll set the priorities,” Kellett said. “What is it that our clinicians need?”

Limited electronic medical record sharing began in 2001; the law that authorized it was passed in 1984, according to Arthur Wu, Republican deputy staff director for the House Veterans’ Affairs Committee’s oversight and investigations panel, who attended the press conference.

A shared system holds much promise, Jones said: reducing duplicative testing and adverse drug reactions; increasing preventive care and adherence to evidence-based practice, and improving chronic disease treatment. Cost savings will run in the multiple billions, experts say.

But such a system remains a work in progress. Today, VA has access to digital health information on more than 4.5 million current and former service members, according to Kellett. That figure does not include all current service members, she said; VA has access to current service member data only if VA is actually treating that patient.

That figure also does not include all possible medical data.

For instance, only seven VA sites are able to exchange visual data, such as X-rays: El Paso, Texas; Denver, Colo.; North Chicago, Ill.; Washington, D.C.; Richmond, Va.; Tampa, Fla.; and Biloxi, Miss.

A promising automated system that allows a doctor in one system to see what drugs a patient has been prescribed in the other is currently available at just seven sites: El Paso, Texas; Augusta, Ga.; Pensacola, Fla.; Puget Sound, Wash.; Chicago; San Diego; and Las Vegas.

More encouraging is the sharing of inpatient data such as discharge summaries, now possible on more than 50 percent of inpatient hospital beds, Kellett said; by December 2009, that figure will rise to between 70 percent and 80 percent, she said. Data such as lab results and radiology results “are the types of things that have been shared,” she said, but she provided no statistics.

Shared data also includes more than 2.4 million pre- and post-deployment health assessments on more than 971,000 service members who have been deployed overseas, she said.