Government Health IT ran an interesting article talking about the Department of Defense (DoD) and Veterans Affairs deadline for interoperability of electronic health records. Here’s a short section of the article:
For Navy Capt. Michael Weiner, acting deputy program officer of the Defense Health Information Management System, the two departments have met the relevant interoperability criteria, which were set by the Interagency Clinical Informatics Board, he said.
These included making DoD inpatient discharge notes available to the VA; increasing the number of electronic gateways deployed between the two systems; enhancing the sharing of social history; creating the ability to view scanned documents between systems; and making available DoD periodic health assessments and separation physicals to the VA.
“These were the agreed upon metrics and measures of success and we have achieved them all,” Weiner, told Government Health IT.
However, Rear Adm. Gregory Timberlake, the now retired head of the IPO, committed earlier this year to the complete and computable interoperability of six categories of data by September 30. Not all of these are now shareable in computable form, Weiner acknowledged.
Those six classes of data–for prescriptions, laboratory results, radiology results, and physician, nursing, and therapist notes–were to augment the exchange of drug interaction and allergy information for shared DoD/VA patients previously available. Lab results and radiology results are still not shareable in computable format, according to Weiner.
Of course, we should applaud those who are working on interoperability of EHR software. However, this is a small example of the complexity that’s involved in trying to make healthcare data interoperable. If two organizations that are so closely tied as the DoD and VA are having a challenge sharing their EHR records, imagine what it’s going to be like in the private sector.
The first two HITECH priority grant programs, funded through the Recovery Act, support the national implementation of electronic health records (EHRs) initiative.
Approximately $598 million is being made available through the Health Information Technology Extension Program (Extension Program), to ensure that comprehensive support is available to health technology users.
Under the State Health Information Exchange Cooperative Agreement Program $564 million will be awarded to support efforts to achieve widespread and sustainable health information exchange (HIE) within and among States through the meaningful use of certified Electronic Health Records.
State Health Information Exchange Cooperative Agreement Program
The State Health Information Exchange Cooperative Agreement Program will help States and Qualified State Designated Entities (SDEs) to develop or align the necessary policies, procedures and network systems to assist electronic information exchange within and across states, and ultimately throughout the health care system. A key to this program’s overall success will be technical, legal and financial support for information exchanges across health care providers.
The Extension Program will provide grants for the establishment of Regional Health Information Technology Extension Centers (Regional Centers) that will offer technical assistance, guidance and information on Electronic Health Records best practices. These estimated 70 (or more) Regional Centers each will serve a defined geographic area. The Regional Centers will support at least 100,000 primary care providers, (and receive $5,000 for EACH PROVIDER that is successful at “meaningful use”) through participating non-profit organizations, in achieving meaningful use of EHRs and enabling nationwide health information exchange with direct, individualized and on-site technical assistance in:
Selecting a certified EHR product that offers best value for the providers’ needs;
Achieving effective implementation of a certified EHR product;
Enhancing clinical and administrative workflows to optimally leverage an EHR system’s potential to improve quality and value of care, including patient experience as well as outcome of care; and,
Observing and complying with applicable legal, regulatory, professional and ethical requirements to protect the integrity, privacy and security of patients’ health information.
The Extension Program will also establish a national Health Information Technology Research Center (HITRC), funded separately, which will gather relevant information on effective practices from a wide variety of sources across the country and help the Regional Centers collaborate with one another and with relevant stakeholders to identify and share best practices in EHR adoption, effective use, and provider support.
Grants under the Extension Program will be awarded on a rolling basis with an expected 20 grants awarded in the first quarter of FY2010, another 25 in the third quarter and the remaining awards in the fourth quarter of FY2010. The initial funding includes approximately $598 million to ensure that comprehensive support is available to providers under the Extension Program beginning early in FY2010, with an additional $45 million available for years 3 and 4 of the program. Federal support continues for four years, after which the program is expected to be self-sustaining. Of the total federal investment in this program, about $50 million is dedicated to establishing the national HITRC, and $643 million is devoted to the Regional Centers.
The law requires that Regional Centers be affiliated with a U.S.-based, nonprofit institution or organization, or an entity thereof, that applies for and is awarded funding under the Extension Program. The program anticipates that potential applicants will represent various types of nonprofit organizations and institutions with established support and recognition within the local communities they propose to serve.
The performance of each Regional Center will be evaluated every two years by a HHS-appointed panel of private experts, none of whom are associated with the center being evaluated. Continued support for the Regional Center after the conclusion of the second year of performance will be contingent on the panel’s evaluation being, on the whole, positive and on HHS’ determination that such continued federal support for the center is in the best interest of the program.
The Regional Centers will focus their most intensive technical assistance on clinicians (physicians, physician assistants, and nurse practitioners) furnishing primary-care services, with a particular emphasis on individual and small group practices (fewer than 10 clinicians with prescriptive privileges). Clinicians in such practices deliver the majority of primary care services, but have the lowest rates of adoption of EHR systems, and the least access to resources to help them implement, use and maintain such systems. Regional Centers will also focus intensive technical assistance on clinicians providing primary care in public and critical access hospitals, community health centers, and in other settings that predominantly serve uninsured, underinsured, and medically underserved populations.
The Extension Program expects all Regional Centers to be operating at full capacity by the end of December 2010. In addition, it is expected that by the end of December 2012, the Regional Centers will be largely self-sustaining and their need for continued federal support in the remaining two years of the program will be minimal.
Additional information is available at http://healthit.hhs.gov/extensionprogram
I think its all fine and good for all the VA Health System entities to be interoperable. But what happens when someone has to go out of that system, say, for emergency care. What will the VA system do to be sure that it will be interoperable with the records managed by non-VA providers?
The interoperability standards have to be universal and applied to everybody. Is the VA’s EMR going to be compatible with an emergency room in Cleveland, Ohio?
And will the VA have to work through RHIOs, one in each geographic region of the country where there is a VA facility — or is the VA big enough and insulated enough to be a RHIO or HIE unto itself?
We still have a while lot more questions than we do answers, not just about the VA, but about everything.
Rich Silverman
PSHS Healthstop Blogging Team
Rich,
I think that this is a major problem that the VA EMR will face. In fact, it was confirmed recently by this report that talks about the VA System not being able to interact with more modern technology: https://www.healthcareittoday.com//2009/11/10/issues-with-va-vista-emr/#comments