Veterans Affairs Archives

As Nextgov's Bob Brewin has reported, the Pentagon and the Department of Veterans Affairs will create a common platform for their electronic health records. A plan for implementing the joint venture is due in early May.

Lt. Gen. Eric Schoomaker, the Army surgeon general, said last week that a single EHR would make it easier to transfer patient data and increase the amount of patient information shared between the two departments. As Brewin noted in a blog post last week, Defense Secretary Robert Gates and VA Secretary Eric Shinseki agreed to the common platform in a March 17 meeting.

A General Accounting Office report dated Feb. 2 sharply criticized the VA and Defense departments for failing to articulate explicit plans, goals and timeframes for common health IT requirements. GAO said each organization was too narrowly focused on their own EHR modernization, among other issues, to join in planning for their common requirements together.

The departments have separate EHRs. DoD uses the Armed Forces Health Longitudinal Technology Application, commonly known as AHLTA. It is transitioning to the Electronic Health Record Way Ahead system. The VA's system is called VistA, for Veterans Health Information Systems and Technology Architecture.

DoD and VA agreed in April 2009 to create something called the Joint Virtual Lifetime Electronic Record to facilitate sharing of medical records between them. Testing is under way in five pilot programs, according an article Tuesday by the American Forces Press Service.

"No two health organizations in the nation share more nonbillable health information than the DoD and the VA," Schoomaker said in testimony before the Military Personnel Subcommittee of the House Armed Services Committee. "The departments continue to standardize this sharing activity under delivering information technology solutions that will significantly improve the sharing of appropriate electronic health information."

The Departments of Defense and Veterans Affairs need a unified battle plan when it comes to health IT investments, the General Accounting Office says.

In a report issued last week, the GAO blames barriers in IT strategic planning, enterprise architecture and investment management. The two departments are establishing the Virtual Lifetime Electronic Record (VLER) and shared health IT capabilities for the first joint DoD-VA hospital, the James A. Lovell Federal Health Care Center, in North Chicago.

The report noted a number of failures, including:

• Not having explicit plans, goals and timeframes for common health IT requirements for the DoD and VA electronic health record systems.


• Not establishing a clear path for transitioning to future IT architecture.


• Not creating a joint process for approving IT investments based on cost, benefit, schedule and risk for each department.


• Not knowing whether IT capabilities developed for the Lovell hospital are transferrable to other DoD and VA medical facilities.

DoD and the VA, which operate two of the largest health care systems in the country, are too focused on the nuts and bolts of their own EHR modernization to plan for their common requirements, the report says.

GAO recommends revising the departments' joint strategic plan to specifically address common business needs as both EHR systems are modernized; defining future joint health IT architecture and a detailed plan for transition; and developing a robust plan for identifying and selecting joint health IT investments.

The vast majority of Americans have never asked a doctor to provide them with personal health information or medical records in an electronic format, yet 70 percent of people responding to a new survey said it's important for doctors and hospitals to provide them with electronic copies of that information.

Almost two-thirds of doctors agreed that they should provide medical records to patients in electronic format, according to results of parallel surveys conducted in August by the Markle Foundation, which promotes "health and national security through the use of information and technology."

This fall, for the first time, patients receiving health care from the Department of Veterans Affairs will be able to download "pertinent health information," the foundation notes. And Medicare beneficiaries are gaining the ability to download claims information.

"Government has demonstrated what should be possible for health consumers everywhere," Markle said.

More than 60 percent of lay respondents and almost half the physicians said the ability of patients to access electronic records will be an important standard by which to measure the success of a $27 billion federal subsidy program created to encourage adoption of electronic medial records by healthcare providers.

The foundation noted that "new federal rules require health care providers and hospitals to give patients electronic copies of their lists of medications, after-visit summaries, lab results and other pertinent information in order to qualify for an estimated $27 billion in federal subsidies for using health information technology."

Despite the interest in exchanging electronic data, 93 percent of patients surveyed said they rarely or never ask for copies of personal health information or medical records in electronic format. Almost the same percent of doctors reported that patients rarely or never asked for such information.

One part of the Markle Survey on Health in a Networked Life 2010 sampled 2,463 people in the general population. A separate survey queried 779 physicians. The foundation released results of the survey this month.

When members of a federal advisory group suggested recently that the government shouldn't be in the business of designing electronic health records, Rick Jung nearly fell out of his chair.

Apprehending his attention was a comment that appeared in a post on this blog:

"I am nervous that the government is going to get into the EHR design business," said Judy Faulkner, chief executive officer of Epic Systems and a member of the Health IT Policy Committee, which advises the Office of the National Coordinator for Health Information Technology. "We need to be careful about these committees not becoming the design committees for what the country will do."

Jung, chief operating officer at Medsphere, requested equal time. His company deploys an "open-source version of the world's most proven electronic health record system, the VistA EHR developed by the U.S. Department of Veterans Affairs over the course of two decades."

Obviously biased, Jung claims that his company's Vista derived product is a more effective solution and a better value. In West Virginia, he says, Medsphere deployed its system at a 1,200-bed facility for $9 million, a fraction of the $90 million total incurred by a similar facility of the same size that adopted Epic's proprietary system.

HIT Blog: You took exception to Ms. Faulkner's observation. Why?

Jung: It's ironic that she would be talking about the government getting into a business that they've been in for the better part of 30 years. The most widely deployed, highest-level adoption of any electronic health record system, including Epic's, is in the VA. The government built that system (Vista) to take care of our veterans. Not only have they been in the EHR business for the longest time, but VistA is used by every employee in every VA [facility], including every physician and every nurse, every clinician.

HIT Blog: How did Medsphere get into the business of adapting Vista for use in other settings? And why?

Jung: The Freedom of Information Act guarantees that anyone, any hospital anywhere, can download the VA VistA software free. We paid for it with $8 billion-plus taxpayer money.

The only reason we [Medsphere] have a reason for being is that the vast majority of proprietary systems on the market are not adoptable by physicians. They're built by technologists for technologists.

HIT Blog: So what's the difference between proprietary electronic records and the open source version?

Jung: It's great marketing to see a whole bunch of features [on a proprietary EHR]. It's a whole other thing to get physician adoption [of an EHR] and improvement of [clinical] outcomes. The VA has done that. They take care of their patients forever and a day. That [VistA] system has to make sure that it can take care of patients, cradle to grave.

Other [proprietary] systems are great at capturing information, but there is no evidence in studies of their moving the needle on care. To suggest that government not get in the business is masterful marketing.

HIT Blog: So the time for open source is now?

Jung: We are in adoption mode right now. Health care costs are out of control. If you don't have a system in place that's adoptable by physicians and clinicians, there's no way to rein in runaway costs.

If at the care giver level all you have is a bunch of slick fields that nobody uses, you've not moved the needle at all. What Open Vista is about, from Medsphere's perspective, is minimizing barriers to adoption. You don't pay for software, you pay for results. The system already works. And the government is paying 45 percent to 55 percent of [reimbursements] at every hospital in America [through Medicare and Medicaid]. Shouldn't the government have an interest in what is in the system? They absolutely have an interest.

HIT Blog: Why hasn't there been greater adoption of EHRs, particularly open source solutions?

Jung: In fairness, health care is not the most advanced industry in the world in terms of technology. Generally speaking, health care is about a decade behind every other industry. Web-based applications are just now catching on in hospitals. The challenge for health care has been compounded for three reasons: One, proprietary systems are expensive. Two, they [would-be adopters] are not aware that Vista is actually as ubiquitous as it is. Three, we're not yet an open source culture. In America, we want to have it our way. It's got to be feature- and function-focused for people to think it's high quality. In reality, you pay for bells and whistles but you still don't have adoption.

The people who have bought proprietary systems are the people with tens of millions of dollars to blow--Johns Hopkins and Kaiser. The rest of America does it on paper because there is no capital to buy a system.

Hit Blog: Now there is. How do incentives for adoption change the playing field?

Jung: The [EHR] certification process finally got some legs. In the last six months, the market has exploded. People are making purchasing decisions. They've downloaded our software. They've stood it up. People are moving rapidly.

Quick, what is the first image that comes to mind when you think about team work, as in "health IT is a team effort -- one that requires different players working together toward the common goals of increased coordination, quality, safety and efficiency in our health care system?"

Do you see one half of an orangey-gold five-point star at the end of a two-band rainbow of red and blue? Do you hear Judy Garland singing about an enchanted land of functional heath IT, somewhere over the rainbow? If so, you could do marketing for the Office of the National Coordinator for Health IT, which recently unveiled a new theme and visual identity for the ridiculously difficult task of moving the country's health IT system into the 21st century.

Having determined the necessity of branding that effort, ONC came up with a slogan, "Connecting America for Better Health," and a visual identity, the aforementioned half star (a ubiquitous motif) and arcing lines.

So, what's with the red and blue rainbow? Did the spectrum of light lose most of its colors in the economic downturn? Did Roy G. Biv shorten his mnemonic moniker to R.B.? I'm guessing that the design team, having agreed to be visually inclusive of red and blue America, called it a day.

Than again, maybe those arcing bands aren't a rainbow. Perhaps they're streams of cosmic dust trailing a shooting star that is plummeting toward a vast sea of paper medical records that will vaporize upon impact. Perhaps those arcs are the outline of a stylized horizon above which the star is rising, a take on Reagan's Morning in America kitsch, which the Obama campaign visually interpreted to good effect. If I didn't know better, I'd swear that the design is a rip-off of the Energy Star logo.

"This message clearly illustrates one of HITECH's guiding principles -- namely that we are all in this together," wrote Peter Garrett, ONC communications director, in an entry posted to ONC's edgy blog, Health IT Buzz. "The new theme and visual identity . . . really captures the spirit of these combined efforts to boost national adoption of electronic health records and ensure success."

The news hit the Buzz site on Aug. 27 -- a Friday -- a day of the week favored by public relations pros seeking to bury a dog of a story.

Which is fine, so long as I never hear a digitally altered recording of Judy Garland pining for an EHR ...

Somewhere over the rainbow
Way up high,
There's a paperless health care system that I heard of
Once in a lullaby.

Somewhere over the rainbow
Skies are IBM blue,
And the electronic health records that you dare to dream of
Really do come true.

Someday I'll wish upon a star
And wake up where unconnected data are
Behind me.
Where file cabinets melt like lemon drops
And meaningful use is really tops
That's where you'll find me.

Somewhere over the rainbow
Bluebirds fly.
VA docs use Vista.
Why then, oh why can't I?

If happy little bluebirds fly
Beyond data exchange centers
Why, oh why, can't I?

As the Obama administration showers doctors and hospitals with stimulus money, it should tell the takers to embed an icon on their subsidized e-health records that allows patients to download their records, according to a new paper backed by 46 consumer, provider, corporate, insurance and privacy groups.

The Markle Foundation, a N.Y.-based organization that studies national security and health information technology, released on Tuesday a report that advocates for a so-called blue button. Some government websites for Medicare and veteran beneficiaries, including MyHealtheVet.gov, are beginning to offer this feature. The file that the button pulls up for Internet users looks like this.

Currently, the Centers for Medicare and Medicaid Services is paying providers billions of bonus payments, allocated under the 2009 American Recovery and Reinvestment Act, to program and share patient health information electronically. The goal of health IT is to reduce errors, speed treatment and improve quality of care, activists say. But some consumer and patient groups have raised concerns about the cost and security of such systems.

Markle envisions the blue button as a common tool on secure websites for patients and beneficiaries that are hosted by medical practices, hospitals, insurers, pharmacies, laboratories and commercial information services. Tuesday's paper contains a set of privacy and security specifications for the gadget.

"By clicking the blue button, you could get your own health information electronically -- things like summaries of doctor visits, medications you are currently taking, or test results," said Carol Diamond, managing director at Markle. "Being able to have your own electronic copies and share them as you need to with your doctors is a first step in truly enabling people to engage in their health care."

Supporters of the proposal include the following organizations:

AARP • Allscripts Healthcare Solutions • American Academy of Family Physicians • American College of Cardiology • American College of Emergency Physicians • American Medical Association • Anakam Inc. • Axolotl • BlueCross BlueShield Association • Center for Connected Health • The Children's Partnership • Center for Democracy and Technology • Center for Medical Consumers • Children's Health Fund • Chilmark Research • Computer Sciences Corporation • Consumers Union • Dossia Consortium • DrFirst • Google • Initiate, an IBM Company • The Institute for Family Health • Intel Corporation • Intuit Health • Keas, Inc. • LifeMasters-StayWell Health Management • Markle Foundation • McKesson Technology Solutions/RelayHealth • MedCommons • Medical Group Management Association • Meditech • Microsoft Corporation • National Coalition for Cancer Survivorship • National Committee for Quality Assurance • National Partnership for Women & Families • National Quality Forum • NaviNet • Pacific Business Group on Health • PatientsLikeMe • Prematics, Inc. • Press Ganey • PricewaterhouseCoopers LLP • RTI International • Vanderbilt Center for Better Health • Visiting Nurse Service of New York • Wal-Mart Stores, Inc.

This item was posted by Nextgov Editor at Large Bob Brewin.

The Veterans Affairs Department has added its Richard L. Roudebush Medical Center in Indianapolis to a list to test medical data exchange through the Nationwide Health Information Network in partnership with the Indiana Health Information Exchange, the largest health information exchange organization in the United States.

VA already is testing NHIN for data exchange with private health care providers in San Diego and the Tidewater area of Virginia. The department has invited veterans in the Indianapolis area to sign up for the pilot.

VA said veterans who participate in the pilot will not have their medical information shared without their authorization. Participants will be asked to allow their public and private sector health care providers and doctors to share -- safely, securely and privately -- specific health information electronically.

VA Secretary Eric Shinseki described the pilot, which will run through 2012, as another step in the development of a Virtual Lifetime Electronic Record for veterans.

The following item was posted by Nextgov Editor at Large Bob Brewin.

We've all heard of electronic whiteboards used to add a little punch to usually boring presentations, but how about "electronic bed boards" to track the status of hospital beds?

I stumbled into the world of electronic hospital bed tracking last week when I ran across a contract notice from the Veterans Affairs Department's Jesse Brown hospital in Chicago to lease software from an outfit called Tele-Tracking Technologies Inc. in Pittsburgh.

Tele-Tracking, according to its website, has developed some truly nifty bed tracking software, all bundled into its Bed Manager Suite, which includes real-time bed tracking so "idle, dirty beds are a thing of the past."

That's not all: "Upon patient discharge, a quick and easy interactive voice response telephone request automatically pages an environmental services staff member to begin the cleaning process."

If Tele-Tracking ever decided to come up with a retail version, this could be a handy item for families with children who never make their beds.

Standards that facilitate the sharing of electronic medical records between health care providers still aren't perfect, according to members of the federal advisory Health IT Standards Committee.

Government Health IT reports that while the new certification and standards final rule from the Office of the National Coordinator for Health IT do allow some additional flexibility for how patient information is entered and used, the guidelines may not be specific enough.

For example, the Veterans Affairs and Defense departments use C32, a standard format recommended by the ONC. C32 includes information about a patient's medical status but can be tailored based on an organization's needs. That flexibility may work for sharing data on some levels but not on others, the article states, which has left the agencies unable to pass records back and forth.

With the first stage of meaningful use, "we pushed the ball a little further down field. But I don't think we have sufficient specificity to guarantee interoperability," [said Dr. Doug Fridsma, acting director of ONC's standards and interoperability office]. At the same time, too much specificity can preclude innovation. "We're still trying to get this right," he said.

A pilot project underway in California is testing the use of wireless technologies to treat veterans with mental health issues.

The Veterans Transition to Community project leverages patients' cell phones and PDAs to collect their mental health data and increase their contact with health care providers, said Lincoln Smith, the president and CEO of the Altarum Institute. Smith testified before the House Veterans Affairs Committee on Thursday.

The nonprofit health systems consultancy developed the protocol to treat veterans suffering from post-traumatic stress disorder, substance use disorders, major depressive disorders and mild traumatic brain injury. Several times a day, over a period of months, the system prompts veterans under care to answer questions designed to document emotional states such as stress, rejection, fear, craving, pain and coping. By amassing a rich data set, Altarum hopes to improve assessment of behavioral health disorders and improve treatment options.

"Reminders, supportive messages, pictures of pleasurable memories, inspirational music, and an interactive pain-scale support the service members and veterans to avert crises that may affect them in their transition from the therapeutic environment to work and community life," Smith told lawmakers. "In a time of increasingly tight budget, the incremental cost of maintaining a service member in this program is negligible."

Altarum has tested the system at a residential veterans treatment center in Napa Valley. Combining data collected from multiple patients will afford a means to assess treatment options and outcomes of cohorts defined by theater of conflict, service, gender, age and other factors.

Up to 20 percent of soldiers serving in Iraq and Afghanistan have been in proximity to explosions that resulted in positive screenings for mild traumatic brain injury, which is associated with a 90 percent increase in the occurrence of post-traumatic stress disorder, reports Altarum.

I'm reminded of what the late, great George Carlin had to say on the subject way back in the 1980s, long before cell phones and the war in Afghanistan, which this month became the longest in our nation's history:

There's a condition in combat. Most people know about it. It's when a fighting person's nervous system has been stressed to its absolute peak and maximum. Can't take anymore input. The nervous system has either snapped or is about to snap. In the first world war, that condition was called shell shock. Simple, honest, direct language. Two syllables, shell shock. Almost sounds like the guns themselves. That was seventy years ago. Then a whole generation went by and the second world war came along and the very same combat condition was called battle fatigue. Four syllables now. Takes a little longer to say. Doesn't seem to hurt as much. Fatigue is a nicer word than shock. Shell shock! Battle fatigue. Then we had the war in Korea, 1950. Madison Avenue was riding high by that time, and the very same combat condition was called operational exhaustion. Hey, we're up to eight syllables now! And the humanity has been squeezed completely out of the phrase. It's totally sterile now. Operational exhaustion. Sounds like something that might happen to your car. Then of course, came the war in Vietnam, which has only been over for about sixteen or seventeen years, and thanks to the lies and deceits surrounding that war, I guess it's no surprise that the very same condition was called post-traumatic stress disorder. Still eight syllables, but we've added a hyphen! And the pain is completely buried under jargon. Post-traumatic stress disorder. I'll bet you if we'd of still been calling it shell shock, some of those Viet Nam veterans might have gotten the attention they needed at the time. I'll betcha. I'll betcha.

Today, veterans receiving some type of treatment from the Veterans Affairs Department attempt 950 suicide each month, according to Army Times. Suicide is a bigger risk factor for death than is suicide bombers. Thank god we now have an app for that.

I wonder what George would say?