VHA, Kaiser, DoD Health Information Exchange Using NHIN

As announced in Healthcare IT News, VHA, DOD, and Kaiser will exchange health information using the NHIN Connect solution. VHA and Kaiser will be first out of the gate, with DOD expected to join in early calendar year 2010. Initial exchange will focus on a HITSP compliant c.32 document.

http://www.healthcareitnews.com/news/va-kaiser-plan-link-electronic-medical-records

AHLTA CITRIX Roaming Sessions

AHLTA, DoD’s Electronic Health Record, has been getting some bad press lately due to user interface and performance and reliabilty issues, but instead of complaining, some saavy military CIOs, like Captain William E. Sorrells, MSC, USAF, FACHE, CPHIMS, are doing something to improve the situation now.   Volume 12, Issue 6, September 2008 of Military Medical Technology reports that 3rd Medical Group had great success in deploying a roaming session environment for several applications.  The CITRIX roaming sessions keep a single session open all day for a provider. The provider can access this session all day as he/she moves from room to room.  This simple innovation saved 2880 hours per year for the 18 providers at Elmendorf.  Many MTFs have  yet to implement this option for AHLTA.

Single Life-Long EHR for DOD and VHA?

Government Health Executive reports on 27 March 2009 that The Defense and Veterans Affairs departments have formed a working group to pursue a joint lifetime electronic heath and benefits record for service members, veterans, and their families.

http://govhealthit.com/articles/2009/03/27/joint-lifetime-health-record.aspx?s=GHIT_310309

It only makes sense for DoD and VHA to use the same electronic health record, particularly in those cases where VHA and DOD operate joint facilities, such as in Great Lakes.

It is still not clear, however, if there will be a single hosted EHR system using the same code for both DoD and VHA,  or whether the agencies will use Service Oriented Architecture to merge the best elements of the VHA VISTA and DoD AHLTA systems to create a single view and a life-long longtitudinal EHR.

Past efforts to create a Government Computerized Patient Record (GCPR) in the 90s resulted only in the establishment of the DoD/VHA Bi-Directional Health Information Exchange (BHIE), and not a single unified, computable DoD/VHA record.

See http://www.usmedicine.com/article.cfm?articleID=66&issueID=16

It seems likely that the leadership should pull the GCPR plans off the shelf?

Although oversimplified, DoD AHLTA probably has a better back-end with its use of the 3M CDR and HDD to provide for highly structured reference data to support computability and interoperability.

VHA’s VISTA may have the better front-end, but it also relies heavily on free text, which is not computable unless converted to codes using NLP.

To this end, VHA recently hired Dr. Quing Zeng from Harvard to lead VHA’s initiative in Natural Language Processing (NLP).

Where Can I Find Tips on AHLTA Usability?

AHLTA is DoD’s Electronic Health Record, which is used by 50,000 military clinicians to provide clinical encounter documentation for 9.3 million military beneficiaries.

I recently found a great AHLTA Usability web site from the Uniformed Services Family Practice Association, which aggregates a lot of information.

http://www.usafp.org/AHLTA-838-Information-FAQs.html#