The Nationwide Health Information Network (NHIN) and Virtual Lifetime Electronic Record (VLER) and Why They Are Important to the Department of Defense (DOD)

http://www.health.mil/MHSBlog/Article.aspx?ID=764

LCDR Steve Steffensen, MC, USN, Chief Medical Information Officer for the U.S. Army Telemedicine and Advanced Technology Research Center, Fort Detrick, MD, and the Military Health System’s Coordinator for the Nationwide Health Information Network (NHIN) and Virtual Lifetime Electronic Record (VLER), discusses both projects.

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

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).