Book Description

Electronic health records (EHRs) play an important role in optimizing the health care provided to active duty servicemembers and veterans. When a servicemember leaves military service by way of discharge, separation, or retirement he or she may become eligible for VA benefits and services including VA health care. Transitioning their health care information from one large health care system (Department of Defense; DOD) to the other (Department of Veterans Affairs; VA) involves coordination of data and information between DOD and VA. Longstanding concern that this exchange be effective has been expressed in many quarters, including Congress. The DOD and the VA have been working to exchange patient health information since 1998. To date, both Departments' initiatives include (1) the Federal Health Information Exchange (FHIE), which enables the one-way transfer of servicemembers' electronic health information from DOD to VA for all separated servicemembers; (2) the Bidirectional Health Information Exchange (BHIE), which allows health care providers from both Departments viewable access to records of shared patients; (3) the Clinical Data Repository/Veterans Affairs Health Data Repository (CHDR),which enables the DOD and VA to exchange computable outpatient pharmacy and drug allergy information for shared patients; and (4) the Laboratory Data Sharing Interphase (LDSI), which allows DOD and VA facilities to share laboratory information. Congressional committees with oversight over veterans matters have devoted attention to health information sharing between the DOD and VA. In 2008, they included relevant provisions in the National Defense Authorization Act for FY2008 (P.L. 110-181). The law mandated DOD and VA to jointly develop and implement electronic health record systems or capabilities to allow for full interoperability of personal health care information, and to accelerate the exchange of health care information between DOD and VA by September 2009. To this end, the law also established an interagency program office (IPO) to act as a single point of accountability. In December 2010, the Deputy Secretaries of DOD and VA directed the development of an integrated Electronic Health Record (iEHR), which would provide both Departments an opportunity to reduce costs and improve interoperability and connectivity. On March 17, 2011, the Secretaries of DOD and VA reached an agreement to work cooperatively on the development of a common electronic health record and to transition to the new iEHR by 2017. On February 5, 2013, the Secretary of Defense and the Secretary of Veterans Affairs announced that instead of building a single integrated electronic health record (iEHR), both DOD and VA will concentrate on integrating VA and DOD health data by focusing on interoperability and using existing technological solutions. This announcement was a departure from the previous commitments that both Departments had made to design and build a new single iEHR, rather than upgrading their current electronic health records and trying to develop interoperability solutions.