VA and Defense near agreement on single electronic health record

The Veterans Affairs and Defense departments are close to reaching an agreement to use a single electronic health record system, VA Chief Information Officer Roger Baker told lawmakers at a House Veterans Affairs Committee hearing today.

If this deal goes through, the single Defense-VA electronic health record system would be the largest in the world today, serving 15.8 million patients -- 9.6 active-duty service members, retirees and their families in the Defense system and 6.2 million veterans in the VA system.

Baker, responding to a question from Rep. Silvestre Reyes, D-Texas, said discussions on developing a single Defense-VA electronic health record have been going on this year at the highest levels in both departments and he expected an agreement within a month or two.

Veterans Affairs Secretary Eric Shinseki told lawmakers that when he first took office two years ago he and Defense Secretary Robert Gates made a handshake agreement to develop a single electronic health record for the two departments, which currently use different systems, AHLTA in Defense and the Veterans Health Information Systems and Technology Architecture, VistA, in VA.

Shinseki said he met with Gates the first week of this month and said they "renewed [our] pledge to go after a single electronic record."

Congress has pushed Defense and VA to develop a single electronic health record for more than a decade, based on the simple premise that it would ease troops' transition from active duty to veteran status and help ensure a continuum of care.

But, as Rep. David Roe, R-Tenn., pointed out at the hearing, instead of working on a single system, the two departments have spent $10 billion during the past decade developing dueling electronic health records. Roe said for Defense and VA to finally come up with a single health record this "means someone has to pick one ... [and that means there] will be a winner and a loser."

Baker did not indicate what the single record system will be, but industry insiders, who declined to be identified, predicted the winner would be VistA, with some modifications.

Shinseki told the hearing VistA has provided VA with significant savings. He said between 1997 and 2007 VA invested $4 billion in health information technology but an independent study showed during the same period this investment yielded more than $7 billion in savings. "More than 86 percent of the savings were due to the elimination of duplicated tests and reduced medical errors," Shinseki said.

Deployment of the single electronic health record system will be a daunting and years-long exercise, one industry insider said considering the scale of the VA and Defense heath care systems.

The Military Health System operates 59 hospitals and 354 health clinics around the world, served by 53,198 military personnel and 53,278 civilians. The Veterans Health Administration operates 153 hospitals, 135 nursing homes, 50 residential rehabilitation facilities and 15 clinics supported by a staff of 252,925. Most of the personnel, one industry source said, will need access to the new, single electronic health record.

Kaiser Permanente, the largest private health care provider in the country, serves 8.3 million people with 35 hospitals, 431 medical offices and a staff of 167, 00 employees. Kaiser spent $4 billion during a six-year period from 2003 to 2009 to deploy its electronic health record system that Epic Systems of Madison, Wis., developed.

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