Industry Roundtable

Written by Marty Kauchak

MMT 2010 Volume: 14 Issue: 2 (March)

Briefly summarize recent successes in implementing and using electronic health care records (EHRs) throughout DoD, the VA and the nation as a whole. More important, discuss the obstacles to more effectively using EHRs in the DoD.

Nationally, large hospitals and health systems are making great progress toward implementing electronic medical records, spurred on by incentive payments created under the American Recovery and Reinvestment Act of 2009; however, smaller physician practices representing the bulk of where medical care is delivered in this country today continue to lag far behind in the rate of adoption. Barriers to the adoption of EMRs include interoperability, standards and data exchange, both within the government and between the government and private sector.

While these issues are being addressed through projects such as Virtual Lifetime Electronic Record (VLER) Communities, a broader challenge looms. The adoption of new technologies is hindered by the current lack of financial and technical resources, the disruption to clinical workflows, inadequate training and support, and difficulty managing mission-critical applications while maintaining privacy and security.

The IT industry is responding to these challenges with new delivery paradigms. Vendors are offering applications using software-as-a-service, hosted in a private, secure cloud environment, which removes the burden of significant on-site technical expertise and enhances security. It enables additional services such as health information exchange, informatics, and public health reporting centrally, providing a higher level and range of service to customers. Software-as-a-service aligns with CMS incentive payments which reward physicians for ongoing use of EMRs as opposed to subsidizing initial acquisition.

Changing needs require veteran and warrior treatment from the private sector. A solid EMR strategy supports the exchange of crucial information between Veterans Affairs, Department of Defense and the private sector for the continued delivery of health care to a most deserving population.

Dell is a pioneer in this area, and our recently announced partnership with the American Medical Association will help physicians obtain expert content, applications and unified support. We also offer a program partnering with hospitals and health systems to bring a range of applications to physicians in those communities, improving coordination of care and local support.

Huy Nguyen, M.D.
CEO
Cogon Systems Inc.
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By some estimates, more than 60 percent of health care delivered to DoD beneficiaries is provided by private sector health care providers. Those providers are unable to access information regarding a patient’s health status or care episodes in the DoD’s disaggregated electronic health/medical record systems. Similarly, patient visits to private sector health care providers which capture an enormous amount of information regarding care, health and readiness are not available to DoD health records. This is the reality of patient care in MTF communities across the country.

An innovative project facilitated by the Telemedicine and Advanced Technology Research Center (TATRC) has successfully tested the concept of exchanging protected health information between Naval Hospital Pensacola and private sector health care providers in Pensacola using DoD/ VHA Bi-Directional Health Information Exchange (BHIE) linked to Cogon Systems’ Virtual Health Network. Currently, more than 250,000 patient records from the Sacred Heart Healthcare System and 100,000 from the Baptist Health System are announced to the BHIE, and more than 40,000 patient records are cross-related and accessible by private sector/TRICARE and DoD providers. The following data set can currently be accessed transiently by military and civilian providers via Web services: C32 Patient Summary, patient demographics, diagnoses/problem list, providers, allergies, medications, laboratory results, radiology results and clinical notes. This is the reality of patient care in Pensacola today.

In moving forward, we plan on transitioning to the NHIN and to a sustainment model for health information exchange as a public utility under the auspices of Pensacola Chamber of Commerce. As we embark on health information exchange, we need to remember that the perfect is the enemy of the good. Community-wide health information exchange between civilian and military health care providers is a good place to start. And a market-based approach to cost sharing is the key to long term sustainment of VLER-like communities.

Robert Wah, M.D.
Vice President and Chief Medical Officer
North American Public Sector
CSC
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For over 18 years, I have not written a prescription on paper pads in the U.S. Military Health System (MHS). This is part of the many successes the MHS has accomplished in electronic health records. When I see my patients at Bethesda National Naval Medical Center and push “Enter” on my prescription, the system goes out and checks the Pharmacy Data Transaction Service (PDTS). Within two seconds, I receive information if there are any drug contraindications from PDTS, which contains information on over nine million patients from military pharmacies, mail order and 60,000 civilian pharmacies. This process has prevented nearly 100,000 potential harmful drug complications each year since CSC began providing PDTS for the MHS.

It is encouraging to see the MHS working to overcome obstacles and looking for new technology partners to bring its EHR system to its full potential. By moving away from traditional government contractors with static applications and rigid architectures which have prevented innovation, the MHS will be able to better leverage successes and best practices from the commercial health IT world. With partners like CSC, who has deep experience and expertise in deploying all major EHR systems and products in both the commercial and global markets, the MHS can move into the future with agility, stability and innovation. CSC’s expertise includes deploying and running the ambulatory clinic EHR for over 60 percent of the United Kingdom in over 1,100 clinics, caring for over 15 million patients with 50 million patient interactions per month. In another important area, with over 50 percent of MHS care being done in civilian practices, there is a need to connect the many health data islands. As the developer of the first U.S. nationwide health information network (NHIN) prototype and our support of three NHIN trial implementations sites, CSC transforms health care with better information for better decisions to improve the quality of patient care—saving lives and money.

Damon House
Project Manager
Catapult Technology Ltd.
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The federal government has defined electronic medical records as containing four separate components: computerized prescription orders, reporting for patient test results, computerized orders for patient tests and all physician notes.

As wireless technologies advance, EMRs and electronic health records are quickly becoming more prevalent in the halls of medicine, and the Department of Veterans Affairs (VA) is embracing this trend as well. Catapult Technology is helping the VA to update the drivers on the biomedical devices so that they are able to connect to specially designed “legacy” virtual local area networks, which will enable these devices to continue to work wirelessly and to support the VA’s drive to reduce paper for their patients.

Catapult is also working with the VA to understand and streamline the processes and procedures that form the basis of EMRs, and how they can be optimally utilized in the VA Medical Centers. The VA is currently trialing a Cisco system in Pittsburgh based on a combination of radio frequency identification (RFID) and wireless voice over Internet protocol over a wireless fidelity network. This system is designed to provide both patients and doctors updated patient information and treatment plans using mobile phones and in-room television monitors.

Unfortunately, there are several barriers to the adoption of these technologies within an organization like the VA. The average age of a VA facility is approximately 50 years, and early construction methodologies were not conducive to RF transmissions. Concrete walls with steel reinforcements preclude the wireless signals from passing throughout the facility easily, and additional antennas or access points (APs) are required to provide effective coverage and location-based services. The VA’s commitment to its patients has led to the federal government’s largest wireless deployment (in terms of square footage and number of APs). In the end, any obstacle can be overcome when striving to meet the goals of effective patient care. ♦

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