Complete Development of a Jointly Usable Electronic Health Record System Before Establishing Additional Federal Health Care Centers
The IM/IT goal for the Lovell FHCC is to “safely interface VA and DoD legacy systems to support an integrated DoD/VA facility with multiple care locations” (Filippi, 2011). The Lovell FHCC expected the software capabilities that its clinicians and other subject matter experts had identified in early 2009 as the minimum needed for integrated use of the VA and the DoD EHR systems to be in place when the FHCC opened on October 1, 2010, but they were significantly delayed. These included single registration and single sign-on (implemented in December 2010), orders portability for radiology (implemented in June 2010), and orders portability for laboratory (implemented in March 2011). Two capabilities are still not ready for implementation, namely, orders portability for pharmacy and for consults, and are not expected to be ready for several years.
The lack of EHR interoperability, despite the development of workarounds (such as hiring five pharmacists to manually check both EHR systems for possible drug allergies and interactions), significantly reduced the efficiency of health care delivery for at least the first year of Lovell FHCC operations. The lack of single-entry access to both EHR systems has hindered the ability of the Lovell FHCC to deliver higher-quality or more efficient, cost-effective health care and to provide better research opportunities. The ability to seamlessly deliver electronic health information from the veteran, military beneficiary, and health care provider perspectives should be the hallmark of an FHCC.
RECOMMENDATION 2. Additional federal health care centers should not be implemented until an interoperable or joint Department of Defense/Department of Veterans Affairs electronic health record system becomes available.
The DoD and VA secretaries have committed their departments to developing such a system together—a new joint EHR system (the iEHR)—rather than upgrading their current (now legacy) EHR systems and trying to develop interoperability solutions. The iEHR will be developed in phases with some modules, such as pharmacy, scheduled to be completed in 2014; the final modules are due for completion in 2017. It would be helpful for the iEHR to have the capabilities identified by the FHCC clinical task group