of authority. The decision to adopt a single chain of command was unprecedented. The VA and the DoD had each built an ambulatory care center next to the other’s hospital in Honolulu and Albuquerque and were even sharing a “federal” hospital built for that purpose by the DoD in Las Vegas; however, in each case, the organizations operated alongside each other and billed each other for the services provided to the other’s beneficiaries. The Lovell FHCC was going to be, and still is, unique in having a single overall command structure, integrated staff, and unified budget. The intent was to create an organizational structure in which health care services could be better coordinated with patient needs, which would presumably improve the range of, the access to, and the quality of the services. The FHCC was expected to be a showplace for new software that would enable providers to enter either the DoD or the VA electronic health record (EHR), or a common interface, and see and enter information in both EHRs in real time, a capability called interoperability. It was also expected to increase efficiency—by enabling FHCC managers to match resources to needs in ways that would be impeded by having to coordinate separate bureaucracies and budgets—and to produce cost savings by eliminating duplication.

The 2005 decision to have an integrated federal health care facility also included approval for construction by the Navy of a 201,000-square-foot ambulatory care center (ACC) connected to the VA hospital building and expanded parking facilities and renovation of 45,000 square feet in the hospital building for outpatient clinics. The timeline for the completion of the ACC in 2010 gave the planners 5 years to prepare for the switch to a single organization.


The HEC formed six task groups to develop the detailed operational plans for an integrated health care center.1 Each task group was co-chaired by the VA and the DoD and included local, regional, and central office representatives of each department. They met monthly, except for the leadership task group, which met weekly and coordinated the overall effort.


1 The six were the leadership, clinical, information management/information technology, administration, human resources, and finance/budget task groups. A seventh task group, for communications, was formed later.

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