update patient information in both systems simultaneously (Brewin, 2007). Single entry into and simultaneous access to both systems would not only be more efficient, it would promote continuity and coordination of care and help reduce errors that might affect patient safety.
The departments agreed with the need for interoperable EHR systems when the Lovell FHCC was launched in 2010. Development of interoperability solutions—beginning with the identification of system requirements to meet the needs of the clinicians and the identification of sources of funding for development—began in earnest in late 2007. A proposal for JIF funds was developed for $11 million for support for 2–2.5 years of a joint local program management office and a joint enterprise-level (i.e., national-level) office for systems development (Hassan et al., 2008). The proposal, which was funded, was justified in part on the basis that the interoperability solutions—although expensive to develop—could be used by all VA/DoD joint health care ventures (VA/DoD, 2009, p. 46) and could potentially be exported to all other VA and DoD facilities to provide a seamless medical record from active duty to veteran status. The $11 million was for developing the requirements, not the solutions. Funding for the latter was estimated to be $100 million over 3 years.
A tiger team was dispatched several times to North Chicago to identify the technical requirements for critical interoperability solutions—including a single sign-on solution that would allow providers to log in once to see clinical data from both AHLTA and VistA (including the medical readiness status of active duty servicemembers).
When the JIF funds became available, contracts were awarded to complete the specifications for solutions that would meet the Lovell FHCC’s baseline functional requirements when it started up in 2010. The CTG had come up with various lists of critical functional requirements. Certain items were common to those lists: