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:

  • Single patient registration in AHLTA and VistA
  • Single medical sign-on to access AHLTA and VistA
  • Single entry into either AHLTA or VistA that allows the user to
    • enter and view the results of laboratory, radiology, and pharmacy orders, and order and view consults and referrals, and have them appear in the other system while preventing duplication (i.e., orders portability)
    • read test results and progress notes originating from either system and enter or revise them once and have them appear in both systems
    • be assured that the records are for the same patient, regardless of the application, a function called “context management”


The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement