Dr. Ross Fletcher, chief of staff of the Veterans Affairs Medical Center in Washington, D.C., asked a recent patient, a war veteran, how many times he had been exposed to the blast of an improvised explosive device.
Answer: about 11.
“This particular one,” Fletcher said, “had ruptured his tympanic membrane and also caused — not severe but some — traumatic brain injury.”
To review the veteran’s medical history, Fletcher didn’t need to consult a bulky file of paper documents. On his computer screen was the VA’s medical record system and the display for this patient showed a small blue flag in the upper right corner with the words “remote data available.”
With a click, Fletcher called up an extensive list of reports. The links on allergies and pharmaceutical history, including drugs dispensed recently at nearby Walter Reed Army Medical Center, had been delivered to VA as “computable data.” That meant Fletcher would be warned by the system if he prescribed a drug that would put the patient at risk.
Other information viewable by Fletcher included military discharge summaries, procedures performed, outpatient encounters, patient vital signs, lab test results, notes on medical problems, family history, social history and even clinical data that had been gathered in the war theater.
It was all the essential health care information a clinician would need. For this patient, Fletcher read outpatient notes from the field hospital in Afghanistan after the patient’s most recent IED attack. It said he was taken to an operating room where shrapnel was removed from the right side of his scalp.
“I can see exactly what the doctor saw when he first saw this patient, which is really quite beneficial,” said Fletcher.
Two decades after the bugle first sounded, a revolution is well underway in the sharing of electronic health records between the departments of Defense and Veterans Affairs. Their progress also is serving as the cutting edge of a nationwide effort to make electronic health records transferable between any hospital, clinic or caregiver across the country.
Accelerants to some stunning recent gains have been: mounting casualties of war from Iraq and Afghanistan; the scandal of bureaucratic neglect found at Walter Reed in 2007, and vigorous prodding by Congress.
The National Defense Authorization Act of 2008, for example, directs Defense and VA to have their electronic personal health information systems “fully interoperable” by Sept. 30. Lois Kellett, acting director of the office, said the congressional deadline will be met, in part because lawmakers left it to a committee of Defense and VA clinicians to define “fully interoperable.”
Kellett and Dr. Fletcher were among a half-dozen senior health care officials at a Nov. 24 Pentagon press briefing to discuss progress between the two departments in the sharing of electronic patient health information.
Defense-VA information sharing takes several forms. For several years, for example, there has been a monthly transfer of historical electronic health information from Defense to VA on all separating service members. This health data now covers 4.5 million former military patients and is accessible for reading by VA providers when one of them seeks VA medical care.
A more sophisticated system for sharing real-time electronic information is available when service members or severely wounded veterans need care from both Defense and VA. For them an information exchange program sends text data between any Defense and VA sites.
For severely wounded warriors transferred from one of three military medical centers to one of four VA polytrauma centers, a new capability exists to send electronically their radiology images such as X-rays and MRIs.
A study completed in September this year, by the consulting firm Booz Allen Hamilton recommended that VA and Defense continue to operate separate systems but to make them more compatible. That can involve such things as standardizing codes and abbreviations.
“We’re already interoperable,” Kellett said. “But some of it requires some translation or mediation, to go back and forth, so each side clearly understands.”
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