Progress Remains Slow Digitizing Health Records

The Pentagon and Department of Veterans Affairs say they have made progress digitizing medical records and easing the transfer between the two groups, but not nearly fast enough, according to outside observers.

The issue is one that has attracted much attention over the years, with critics from Congress and government watchdog groups complaining that the Pentagon and VA use different databases for medical information that are not compatible and that both organizations are taking too long to digitize records.

VA leaders have fallen under intense scrutiny in recent weeks and lawmakers have called for VA Secretary Eric Shinseki's resignation following the discovery of executives manipulating waiting lists at hospitals. Shinseki has ordered a comprehensive review of all VA health care operations.

In response, Defense Secretary Chuck Hagel has also ordered a review of the Defense Department's military health care system. A spotlight will likely fall on each agency's drawn out process to digitize medical records -- a process many analysts say should have been accomplished years ago, leaving veterans at risk.

The Pentagon says its digital Health Artifact Imagery Management System, or HAIMS, provides an electronic record of a service member's treatment. Medical treatments, X-rays, hospital visits and combat injuries from theater and deployments all get uploaded into the system, said Pentagon spokeswoman Lt. Col. Catherine Wilkinson.

Since January of this year, all separating service members have been required to add their medical information into HAIMS, a system that can be accessed by a segment of the VA called the Veterans Benefits Administration, Wilkinson added.

"There is a mandate that every separating service member's records get uploaded into HAIMS. We've uploaded more than 50,000 records and approximately 5,000 have filed claims with the VA. The Veterans Benefits Administration can query HAIMS," Wilkinson said.

At the same time, there are still U.S. military medical records which need to be digitized, she added. The effort to digitize medical records for service members is an ongoing initiative that goes back many years.

"Our current system dates back more than a decade, but there are still parts that are on paper. Now, if I go to the doctor everything is digital," Wilkinson said.

Government watchdog groups such as the Government Accountability Office and members of Congress have been critical of the VA's efforts to digitize records and streamline interoperability with the Pentagon.

"Their efforts to achieve fully interoperable  electronic health record capabilities have been limited by long-standing project management and planning weaknesses, inadequate accountability and poor oversight," Valerie Melvin, director of information management and technology resource issues for the GAO, told Congress last year.

Meanwhile, a GAO report in February found that the Defense Department and VA need to improve collaboration, develop interoperability plans for electronic health records, and come up with cost-effective and timely solutions.

"The Departments of Veterans Affairs and Defense abandoned their plans to develop an integrated electronic health record (iEHR) system and are instead pursuing separate efforts to modernize or replace their existing systems in an attempt to create an interoperable electronic health record," the report states.

The report points out that the respective individual efforts by the Defense Department and the VA need to be better integrated and coordinated. The VA intends to deploy clinical capabilities of its new system at two locations by September, and DoD has set a goal of beginning deployment of its new system by September 2016, according to the report.

"The departments have yet to update their joint strategic plan to reflect the new approach or to disclose what the interoperable electronic health record will consist of, as well as how, when, and at what cost it will be achieved," the report states.

HAIMS is designed to address some of the VA-DoD compatibility issues because VA officials can access the electronic information contained in the system.

VA officials said that they are making great progress on a joint DoD-VA effort to create a single, secure electronic record called Virtual Lifetime Electronic Record, or VLER.

"VLER will enable quicker and easier access to benefits while on active duty and after separation and assist with a smoother transition from military to civilian life for veterans and their families," according to a written statement from VA spokeswoman Ndidi Mojay.

VLER catalogs prescription information on patients as well as details on allergies, past medical procedures and lab results. The VLER program, which was started in 2009, is available to service members and veterans at several locations, including Madigan Army Medical Center in Tacoma, Wash., and the Naval Medical Center at San Diego.

VLER is designed to allow caregivers, clinicians and benefits providers to view all relevant information about the veteran securely, regardless of where it was documented, in a single, secure electronic record, she added.  

The VLER effort is intended to span the lifetime of a veteran and service member, Mojay added.

"This capability will feature an electronic record that initiates at the point of accession, may contain information from birth, accompanies every service member throughout the life of their service, and continues beyond their separation until the last benefit is realized," she added.

VA officials say VLER has been unfolding over the last several years through work by CACI, an IT-focused firm that won a new $14 million VA contract to continue work on the system last year.

-- Kris Osborn can be reached at Kris.Osborn@monster.com.