VA, DoD moving toward SOA as iEHR takes shape

Posted on: October 24, 2011

The Scan Man sees the move towards standards that will be immediately utilized in a significant manner as a big leap forward for integrated health records.  There are many issues yet to be solved, however their is no way to deny that these integrated health records will improve patient outcomes.  From the pages of Goverment Health IT:

Military badgesALEXANDRIA, VA – The Defense and Veterans Affairs Departments are much more alike in the healthcare services they deliver than they are different. That is critical as they build the components of their integrated electronic health record (iEHR), which will be based on common services applications instead of a large proprietary technology system, said Mark Goodge, chief technology officer of the Military Health System.

“We’ve done the mapping of what the VA and DOD do, and we’re so much alike, about 98 percent alike. There are some things that are different, like theater [battle operations] for us and long-term beneficiary care that VA does,” he said atan Oct. 12 conference sponsored by Defense Strategies Institute.

[Reader poll: Control an issue for open source piece of joint DoD/VA EHR.]

VA and DOD will shift their clinical systems to a modern architecture of standards, applications, databases and middleware based on common services and a Web-based interface, which will be able to operate with the legacy as well as the new iEHR capabilities as they become available. Both departments will contribute services to the platform and use each other’s services.

“We’re getting more common about what common is, defining terms and working internally within our agencies and with our partners,” Goodge said. For example, mapping and defining the services used to adopt the Health Level 7 standard can enable the quick exchange of information about a patient’s allergies and other summary data.

The Military Health System is moving toward service-oriented architecture (SOA) and away from siloed systems as plans take shape for the iEHR, he said. A lot needs to be put in place or streamlined. “We have a big portfolio with a lot of services and some are duplicates,” he said.

An important piece of the iEHR architecture will be a common services broker, which provides the interconnections among various applications and services and enables internal and external systems to exchange information, said Peter Levin, VA chief technology officer.

[Q&A: Between the lines of NEJM’s EHR report, ‘trust trumps tech’.]

Those services will be able to be unplugged and replaced when better ones become available over time. The common services broker is made up of an enterprise services bus and associated standards.

“The common services broker is like a socket and the enterprise services bus is the power line,” he said.

The shared graphical user interface (GUI), which has been in testing since July, will unify what clinicians see even as the iEHR’s functions and systems change.

One of the functions VA is considering developing is automated medication reconciliation with the pharmacy data from both departments’ systems, Levin said. The GUI as designed presents consolidated data, but clinicians need more information about medications that the patient has been prescribed to avoid adverse reactions or allergies.

VA has also established an open source agent and community to accept code contributions and foster innovation. Among its activities, OSEHRA will serve as a certifying agent of applications that innovators may want to sell or give to the code base. DOD is part of the community.

[Related: Building a mammoth federal EHR, tech is the easy part.]

VA and DOD are also collaborating on how to identify patients, which will be a common service of the iEHR, said Janine Groth, director of the Defense Enrollment Eligibility Reporting System in the Defense Manpower Data Center.

Currently, the DOD’s and VA’s EHRs use several identity management processes. “Where we’re going is unified patient identity management capability between the DOD and VA, incrementally,” she said.

VA has agreed to use DOD’s Electronic Data Interchange Personal Identifier (EDIPI), which is assigned to individuals upon entrance to military service, for its health and benefits records and VA ID cards. DOD has started using the EDIPI to replace the Social Security number in its ID cards and technologies, Groth said.