A Healthy Exchange
A Healthy Exchange More ambitious was the project to permit the electronic exchange of medical records.The VHA wanted to share everything from laboratory results to prescription information to radiology reports. "Essentially whatever was there to share," says acting deputy CIO Kolodner. By August 2000, with $27.8 million spent, the GAO found the project wasnt anywhere near completion. The projects scope was overwhelming. "What we were trying to do was huge," Kolodner says. Trying to coordinate and respond to the interests of the VA, DoD and Indian Health Services was a tall order. For instance, Kolodner says, each of the agencies had its own business cycles. The VA works its business plans year-by-year, he says, while the DoD works in five-year plans. In addition, the DoD was trying to create a new system for keeping its own medical records, even as it worked on the GCPR project to exchange records with its existing system. Just like VetsNet, managers of the GCPR initiative failed to adhere to elementary practices. Among the projects deficiencies, according to the GAO: a lack of clear goals; inadequate plans for swapping the data, which each organization kept in different formats; and dubious definitions of how the electronic transfers would take place. The agencies, for instance, had to figure out how to identify a patient. The DoD used Social Security numbers to keep track of patients. The Indian Health Service used a system that generated unique IDs for each of its patients. Faced with such conflicts, the projects managers began to think of folding the project. "That was a concern," Kolodner says. The idea of doing less gradually become more acceptable. The DoD had worked out a system using an emerging healthcare-industry messaging standard called Health Level 7 that would allow it to send medical records to parties that request them. So, in April 2001, DoD and VA information-technology managers okayed the decision to minimize the project to a one-way transmission of data, from the DoD to the VA. The Indian Health Service withdrew from the project altogether. The scaled-down effort was named the Federal Health Information Exchange (FHIE). The DoD would transmit lab results, pharmacy records, radiology reports and other medical information to the VA, over a virtual private network. The records would be put into a repository that would store information on almost 2 million patients. Through the repository, clinicians would be able to access and display the DoD data, along with VA records. "It was a decision to say we had to getting something working—in the real world, in production—quickly," says Michael Luby, director of information technology solutions at Northrop Grumman Information Technology, a systems integrator working on both FHIE and VetsNet.
The Veterans Health Administration (VHA), a part of the VA and one of the worlds largest deliverers of medical services, led the effort. Begun in 1998, the goal of its Government Computer-based Patient Record (GCPR) initiative was to build a system allowing physicians and other healthcare workers at 750 VA, 600 DoD and 550 Indian Health Service facilities to share medical records electronically. Indian Health Service is a government agency that provides healthcare to native Americans.