VA, DoD climb the stairs to interoperability together

Thursday - 11/14/2013, 5:08pm EST

Dr. Theresa Cullen, chief medical informatics officer, Veterans Health Administration

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Leaders in the healthcare community are thinking of ways they can use data to improve the quality of health care. The departments of Veterans Affairs and Defense have joined forces to create VistA Evolution, a system that allows the exchange of electronic health records information between the two.

Dr. Theresa Cullen, chief medical informatics officer at the Veterans Health Administration and the head of this initiative, discussed the next steps in this process in an interview with Federal News Radio's Emily Kopp at AFCEA Bethesda's sixth annual Health IT Day.

"We have to have data standards that are consistent and integrated into the system," said Cullen, who until recently was the acting deputy director of the DoD/VA Interagency Program Office. "We have to have messaging standards that enable us to go send data back and forth."

She described that process as a stair step.

"Most public and private partners are starting up the stairs," she said. "We're pretty early in this. I always say to people ... it's really hard work. It's not very sexy. It's really hard work to figure out does this data set, this data name, mean the same as it does over here."

Making matters more difficult is the fact that the entire U.S. healthcare arena is switching over to the 10th version of the International Classification of Disease (ICD-10), which most of the world is already using.

"That's about nomenclature and standards applied to what we have traditionally known as diseases," Cullen said, adding that ICD-10 gives medical professionals more granularity when it comes to classifying diseases. "If you had one word to name 'heart attack,' you may now have 50 words, because now it's a heart attack with cough, or a heart attack with congestive heart failure or a heart attack with chronic kidney disease. So, you now know a lot more about what's wrong with this patient because you have more granular and specific data."

The standard to date has been ICD-9, which is what the U.S. health care industry has been coding in. Another classification system, SHOWMED-CT, is even more granular and that's where Cullen says the healthcare profession should be heading.

"We have lots of competing priorities and a need to converge," she said. "The beauty of what the DoD and VA is doing, in my opinion, is that we are at the sharp end of the stick. We are out there trying to make this work. We have separate domains right now that we're sharing information in. They're the typical domains — medications, allergies, vital signs, — things that you think are critical to the healthcare delivery space. If we figure it out and we figure out how to do that well, efficient, effective, consume that data and integrate, it benefits the entire health IT space. Its benefit is far beyond just the federal community."

Cullen said VHA is committed to interoperabiity. "We're committed to sharing our records with DoD, working closely with DoD in the interoperability program office (IPO) space still, around interoperatiliby, around data, around data sharing, figuring out health for both of us," she said. "We will consume data from external partners."

A lot of the work VHA is doing recognizes a continuum of care that is critical for VA's patients.

"We're going to improve our usability, which means for the end user of this system," she said. "Our end users aren't just clinical. They're patients because they use Blue Button, they use our personal health record, and they're using our mobile apps. Caretakers of traumatically injured patients have an application on an iPad now to take care of that person. So, our usability is really about anything that somebody else touches. It's not code in the back. It's what I see when I'm there."

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