Military Health System must balance old, new health IT

Friday - 4/6/2012, 12:54am EDT

Karen Guice, acting CIO, Military Health System

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This show was rebroadcast on June 14, 2012.

The Military Health System is knee-deep in working with the Veterans Affairs Department to develop an integrated health records system. But the Defense Department agency also must keep its legacy systems running in the meantime.

That balancing act, said Karen Guice, the principal deputy assistant secretary of Defense for Health Affairs and acting MHS chief information officer, is one key factor to their long-term success.

"What we are trying to pull off here is an iterative way of adding the new components or capabilities of an electronic health record, and then graying out that similar capability in our existing system," Guice said. "We are working on how to do that. How would you execute that?"

She said the goal is to make it seamless for the providers as possible so they get the benefits of the new systems without any consequences about keeping the legacy in the background for a time until it's safe to turn off the legacy system.

"We've had a series of transition planning events at DoD to really understand the implications of the new framework," she said. "With the new systems-oriented architecture, it changes the architecture of all of our platforms. It's not just about the legacy system and moving it to the new IEHR, but it's about all the systems we support and how they fit in to the new framework."

She said some systems will easily be put into the new framework because they were built with SOA in mind. But others will take more work to figure out how to move it and maintain the consistency to the provider.

Guice is getting some help in figuring all of this change management out. Along with VA, DoD named Barclay Butler to lead the Interagency Program Office (IPO).

Congress created the IPO to better integrate the DoD-VA effort.

"The IPO is working on the new stuff, the new integrated health record," Guice said. "The path that has been selected is a systems-oriented architecture so having that plug-in-play capability in the SOA suite format is the end game we would like to move to. What that means is our individual capabilities have become more like applications you can use in an integrated manner."

She said over the long-term using SOA means if you change something in one application it doesn't affect the entire suite of capabilities.

Guice said DoD and VA are making progress on building the integrated health record. She said the contract problems for the enterprise service bus (ESB) only set back the development by about four weeks.

VA awarded a $100 million contract, which was called the "heart" of the system, to ASM Research, but had to cancel it when one of its subcontractors came under investigation for conflict of interest violations. The agency then awarded the contract to Harris Corp. a few weeks later.

Guice said the affect on the system was minimized.

"The ESB is the software that makes all of this work in a coordinated way," she said. "The other significant piece of it is the data layer and having common data elements and having things mean the same thing. With DoD and VA, it's making sure the data elements they have match with the data elements we have."

DoD and VA are working on a common data taxonomy.

"It's a critical foundational element," Guice said. "We use a health data dictionary and VA is doing a match to that data dictionary to make sure we have consistency across and figuring out where we have gaps and how to close the gaps."

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