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Introduction

Mr. Chairman and members of this distinguished committee, thank you for the opportunity to be here today to discuss the progress being made by the Department of Defense (DoD) and the Department of Veterans Affairs (VA) with the sharing of medical information and development of interoperable electronic medical records.

Today, we have more then 253 thousand service men and women deployed in support of our nation’s defenses, including those in Afghanistan and Iraq. DoD is firmly committed to providing the best health care services for our operating forces. In the past year, more than 180 thousand men and women have left military service, and the vast majority are eligible for VA care. I want to assure you that as the Military Health System, Chief Information Officer, my highest priority is to maintain the health of our military members with a continuum of medical care protecting each service member from entrance into the military to separation from the military and the transition to the VA health care system. Over 700,000 individuals receive care from both DoD and VA annually, thus the ability to transfer electronic health information is a significant factor for improving the continuity of care for those who have served our country.

As you know, DoD and VA have joined forces to provide our nation’s military and veterans with improved health care services. Over the past year, many initiatives between the two Departments have launched a new era of DoD/VA collaboration, with unprecedented strides toward a new federal partnership that promises to transcend business as usual, and is already seen as a model for inter-agency cooperation across the federal government.

We are pleased to report that we have approved a VA/DoD Joint Strategic Plan to guide our relationship over the coming years. We believe that this plan not only institutionalizes our current collaborative efforts but also identifies joint objectives, strategies, and best practices for future collaboration. Through our VA/DoD Joint Executive Council, we will ensure leadership oversight is given to all of these initiatives as we continue to develop our strategic partnership. The ability to transfer and share electronic health information is a major area of focus in this joint strategic plan. In fact, many of the recommendations of the President’s Task Force to Improve Health Care Delivery For Our Nation’s Veterans are reflected in the VA/DoD Joint Strategic Plan and also in the initiatives underway between the Departments.

Seamless Exchange of Electronic Health Care Data

There are a number of current initiatives addressing clinical data interoperability and data exchange that will benefit Service members as they transition to veteran status. The Federal Health Information Exchange (FHIE) supports the transfer of electronic health information from DoD to VA at the point of a Service member’s separation. As an exemplary model of collaboration between DoD and VA, it markedly enhances the continuity of care to our nation’s veterans. VA providers nation-wide, at over 200 VA medical facilities, have access to this data on Service members. This initiative leverages existing agency information systems to facilitate the electronic transfer of patient information from DoD to VA. To date, DoD has transmitted electronic medical information to the VA on more than 1.7 million retired or discharged Service members. This number is consistently growing as health information on recently separated and retired Service members is packaged and transferred to the VA.

The information currently available to VA providers includes demographic data, laboratory results, outpatient military treatment facility pharmacy data, radiology results, allergy information, discharge summaries, consult reports, and admission, discharge and transfer information. All information is sent using secure messaging to protect this information during the transfer process.

Future enhancements will include additional pharmacy information, and key elements of the standard ambulatory data record, such as the diagnosis codes, primary care manager, treatment provider, and other pertinent data. The FHIE initiative is planned and executed as required under the Health Insurance Portability and Accountability Act, the Privacy Act of 1974, and other privacy regulations that protect the sensitive health care information of our beneficiaries.

FHIE is also being used by authorized Veterans Benefits Administration personnel. The FHIE Compensation and Pension Record Interchange allows selected Veterans Benefits Administration personnel to access DoD clinical data resident in the FHIE repository in support of disability claims processing. This enables them to begin adjudication of disability claims.

Finally, in support of these efforts, DoD and VA have successfully conducted joint acquisitions, are sharing contract vehicles, coordinating FHIE funding, and have developed a process to efficiently apply funds to joint contracts. Our success in FHIE has been made possible by a strong spirit of teamwork and cooperation from our contractor team members such as Northrop-Grumman Information Technology and Science Applications International Corporation.

The Departments continue to build on the successful implementation of the Federal Health Information Exchange. To provide a more robust capability and institute a two-way exchange of information, the Departments are working on interoperability between DoD’s Clinical Data Repository (CDR) and VA’s Health Data Repository (HDR). This initiative, which will be functional in FY05, responds to the needs of DoD/VA providers and will meet the recommendation by the President’s Task Force to Improve Health Care Delivery For Our Nation’s Veterans and the VA/DoD Joint Strategic Plan objective for interoperable electronic medical records.

At the September 2002, DoD/VA Health Executive Council meeting, the Assistant Secretary of Defense (Health Affairs) and the Department of Veterans Affairs Under Secretary for Health signed an Executive Decision Memorandum defining the goals of the DoD/VA Electronic Health Records Interoperability Initiative. To manage the development of this important capability and ensure interoperability between the DoD CDR and the VA HDR, a DoD/VA working integrated product team was formed. It is led by senior health information technology managers from both Departments. The group is actively developing information exchange requirements, technical and data standards, and a technical architecture to support the exchange which includes appropriate security and data protection. The Departments are actively engaged in the design of a prototype which will support the bi-directional exchange of health information beginning with pharmacy data, allergy information, patient identification, and demographic information. Testing in a laboratory environment is scheduled to begin in 2004. Work on subsequent data elements will continue in parallel so that development is ongoing in multiple areas at any given time. The standards and processes developed in this VA – DoD initiative will be beneficial to the private sector effort to transmit medical information electronically.

One of the cornerstones of this initiative is DoD’s Clinical Data Repository (CDR) developed for the Composite Health Care System II (CHCS II), the military Electronic Health Record. DoD’s CDR is operational, supporting 20 thousand patient visits per week, and contains enrollment eligibility records for all DoD beneficiaries and clinical data records for 447 thousand individual patients. CHCS II is an enterprise-wide medical and dental clinical information system that maintains and provides secure online access to comprehensive longitudinal health records. Worldwide deployment of CHCS II will begin in January 2004.

The DoD and VA have selected eight medical demonstration sites that will test the capabilities of the two departments to provide a seamless delivery of benefits and services to military members and veterans by sharing information and other efficiencies. Mandated by the FY03 National Defense Authorization Act, the demonstrations will test three separate areas: budget and financial management; staffing and assignment; and medical information technology systems. These projects will operate through FY07.

Another significant DoD/VA medical information sharing initiative is Laboratory Data Sharing and Interoperability (LDSI). This initiative facilitates the electronic transfer/sharing of laboratory order entry and results reporting among DoD, VA, and commercial reference labs. Computerized order entry and results reporting support the delivery of higher quality patient care and patient safety by eliminating much of the manual entry that was the practice in the past. Following a successful pilot test in Hawaii, this initiative is being deployed to other DoD and selected joint venture sites during FY04.

Underpinning many of the initiatives that support sharing and interoperability is DoD/VA work in the area of health care standards. DoD and VA are actively engaged in the study and adoption of common information standards in the areas of technical, information, data, security, and communications standards. The Departments participate in multiple standards boards, and collaborate and share expertise.

In addition, DoD and VA continue to be leaders in the health care standards arena through their roles as lead partners in the Consolidated Health Informatics project, one of the 24 eGov initiatives in support of the President’s Management Initiative, and participation in many of the nation’s standards development organizations.

The goal of the Consolidated Health Informatics initiative is to establish federal health information interoperability standards as the basis for electronic health data transfer in federal health activities and projects throughout the federal government. The new standards will help improve the quality of care by ensuring federal entities use common standards that will make it easier to exchange needed information. In March 2003, the Department of Health and Human Services (HHS) announced the first set of standards to be adopted. They include standards in the areas of clinical laboratory results, health messaging, prescription drug codes, digital imaging, and connectivity of medical devices to computers. Work in many more areas, such as demographics, immunizations, and interventions/procedures is underway. The Departments also provided key support to HHS in the recent purchase of a U.S. wide license for the use of the Systematized Nomenclature of Medicine (SNOMED) clinical terminology.

The initiatives highlighted today directly support sharing of medical information and development of a seamless electronic medical record and are administered in compliance with all applicable privacy safeguards. To ensure that these, and other DoD/VA initiatives, continue to progress, the VA/DoD Joint Executive Council receives quarterly updates. In addition, DoD and VA share information on a quarterly basis with the Office of Management and Budget on the status of DoD/VA Joint Electronic Health Care Records Plan.

Closing

Mr. Chairman, the Department of Defense and Department of Veterans Affairs have joined forces to improve the sharing of medical information and continue to make progress on development of interoperable electronic medical records. This past year has seen DoD and VA continuing to make solid progress in the secure sharing of medical information and the development of interoperable electronic medical records. Our shared commitment to strong DoD/VA collaboration and the bi-directional exchange of appropriate electronic health information will ensure significant progress is achieved in the future. This collaboration allows us to be in the forefront of inter-agency cooperation and health data exchange across the federal government.

The VA/DoD Joint Strategic Plan will serve to guide us in the future. In addition, through the VA/DoD Joint Executive Council, senior leadership will continue to provide the necessary oversight to all of these initiatives.

Thank you for the opportunity to testify before your Committee on this important issue.