Whether it is a solo medical practice, rural hospital, or massive health system, sharing medical data securely between the complicated web of electronic health records (EHRs) is an ongoing challenge that both big and small healthcare providers face. As one of the largest health care delivery systems in America, interoperability is not a new concept at the Department of Veterans Affairs (VA). In fact, in VA facilities enterprise-wide, our Veterans are benefiting from healthcare interoperability that is happening on a massive scale not only within the agency, but also with Department of Defense (DoD) facilities around the globe. Clinical data exchange between VA and DoD has been ongoing in some form or another since the early 2000s, but a major overhaul in 2016 replaced legacy data sharing services with a state-of-the-art, HL7 FHIR-based system which makes DoD clinical data from around the world easily accessible to VA clinicians in their existing desktop applications
What VA is Doing Right
Standards. Over the past two years, VA has brought progress in the form of standards adoption. Simple standards with fine-grained capabilities such as FHIR (Fast Healthcare Interoperability Resources) can be used for stand-alone data exchange as well as in partnership with existing standards that are already widely used throughout VA and DoD. Since the VA’s FHIR data service architecture was deployed in late 2016, it has enabled thousands of unique users to make millions of queries for DoD clinical data at hundreds of VA locations resulting in improved patient care. Leveraging the latest FHIR standards has also resulted in a significant performance improvement, making data available 60% faster than legacy systems. By becoming an early adopter of the FHIR standard, VA has aligned today’s interoperability needs with the modernization plan of the future. 
Use of COTS Products. In the past year, VA has shifted their approach to software development from custom software products and development in favor of commercial-off-the-shelf (COTS) products. The most recent example of this shift is VA’s decision to invest in InterSystems’ HealthShare as the healthcare informatics platform for integrated delivery networks and regional and national health information exchanges (HIE). This investment in HealthShare has some marked advantages that will translate into cost benefits. By going with a COTS product rather than a custom-built solution, VA is effectively reducing maintenance costs such as keeping up with evolving standards and changes, as well as typical software sustainment such as security patches and upgrades by diffusing that cost across all the vendor’s customers.
How to Expand on Existing Success
Consolidation of Data Centers. VA maintains hundreds of large data centers all over the United States as well as the legacy systems that are still partially in use today. According to VA’s own review in 2017, the data centers can be “inefficient, costly, and non-compliant with the Office of Management and Budget’s (OMB) Data Center Optimization Initiative (DCOI) memorandum or the Federal Information Technology Acquisition Reform Act (FITARA)”. VA has already closed 24 of 376 data centers nationwide in 2017, and they are on track to close 68 more in 2018. By following this course of action, VA can optimize existing facilities, improve their security posture, achieve cost savings, and continue the transition to more efficient infrastructure.
Strategic Planning. VA lists modernizing systems to provide better capabilities to Veterans and employees as one of their top priorities for 2018. The challenge of modernizing legacy systems will require smart decisions and strategic planning to set VA up to optimize IT functions and implement a sturdy yet scalable infrastructure. Some of the ways that modernization of VA systems going forward can become a reality are using the latest testing methods to improve deployment, eliminating inefficient legacy systems, using cloud-based analytics through VA’s delivery networks, employing agile integration of technology, improving VA facilities with the latest technology, and leveraging commercial capabilities wherever possible.
VA’s interoperability landscape is changing quickly and true interoperability is no longer just about a longitudinal EHR between proprietary systems at VA and DoD. The comprehensive VA healthcare record of the future will need to seamlessly incorporate clinical data from legacy VistA, DoD-Legacy, MHS Genesis (Cerner), commercial EHRs used by Community Care partners (Cerner, Epic, etc.), COTS products (such as InterSystems’ HealthShare), and wearable devices. Supporting Veterans with the best possible healthcare requires VA to place patients at the center of the healthcare experience and break down the barriers to true interoperability. Having implemented the latest in modern HIE standards, VA is positioned to maximize their return on investment by utilizing the VA’s FHIR data service architecture to incorporate data from the myriad of systems that will comprise the HIE landscape of the future. Leveraging technology that is demonstrable today, we can connect teams of clinicians from multiple agencies and the private sector to enable more informed clinical decision making and better healthcare outcomes.
For more information on interoperability and modernization at VA, checkout our webinar from the HIMSS 2018 Conference here.