Frequently Asked Questions
- What is the Federal Electronic Health Record Modernization office’s role in the electronic health record space?
- Is the federal EHR truly a single record, or just DOD and VA products running side by side?
- How is the Federal Electronic Health Record Modernization office different from the Interagency Program Office?
- What is the Federal Electronic Health Record Modernization office’s level of authority?
- Why is a single, common federal electronic health record necessary?
- Who owns the patient health data in the electronic health record?
- Are the Department of Defense, Department of Veterans Affairs and Department of Homeland Security’s U.S. Coast Guard using different electronic health records or one single, common electronic health record?
- How is the Federal Electronic Health Record Modernization office partnering with the private sector/commercial partners to advance interoperability?
- Will the Federal Electronic Health Record Modernization office collaborate with the Office of the National Coordinator for Health Information Technology and standards development organizations?
- What are the Federal Electronic Health Record Modernization office’s top priorities for the next year?
- What are some of the lessons learned to date with the federal electronic health record?
- Looking to the future, what does the Federal Electronic Health Record Modernization office see as a vision for using information technology to improve health care services?
- How can industry support the Federal Electronic Health Record Modernization office?
Joint Health Information Exchange
- What is the joint health information exchange?
- What information is shared through the joint health information exchange?
- What are the benefits of the joint health information exchange?
- How do I share my DOD or VA medical records with an outside provider?
- How has the data gained from the federal electronic health record and joint health information exchange been used to enhance health care? How did it help in 2020 during the COVID-19 crisis?
- Has COVID-19 impacted the Federal Electronic Health Record Modernization office's activities and the future of electronic health record modernization?
Lovell FHCC Overview
- What is the Captain James A. Lovell Federal Health Care Center?
- Who are Lovell FHCC’s beneficiaries?
- What’s the history behind the development of Lovell FHCC?
- What is Lovell FHCC’s reporting structure?
- How is the Lovell FHCC facility structured?
Lovell FHCC EHR Implementation
- Who is involved with the deployment of the federal EHR at Lovell FHCC?
- What is the timeline for federal EHR deployment at Lovell FHCC? Where are things now and what’s next?
- Will providers have to check two different areas for medication reconciliation?
- What is different about what the Lovell FHCC is deploying versus other DOD/VA sites?
- How will the patient portals work compared to other DOD and VA sites? Specifically, what will the experience be like for dual eligible patients?
- If the VA is pausing their deployments at VA medical facilities, why is Lovell FHCC deployment proceeding?
- Are there concerns about patient safety, given the experiences other VA medical facilities have had?
- How will deploying the federal EHR at Lovell FHCC lead the way for other health care systems?
- What are the benefits of the Lovell FHCC federal EHR implementation?
Joint Sharing Sites
- What are joint sharing sites?
- What are the benefits of DOD and VA medical sharing?
- How many joint sharing sites exist between DOD and VA?
- Why are joint sharing sites a unique challenge due to the asynchronous deployment of the federal EHR across both Departments?
- What does the federal EHR deployment process look like for joint sharing sites?
- What are the lessons learned from previous federal EHR deployments at joint sharing sites?
Chartered in December 2019, the Federal Electronic Health Record Modernization (FEHRM) office works within the federal space to implement a single, common federal electronic health record (EHR) that enhances patient care and provider effectiveness. The FEHRM unites efforts and delivers common capabilities that enable the Department of Defense (DOD), Department of Veterans Affairs (VA), Department of Homeland Security’s U.S. Coast Guard (USCG), Department of Commerce's National Oceanic and Atmospheric Administration (NOAA) and other federal agencies to deploy the federal EHR. Common capabilities refer to common solutions, tools and activities identified as needed to effectively deploy the federal EHR.
The common capabilities the FEHRM delivers in support of the federal EHR include managing the Federal Enclave; managing the joint health information exchange; leading analysis and integration of deployment activities at joint sharing sites; overseeing EHR configuration and content changes; providing software updates and solutions; tracking joint risks, issues and opportunities as well as lessons learned; maintaining an integrated master schedule; and advancing interoperability.
These capabilities are also helping drive federal solutions to support effective health care delivery within the federal space that puts patients in the center. Through the FEHRM’s contributions and solutions, federal agencies like DOD, VA and USCG can lead the deployment of the federal EHR.
The Department of Defense (DOD), Department of Veterans Affairs (VA), Department of Homeland Security’s U.S. Coast Guard (USCG) and Department of Homeland Security's National Oceanic and Atmospheric Administration (NOAA) are all implementingthe same single, common federal electronic health record (EHR). The DOD, USCG and NOAA named the EHR MHS GENESIS, while VA refers to it as the new EHR. However, the federal EHR is the same single instance of the commercial product (Oracle CernerMillennium) the Departments purchased. The Departments are not developing different custom systems.
With that, DOD and VA are given a certain amount of flexibility to configure the federal EHR differently to meet specific facilities’ needs while still maintaining interoperability between the Departments. Regardless, they are using the same instance of the federal EHR.
The Departments purchased a commercial product (Oracle Cerner Millennium) and must first maximize the solutions available within the product. Occasionally, elements of the core product require configuration changes to meet departmental or businessrequirements.
Through established governance and change control processes, DOD and VA sites can each request configuration changes (e.g., add, edit or remove user roles, workflows and other configuration items such as interfaces, forms, assessments and scales) as long as these changes do not undermine interoperability between the Departments. Approved changes are implemented within the federal EHR, and any Departments using the EHR have access to these changes.
The FEHRM focuses primarily on determining ways to converge EHR configurations tostreamline the patient and provider experience between the Departments. The goal isto ensure providers have a common user experience defined by evidence-based best practices, and patients have a consistent care experience, regardless of where they get care.
The Interagency Program Office (IPO) served as a successful coordinating body providing measurable impact on setting health data standards for the Department of Defense and Department of Veterans Affairs. It no longer exists. The Federal Electronic Health Record Modernization (FEHRM) office’s mission—to implement a single, common federal EHR to enhance patient care and provider effectiveness, wherever care is provided—is much more expansive than the IPO's mission. The FEHRM has a broader focus and more authority than the IPO had.
The Federal Electronic Health Record Modernization (FEHRM) office's Director and Deputy Director report to the Deputy Secretary of Defense and the Deputy Secretary of Veterans Affairs. The FEHRM Charter and the National Defense Authorization Act for Fiscal Year 2020 (NDAA FY2020) give the FEHRM decision-making authority within the joint space. The NDAA FY2020 specifies that the FEHRM "shall carry our decision-making authority delegated to the Office by the Secretary of Defense and the Secretary of Veterans Affair with respect to the definition, coordination, and management of functional, technical, and programmatic activities that are joint used, carried out, and shared by the Departments."
The implementation of a single, common federal electronic health record (EHR) is a massive transformation with multiple cabinet-level offices involved, and it will not succeed with a command-and-control approach. Instead, the FEHRM works through collaboration, facilitation, consensus building and the commitment of its partners to provide the best health care experience for patients and providers.
If there is an irrevocable dispute, then the FEHRM will execute its authority and act as an arbiter as needed. However, the FEHRM has created an environment, including collaborative processes, procedures and forums, to enable joint decision-making and issue resolution at the lowest possible levels.
A single, common federal electronic health record (EHR) means the Department of Defense (DOD), Department of Veterans Affairs (VA), Department of Homeland Security's U.S. Coast Guard (USCG), Department of Commerce's National Oceanic and Atmospheric Administration (NOAA) and other partners will be able to document care from the time a Service member enters the military through their care as a Veteran in one, complete patient health record. This record will be accessible to DOD, VA, USCG, NOAA and participating provider organizations and, of course, to patients themselves.
To effectively deliver health care and benefits to our beneficiaries, DOD, VA, USCG and NOAA need to be able to access a patient’s longitudinal health record. The separate, legacy EHR systems are outdated and unable to create a seamless care experience as provided by the federal EHR.
Having a federal EHR among DOD, VA, USCG and NOAA puts patients at the center. It allows the Departments and other partners to achieve the following:
- Support Service members from the time they join the military through their care as a Veteran in one, complete patient health record that the patient can access—enabling an integrated, patient-centered continuum of care.
- Access data such as service treatment records, Service medals and honors, housing status and other information to ensure a transitioning Veteran receives all the benefits they have earned in a seamless, timely fashion.
- Minimize the number of times patients need to share their health histories, undergo duplicative tests or manage printed health records.
- Enable comprehensive patient data, whether recorded by a DOD, VA, USCG, NOAA or participating provider organizations, to be readily available wherever care is provided—the more patient data clinicians have, the more informed care they can deliver to their patients.
Patient data is owned by the patient. Patients have the right to access their personal health record. They retain control over their own health data.
Are the Department of Defense, Department of Veterans Affairs and Department of Homeland Security’s U.S. Coast Guard using different electronic health records or one single, common electronic health record?
The Departments are implementing the same single, common federal electronic health record (EHR). The Department of Defense, Department of Homeland Security’s U.S. Coast Guard and Department of Commerce's National Oceanic and Atmospheric Administration call the federal EHR MHS GENESIS, while the Department of Veterans Affairs use other names for the federal EHR. However, they are deploying, using and updating the same federal EHR. If one Department adds new capabilities to the federal EHR, the other Departments have access to the same capabilities.
We rely heavily on providers outside of the federal health care systems (for example, the Department of Defense [DOD]; Department of Veterans Affairs [VA]; Department of Homeland Security's U.S. Coast Guard [USCG] and Department of Commerce's National Oceanic and Atmospheric Administration [NOAA]) to provide health care to Service members, Veterans and their families. In April 2020, the Federal Electronic Health Record Modernization office launched the joint health information exchange to enhance data sharing between the Department of Defense, Department of Veterans Affairs, Department of Homeland Security’s U.S. Coast Guard, Department of Commerce's National Oceanic and Atmospheric Administration and participating provider organizations.
COVID-19 showed us how important such efficient electronic health information sharing is for clinicians on the front lines. The more information they have about their patients, the better they can meet their needs.
We also work closely with federal and standards organizations and private sector partners to advance interoperability standards that enable the exchange of information across all sectors of industry and government.
Yes, the Federal Electronic Health Record Modernization office engages with federal and national standards organizations, including the Office of the National Coordinator for Health Information Technology, and private sector partners to advance interoperability standards that enable the exchange of information across all sectors of the industry and government, a key driver to effective transformation. This effort improves the continuity of care among and between public and private sector providers.
Some of our top priorities include operationalizing the Federal Electronic Health Record Modernization (FEHRM) office and focusing on convergence.
We are operationalizing the FEHRM by evolving the FEHRM to become the single provider of the federal electronic health record (EHR), providing a common set of capabilities across the health care industry.
We focus on convergence by figuring out how to converge EHR workflows and configurations to streamline the patient experience. While the Department of Defense (DOD), Department of Veterans Affairs (VA), Department of Homeland Security's U.S. Coast Guard (USCG) and Department of Commerce's National Oceanic and Atmospheric Administration (NOAA) have unique clinical and business issues that differ based on their missions, the FEHRM is focused on converging DOD, VA, USCG and NOAA clinical and business capabilities where appropriate. The FEHRM overseas configuration and content changes to the federal EHR that are agreed on by the Departments through a joint decision-making process facilitated by the FEHRM. The goal is that DOD, VA, USCG and NOAA providers in the same roles will have a common user experience with the federal EHR defined by evidence-based best practice. Providers won't need to relearn things depending on where they provide care. From the patient perspective, this means health care will be delivered the same way regardless of where they get care. They have a consistent patient care experience. Convergence ultimately helps us enable more standard workflows and practices to enhance clinical decision-making and health care. Workflows are the series of tasks required to complete a health care function (for example, ordering a medication). Standard workflows are considered best practices because they guidance compliance with clinical best care guidelines. Convergence helps us determine the best workflow solutions that are safe, effective and efficient.
We are also prioritizing joint sharing sites, which are sites where DOD and VA resources (like staff and facilities) are shared. Leading the deployment of the EHR joint sharing sites, the FEHRM has the potential to enable the DOD and VA health care systems to work together in new ways to deliver health care to Service members, Veterans and their families.
We are also focusing on bringing additional federal agencies to the federal EHR and determining what that looks like.
At the Federal Electronic Health Record Modernization office, we are capturing and sharing lessons learned and best practices as we work in a common environment and deploy the federal electronic health record.
We’ve learned that the technology works. So, it’s really about change management—the processes, people, culture, training and communications that need to be in place to be successful. The infrastructure also cannot be antiquated. It must be able to support the newer technologies.
We adapted to the current pandemic environment and used it as a catalyst: How can we do things better, smarter and take advantage of tools at our disposal now?
It takes the right people, and the right people are coming together every day. It takes a team. No individual or organization possesses all the expertise to make this a reality. We will continue to build on the team.
The efforts and successes with the federal electronic health record (EHR) and with our partners are only the beginning. We are just scratching the surface on what is possible with EHR, joint health information exchange (HIE) and other health information technology capabilities to transform health care delivery.
Partnerships between the federal government, community providers and commercial vendors will continue to be critical. These partnerships will drive integration, interoperability and the best possible health care for all patients regardless of where they receive care and who provides it.
The Federal Electronic Health Record Modernization office's vision is that we take technology out of the equation, so providers and administrators can make the best decisions together on care delivery. We want to remove technology as a barrier. It’s about getting the right data to the right person at the right time to make informed health care decisions.
We are energized and excited to continue to work with our federal, community and industry partners to improve health care for all our beneficiaries. The possibilities are limitless now that we have a foundation in place.
We continue to look to industry for partnerships, for relationships that can help us shape our path moving forward. We highly value the innovative ideas vendors bring to the table, and we rely on those steadfast partnerships, such as those with the Leidos Partnership for Defense Health for the Department of Defense and that we see between the Department of Veterans Affairs and Oracle Cerner.
There are a lot of other relationships and partnerships being developed as we look toward new technologies and available capabilities.
In navigating the future, we look for innovative ideas for improving the patient experience and enhancing the quality of care delivery during this time. For example, how do we implement the EHR and train end users with the social distancing precautions in place during the pandemic? Or, how do we deliver technology at the frontlines of care—whether it’s in theater, in rural America or while a patient is being transported?
Also, the federal electronic health record and joint health information exchange means our providers now have access to more information about their patients than ever before to make the best care decisions. We need to make sure this data is usable and built into provider workflows. We need vendor engagement as we do this.
When we are all focused on delivering high-quality care seamlessly as patients move from one delivery system to another, innovation, integrating new capabilities through expanded partnerships and collaboration will move us ahead.
Joint Health Information Exchange
Launched in April 2020 by the Federal Electronic Health Record Modernization (FEHRM) office, the joint health information exchange (HIE) builds upon the success of the Department of Defense (DOD) and Department of Veterans Affairs (VA) HIE work.
The joint HIE is a secure gateway used to connect to participating provider organizations across the United States who agree to securely share clinical information with the DOD, VA, Department of Homeland Security’s U.S. Coast Guard (USCG) and Department of Commerce's National Oceanic and Atmospheric Administration (NOAA) providers. Participating provider organizations include single-physician offices to multi-hospital systems outside the federal health care systems (for example, DOD, VA, USCG and NOAA) that participate in the joint HIE. While the federal EHR is the federal source for a patient's health history, the joint HIE links the EHR information with participating provider organizations.
The joint HIE enhances the ability of DOD, VA, USCG and NOAA providers to access patient electronic health information quickly and securely from participating provider organizations and vice versa. Participating provider organizations now have a single point of entry to request and access DOD, VA, USCG and NOAA patient information to support the continuity of care for Service members, Veterans and other beneficiaries.
The launch of the joint HIE is a critical step forward in significantly expanding DOD, VA, USCG and NOAA partnerships and interoperable capabilities. The FEHRM continues to optimize and expand the joint HIE.
The information shared through the joint health information exchange includes prescriptions, allergies, illnesses, lab and radiology results, immunizations, past medical procedures and clinical notes.
COVID-19 showed us how important efficient electronic health information sharing is for clinicians on the front lines. The more information they have about their patients, the better they can meet their needs.
The Federal Electronic Health Record Modernization (FEHRM) office, Department of Defense (DOD) and Department of Veterans Affairs launched the joint health information exchange (HIE) in the middle of the pandemic. During this critical time, the joint HIE is enhancing the ability of DOD, VA, Department of Homeland Security's U.S. Coast Guard and Department of Commerce's National Oceanic and Atmospheric Administration providers to share patient electronic health information quickly and securely with participating provider organizations.
It’s magical when a patient shows up at a health care system and that system already knows about the patient and what happened in a different health care system and acts like its normal. This is the experience the Departments are building toward.
With 60% of Department of Defense (DOD) beneficiaries accessing care outside of the federal health care systems, and 30% of Department of Veterans Affairs (VA) beneficiaries doing so, DOD and VA have a lot of intersection with outside provider organizations and need to be able to efficiently exchange data.
By combining DOD and VA’s individual HIEs into a single joint HIE, we significantly expanded the data available to all clinicians.
Our recent expansion to include the CommonWell Health Alliance in our joint HIE brings a nationwide network of 15,000-plus hospitals and clinics to the 46,000-plus community partners already part of the joint HIE.
Your medical records should be visible in your MHS GENESIS patient portal or My HealtheVet patient portal. Additionally, if your outside provider is a member of either the CommonWell or eHealth Exchange network, they have the ability to retrieve your DOD, VA, USCG and/or NOAA records.
These networks, comprised of 100,000 members ranging from single-physician offices to multi-hospital systems, participate in the joint health information exchange (HIE). The joint HIE is a secure gateway that connects your federal EHR information with EHR information from participating provider organizations that provide care outside of DOD, VA, USCG or NOAA.
Visit Health.mil for the list of provider organizations who are part of the joint HIE. If your provider organization is not part of the joint EHR, encourage them to join by directing them to the FEHRM website for more information.
The federal electronic health record (EHR), along with the joint health information exchange (HIE), is empowering health care administrators and providers with more data. The data we gain from the federal EHR and joint HIE helps enable more standard workflows and practices to enhance clinical decision-making and health care. It also helps drive business decisions, inform population health initiatives and improve patient outcomes through innovations.
For example, the Department of Defense (DOD) and Department of Veterans Affairs (VA) joint data management and analysis efforts led to our ability to improve the process for prescribing opioids. Patients at risk of an opioid overdose who receive opioid pain medication will also receive a life-saving drug that counteracts the opioid prescribed along with education.
Another example of effective HIE, is our integration of an Immunization Forecaster into the EHR. The forecaster embedded into the EHR leverages Centers for Disease Control and Prevention clinical decision support of immunizations to help pediatricians know when patients need the next round of appropriate vaccines. This new functionality also reduces clinician time and effort, assessing and deciding which vaccines may be due. Even if a child falls behind, it recommends a catch-up schedule. This effort is especially timely with regard to the forthcoming COVID-19 vaccine.
DOD is also looking into developing a trauma registry to capture battlefield injuries and the impact of such injuries throughout a beneficiary’s lifetime.
The EHR and subsequent data we now have available help make all these innovations in health care possible so beneficiaries can get the best health care as soon as possible. We are just scratching the surface on what is possible with EHR data to transform health care delivery to Veterans.
The Department of Defense (DOD) and Department of Veterans Affairs (VA) did disengage with providers at the start of COVID-19, so the providers could focus on responding to the national pandemic. In the meantime, the Departments re-planned continuously, seeking ways to enhance capabilities and gain efficiencies, so they were ready to respond once the providers could focus on electronic health record (EHR) deployments again. For example, the Department of Homeland Security’s U.S. Coast Guard (USCG) shifted to an entire virtual training model that DOD and VA are learning from and incorporating into their training techniques.
COVID-19 has demonstrated the ability of the single, common federal EHR to quickly adapt to changing demands and support providers during the pandemic. For example, when providers needed to order COVID-19 tests, and the EHR didn’t yet have that capability, we were able to make those changes in four hours within the new EHR versus four weeks within the legacy system. The new EHR is much more responsive to changes driven by COVID-19.
So, we have not slowed down our progress with EHR modernization during the pandemic. We remain focused on delivering capabilities to those we serve: clinicians on the front lines delivering care and their patients.
As for how it has impacted the future of EHR modernization, COVID-19 demonstrated virtual health as a priority. In response, the FEHRM pivoted toward accelerating the adoption of tools, platforms and joint capabilities to deliver telemedicine solutions that meet the operational requirements driven by the pandemic. For example, the FEHRM is leveraging VA’s patient-facing video platform to develop a parallel platform for DOD.
Moving forward, there are many opportunities to understand and think about the impact of the new normal of health care delivery and how the EHR and information technology capabilities the FEHRM delivers can support the new normal.
The Captain James A. Lovell Federal Health Care Center (Lovell FHCC) is a first-of-its-kind partnership between the Department of Defense (DOD) and Department of Veterans Affairs (VA). It’s a fully integrated federal health care center that serves both DOD and VA patient populations. Located in North Chicago, Illinois, Lovell FHCC was established in October 2010 to provide health care to Service members, Veterans and other beneficiaries.
Lovell FHCC shares medical and non-medical services and operates via fully integrated DOD/VA medical personnel and leadership team. Now known as legacy interoperability capabilities, DOD and VA implemented functionalities enabling joint patient registration and orders portability for laboratory results and consultations; one medical staff with single departments; single systems such as human resources, finance, performance measures, workload and personnel; and one local budget.
Lovell FHCC provides eligible beneficiaries with a single check-in process and standardized patient care. Lovell FHCC provides a full spectrum of health care for patients, including full medical and surgical care, a large array of medical sub-specialties, a variety of mental health services, a Community Living Center and many other programs.
Lovell FHCC’s information technology and information management teams safely interface DOD and VA health information technology systems to support an integrated facility.
Lovell FHCC provides health care to 90,000 patients per year, including Service members, Veterans and other beneficiaries throughout northern Illinois and southeastern Wisconsin. Lovell FHCC ensures the nearly 50,000 Navy recruits who transition through Naval Station Great Lakes each year are medically ready.
In May 2005, the DOD/VA Health Executive Council signed an agreement to integrate the North Chicago VA Medical Center and the Naval Health Clinic Great Lakes, establishing Lovell FHCC. The two facilities merged and became Lovell FHCC in October 2010. In 2014, the Defense Medical Information Exchange Program Management Office and VA Office of Information and Technology assumed Lovell FHCC management roles and responsibilities. In March 2016, DOD and VA recommended, and Congress concurred with, the continuation of Lovell FHCC as a demonstration of an integrated facility, focusing on implementation and improvements.
Lovell FHCC operates under an integrated governance structure and a single line of authority to manage DOD and VA medical and dental care, while continuing to meet the unique missions of both Departments. A senior VA official serves as the Lovell FHCC Director with a Navy Deputy who has management authority over all military-related activities to ensure complete operational readiness. An advisory board of senior DOD and VA representatives oversees Lovell FHCC operations, providing input and monitoring performance as an integrated facility. Currently, Lovell FHCC reports to Veteran Integrated Service Networks (VISN) as a VA facility, to the Navy as a military medical treatment facility and to the Lovell FHCC Advisory Board, DOD/VA Health Executive Committee and Joint Executive Committee.
Lovell FHCC consists of the East Campus and the West Campus. The East Campus hosts the Navy Recruit Training Command and provides care to active-duty Navy personnel and recruits. The West Campus provides a full spectrum of health care for both DOD and VA patients, including full medical and surgical care, medical sub-specialties, mental health services and many other programs.
Lovell FHCC EHR Implementation
The deployment of the single, common federal EHR at Lovell FHCC is led by the FEHRM in collaboration with the DOD Healthcare Management Systems Modernization (DHMSM) Program Management Office, VA’s Electronic Health Record Modernization Integration Office and Lovell FHCC stakeholders. The resulting EHR will be a true federal EHR, not a DOD system nor a VA system.
The deployment of the federal EHR at Lovell FHCC was previously scheduled asynchronously, meaning DOD and VA users would go live with the EHR at different times. The asynchronous deployment approach posed a high risk of disrupting the integrated operations at Lovell FHCC. Potential risks included severely impairing existing shared services, jeopardizing patient safety and increasing costs to the Departments for delivery of care.
In November 2019, at Lovell FHCC’s request, the FEHRM committed to a joint site engagement to assess the risk. In September 2020, the FEHRM, with various DOD, VA and vendor stakeholders, conducted a site engagement during which there was consensus for a synchronous deployment approach. By conducting a synchronous deployment, the Departments can realize cost-savings by reducing the duplicate work of two deployment efforts and mitigate the risks introduced through an asynchronous deployment at this fully integrated site. Through collaboration led by the FEHRM, the team agreed to use the DHMSM contract vehicle to deliver the federal EHR.
The synchronous deployment of the federal EHR at Lovell FHCC is following a phased approach:
- Phase 0: Planning
- Phase 1: Assessment and Design Concept
- Phase 2: Configure, Test
- Phase 3: Deployment, Activation and Sustainment
Currently in Phase 1, the multi-agency team completed a comprehensive end-to-end assessment at Lovell FHCC focused on gathering current state clinical and business process workflows. Now, the team is executing the Lovell FHCC Enterprise Requirements Adjudication (ERA) process. The ERA process is a thorough, high-impact decision-making process focused on DOD and VA requirements and deployment approach, where discrepancies exist. The ERA process deconflicts the build between DOD and VA, leverages existing governance boards and drives toward convergence. The ERA process is defining the design of the federal EHR for implementation at Lovell FHCC and the approach for the deployment.
Outputs of the end-to-end assessment and the ERA process will inform the Lovell FHCC Implementation Plan, which will include milestones and timelines for the deployment. Once the Lovell FHCC Implementation Plan is finalized, the FEHRM will lead discussions between senior Department leadership to assess the projected Lovell FHCC go-live timing with DOD wave and VA VISN deployment timelines.
No, there is a single location for medication reconciliation.
Lovell FHCC is receiving the same federal electronic health record (EHR) as other Department of Defense (DOD) and Department of Veterans (VA) sites. Lovell FHCC is using what DOD and VA already have. DOD and VA are given a certain amount of flexibility to configure the federal EHR differently to meet specific facilities’needs while still maintaining interoperability between the Departments. Any Departments using the EHR have access to these changes as well as other capabilities their specific facilities may need (that they may choose to turn on or off,as allowed). Patient care location (PCL) hierarchies is one example where Lovell FHCC requires a unique approach as a result of being a fully integrated, joint sharingsite.
PCL hierarchies correspond to physical locations of patients receiving health care services, with facilities at the top level of the hierarchy followed by buildings, nursing units, rooms and beds. Lovell FHCC will use two PCL hierarchies—one for each Department, in their respective facilities. All other DOD and VA facilities currently use either a DOD or VA PCL (not both) when they implement the federal EHR. Because patient care locations are associated with either DOD or VA locations at Lovell FHCC, they can be leveraged as the basis for user role assignment, workflow (1DOD or 1VA), interface, configuration and end-user training. Using both DOD and VA PCL hierarchies at Lovell FHCC allows each Department the ability to satisfy their respective statutory requirements regarding eligible beneficiaries and encounter charging.
While a single PCL is the preferred option, existing legal and business barriers presented the need for a near-term solution to avoid significant schedule risks for the Lovell FHCC federal EHR implementation. Ultimately, DOD and VA can use this dual PCL configuration to provide Lovell FHCC with the existing DOD and VA enterprise configurations, without having to maintain a “Lovell FHCC specific” configuration. Further, orders portability is maintained, as orders can be associated (or “flexed”) to the correct PCL and service resource location within the federal EHR.
Lovell FHCC will use both Department of Defense (DOD) and Department of Veterans Affairs (VA) patient portals. DOD beneficiaries will use the DOD patient portal, VA beneficiaries will use the VA patient portal. Dual eligible patients can use either portal. There are some differences between how each portal is set up, most notably:
- VA uses relationship-based scheduling, meaning only providers with an established relationship will appear to the patient for messaging and scheduling. DOD is moving to relationship-based scheduling; however, beneficiaries can direct book an appointment, which is not currently a feature enabled for VA.
- VA can request prescription renewals from their care team and medication refills from pharmacies. DOD can request prescription renewals; however, medication refills is not enabled.
DOD and VA beneficiaries can view and download Pathology and Radiology reports. Additionally, VA beneficiaries can view and download Microbiology and Cardiology reports.
The process to login to the patient portal also differs by Department.
- There are two ways to access the MHS GENESIS Patient Portal: 1. Using a Common Access Card reader, or 2. Creating a DS Logon account.
- A direct link to VA’s patient portal is sent to Veterans. The portal is accessible through MyHealtheVet and VA.gov.
As both DOD and VA use DS Logon to access their portals, it is important for beneficiaries to make sure their personal information (name, address, email and phone numbers) are listed correctly in the Defense Enrollment Eligibility ReportingSystem (DEERS) to avoid problems with claims, referrals, delivery of home prescriptions and access to care for dependents. Veterans and family members who receive health care or direct benefit payments from VA and changed their legal names since discharging from military service must update their new name with DEERS.
The Department of Defense (DOD) and Department of Veterans Affairs (VA) are committed to deploying the single, common federal electronic health record (EHR) synchronously at Lovell FHCC in March 2024. Lovell FHCC is the only exception to the full-stop of VA deployment activities. VA is pivoting resources to ensure the Lovell FHCC deployment is a success. Since Lovell FHCC is a jointly run DOD and VA facility, the deployment will continue as planned to ensure that all beneficiaries who visit the facility are covered by one federal EHR. To ensure success, Lovell FHCC will continueto benefit from a multi-agency team of FEHRM, DOD and VA leaders who are working together to address and mitigate identified risks and implement lessons learned and best practices from other sites.
Lovell FHCC federal EHR implementation is fundamental to interoperability and the federal EHR moving forward. The FEHRM, DOD and VA are committed to getting it right. By ensuring the Departments can work together as a single unit, Lovell FHCC becomes a model for how we can do this across DOD, VA and the broader federal enterprise to ensure seamless, integrated care for patients. It will help simplify our ability to work together and how the Departments can demonstrate interoperability.
The Department of Veterans Affairs (VA) goal for the federal electronic health record (EHR) is, and always has been, to provide improved health outcomes for Veterans and a better experience for providers. VA acknowledges thatt here have been challenges with their efforts to date. VA will be working closely with Oracle Cerner to resolve outstanding performance, reliability and patient safety concerns, prior to the March 2024 deployment at Lovell FHCC.
As with any site, the Lovell FHCC federal EHR deployment includes a 12-month cadence of deployment events to prepare the facility’s technology, processes and people for the change in systems. As a result of the enterprise nature of the federal EHR, VA and Oracle Cerner can address the four patient safety issues identified in their Sprint Report (i.e., unknown queue, no show/cancelled appointment routing toscheduling queues, creation of visible external referrals for worklist action and ordering procedure charge codes without ordering the actual clinical imaging) ahead of Lovell FHCC’s go-live.
It’s also worth noting the federal EHR exceeds industry standards for protecting patient information, satisfying DOD standards for cybersecurity and DOD and VA agreed-to standards of privacy.
Lovell FHCC is a perfect example of true jointness. The deployment of the federal electronic health record (EHR) at Lovell FHCC will lead the way for how two large health care systems work together to make the best care decisions without technology being a barrier. The FEHRM will converge configurations, where appropriate, to integrate processes and harmonize workflows between Department of Defense (DOD) and Department of Veterans Affairs (VA) as part of deploying the federal EHR at Lovell FHCC. By ensuring the Departments can work together as a single unit, Lovell FHCC becomes a model for how we can do this across DOD, VA and the broader federal enterprise to ensure seamless care for patients. It will help simplify our ability to work together and how the Departments can be engaged with each other. This work will evolve the federal EHR baseline to better serve providers and patients across the federal government. Ultimately, Lovell FHCC will serve as a prototype for how different health care systems can work together in new ways to deliver care to their patients.
Implementation of the federal electronic health record (EHR) at Lovell FHCC benefits providers, patients and the broader health care enterprise in the following ways:
- Enhances the federal EHR baseline to better serve patients and providers across the federal government
- Converges configurations, workflows, terminology and content, where appropriate, between the Department of Defense (DOD) and Department of Veterans Affairs (VA) to improve clinical decision-making
- Documents lessons learned and provides a roadmap for future federal EHR deployments and troubleshooting, especially at joint sharing sites where care is integrated
- Standardizes user roles, forms and configuration variations between DOD and VA, where appropriate
- Models how large health care systems can leverage technology to drive the best health care decisions
- Allows for the test and evaluation of meaningful exchange and use of data between DOD, VA and other health care systems, as required by the National Defense Authorization Act for Fiscal Year 2020
Ultimately, Lovell FHCC leads the way for future federal EHR deployments and improving patient care and the end-user experience.
Joint Sharing Sites
Department of Defense (DOD)/Department of Veterans Affairs (VA) sharing sites, also known as joint sharing sites, are medical facilities where DOD and VA collaborate to support health care delivery to Veterans, Service members and their beneficiaries. DOD and VA medical sharing varies significantly from facility to facility—from providers, clinical, janitorial and administrative staff to physical space, processes and technologies.
The least integrated joint sharing sites may only share custodial services or coordinate purchases of supplies, while more tightly integrated joint sharing sites embed providers in the other Department’s space, coordinate care and treatment options and access the other Department’s electronic health record (EHR) to document care and submit clinical orders (until the Departments are using the same single, common federal EHR). The most highly integrated joint sharing site is the Captain James A. Lovell Federal Health Care Center (Lovell FHCC) in North Chicago, Illinois.
By leveraging the existing services of both DOD and VA facilities, a joint sharing site can take advantage of economies of scale and offer a broader range of services to both DOD and VA patient populations in their catchment area. In some cases, a joint sharing site also expands the access to care options a patient may have available by providing multiple locations to receive the same type of care.
Joint sharing sites are also a net benefit to DOD and VA clinical staff in locations where the increased patient acuity and volume supports training and readiness objectives.
As of July 2022, there are 159 facilities (85 DOD and 74 VA) that have active resource-sharing agreements nationwide. The number of active resource-sharing agreements changes monthly based on the clinical needs of the sites, availability of personnel to support those agreements, and whether agreements are activated, de-activated or renewed.
DOD and VA federal EHR deployment timelines are not always synchronized for joint sharing sites. Consequently, the asynchronous nature of the deployments may result in some level of risk and impact to required workflows and service offerings that are managed by the FEHRM to ensure continued health care. The FEHRM’s focus is on the gap created by the asynchronous deployment.
The FEHRM views asynchronous deployment of the federal EHR as occurring through sequential phases. In most instances, DOD will deploy ahead of VA. The first DOD deployment will bring the joint sharing site to an interim state or transition state, in which DOD is on the federal EHR and VA is on the legacy EHR. The joint sharing site is at its end state when DOD and VA are on the same federal EHR.
There have been multiple successful DOD EHR deployments at joint sharing sites to date. The first VA deployment at a joint sharing site is scheduled for March 2023. The FEHRM, DOD and VA continue to refine their approach to address lessons learned, including the following:
- Early identification of VA users at joint sharing sites impacted by DOD deployment who will require access to the federal EHR prior to VA deployment
- Development and application of new-user provisioning scenarios to be leveraged by the program management offices based on standard business rules
- Development and deployment of federal EHR access tip sheets to support end users
- Development of interim-state process maps to ensure the continuity of shared clinical services through the transition state
- Analysis and adjudication of the differences between DOD and VA roles (e.g., DOD/VA Surgeons and Intensive Care Unit Nurses)