The Business of Government Hour

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The Business of Government Hour features a conversation about management with a government executive who is changing the way government does business. The executives discuss their careers and the management challenges facing their organizations. Past government executives include Administrators, Chief Financial Officers, Chief Information Officers, Chief Operating Officers, Commissioners, Controllers, Directors, and Undersecretaries.

The interviews

Join the IBM Center for a weekly conversation about management with a government executive who is changing the way government does business.

Dr. Gerald Cross, Dr. Steven Jones, & Dr. Robert Kolodner interview

Friday, April 10th, 2009 - 20:00
Phrase: 
Join us for a SPECIAL EDITION of The Business of Government Hour -- a panel of key leaders from DoD, VA, and HHS will discuss the progress, the promise, and the importance of electronic health records and health information sharing to the delivery of health care. We are pleased to have Dr. Steven Jones, Principal Deputy Secretary for Health Affairs, Dr. Gerald Cross, Principal Deputy Under Secretary for Health at the VA, and Dr. Robert M. Kolodner, National Coordinator for Health
Radio show date: 
Sat, 04/11/2009
Intro text: 
Dr. Gerald Cross, Dr. Steven Jones, & Dr. Robert Kolodner
Complete transcript: 

Originally Broadcast January 24, 2009

Washington, D.C.

Mr. Morales: Welcome to a special edition of The Business of Government Hour. Today, we're featuring another conversation on healthcare innovation. I'm Albert Morales, your host and managing partner of The IBM Center for The Business of Government.

Today, electronic health records and health IT offer promise for improving patient safety and reducing inefficiencies. Given its role in providing healthcare in the United States, the federal government has been urged to take a leadership role to improve the quality and effectiveness of healthcare by promoting health records and health IT.

To that end, the US Department of Defense and the US Department of Veterans Affairs have come a long way in the areas of health IT, inoperability standards and healthcare information sharing. Both continue to work towards improving the exchange of medical information to best serve the country's active duty service members and veterans. They're also working with the National Coordinator for Health Information in promoting the adoption of federal standards and broader use of electronic health records.

It is my pleasure to welcome our very special guest today. A panel of key leaders from DoD, VA and HHS to discuss progress in this area. I'm pleased to welcome to our expanded studios today, Dr. Steven Jones, Principal Deputy Assistant Secretary for Health Affairs at the DoD, Dr. Gerald Cross, Principal Deputy Undersecretary for Health at the VA and Dr. Robert Kolodner, National Coordinator for Health Information Technologies at HHS. Gentlemen, thank you for taking time to come to our show today.

Dr. Jones: Thank you.

Dr. Cross: Thank you.

Dr. Kolodner: Thank you.

Mr. Morales: Also joining in our conversation is Tom Romeo, IBM's General Government Industry Leader. Tom, thanks for coming out today.

Mr. Romeo: Thanks, Al.

Mr. Morales: So before delving into our conversation on DoD and VA electronic health information sharing I'd like to begin by setting some context around the tools that even make this possible. Let me start with you, Dr. Kolodner. What is health IT and more specifically, what is an electronic health record and how does it contribute to care?

Dr. Kolodner: Thanks, Al. An electronic health record or EHR is the component of health IT that's most well known to people. There's several other important pieces as well and I'll describe in just a moment. When they're used together effectively, health IT enables us to manage the vast amount of health information in a more efficient and useful manner. Increasing our ability to deliver patient-centered healthcare and improving population health. The bottom line is that health IT is necessary to achieve not only healthcare reform but our real goals for change. Improving the health and well being of individuals and communities across the country.

There are five categories that together make up health IT They are the electronic health records or EHR, the personal health records or PHR and applications that provide population health systems and tools including public health, biosurveillance, quality improvement and research. The last two categories are more technical in nature. The fourth category consists of a variety of data, technical and security standards and the fifth category is a robust interoperable, secure nationwide health information network.

Mr. Morales: Dr. Jones, your perspective?

Dr. Jones: The American Health Information community defines an electronic health record as an electronic record of health related information on an individual that can be created, managed and consulted by authorized clinicians and staff across more than one healthcare organization.

We believe broad us of health IT will help, one, improve healthcare quality; two, prevent medical errors; three, reduce healthcare cost; four, increase administrative proficiencies; five, decrease paperwork; and six, expand access to affordable care.

Mr. Morales: Now let's talk about each department's electronic health records. Dr. Jones, would you tell us more about the evolution of DoD's electronic health record efforts also known as AHLTA. Exactly what is this record and what clinical information does it capture and how is it used by clinicians?

Dr. Jones: AHLTA is the military's electronic health record. Two major points, one is it is outpatient focused and secondly, it also is very helpful in the area of surveillance. AHLTA generates, maintains, stores and provides secure online access to comprehensive patient records, accessibility from military treatment facilities across the globe. And as you know we have people, uniformed services members, that move very often during their careers and also of course globally so it's important that it's worldwide.

With worldwide deployment beginning in January 2004, AHLTA is a key enabler to military medical readiness. It supports more than 9.2 million military health system beneficiaries. AHLTA use continues to grow at a significant pace.

Currently, AHLTA captures allergy information, VA clinical data, outpatient medications, inpatient and outpatient laboratory results, radiology reports, demographic details, clinical notes, procedures, problem list, vital signs, family history, social history and health questionnaires. AHLTA is in the process of incorporating imaging into the electronic health record.

Mr. Romeo: Dr. Cross, in a similar vein, would you tell us more about the evolution of VA's electronic health record system, the Veterans Health Information Systems and Technology Architecture known as VistA. And if you could describe it for our listeners and illustrate for us the type of clinical information it captures and how to use by the clinicians.

Dr. Cross: Well Tom, the VA's electronic health record is an integrated system and it's used throughout the VA. And that means it's used at approximately 1,400 sites of care nationwide. And by the way that includes sites overseas as well, and it covers both inpatients and outpatients.

As an integrated system, if a veteran travels from one part of the country to another, wherever he or she goes a VA medical facility can open the veterans VA medical record. Outside our medical facilities, our electronic health record can be used remotely. For example, you know our social workers doing outreach to homeless veterans on the street can use it.

The system was developed starting back in the 1970's. A key point is that the central role that doctors and other clinicians played in developing this system. The VA system is really an electronic health record designed by clinicians for clinicians, and that's why it has achieved high satisfaction among our clinical staff. It is also a high satisfaction among the many thousands of students who train at the VH each year. VA's electronic health record plays a key role in transforming veterans' medical care. We no longer have to waste time looking for lost records as happens in a paper based system. Lab and x-ray results are not lost. This promotes both quality of care and avoids re-ordering test because the previous test result cannot be found.

Also, we don't have outpatient records and inpatient records, we have one. We have an electronic record that incorporates both. Actual x-ray images can be seen in the VA health record along with their reading for that image. Blood pleasure results, rather than being presented as a series of numbers, can be seen as a graph showing changes over time. All of the patient's medications are listed. This allows us to provide higher quality care by giving the physician information that is far more usable.

Mr. Morales: So we've talked a little bit about what an electronic health record is but if we cut to the core, could you elaborate on some of the key specific benefits of an electronic healthcare record to say both the clinician and to the patient? Can I start with you, Dr. Jones?

Dr. Jones: Sure, Al. The EHR's benefit to both clinicians and patients are improving the coordination of care within the healthcare delivery system by increase sharing of health information among all authorized clinicians, elevating the standard of care for everyone. This has been a joint effort where we in VA have worked very closely together, trying to insure that we're meeting those needs for continuity of care, quality care.

Helping to populate a personal health record by having an electronic health record, we will be able to move the information we have from the electronic health record to the person's personal health record which again will be a positive step.

And then improving the health of the community, using aggregated health data for research, public health, emergency preparedness and quality improvements. We have a rich database. We have the ability to help the Food and Drug Administration when they have questions about certain events as a result of a device or a drug.

And then, insuring the use of preventive services such as health screenings which can help reduce healthcare cost.

Mr. Morales: That's great. Dr. Cross, some of the key specific benefits that you see to both the clinician and the patient?

Dr. Cross: I'll give you a couple of examples, Al. I agree completely with Dr. Jones as well, the examples that he gave. But the VA electronic health record is being used very creatively to enhance the quality of care.

Now here are a couple of examples. we set up radiology reading center out in California. And so if we have a radiologist in one of our facilities anywhere across the country who has gone or leave or vacation or has been ill and is missing some time from work, they can pick up the pace out there. The images are transmitted immediately and the reading comes back just as fast as if it was read locally and that has been a tremendous help to us and that helps us work as an integrated system.

Our Barcode Project is a unique tool I think that helps us eliminate medication errors. And in the way that we're using it, it eliminates the error at the point of administration right where the nurse is seeing the patient. And on the other end of the process, our electronic ordering medications by the docs and clinicians, helps to prevent errors.

Remember Hurricane Katrina? With electronic health records, patient data is secure and yet it's still accessible to healthcare professionals even in emergencies. In the aftermath of that hurricane, Hurricane Katrina, thousands of our patients were evacuated from the storm area. And despite that, our patients' records were fully accessible to VA providers throughout the nation.

And one more thing, the personal aspect of this, a personal record, we're working in My Healthiest at www.myhealth.va.gov, empowers veterans to take charge of their own healthcare online.

Mr. Morales: That's great. Dr. Kolodner, any final words on the key benefits to clinicians and patients of the electronic healthcare record?

Dr. Kolodner: I'd like to highlight five key benefits of the fully operational EHR for both clinicians and for patients. So first of all, as clinicians we're able to deliver better care because we are able to focus on prevention and not just responding to the onset of chronic illness or to a particular acute complaints. Second, we can provide improved coordination of care because of the elimination of barriers to that coordination across multiples sites and across multiple clinicians. And I think most of us who aren't cared for in the VA have those multiple clinicians but even in VA and DoD, a lot of the care is provided outside and so you've got multiple sites that need to be coordinated.

Third, we're able to provide more convenient care for the patients by allowing widespread use of telecare and telemonitoring so they don't have to come to the facility to get care, but there's a lot of ways that we maintain their health remotely. Fourth, patients are able to proactively participate in the care through the use of personal health records. And fifth, we as clinicians are able to provide higher quality care consistent with the institute of medicine's six characteristics of quality care. That it be safe, timely, effective, efficient, equitable and patient-centric.

Mr. Morales: That's great. What is interoperability? We will ask our panel on healthcare innovation to share with us when our conversation continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to our special edition of The Business of Government Hour. I'm your host, Albert Morales, and today we're featuring a panel discussion on health care innovation with Dr. Steven Jones from the U.S. Department of Defense, Dr. Gerald Cross from the U.S. Department of Veterans Affairs, and Dr. Robert Kolodner from the U.S. Department of Health and Human Services. Also joining me in our conversation from IBM is Tom Romeo.

Gentlemen, it seems obvious that the key to making health care information electronically available is the ability to share that data amongst the various health care providers. Today, from what I understand, you're sharing most, but not all of the electronic health care information at different levels of interoperability.

Can we take a moment to explain what exactly constitutes interoperability? And could you describe the different levels of interoperability and perhaps give some examples of the types of data that can be shared at each level? Let me pitch this to Drs. Jones and Cross. Dr. Jones, can you start please?

Dr. Jones: Thank you. Interoperability is based on DoD's and VA's mutual understanding of shared information, and we utilize provider groups in both organizations to help us focus and prioritize what information we do share electronically. It is our vision that the users have equal understandings of unstructured or structured information, which is shared between them in an electronic form.

The two departments are guided by the Center of Information Technology Leadership's standardization levels group. Try saying that fast.

And they provide an analytical framework for defining interoperability. CITL, defines four levels of health care information exchange in interoperability

And therefore, the Levels of Standardization. Level 1 is non-electronic data exchange which we all use everyday: mail, telephone, etcetera. Level 2 is machine transportable, and most of us recognize that through fax and scanned document. Level 3--Level 3 and 4 are the areas which we tend to be focusing on in most of these discussions are coursed around--is machine organizable transmission of structured messages containing non-standardized data. And Level 4 is system exchange information and standardized data that uses the same structure in vocabularies.

And that sounds fairly simple, but when you talk about the thousands and thousands of pieces of information that has to be exchanged it is a very complicated process and one that all three of us and many others are working on that we perceive down this road.

Mr. Morales: Great. Dr. Cross, can you tell us a little bit of interoperability from your perspective? Perhaps some examples?

Dr. Cross: I think the first thing is why it's so important. It turns out that our patients used to be their patients. And the second thing about interoperability is that our clinicians are making the decision about what's most important, what to focus on, and what we really need.

I think you could argue that not everything needs to be computable in our health record, We use something called the Interagency Clinical Informatics Board, the ICIB. It has stated that not all of the information is to be shared at the highest level of interoperability as Level 4 that Dr. Jones talked about, and they're working to identify those specific data that are needed at this level to support decision-making.

Mr. Romeo: As a follow-up, would you describe for us the types of clinical information currently being exchanged? What are the characteristics of the health data? Is it outpatient versus inpatient? And is it just viewable or can it be understood and acted on by the computer?

Dr. Jones: Well, on separated service members, DoD is providing VA one-way historic information through what we call the FHIE on a monthly basis. And those are the materials that VA needs when a veteran approaches for example such as lab results, radiology reports, outpatient information, allergy information.

we do a lot of assessments with our military post-deployment health assessment. So all that information is sent over on a readable basis, on a monthly basis.

As of November 2008, we transmitted messages to the FHIE data depository on more than 4.6 million unique retired discharge service members.

Now for those information patients who are treated both by DoD and VA, we use real-time sharing of current health information bidirectional through what's called BHIE.

So when Congress and others think of interoperability, in most cases, that's what they're thinking of. Real-time sharing. So when the physician or clinician enters in that information, it is readily available to be picked up by both facilities.

This bidirectional information is available at all VA and DoD sites and exchanges in a readable tax data. And DoD provides access VA data through Alta, and of course VA providers have access of our data through Vista, their system. We are sharing two-way enterprise computable data through DoD's clinical health data depository and VA's health data depository on standardized and computer data, outpatient pharmacy data, and medication allergies.

In other words, this total inoperability is not available from us to VA in all cases. We're still building that block on a demonstration in pilot sites for some of the information that we have. And so those are some of the challenges that we have into the future.

As of November 28 of '08, we exchanged computable pharmacy and medication allergy data on approximately 25,000 patients who received health care from both systems. And DoD electronically sends radiology images and scanned medical records for the severely wounded and injured service members transferring from one of DoD's three major trauma centers, Walter Reed, Bethesda and Brook Army Medical Center, to one of VA's four main polytrauma centers located in Tampa, Richmond, Minneapolis and Palto Alto.

Mr. Morales: That's great. So I can clearly begin to see the benefits of interoperability. So, I'm curious. What are some of the key barriers or challenges to achieving this interoperability? Let me start with you, Dr. Kolodner.

In terms of those barriers and challenges, there are some that affect the VA and DoD exchange and there are some that are more general and affect the care that VA and DoD have with the private sector.

First of all, one of the things that VA and DoD have to face that Dr. Cross mentioned are the fact of standards, some case the absence of standards, some case the reverse of that, too many standards, and you need to be able to use the same standards have the term mean the same thing in the two different systems, decoded in the same way.

For example, even something like the coding of gender. There's the number of codes and then are there 4 or 6 or 8 or 12? Or if you agree on the number, in this case it turns out that there's a subset of four that are often agreed upon, do you give it a number, 1, 2, 3, 4, or do you give it a letter? So, things like that. Now, those are the standards.

The other thing that is a challenge because of the success for VA and DoD is the fact that they have a lot of data from going back over 20 years. And this means that some of the early data did not use the current standards, and yet you don't want to lose that because it may be important for current clinicians to be able to look back at that. So, being pioneers in this, actually, it creates a little more challenge in moving forward.

Now, as far as private sector, one of the challenges there is that there's a lack of incentives to share the information. And I think this may be one of the areas that the new administration is looking at, to incentivize this sharing.

Another challenge, at least for getting information to or from the private sector, is that the current use of electronic health records is still very low out in the private sector especially, as I mentioned, compared to VA and DoD.

The final thing, again, more of a challenge in the private sector than the public sector, is the absence of a patient identifier on a nationwide basis. So, those are a number of the barriers and challenges that we have right now for achieving interoperability.

Mr. Morales: Great. Dr. Cross, from your perspective, some of the key barriers and challenges to achieving this interoperability?

Dr. Cross: Well, you know, I think the first thing is the size of these two organizations, depending on how you define them. The DoD is the largest cabinet organization in the United States government, in where the second, we have millions of patients in the VA with their millions of patients in the DoD. So you're talking about a system that has to encompass very large numbers of individuals and then spread across the nation and even outside the nation. So it's complexity. That's an issue of complexity and size.

The second thing I think perhaps is structure. And so what we're doing right now with tremendous energy is to create a structure, and one of the things that we're doing is an office to guide us, an interagency program office to work with both of our agencies as we move forward towards some kind of common services solution to guide us through that process and to make sure that we're staying on track. But you talk about obstacles. The truth is, there's tremendous motivation in both of our departments to make this succeed, to make this successful.

Mr. Morales: Great. How does DoD and VA health information sharing align with the National Health Information sharing efforts? We will ask our panel to share with us when our conversation on health care innovation continues on The Business of Government Hour. All right. Great!

(Intermission)

Mr. Morales: Welcome back to a special edition of The Business of Government Hour. I'm your host, Albert Morales and today we're featuring a panel discussion on healthcare innovation with Dr. Steven Jones from the U.S. Department of Defense, Dr. Gerald Cross from the U.S. Department of Veterans Affairs and Dr. Robert Kolodner from the Department of Health and Human Services. Also joining us on our conversation from IBM is Tom Romeo.

Dr. Kolodner, would you elaborate on your efforts to establish a National Health Information Network or NHIN? First of all, what is this network and second, how have DoD and VA partnered with you and the private sector in forging such a network? And how does the DoD, VA joint information sharing project align with these efforts?

Dr. Kolodner: Sure, Al. The Nationwide Health Information Network or NHIN is an ambitious and exciting initiative that will create this virtual health information highway that provides a secure nationwide interoperable health information infrastructure, operating across the Internet. The information highway will link together individuals and organizations that support and advance health and healthcare. These include providers and consumers, pharmacies and laboratories, public health agencies and researchers to name just a few.

This NHIN is a key part of the National Health IT agenda and its capabilities will enable health information to follow individuals, consumers, be available for clinical decision support by their providers. And support appropriate use of health information beyond direct patient care to improve the health of individuals and communities such as enabling individuals to release their information to Social Security if they're disabled or to their school if it's about immunization data.

As participants in a cooperative with 16 private sector entities and several other federal agencies, VA and DoD have been among the most energetic and committed participants. Together with these other organizations, they are working to define and test the set of standards, specifications and agreements necessary to create this nationwide health information network.

I want to emphasize the importance of having these health IT tools be interoperable. Interoperability is the ability of two or more systems or components to exchange information and to use the information that has been exchange. Interoperability is what unlocks the power of health IT as a tool and enables the potential benefits that this technology offers.

Mr. Morales: So staying on this theme, can you tell us a little bit about the recent American Health Information Communities NHIN demonstrations and DoD and VA's role in enhancing the national health information sharing capabilities.

Dr. Kolodner: The NHIN held two events. The NHIN held an event in September 2008, to showcase the technical capability of electronically sharing the summary records of test patients among 18 federal and private sector entities. A second and final trial implementation was held in December. This latter even demonstrated important new capabilities of the NHIN as well as the exchange of critical additional health information beyond that of the summary record.

It was quite a sight to see the dedicated DoD and VA staff working with their public and private sector colleagues to lay the foundation for the nationwide interoperable health IT infrastructure. Several scenarios demonstrated that the NHIN capabilities could be used to electronically process Social Security disability determinations. To improve population health and to coordinate care across VA, DoD and private sector providers

In 2009, the NHIN will come online and begin to exchange live data among those organizations that are ready, willing and able to exchange the health information using the NHIN specifications and standards. And we fully expect that VA and DoD will be among those that will be using the NHIN. Beginning in February 2009, the Social Security administration will work with MedVirginia to begin electronically processing Social Security disability determinations using the NHIN to transmit that data.

Mr. Morales: Dr. Jones, what's your perspective on the NHIN demonstrations and DoD's role?

Dr. Jones: We've stated earlier, Al, DoD because so many of our patients are treated under TRICARE which is our health plan with help provided by private sector physicians. It's important for us to try to get that information back into their health records. So when we had the opportunity to participate with the National Coordinator of course we were very excited and had supported that effort.

Our goals of participating was one to insure that we can provide our service members, veterans and other eligible beneficiaries with that longitudinal electronic health record that is complete as possible. And right now, we aren't able to insure that those records are complete as possible.

Mr. Morales: Dr. Cross, if I may, your perspective from VA.

Dr. Cross: We also participated in the 2008 demonstrations and they showed the ability to exchange electronic health information for the test patients that were used. In 2009, we're going to focus more attention on this and to accomplish this to support more patients.

Now, let me say a word about why this is so important to the VA. Our patients get cared on many different venues. The forward thinking activities that are being led by Dr. Kolodner's office will for the first time give VA a way to move the information to wherever the veteran chooses to receive care in any of the VA or private sector.

Dr. Kolodner: Al, if I may, one other thing I think would be important to emphasize in this demonstration that VA and DoD participated in, is that while the data was about test patients, it was actually being transmitted from systems scattered all around the country at the actual sites of all the participating organizations. So this was real time exchange using the standards that have been moving forward nationally.

Mr. Morales: Great.

Mr. Romeo: It strikes me that a strong governance structure is critical for the success of any joint project of this scope and complexity. Would you elaborate on the joint governance and oversight structure being used to insure the success of the interagency health sharing program? And specifically, maybe touch on the role of the DoD, VA Interagency Program Office and the DoD, VA Information Interoperability Plan. Dr. Jones?

Dr. Jones: As Dr. Cross has mentioned, VA and DoD has been working more closely together, particularly this last year or so than ever before -- just for an example this last year, we've had what's called a special oversight committee which has been chaired by the Deputy Secretary of DoD and the Deputy Secretary of VA. And for about a year they along with leadership and VA and DoD met on a weekly basis. So the top administration focus was on insuring that we were doing all that we could to share information and to insure that all of our programs that VA and DoD have are compatible and working together.

For a number of years we have also had a group called the JEC, which is a Joint Executive Council. We have a joint strategic plan which is developed between the two agencies and reassessed and analyzed every year. We have goals and objectives in that plan And we're making real progress across the entire front of VA and DoD relationship.

Congress wanted expedited progress, they did form a legislation this IPO an Interagency Program Office. We have established that program office. We have about 30 some odd people. It's jointly staffed by VA and DoD individuals. The director is an DoD employee. The deputy director is a VA employee. And their entire focus is to insure that all those electronic health systems and electronic information that we are working on and developing that we are in concert. And that we will be doing it jointly and together and planning together and implementing together.

The legislation requires that we have in the electronic health area for health records interoperability by September of this year. We believe we will meet that deadline and we'll report to Congress to that.

Mr. Romeo: Thank you, Dr. Jones. Dr. Cross, would you like to add your perspective?

Dr. Cross: Governance and coordination is of course very important. Those things have to built into the structure of the organization to make sure that they are successful now and for the long term. And as Dr. Jones was saying, in April of 2008, the departments formed the Interagency Program Office as mandated by the National Defense Authorization Act.

The IPO, the Interagency Program Office serves as a coordinator -- a management oversight body but is not charged with responsibility for the execution of interoperability projects. The activities related to the requirements, development and acquisition remains with each department.

The IPO, the Interagency Program Office serves as a coordinator -- a management oversight body but is not charged with responsibility for the execution of interoperability projects. The activities related to the requirements, development and acquisition remains with each department.

The IPO is also responsible for insuring the departments maintain a strategic direction. It will insure interoperability is achieved. And that strategic blueprint that identifies future initiatives, many of which are not yet funded but had been identified for the purpose of providing clear strategic direction on moving forward.

Mr. Morales: So making data available is one thing but knowing how to get it and use it is entirely a different issue. And it strikes me that clinicians not only need to be aware that the healthcare data is available for viewing but also must be skilled in using the tools to obtain this data. Dr. Cross, could you tell us more about VA's efforts in developing communication and training strategies to remove any barriers to using available tools?

Mr. Morales: Great, thank you. What about the future of DoD and VA health information sharing and the broader National Health Information Sharing efforts? We will ask our panel to share with us when the conversation on healthcare innovation continues on The Business of Government Hour.

(Intermission)

Mr. Morales: Welcome back to the final segment of our special edition of The Business of Government Hour.

I'm your host, Albert Morales and today we're featuring a panel discussion on HealthCare Innovation with Dr. Steven Jones from the U.S. Department of Defense; Dr. Gerald Cross from the U.S. Department of Veterans Affairs; and Dr. Robert Kolodner from the U.S. Department of Health and Human Services. Also, joining me in our conversation from IBM is Tom Romeo.

Gentleman, would you elaborate on how critical collaboration is to the success of the efforts that we've been talking today. Dr. Kolodner, let me start with you.

Dr. Robert Kolodner: Well, as I have mentioned, for many years DoD and VA have been national leaders in the development and use of Health IT particularly with their electronic health records. As we've heard today, these agencies have been making tremendous contributions beyond sharing health data between DoD and VA in the broader collaboration area. They have brought and continue to bring their wealth of experience in sharing health data to national initiatives like the NHIN.

As the national coordinator for Health IT, I believe it's important for the public and private sectors to continue this collaborative work to advance intraoperability. And it's through these collaborations that we'll be able to provide service members, veterans, and in fact, all of us in the U.S. with the benefits of better care and improve population health that are enabled through the use of Health IT.

Dr. Jones?

Dr. Steven Jones: As we talked today, we are pleased that we do collaborate in achieving intraoperability with the VA and also now through Dr. Kolodner's effort with private sector.

We will continue to collaborate to build and buy technology that fulfills our requirements not only for us but also with our agencies that we will be working with in the future.

Mr. Morales: Dr. Cross, your perspective on collaboration?

Dr. Gerald Cross: At VA, we're highly motivated to continue and to enhance collaboration because we want to provide the best care that we can for our veterans. When I look at all the work that is being done in this area between VA and DoD, there has never been, in my opinion, greater collaboration, greater work, greater emphasis, faster pace in bringing this forward than there has been over the past several years and it's going to continue.

Mr. Morales: I'd like to transition to the future. Could you tell us more about the joint inpatient electronic health record study which I understand is assessing the future requirements for a seamless fully intraoperable electronic health care record? Dr. Cross, what are some of the key recommendations outlined in this report and what recommendations will you be pursuing and why?

Dr. Gerald Cross: We are going to pursue this and some other key recommendations I can summarize very simply - clinical leadership. There has to be clinicians directly involved in guiding this process, deciding what's important, deciding how it's structured, how it works so that it's really functional in their hands. We have to still those joint ground rules right upfront, for example, how we will manage security, the configuration, the interface.

Mr. Morales: Dr. Jones, what are some of the recommendations that you all be following?

The departments concluded the VA and DoD joint inpatient electronic health record study with recommendations that the departments jointly adopt a common service strategy is the best approach for the inpatient AHR. Those approaches will provide the flexibility which will not only achieve broader DoD and VA intraoperability but will also set the stage for the appropriate level of intraoperability with other government and private sector organizations.

Tom Romeo: In our conversation today, it's clear that establishing a seamless fully intraoperable electronic health record is not just about technology but about enhancing the continuity of care for service members and veterans. Dr. Jones, would you like to comment on that statement?

Dr. Steven Jones: Thank you, Tom.

The DoD-VAs ability to share information greatly impacts a full continuum of medical care. We like to look at this as a full continuity of care from the time the individual joins military to the time the individual moves into VA.

Through the DoD-VA IPO, we have taken those coordination and cooperation to new levels with oversight and governing bodies form to ensure that a shared effort continue to exceed expectations and meets the needs of our service members and beneficiary. The departments recognize all veterans start as service members and we need to share information to provide for this continuity of care.

We recognized this is a not a one way flow of information and that many veterans served as reserve and guard members, and of course in the present conflicts, we see this more than we have in the past.

Mr. Morales: So given all of your unique perspectives, what are some of the major opportunities and challenges that lie ahead of us and what advice may you have for the new administration. Let me start with you, Dr. Jones.

Dr. Steven Jones: Well, being an optimist, I think we have wonderful opportunities before us and particularly in electronic health record area, and one is I hope that the listeners have gathered from the day, because of this collaboration and sharing and working together, these opportunities are even increased more than it would be otherwise. So evolving technologies that are currently available make it more feasible to implement technologies that were difficult to implement years ago and all of us are aware of the speed of change .

And DoD and VA have a history of collaboration and established processes in several successful intraoperability initiatives from which to draw and as we continue to develop along these lines, again I think we will have lessons learned which hopefully will be applicable to others as they approach the challenges.

And I think the additional challenge is that to ensure that all of those who follow us and I'm sure it will occur that will maintain and be committed to working together in the collaborative forum which we have.

Mr. Morales: Great. Dr. Cross, your perspective on the future and advice.

Dr. Gerald Cross: I want to talk about two opportunities that I think can be found here.

The first is in training. In the VA we trained perhaps 100,000 clinicians per year. Each of them are being introduced to the use of electronic health care record systems and I think as they go forward into other areas of practice outside the VA, they will demand that they have this kind of tool made available to them as they see the benefits of it. And as what I said earlier, the research is a tremendous opportunity that is often unrecognized in regard to electronic health systems, health records. In the VA, we are doing tremendous amount of work in publishing thousands of papers that come out of the system. These serve not just the VA but the nation overall to improve health care not just veterans but everyone and some of the research involves finding out what kind of therapies work best, finding out new relationships between DNA and certain conditions.

Mr. Morales: Great. Dr. Kolodner, final thoughts and advice.

Dr. Robert Kolodner: I think, as both Dr. Jones and Dr. Kross have mentioned, we are really in a unique time right now where there's a real alignment and an understanding that we have to succeed in the area of Health IT.

I think some of the challenges include the fact that we need to be sure as we make this commitment of a very, very large investment in the area, a huge investment in this area that we use those fronts effectively and that we are clear about the targets we need to achieve. It's not just that we get electronic health records every place. It's that we get the effective use of those by health care providers to make sure that we bake in at the very foundation the privacy and security that's needed and the policies that allow individuals to know that their privacy will be respected and that their information will be handled securely.

So what we really wanting to do is to put in a nationwide health information network that actually fosters innovation and creativity and allows new ideas to come out and allows the system to evolve this is about using the technology to advance the health and well-being of the nation and of person-centered health and care.

Mr. Morales: Great. Thank you. Gentlemen, this has been a terrific and certainly a very compelling discussion and I certainly look forward to the advancement of this technology to increase the efficacy of health care within our country. Unfortunately, we have reached the end of our time. I want to thank you all for fitting us into your busy schedule, but more importantly, Tom and I would like to thank you for your dedicated service to our country, but more importantly, to the health of our men and women in uniform and our veterans.

Dr. Steven Jones: Thank you for saving us today and allowing us to discuss this important topic.

It's a wonderful mission serving in the Department of Defense ensuring that our military members from a health standpoint are ready to perform their duty when necessary, and when they are ill or injured that we're able to treat them with the highest quality of care and so that we can guarantee those moms and fathers and spouses that they will be taken cared of. I believe or I hope that our discussion today has demonstrated that we in DoD and VA and Health and Human Services are committed to working together and as federal partners to ensure that we are doing the utmost, provide the highest quality care prevention and rehabilitation to those who are willing to serve our great nation so thank you.

Dr. Gerald Cross: Our veterans have earned their health care through their sacrifice and we are absolutely committed to providing the best health care that we can. And the tools that we've been talking about in these discussions are tools that can be used very effectively I believe to further us toward that goal and we're absolutely committed to doing that and continuing to work with DoD to make sure that we work together for those same goals.

Dr. Robert Kolodner: I think it's right that the first groups that benefited from the pervasive use of Health IT have been those who've put their lives on the line for the nation. I think now is the time for us to leverage those investments the nation has made in understanding how to use those tools to help us to spread that adoption so that it in fact can benefit everyone in the nation. I look forward to working with all of you to do that.

Mr. Morales: Great. Thank you. Thank you, all.

This has been a special edition of The Business of Government Hour featuring a conversation on health care innovation. Our special guests have been Dr. Steven Jones from the U.S. Department of Defense; Dr. Gerald Cross from the U.S. Department of Veterans Affairs; and Dr. Robert Kolodner from the U.S. Department of Health and Human Services. My cohost has been Tom Romeo, IBM's General Government Industry Leader. As you enjoy the rest of the day, please take time to remember the men and women of our armed and civil services abroad who may not be able to hear this morning show on how we're improving their government but who deserve our unconditional respect and support, for The Business of Government Hour, I'm Albert Morales.

Dr. Gerald Cross, Dr. Steven Jones, & Dr. Robert Kolodner interview
04/11/2009
Join us for a SPECIAL EDITION of The Business of Government Hour -- a panel of key leaders from DoD, VA, and HHS will discuss the progress, the promise, and the importance of electronic health records and health information sharing to the delivery of health care. We are pleased to have Dr. Steven Jones, Principal Deputy Secretary for Health Affairs, Dr. Gerald Cross, Principal Deputy Under Secretary for Health at the VA, and Dr. Robert M. Kolodner, National Coordinator for Health

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