Veterans Health Administration thinks key to interoperability may be in the cloud

The giant Veterans Health Administration is poking its head into the cloud to see if therein lies the key to sharing data within and outside of its sprawling healthcare delivery system.

The goal of the Digital Health Platform is to pull patient data from the VA, military and commercial electronic health record systems, applications, devices and wearables and send it to a patient's healthcare team in real-time. That would allow patients to more easily obtain health care from physicians and hospitals outside of VA facilities, but some experts say a cloud-based platform also leaves it vulnerable to hackers.

So far, the DHP pilot program has drawn three participants — Chicago-based Apervita, as well as MuleSoft and Salesforce Health Cloud, both of which have headquarters in San Francisco.

Apervita will provide what it says is a real-time healthcare data analytics platform; MuleSoft, a layer of application programming interfaces for data extraction and Salesforce, its expertise in cloud-based customer relationship management.

President elect Donald Trump recently suggested through his transition team that veterans should be able to have more choices in where they go for their healthcare, saying they should be able to visit private sector providers.

The Trump proposal is broader than Veterans Choice program reforms passed in 2014 in the wake of the wait times scandal.

Either approach puts pressure on the VHA to improve interoperability.

The VHA and the Military Health System have spent more than a decade and hundreds of millions of dollars to enable their two EHRs to communicate patient information between each other.

The VHA is the largest integrated healthcare delivery system in the U.S., providing care to about 8.7 million veterans a year at 152 hospitals and 990 outpatient clinics and 102 residential rehab centers among other facilities. The system uses the venerable VistA electronic health record and other systems that the VHA developed itself in an effort to contain costs.

For more than a decade, various efforts have been made to scrap VistA in favor of a commercial EHR purchased off the shelf. The military awarded a $4.3 billion contract in 2015 to Cerner, Leidos, Accenture and several other firms.

Work on DHP began last summer under contract with Georgia Tech, said spokesman Rick Halton.

The DHP has a "very, very ambitious goal trying to come up with the ultimate solution” to address interoperability, said Seong Mun, CEO of one of the VA's not-for-profit arm, the Open Source Electronic Health Record Alliance, which aims to coordinate its future open source projects.

OSEHRA has updated VistA's interface and improved its interoperability with outside providers.

But the entire DHP process “has been somewhat opaque to us,” despite efforts by OSEHRA and its members to participate, Mun said.

Mun likened the two approaches taken by the VHA as branches of the same religion.

Historically, the healthcare industry has been reluctant to embrace cloud-based approaches to handling clinical data. Some argue that cloud is more secure, because the economies of scale that make them cost-effective also enable greater investment in data protection. Others argue that it's less secure since going to cloud adds that many more entities in which data is handled.

Interoperablity is "heaven," but the commercial or open source routes mean they are taking either a Catholic or Protestant route to arriving to the gates.

The relationships being built through the DHP project given the VHA the option of marketing its cloud-based solution if it works.

Apervita, one of the participants, operates an online marketplace in which providers and other users of its platform can sell their intellectual property. For example, the Mayo Clinic offers an application that enables users to estimate a heart disease patient's risk of sudden cardiac death and recommends whether an implantable defibrillator is indicated.

However, Halton said there are no plans at this time for the VHA to offer its intellectual property.

Last week, President Barack Obama said the lack of advancement in sharing data was the in the Affordable Care Act. During an interview with Vox, Obama blamed healthcare's decentralized nature and “economic incentives against making the system better."

"Doctor make money on keeping people's medical records – so making it easier for everyone to access medical records means that there's some folks who could lose business,” he said.

The Obama administration spent nearly $36 billion to subsidize providers' attempts at improving EHR systems and their usability.

Joseph Conn

Joseph Conn reports on information technology, privacy and data security. He has been a reporter and editor for 35 years for various news publications and taught journalism at Valparaiso (Ind.) University, where he earned his bachelor's degree in English. He also worked as a Peace Corps volunteer in Sierra Leone. Conn joined Modern Physician in 2000, serving as reporter, editor and online editor. He joined Project Japan in 2005.



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