Alie Cohen

Military Healthcare Interoperability 101

May 27, 2021

Healthcare in the military has achieved significant progress in the interoperability landscape. Both the Military Health System and Veterans Affairs have worked together to develop and implement interoperable technologies that allow the secure exchange of records.

Military Healthcare Interoperability 101

After the longest year of our collective lives, we greet Memorial Day Weekend with a sense of disbelief. I’m still stuck in March… 2020… as I’m sure many of you are feeling too. Yet, here we are, on the verge of a new summer. Memorial Day weekend is pretty special for me from a personal perspective as five years ago, on Monday, May 30th, 2016, I welcomed identical twin girls into my life. Giving birth on Memorial day always gets me thinking about hospitals and how they work around this time each year. I figured what would be a better way to take a quick break from our federal policy series than to pay homage to the meaning of Memorial Day and talk about healthcare in the Military, what has been done to ensure the system is interoperable and that records are accessible. Okay, not really a break from federal policy per se… but something a bit different.

Military Healthcare Interoperability 101:

Healthcare within the military is split into two federal government institutions that reside in different Cabinet-level departments. Within the U.S. Department of Defense (DoD), the Military Health System (MHS) is responsible for the healthcare of active duty and reserve military personnel and their dependents and operates both military facilities and a military-specific insurance plan called TRICARE. Once a service member leaves active or reserve duty, that responsibility shifts to the U.S. Department of Veterans Affairs (VA) to provide healthcare to eligible retirees where there is space within the VA system. As with many cash-strapped agencies, the VA does not have enough resources to provide care to all Veterans so in many cases, the responsibility for veteran care shifts back to the MHS and care is provided through TRICARE. Veterans can go back and forth through the different parts of the system for years as their circumstances change.

Both the MHS and the VA do a lot of work to coordinate care within their own system as well as across the departments, specifically when it comes to the transition of a service member from active duty to veteran.  As part of the 2008 National Defense Authorization Act (section 1635 for my policy people) the MHS and VA were required to develop and implement an interoperable system that allowed for the exchange of records between the two departments. What’s amazing, is they actually did it and were somewhat successful in exchanging records—specifically discharge summaries from their hospitals.  

In 2013 the MHS decided to begin an EHR modernization program and the Cerner Millennium platform was chosen for implementation, given the name MHS Genesis.  A few years later, the VA embarked on their own EHR modernization program which ultimately chose the same EHR as the MHS program, paving the way for true interoperability between the two systems.

In 2019, the Federal Electronic Health Record Modernization (FEHRM) program office was chartered to work with both agencies to fully implement the Cerner Millennium system in order to enhance patient care and provider effectiveness, and make records accessible, wherever care is provided within the system.

In addition to modernizing the EHR systems in use and making them interoperable,  in April 2020, the FEHRM launched the Joint Health Information Exchange, an HIE (noun) to provide record sharing both between the common system and private sector systems to increase care coordination for military personnel who may seek care outside of the MHS and VA systems.  This also allows private-sector systems to exchange and access this information for Military personnel who may seek care outside the system. This HIE was then connected to the Commonwell Health Alliance (yes, you remember them) to link federal EHR information to private sector EHR information.

Over the past year+ of the pandemic, the veteran population was hit exceptionally hard with over 250,000 reported cases of COVID-19, and over 11,000 deaths due to the virus. The innovations that have been made to enable care coordination in the military population allowed veterans to continue their care, even as individual systems were overwhelmed. As the vaccine became available, the VA even became a leader in its distribution. The many projects that the military health system has taken on to ensure interoperability and patient access to data (more about something called blue button next time) has made them a model for the private sector to look to as an example of systems working together to exchange information to best serve the needs of their populations. This weekend, when I celebrate the births of my twins, inevitably, I will also stop to salute the innovations of military healthcare interoperability.