VA-DoD electronic records system at Step 1

The Mann-Grandstaff VA Medical Center in Spokane, Wash., is step one in a long-awaited march toward a lifetime electronic system that aims to finally end the days of brown folders, floppy disks, faxes, microfiche, lost, burnt or scattered military medical records. Missing records, to the frustration of veterans and American Legion service officers trying to help them, can mean the difference between VA disability benefits or none.

Two executives from Cerner Corp., which in 2018 began a planned 10-year project to modernize and integrate VA and DoD medical records, told members of The American Legion’s Veterans Affairs & Rehabilitation Commission that the Cerner system is up and running at more than 600 DoD and U.S. Coast Guard sites, but VA’s only live system was installed last fall in Spokane. A timeline for additional VA sites has yet to be announced.

The American Legion has made an integrated DoD-VA medical records system a top priority for over a decade, a point American Legion Veterans Affairs & Rehabilitation Commission Chairman Ralph Bozella noted in his introduction of twice-deployed Army Reserve surgeon Dr. Lisa Flynn, chief medical officer of Cerner Government Services, and Army veteran Danielle Applegate, who leads the company’s Veteran and Military Family Engagement program.

“My mind goes back to 2012, at least, when The American Legion had a resolution supporting this electronic health-care records update and the fact that DoD should be working with VA to get something done,” Bozella said. “That’s what this is all about, so a veteran leaves service with their health records intact, and it transfers over to VA.”

Such a transition, estimated to cost $10 billion in 2018 when VA began working with Cerner on it, has so far involved the migration of about 100 billion pieces of VA medical data and the development of some 24 million VA medical records, Flynn told the commission. “We are not quite at our deployment timeline for VA yet, but we are getting there. After 20 years of starting and stopping, we are getting there.”

Cerner’s medical records platform, which Flynn used as a doctor prior to joining the company, is used by more than 650,000 physicians and 2.2 million non-physician providers worldwide. The system collects and maintains complete health records – prescriptions, lab results, doctor’s notations and other data – to inform patients and providers about treatment histories. “We are also increasing features, such as registries, so all of your toxic exposures, we can get that all in your medical record,” Flynn said.

She explained that when she retired from the Army Reserve about 10 years ago, she received a package that contained a brown folder full of medical records, a diskette and some microfiche. That was her military medical record. The diskette, she found, was particularly useless. “I have no idea what’s on that thing because I don’t know anybody that still has a computer with what used to be called an A drive.”

A lifetime integrated records management system will make such outdated packages go “the way of the dinosaurs,” she said. “We are committed, at Cerner, to get this right. The servicemembers, veterans, families, caregivers and survivors deserve this.”

One feature of the system is patient safety, Flynn said. “We have already had nearly 300 opioid prescriptions modified based on an alert that pops up in the system that lets the provider know that the patient – veteran, servicemember, family – may be at risk for opioid-abuse disorder. Three-hundred times that has popped up, and the provider said, ‘You know, maybe I’ll change this prescription and give them something else.’” She added that the Cerner system is online with 46 of the 50 U.S. states, each of which have their own prescription-monitoring programs.

American Legion Veterans Benefits Committee member Thomas Goodin of Missouri asked the Cerner officials about the records of veterans who served before the computer era.  “What about our records? The people who served before the computers – who served in the ‘60s and ‘70s? Our records are scattered everywhere.”

Applegate said the Department of Defense is plowing through the mountain of older records. “The DoD has been working pretty diligently to digitize all of those records,” she said. “From what I understand, every record post-1990 is already digitized, and there about 12 million outstanding records that are on the list to keep going. It is a process. You are not forgotten. It is a work in progress.”

Goodin also mentioned the 1973 fire in St. Louis that destroyed some 17 million military records and the burden that placed on veterans seeking documentation to prove service-connected health conditions later in life.

“The value of going to an enterprise-wide single system across two and three large government agencies is that we will never have to worry about that again,” Applegate said. “If you break that floppy disk, if you lose that microfiche or something burns down, we will have a backup of a backup across not one, but two government agencies.”

Also, in response to a question from commission member Jennifer Havlik of Minnesota, Applegate assured the group that the system is protected against any kind of catastrophic data meltdown. “The value of Cerner is that we are a global company. We’re on every continent. We have data backed up six ways to Sunday. We haven’t had any data loss to date, and we don’t expect any in the future.”

The system may only be functioning in one VA health-care system at the moment, but Flynn says that first step is working and has proven helpful during the COVID-19 vaccination process. “With 600 DoD sites live and one VA site live, with its CBOCs (community-based outpatient clinics), we already have 700 patients who have seen that system working. We had 320 patients who got their first COVID shot at either VA or DoD, and they got their second COVID shot at the other department, because the systems talk to each other. We’re pretty excited about it.”

As for future sites where the integrated system will go live, Flynn said news is expected soon. “We have heard that we should be expecting a new deployment schedule for VA hospitals in the very near future.”