Nonetheless, 'we fully recognize that medical data interoperability requires steadfast commitment and continuous improvement'

DoD on interoperability requirements: mission accomplished

By Mike Miliard
10:59 AM

In a letter to the U.S. House of Representatives this past week, Under Secretary of Defense for Acquisition, Technology and Logistics Frank Kendall wrote that DoD "has met the interoperability requirements" of the National Defense Authorization Act.

The Defense Authorization Act mandates that the EHR systems of DoD and the U.S. Department of Veterans Affairs be linked with an integrated display of data, complying with standards and technical architectures described by DoD/VA Interagency Program Office and the Office of National Coordinator for Health IT.

"DoD and VA have closely partnered to meet the 2014 NDAA requirements," Kendall writes. "The The VA is  currently working to finalize their efforts; once both Departments have met their requirements, DoD and VA will provide a joint certification to Congress."

In order to have a framework for complying with the NDAA, the DoD/VA Interagency Clinical Informatics Board "has endorsed 25 prioritized data domains to support continuity of care and Veterans benefits adjudication," he writes. "For both Departments, three domains have no structured data to map. For the remaining 22 domains, the IPO has established national standards for both Departments' electronic health record systems. This process is documented in the IPO's Health Data Interoperability Management Plan.

"For domains that do not have structured data, the information is currently captured in the clinical notes in the legacy systems," he adds. "These clinical notes are shared and provided in an integrated display. Moving forward these domains will be included as part of our electronic health record modernization plan."

DoD has now mapped all 21 domains requiring national standard terminologies, writes Kendall -- representing nearly 1.8 million unique clinical terms.

"Over the past year, we have completed four data mapping deliveries," he writes. "DoD subject matter experts and the IPO conducted independent quality assurance reviews of these mappings to ensure their accuracy. Additionally, DoD has established a data governance process to actively manage and continually improve utilization of national standards as they evolve in the future. These domains are available to VA clinicians and benefits analysts through the Defense Medical Information Exchange Program and the Health Artifact and Image Management Solution (HAIMS).

"DoD health data is currently electronically accessible and viewable for the 22 data domains," writes Kendall. "In FY 2014, data and national standard mappings for seven of the highest value clinical care domains were provided in the Joint Legacy Viewer (JLV) for an integrated display. This initial delivery comprised over 70 percent of relevant data for outpatient encounters. In FY 2015, DoD delivered two additional builds of JL V and supporting data infrastructure upgrades.

"Today, JLV includes 13 additional data domains and updated national standards mappings, for a total of 20 domains in an integrated display of data. The additional domains include both DoD, VA and private sector health data and represent more than 99 percent ofthe most frequently used and high value data terms."

The JLV "offers an integrated display and access to more health information than any other viewer or system used by either DoD or VA," writes Kendall. "This capability will be part of DoD's EHR modernization to ensure continued interoperability."

Nonetheless, he writes, "we fully recognize that medical data interoperability requires steadfast commitment and continuous improvement."

Indeed, while DoD may have met the letter of the law as far as its interoperability responsibilities, it recognized that there was a long way to go before data exchange was optimal between the two agencies.

"We've done a lot to get this information to a point where it's both shared and it's usable, but we recognize that we're going to continue to have to do more things to actually continue to make it as useful as possible," said Chris Miller, the program executive officer for Defense Healthcare Management Systems, according to a news article on

In the meantime, even though the Joint Legacy Viewer is still in a testing phase, it's already proving its value, Miller said. "This data does a lot to help people and it also does a lot to improve how our clinical providers do their job."

Read Kendall's full letter here.
Read the article here.

See also:

Interoperability still years away for VA and DoD
DoD and VA: When will your EHRs really interoperate?
DoD: New EHR not about interoperability with VA