Important Lessons Learned

What has been accomplished at the FHCC is that VA and DoD have connected significant portions of the existing legacy records systems — sometimes directly and sometimes using more complex workarounds.

“We’ve been able to build the bridges that allow us to do that work,” said Jeffrey Murawsky MD, director of Veterans Integrated Service Network 12, where the FHCC is located. “The frontline clinician is able to interact on a patient — seeing and able to act on all the information on that individual — and making sure that inputted data gets back to the legacy systems.”

Many of the delays VA and DoD experienced had to do with underestimating the hidden complexity of even the simplest hospital action.

“A lot of the challenges had to do with fully understanding all of the business processes when you’re doing patient care,” Murawsky said. “Lab tests seem easy, but there are a lot of things that go on to make that happen.”

Those challenges included understanding each agency’s nomenclature, because they sometimes use different language to explain the same thing, and maintaining levels of security and privacy while making information transparent to all relevant clinicians.

“We had to do all this while the system is still running. We had to test these things while providing patient care. We can’t compromise safety, so we have to have four or five back-up systems in place, so any error is immediately corrected and fixed,” Murawsky said.

Murawsky said he expects the consults component to become fully functional sometime in the middle of 2013 and for the pharmacy system to be integrated in 2015. A shared progress note system also will be operational in 2015.

The long-term goal of VA and DoD is to have a shared module-based record system, which would require no workarounds. After spending the last few years building bridges between the two legacy systems, Murawsky can testify that a single IT system is the best way to go.

“Connecting two legacy systems, though possible, isn’t what we really needed,” Murawsky said. “I think we would not have a way toward an integrated electronic health-record system as clearly defined as we do if we hadn’t learned the lessons we have at this level.”

Costly Information Technology Delays Continue and Evaluation Plan Lacking

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