Lifetime EHR Could Mean Better Healthcare for Veterans

Lisa Eramo , April 23, 2009

When Deb Howard, 42, of Kingwood, TX was discharged from the military in 1992, she was given eight years' worth of her paper medical records in two tattered and worn out folders. And although the records include valuable health information, including every illness with which she had been diagnosed and every drug for which she had been prescribed during her military career, she says she has no idea where those records are now.

Upon retirement, Howard's husband, a 24-year military veteran, was also given his paper medical record, much of which was illegible and incomplete, Howard says. She says she has watched him carry those records from appointment to appointment ever since.

That's because currently there is no comprehensive system in place that allows for a streamlined transition of healthcare records between the Department of Defense (DoD) and the Department of Veterans Affairs (VA).

Like many other veterans, Howard and her husband must recall in detail their medical histories or simply carry paper medical records to their civilian doctors.

Sounds a bit archaic, right? This process seems especially ineffective, given the often long-term effects of diseases and injuries that veterans acquire or sustain during the course of their careers.

And it's also inefficient. "It's about avoiding unnecessary duplication and wasting valuable time," says Margret Amatayakul, RHIA, CHPS, CPEHR, CPHIT, FHIMSS, president of Margret A. Consulting, LLC, in Schaumburg, IL. "If one provider asks a patient about his or her condition and treatment to date, why shouldn't the next provider have that information?"

When patients must verbally repeat information about their own medical health, providers run the risk of receiving incomplete or inaccurate information on which they could base a potentially harmful decision.

But all of this may soon change as the DoD and VA begin to work together to create a new joint virtual lifetime electronic record that will track veterans' health information from the day they enter the military, throughout their military career, and even after retirement.

The project is a step in the right direction, given the national push for EHRs and interoperability under the American Recovery and Reinvestment Act of 2009. Securely sharing information is the wave of the future, and it will most likely foster more efficient, effective, and personalized patient care than we could ever begin to imagine would be possible today.

President Obama announced the plan in an April 9 article published by the American Forces Press Service and the U.S. Department of Defense. The joint virtual lifetime electronic record will allow the DoD and VA to standardize the way they share information and improve the delivery of care and services to veterans who are transitioning from military to civilian life.

"When a member of the armed forces separates from the military, he or she will no longer have to walk paperwork from a [Defense Department] duty station to a local VA health center," President Barack Obama said in the article. "Their electronic records will transition along with them and remain with them forever."

The need for a more streamlined process is critical in terms of patient care and research into new ways to afford active protection and treatment, says Amatayakul. "Hopefully, it should go a long way to solving the problem, although some veterans are treated in private hospitals, which may be more challenging to integrate."

However, universal integration is what will truly make a difference in veterans' lives and healthcare, says Joe Cruz, healthcare technology consultant in Chesterfield, MO. "Unless you enable universal exchange of data, then you will still be missing critical pieces of that military members' chart from when they were seen or provided care at a commercially contracted hospital or private physician," he says.

The DoD contracts out much of its healthcare to private hospitals when its own facilities are either too remote or when the patient volumes do not justify providing certain services, Cruz says. The ideal goal of the project should be to devise a truly interoperable longitudinal record that can accept data from and send data to disparate systems, including a DoD facility, VA hospital, contracted commercial hospital, or TRICARE contracted private physician's office, he adds.

Howard admits that having a centralized record would ease the burden of having to carry paper information to appointments or recall years' worth of personal health information. "The bottom line is that if all your information was located in one place at the touch of your finger tips in any doctor's office across the country, I think your individual care would be better," she says.

The joint virtual lifetime electronic record will hopefully serve as a model for a national EHR system, Amatayakul says. For now, the DoD and VA are logical agencies with which to begin the process because they are both under the federal government's jurisdiction and are mandated to adopt electronic records, she adds.

The White House has not yet released details of how the DoD and VA will achieve lifetime electronic record; however, the administration has stated that the project is part of an overall increase in funding for the VA that includes $25 billion over the next five years to honor the nation's veterans and expand the services they receive.

Lisa Eramo, CPC is a senior managing editor in the health information management division of HCPro, Inc. She is located in Rhode Island and writes content for the company's flagship newsletter, Medical Records Briefing. Contact her at

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