Leadership Message
Dear colleagues,
The Federal Electronic Health Record Modernization (FEHRM) office looks forward to hosting the fourth Federal Electronic Health Record (EHR) Annual Summit, October 22 to 24. At the summit, Department of Defense (DOD), Department of Veterans Affairs (VA), Department of Homeland Security’s U.S. Coast Guard (USCG), and Department of Commerce’s National Oceanic and Atmospheric Administration (NOAA) end users will share their feedback on the federal EHR to drive enhancements. The FEHRM optimizes the federal EHR by harnessing the critical insights of those who engage with the platform every day. By gathering and incorporating feedback from a diverse array of end users at the summit—including clinicians, allied health professionals, executives, informaticists, and more—the FEHRM ensures the EHR meets the needs of providers and patients.
Like the summit, this edition of FEHRM Frontline centers on the end user. CDR David Wright, FEHRM Optimization and Engagement Lead, shares how the FEHRM’s focus on interoperability helps end users. Dana Crudo, FEHRM Communications Lead, explains how end-user communication efforts led to a successful go-live. Also, read about Capability Block 11, released in August, that provided enhancements addressing end-user needs.
FEHRM Insight
FEHRM Interoperability Is Key to the Federal EHR
CDR David Wright, FEHRM Optimization and Engagement Lead
Health care is undergoing an exciting transition with mass adoption of EHRs. The federal EHR uses interoperability, the ability of different systems to connect and communicate with each other, to change how clinicians deliver better care to their patients.
There are four levels of health care interoperability:
- Foundational: Information technology (IT) systems need human input to understand the information they collect.
- Structural: Data exchanged between systems can only be interpreted at the data-field level.
- Semantic: Systems are fully capable of interpreting exchanged data.
- Organizational: Top-tier systems provide interoperability by including nontechnical considerations, such as policy, social, legal, and organizational aspects.
These concepts are critical to the FEHRM, as evident during the deployment of the federal EHR at the Captain James A. Lovell Federal Health Care Center (Lovell FHCC) in March. At this site, serving both DOD and VA beneficiaries, the federal EHR supports care for active-duty Service members and Veterans. The joint sharing site demonstrated a need for each level of interoperability throughout go-live:
- Foundational: Collaboration from all staff, from leadership to end user, was vital for successful implementation of the federal EHR.
- Structural: With all hands on deck, the Lovell FHCC team achieved seamless data exchange within and between the Departments, enabling high-quality health care regardless of where it is provided.
- Semantic: Clinicians had the right information at the right time for the right patient.
- Organizational: Continual communication and discussion about different organizational aspects ensured meeting Lovell FHCC’s requirements and end-users’ needs.
The results of this work at Lovell FHCC provided clinicians and patients a comprehensive history of health records, better access to managed care, secure communications, and available military treatment when transferring from active to retired status. Seamless patient record sharing enabled the secure exchange of patient health information across different federal agencies, facilities, and private health care providers.
The FEHRM’s investment in health care interoperability is reaping positive results wherever the federal EHR is deployed. Interoperability’s continual presence in the federal EHR underscores the need for systems and staff to communicate and collaborate for safer, more secure information sharing and ultimately better health care experiences and outcomes.
JSS-FHCC Focus
Effective Communication Paved the Way to a Successful Lovell FHCC Go-Live
Dana Crudo, FEHRM Communications Lead
At Lovell FHCC, the FEHRM helped converge and standardize different processes, workflows, and materials to enable DOD and VA to deploy the same federal EHR together for the first time. The deployment resulted in clinicians no longer needing to toggle between multiple EHR systems; instead, the patient record is available in one federal EHR. The deployment not only benefits the patients and staff in North Chicago but all sites within the broader health care system that need joint solutions to effectively deliver care.
To ensure Lovell FHCC deployment success, the FEHRM chaired 12 working groups, bringing together key subject matter experts and stakeholders from various organizations (e.g., DOD, VA, and vendors) to address items that required joint decisions and execution. These working groups proved critical in integrating efforts, overcoming challenges, and delivering solutions to complex problems. The Lovell FHCC Communications Workgroup serves as a leading example of this effort to align capabilities against joint challenges. The FEHRM led the cross-departmental workgroup to identify joint communications opportunities, converge and standardize communications activities, and bridge communications differences and gaps across the Departments and Lovell FHCC to create success. Workgroup members teamed up to:
- Integrate, develop, and distribute beneficiary, end-user, and enterprise communications that applied to DOD and VA—see a sampling in Figure 1.
- Develop joint templates, style guides, and business rules including an integrated template for daily end-user emails that responded to site resource requests and trends during go-live.
- Create collaborative workspaces and websites accessible to both DOD and VA users, including a Lovell FHCC Daily Messaging Resource page that housed daily updates and additional resources for end users.
- Produce crisis and go-live communications plans that established processes, roles, and responsibilities across the Departments and site.
- Collect stories, testimonials, quotes, and photos to promote the deployment success, helping to maintain morale and boost confidence and support.
- Ensure concurred joint press releases, media roundtables, and articles to highlight the collaborative achievements.
Figure 1. Taking the Best of the Departments to Integrate Lovell FHCC Communications
This unprecedented collaboration between the FEHRM, DOD, VA, and vendors allowed Lovell FHCC to benefit from the communications best practices, expertise, and experiences of multiple organizations and reduced duplication of efforts and confusion for the site. It helped build a foundation for future collaborative efforts related to patient portal, sustainment, system upgrades, and system status communications as well as determining federal EHR requirements together.
Ask the FEHRM
Why is the FEHRM using both SNOMED and ICD-10 codes for standardization?
The Systematized Nomenclature for Medicine Clinical Terms (SNOMED CT), overseen by the National Library of Medicine, and the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), overseen by the Centers for Disease Control and Prevention’s National Center for Health Statistics, are both comprehensive standardized clinical coding systems used worldwide, each serving a distinct and significant purpose. SNOMED codes are primarily used by clinicians, health care providers, and health information systems at the point of care, while ICD-10 codes are used for billing purposes and primarily by health insurers, government health agencies, and researchers. These two systems strive to standardize terminology across platforms, but due to the differences in granularity, emphasis, and organizing principles, this is not always possible. The FEHRM is identifying new terms related to military toxic exposure and validating that these terms are represented in both systems to ensure availability to health care stakeholders across the spectrum. These two different code sets help standardize medical terminology, enhancing health care interoperability and making the health care experience more efficient and effective. Visit the FEHRM website for more about the federal EHR and the FEHRM’s related work.
FEHRM Activities
The FEHRM Showcases the Federal EHR’s Capabilities and Benefits at DHITS 2024
FEHRM leaders presented in a plenary session and breakout sessions as well as exhibited at DHITS from August 20 to 22 in Dallas, Texas. Additionally, for the first time, the FEHRM provided an onsite videographer to record videos of leaders, Service members, and Veterans and capture photos of our activities. Here are some DHITS snapshots.
IZ Gateway Expands Immunization Reporting
Last summer, FEHRM Frontline reported on the initial DOD implementation of the federal EHR capability enabling end users to query and report immunizations to state Immunization Information Systems (IIS) via the Centers for Disease Control and Prevention’s Immunization (IZ) Gateway. Now, the capability is used by DOD sites in Virginia, Maryland, Texas, and the District of Columbia. They join the initial DOD sites in Washington, Florida, Oklahoma, North Carolina, and California. VA sites using the federal EHR in Oregon, Washington, Idaho, Ohio, Montana, Illinois, and Wisconsin are also live with this capability.
The IZ Gateway is a secure, cloud-based message routing service that enables data exchange among IIS and multijurisdictional vaccine provider systems. It facilitates a centralized data exchange that allows DOD and VA to eliminate the need for individual agreements with each state IIS. This federal EHR capability simplifies meeting state IIS technical and legal requirements through one point of entry. It also allows the Departments to comply with state laws that require immunization providers to report to state IIS.
IZ Gateway also enables clinicians to request an immunization record, improving access to beneficiary immunization histories when care is obtained outside of a clinic using the federal EHR. They gain access to real-time patient immunization data within their workflows and, in turn, spend less time searching for accurate, complete information. “This capability allows us to have a more complete medical health record because we get those immunizations we wouldn’t normally have from the registries,” Mr. Lance Scott, FEHRM Chief Technology Officer, says. Reporting this data also enables state IIS to better surveil the population and population health to improve vaccination rates and plan for emergencies. The FEHRM looks forward to continuing expansion of the IZ Gateway project to DOD sites in four additional states: Alaska, Colorado, Missouri, and Kentucky.
Recent Go-Lives and Capability Releases
Capability Block 11 Provides the Latest Federal EHR Enhancements
Capability Block 11 is part of a standard, biannual plan for the federal EHR to enhance existing capabilities, introduce new interfaces, and remain current on software code. The block adds new features that help save providers time, enhance medication management, reduce duplicative documentation, and streamline workflows to provide more efficient care. For more information about Capability Block 11 benefits, check out the informational placemat on the FEHRM website’s Lovell FHCC Communications Materials page.
Getting to Know FEHRM Partner Integration Director John Dempsey
How would you describe your job to a child?
First off, hands down, my job is awesome and always different. I build systems, much like robots or spaceships. The same way we make sure they walk, pick up things, or fly us where we need to go, we do it with medical digital systems for doctors, nurses, and paramedics. Basically, we make sure they are built exactly how we need them to be, and we can use them when we need them, safely. Doctors use our products to keep people healthy and make them feel better when they aren’t. Did I mention, my job is awesome?
Pictured: Mr. John Dempsey with daughter Aria Safia Dempsey.
What was your favorite subject in school and why?
My favorite subject in school is a tie between Earth Science and Algebra. Ranging from secondary school days to graduate education, this still holds true. Whether I was looking at the vast properties of the earth or exploring formula-based equations, it cemented a “systems think” mentality in me that would eventually mold and guide my career. Systems thinking always explores why and drives out-of-the-box thinking in an organized way. These two subjects were key in building that.
I was fortunate enough to serve in the U.S. Navy and was able to utilize my VA GI Bill to attend Purdue University and continue to build on this frame of mind within computer and IT business analysis. Additionally, another objective after the U.S. Navy was to graduate from an IT/system engineering program, which I did as well. These were two distinct milestones in my life, and where I am in my career today would not be possible without this foundation and love of system thinking, built from an early age. Boiler UP!
Growing up, what is the best advice you received from a teacher or mentor?
One of the best pieces of advice I received from my mentor was to harness your own voice and opinion. Often, we work in tightknit teams that are limited in staffing across IT development projects, so everyone must contribute. Diverse perspective is everything, and skilled insight across this dynamic is extremely valuable in nearly all cases. Taking this voice ownership to the next level also promotes better inclusion for everyone in the team and expedites team learning cycles. Bottom line, rather than solely depend on other people’s perspective in excess, try to build your own from the ground up and test your theories often as it matures within your circle. This, I think, was sage advice.