Leadership Message
Dear colleagues,
Our focus on interoperability is more critical than ever. It’s thrilling to see all our partners—the Department of Defense (DOD), Department of Veterans Affairs (VA), Department of Homeland Security’s U.S. Coast Guard (USCG), Department of Commerce’s National Oceanic and Atmospheric Administration (NOAA) and so many community providers and stakeholders—collaborating to achieve our shared goal of implementing the federal electronic health record (EHR). Together, we are meaningfully using and sharing data while consistently enhancing the federal EHR to benefit our Service members, Veterans and other beneficiaries.
Our commitment to work as a team, focused on interoperability, is demonstrated in our groundbreaking work to deploy the federal EHR at the Captain James A. Lovell Federal Health Care Center (Lovell FHCC). This summer, the Lovell FHCC Implementation Team conducted a successful walkthrough of its mass readiness capability, which supports annual processing of approximately 40,000 Navy recruits preparing for military service. With the federal EHR implementation, expected in less than six months, Lovell FHCC becomes a model of seamless, integrated patient care for the broader health care space.
I was privileged to join my colleagues, Ms. Holly Joers, Program Executive Officer, Program Executive Office, Defense Healthcare Management Systems (PEO DHMS) and Dr. Leslie Sofocleous, Executive Director, Electronic Health Record Modernization Integration Office (EHRM-IO), on the stage at the Defense Health Information Technology Symposium (DHITS) in August.
I’d be remiss not to mention our recent expansion of the joint health information exchange (HIE) through its participation in Carequality. This one event puts us above all others, connecting the joint HIE to more than 90% of all U.S. hospitals—an incredible step toward interoperability.
With our team approach, we always find better ways to deliver the federal EHR and system improvements by incorporating the latest software and new interfaces while enhancing current capabilities for more efficient and effective health care. Read about these latest efforts in this issue of FEHRM Frontline.
Lastly, on a personal note, I welcome our new Chief Health Informatics Officer, Dr. Francisco Rhein, who comes to us with 20 years of experience as an internist. His expertise is essential to our mission, and we look forward to his unique contributions. As our team continues to grow, I’m excited for what we will accomplish next.
FEHRM Insight
Improving Electronic Health Records Using Artificial-Intelligence-Powered Solutions
CDR David Wright, FEHRM Optimization and Engagement Lead, Interoperability Workstream
Artificial Intelligence (AI) is principally used in EHRs to enhance data discovery and extraction as well as personalize treatments that improve quality of care. Machine learning (ML) applications illustrate AI in action. EHRs contain data assigned to certain areas of the record and others considered unstructured because it is either not designated to a specific area or it requires manual input to classify. ML applications can mine the unstructured EHR data for valuable information that can be difficult to interpret and access. ML can locate, collect, store and standardize many types of information, including data in clinical records, reducing time-intensive tasks. In this way, ML supports clinicians by reducing the need to manually investigate, collect and translate patient information.
ML can even track EHR data and classify markers to help anticipate illnesses—an example of predictive analytics. Research into the use of ML to help predict illnesses led to significant therapeutic advances. In 2019, for example, VA developed AI ML software that recognizes more than 90% of intense Acute Kidney Injury cases 48 hours sooner than conventional care strategies.
When incorporated into the EHR, AI can serve as an important tool to reinforce patient safety, helping to avoid the preventable human errors that cause more than 250,000 patient deaths in hospitals in the United States. This July, the Federal Electronic Health Record Modernization (FEHRM) office deployed a new Longitudinal Natural Language Processing (LNLP) capability into the federal EHR. This AI-driven EHR solution boosts clinicians’ efficiency because natural language processing (NLP) and ML can read an entire patient history in real time and connect it with symptoms, chronic health conditions or a life-threatening illness. This latest LNLP version will reduce Military Entrance Processing Command (MEPCOM) case review times for up to 70% of the 200,000 annual prescreened candidates who use joint HIE community partner data.
Another AI-powered solution is deep learning (DL), which also made great progress with innovations in computer hardware and software algorithms. Increased speed and computing advancements yield more powerful deep neural networks, augment clinical decision systems and give providers opportunities to reduce patients’ health risks. DL helps achieve these goals, as DL models become increasingly accurate in processing more data and essentially learn from repetition by refining the ability to make associations and connections.
AI is steadily redefining health care in several areas. AI-powered solutions enable medical stakeholders, clinical providers and health care professionals to identify patient needs and solutions with acute precision, using datapoints to make informed medical or business decisions quickly. AI-powered solutions incorporated into the EHR continue to make increasingly physician-friendly systems and show great potential for transforming health care.
JSS-FHCC Focus
The FEHRM Facilitates Lovell FHCC Mass Readiness Event
Showcasing the federal EHR’s new capability for mass readiness, the Lovell FHCC Implementation Team conducted a Mass Readiness Clinical Walkthrough in July at the Lovell FHCC U.S.S. Red Rover facility—where all Lovell FHCC naval recruits are processed for mass readiness. The walkthrough noted current-state activities and provided demos for users as a preview of the future state.
The mass readiness capability enables quick, simultaneous high-throughput processing of patients through clinical stations using established enterprise workflows. These stations include behavioral health screenings, immunizations, laboratory testing, ancillary exams, hearing tests and vision tests.
For Lovell FHCC, the mass readiness capability supports the site’s combined VA and Navy mission that includes the annual processing of approximately 40,000 Navy recruits preparing for military service. The U.S.S. Red Rover Team performed site visits where the mass readiness capability is already live to understand how their daily operations and existing automated tasks (e.g., registration and batch lab order entry) will evolve when Lovell FHCC goes live in March 2024.
No major issues or concerns were identified during the walkthrough. The Lovell FHCC Implementation Team recognized that U.S.S. Red Rover leadership and staff are proactively engaged in deployment activities and well-positioned for the Lovell FHCC go-live.
FEHRM Activities
The FEHRM Impresses at DHITS 2023
During DHITS 2023, FEHRM leaders participated in panel discussions and showcased federal EHR capabilities in the exhibit hall throughout the three-day annual conference.
The Joint HIE Now Participates in Carequality
The FEHRM expanded the joint HIE to include participating in Carequality, a framework enabling health data sharing between and among networks. The joint HIE is a secure gateway used to connect to participating provider organizations across the United States who agree to securely share clinical information with DOD, VA, USCG and NOAA. Participating in Carequality significantly expands the percentage of U.S. hospitals connected to the joint HIE from 75% to more than 90%—enhancing the ability to exchange patient data and resulting in more informed care for patients navigating between different health care systems and providers. With this connection, DOD, VA, USCG and NOAA clinicians, nurses and administrators gain access to an expanded set of external health records from participating provider organizations for patients. Other organizations previously unable to query these Departments can now retrieve data from them. The joint HIE is part of the FEHRM’s overarching effort to deliver capabilities that enable the Departments to deploy a single, common federal EHR. Learn more about the joint HIE on the FEHRM website.
Latest C-CDA Meets All USCDI v3 Requirements
A remarkable collaboration between the FEHRM, Office of the National Coordinator for Health Information Technology (ONC) and Health Level Seven® International resulted in the publication of the Consolidated Clinical Document Architecture (C-CDA) Companion Guide Release 4.1. This guide advances data standards for sharing patient information, marking a significant leap in health care interoperability. The guide implements the requirements of ONC’s United States Core Data for Interoperability Draft Version 3 (USCDI v3), which includes a standardized set of health data classes and constituent data elements for nationwide, interoperable HIE. Nationwide, providers exchange five to six million documents daily in support of patient care.
Recent Go-Lives and Capability Releases
- August 25: Capability Block 9 enhances existing capabilities in Pharmacy, Dental and RevCycle; introduces new interfaces, such as Video Visit Services v4; and remains current on software code for all DOD, VA and USCG facilities that are live with the federal EHR or affiliated with a live site.
The FEHRM Funnies
Joke of the Quarter
Wanna hear a joke about paper?
Never mind. It’s tearable.