The closest thing to a stampede at HIMSS12 occurred as soon as they opened the doors for the joint DoD/VA iEHR panel discussion – as people poured in faster than previous session attendees could swim upstream and out of the room. Even the conference officials furiously adding new rows of chairs couldn’t accommodate the crowd.

“Two competing forces are completely shaping our reality,” said David Wennergren, assistant deputy chief management officer at the Department of Defense said during “A new era in DoD/VA health IT.”

The first is the pace of health IT innovation, second being these turbulent economic times in which we live and work. “We can no longer afford to spend millions and millions of dollars,” Wennergren said. Nor can we stick with monolithic tightly-coupled technologies. “The future is about open architecture and modular approaches.”

[Related: MHS gives glimpse of future HIT.]

Acknowledging that will necessitate a fundamental shift, Wennergren added that “together, the DoD and VA account for 18 million patients. That’s a force that can move markets.”

Indeed, the goal of VLER and iEHR is to track patients from the time they sign up for the military until the end of their lives.

As the panel opened up to questions, military pediatrician Alexander Holston, MD, CMIO of Nav Med-East in Suffolk, Va. stood up.

“I have a saying ‘babies aren’t mini-adults but adults can be big babies,” Holston said. His question: If VLER is to be a lifetime record, will it be applicable to newborns?

“First, I’ll establish my credibility to you. My husband is a pediatrician,” said Karen Guice, MD, principal deputy assistant, Secretary of Defense for Health Affairs, and acting CIO.

[Related: Surgeon General awards mobile app winners.]

Guice added somewhat jokingly that her husband would not allow VLER to avoid including newborns, but that is something the DoD and VA have to work on.

Indeed, the military patient population is changing to include more women, more reserves, and ultimately more children.

Adding new types of patients is just one way that the VLER and iEHR projects are evolving. The projects are also turning to the private sector, making sure that standards are there – even if that means iEHR driving standards that don’t already exist.

“Imagine a common platform with a common data model and architecture, with a common look and feel,” Wennergren said. Indeed, that’s the dream of VLER and iEHR.