Is the highly-anticipated joint iEHR that the Departments of Defense and Veterans Affairs have been working on ready for a burial? Or not?

“iEHR is having a Mark Twain moment,” VA CIO Roger Baker answered. “Rumors of its demise have been greatly exaggerated.”

The follow-up question was point-blank: “So it's safe to say that the VA and DoD are continuing to work on a single joint iEHR, while also looking to reap some benefits of work already accomplished, that being what [Feb. 5's] news was all about?” 

“Yes,” Baker wrote in the e-mail exchange with Government Health IT. “We remain committed to the common data, application, and GUI standards we committed to at the start of the program.”

[See also: 3 ways the DoD and VA are accelerating patient data exchange via iEHR]

The departments' approach to iEHR “remains fundamentally consistent,” Elizabeth McGrath, deputy chief management officer at DoD, said in a call Feb. 5, and added that future plans for iEHR include using “common data standards, pulling together authoritative data sources, taking a service-oriented approach, the utilization of an enterprise services bus that enables us to move data to the place it needs to be in a standard way.”

That said, there has been a shift in strategy in that the VA will “use existing EHR technology to jumpstart the iEHR,” as Baker wrote, rather than building one from the ground up. For that existing EHR technology the VA will turn to VistA.

What’s less clear is from where the DoD intends to acquire its EHR technology. Officials said that the DoD is evaluating its choice for that core, and there is some speculation on the website of OSEHRA, the custodial agent working with the departments and the open source community, that the DoD is considering installing a new EHR from one of the vendors.

"I think everything you are seeing now is the result of a fundamental misunderstanding of the precepts you need to run an open source software community well and keep it evolving,” said John Scott, open technologies lead at RadiantBlue Technologies and a member of the Military Open Source Software community. “The fight between DoD and the VA doesn't make it easier.”

But is iEHR actually defunct?

“What they were planning for iEHR would have failed and would have been very expensive,” said Nancy Anthracite, MD, president and CMO of WorldVista, which offers an open source version of VistA.  “But that does not mean iEHR is dead.”

Indeed, the VA’s CTO Peter Levin on Feb. 8 tweeted that “the iEHR reports are incorrect.” 

It appears, instead, that the departments are fast-tracking a specific set of functions based on iEHR work already accomplished to exchange patient information now, rather than killing the project, an important distinction particularly given the cadre of obituaries circulating last week.

“If we leverage existing platforms, sharing data bidirectionally for clinical care, quality measurement, and care management, we achieve the same goals that iEHR proposed via a single integrated system,” John Halamka, CIO of Beth Israel Deaconess Medical Center and a board member at OSEHRA explained after the board met last week to discuss the iEHR strategy.

Whether iEHR ultimately thrives or perishes, time will determine -- just as it will tell if the recalibrated strategy steers VA and DoD physicians and clinicians to a strikingly similar endpoint as the one both departments were aiming toward before the Feb. 5 press conference. 

“Our goal,” Baker said, “is to make certain that we are creating a single medical record for all patients.”

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