By Bob Brewin
December 19, 2013
Decades after the Pentagon and Veterans Affairs Department developed separate electronic health records for military personnel and veterans, here’s how the Navy transfers potentially millions of pages of sailors’ and Marines’ medical files to VA: It prints them out on paper and mails them via the U.S. Postal Service, Nextgov has learned.
At the same time, VA has launched a massive bulk scanning operation to copy 70 million pages a month of the department’s own paper files, including service treatment records, into electronic format as PDF files.
VA and the Defense Department reached an agreement in February for Defense to bulk scan all such treatment records as of Dec. 31 for electronic transfer to the VA, but that process still includes printing and mailing paper records.
Karen Roberts, a Defense spokeswoman, said Defense sends millions of fields of data to the VA daily for both healthcare and benefit adjudication purposes. She did not answer a question from Nextgov about whether the Army and Air Force also print out and mail copies of electronic health records to the VA.
The labor intensive and costly efforts to transfer electronic health records between the two departments contributes to the lengthy backlog of disability claims at VA and illustrates the longstanding need for the departments to integrate their health records systems, critics say.
A service treatment record contains all medical information on an active duty service member, from his or her first physical examination upon entering service through their final physical before they are discharged from service, along with clinical notes on all consultations and treatments received in the interim. Depending on a service member’s time in uniform and medical conditions documented, a single STR can run to thousands of pages. With the Defense Department discharging 300,000 people a year, that means officials must transfer tens of millions of pages of medical records to the VA, an industry source familiar with the process said. VA needs complete treatment records to evaluate disability claims. Currently it takes the department 125 days to retrieve STRs from Defense, considerably extending the time required to process a claim.
Defense began developing its electronic health record in 1988 at a cost of billions of dollars. Its current system, the Armed Forces Health Longitudinal Technology Application, contains records for 9.7 million active duty and retired personnel and their beneficiaries. An industry source said the practice of printing and mailing files from electronic records in 2013 is “ludicrous.”
But that’s exactly the approach the Navy and Marines are taking, according to an internal Nov. 13 Marine Corps message:
“THE BUREAU OF MEDICINE AND SURGERY (BUMED) HAS ESTABLISHED THE NAVY MEDICINE RECORDS ACTIVITY (NMRA) AS THE CENTRAL SITE FOR COLLECTION OF ALL STRS. THE PURPOSE OF NMRA IS TO PERFORM A QUALITY ASSURANCE REVIEW ON ALL STRS TO ENSURE COMPLETENESS PRIOR TO FORWARDING THE STR TO THE VA.
EFFECTIVE IMMEDIATELY AND UNTIL 31 DECEMBER 2013, ALL STRS WILL BE MAILED TO NMRA AT THE FOLLOWING ADDRESS: NAVY MEDICINE RECORDS ACTIVITY (NMRA), BUMED DETACHMENT ST LOUIS, 4300 GOODFELLOW DRIVE BLDG 103, ST. LOUIS, MO 63120.
The address is the location of VA’s national records management center.
The message directed that the STR package mailed to St. Louis include information printed from AHLTA and the Composite Health Care System, which contains pharmacy and lab information.
Another industry source with extensive military background said it makes no sense to send paper rather than electronic files. The fact that the military is doing so illustrates the need for a single electronic health record for both Defense and VA. As a minimum, the Navy should be able to convert the AHLTA files to a PDF, easily read by any computer system, he said.
Longstanding Claims Backlog
VA, which processed more than 1 million disability claims last year, is awash with paper files, and set up a bulk scanning system in September 2012 to convert 165 million pages of veterans’ records into tagged and searchable digital files between then and July 2013.
Defense agreed with VA on Feb. 22 to send complete — and certified — STRs in searchable PDF files by Dec. 31, using the Healthcare Artifact and Image Management Solution, which was originally developed to store, manage and provide access to medical imagery.
An amendment to the 2014 National Defense Authorization Act, expected to pass the Senate this week, gives Defense another six months to deploy HAIMS, an indication the system is not yet ready to handle electronic transfer of service treatment records to the VA.
Defense Secretary Chuck Hagel told Rep. Jeff Miller, R-Fla., chairman of the House Veterans Affairs Committee, in a June 24 letter that “We expedited the deployment of the Healthcare Artifact and Image Management Solution, which will digitize paper-based medical information on all separating service members. This will be in place by December 2013.”
The Marine message indicates that the Navy will still print and mail portions of the STR to its central office co-located with the VA records center. The message said notes in AHLTA will be transmitted electronically “PRIOR TO MAILING A PAPER STR.”
An internal document obtained by Nextgov shows Defense plans to install hardware chosen from a list of 11 manufacturers at the 59 military hospitals and 364 clinics that will handle the bulk scanning of STRs sent to the VA.
Roberts said the services have elected to do the majority of the bulk medical record scanning at central locations and are installing high volume scanners and other supporting hardware. Some larger military treatment facilities may also do bulk scanning onsite.
Defense has developed an image repository and placed additional servers in operational areas to improve the response time and synchronize data with the central repository.
The internal document Nextgov obtained assumes these hospitals and clinics will have network connections ranging in speed from 100 megabits per second to one gigabit per second to handle the fat STR PDF files. An industry source said only two military hospitals have one gigabit connections — Walter Reed National Military Medical Center in Bethesda, Md., and the Naval Medical Center in San Diego, Calif.
An industry source said the numerous configuration requirements for 11 types of bulk scanners imposes a burden on the small IT staffs of military hospitals and clinics, not to mention the personnel needed to manually feed paper into the scanners.
Asked how data will be transferred from HAIMS to the VA paperless Veterans Benefits Management System (VBMS), Roberts answered in the future tense. She said that when a veteran files a disability claim, VBMS will automatically query another VA system, which in turn will query the HAIMS data repository for the certified complete service treatment record. If it is available, the VA system will retrieve and store the treatment record, to be viewed later by a claims adjudicator using VBMS.
Meagan Lutz, a VA spokeswoman, said the interface with HAIMS was integrated into VBMS on Monday, Dec. 16. She said it will be activated after end-to-end system integration testing is completed, which VA estimates will be finalized later this month.
By Bob Brewin
December 19, 2013