The value of medical data and patient electronic medical records is enhanced with the sharing of, or interoperability of, information across multiple health networks, according to Crystal Baum, the director of data exchange at the Federal Electronic Health Record Modernization office.

Common solutions, tools, and activities are needed to ensure meaningful data sharing between patients and providers, said Baum.

The Federal Electronic Health Record Modernization, or the FEHRM, office along with the Department of Defense, Department of Veterans Affairs, Department of Homeland Security’s U.S. Coast Guard, Department of Commerce’s National Oceanic and Atmospheric Administration, and other federal partners are implementing the single, common federal EHR together. DOD refers to the federal EHR as MHS GENESIS, which enables a digital version of a patient’s medical records across the continuum of care for all 9.5 million DOD service members, retirees, and family members. The DOD completed the worldwide deployment of MHS GENESIS on March 9, 2024.

“The FEHRM digitizes patient records and implements capabilities to increase efficiencies, improve data quality, and allow the secure access and exchange of health information in one complete electronic medical record from the time you join the military through your care as a veteran to enhance patient care and clinical decision-making regardless of where care is provided,” said Baum.

According to the FEHRM website, advantages of a unified EHR for patients and providers include:

• Spending less time repeating your health history to providers, undergoing duplicative tests, and managing printed health records
Easing access to health records for providers, even after you leave the military
• Having productive conversations as providers have a comprehensive picture of your health record before your appointment
• Enabling more informed decisions because providers have access to more relevant data
• Experiencing seamless care through the joint Health Information Exchange, which enables providers to easily exchange and access health information to enhance quality of care and satisfaction

The federal EHR provides a tool box of capabilities to enable positive patient outcomes, advances interoperability and distills data now available via the federal EHR.

Data Interoperability

The joint HIE links federal EHR information with participating provider organizations’ EHR information that has been permitted by the patient. These run the gamut from single-physician offices to multi-hospital systems outside of the federal health care system. The FEHRM expanded the joint HIE in August 2023 to include CareQuality, a framework enabling health data interoperability between networks.

The action expanded the percentage of U.S. hospitals connected to the joint HIE from 75% to more than 90%; greatly expanding clinicians, nurses, and administrators’ access to an expanded set of patients’ external health records.

Vaccine Immunization Registries

Connecting with state immunization registries is one way the FEHRM is advancing interoperability, Baum said.

DOD and VA signed agreements to participate in data exchange with state immunization information systems, Baum said. Access to these registries provides consolidated immunization histories within the federal EHR and combines data for better population health outcomes. The Centers for Disease Control and Prevention Immunization Gateway provides a standardized policy infrastructure via a single integration hub and a message routing service, she noted.

Through the CDC’s Immunization Gateway, DOD is currently exchanging immunization data with five states and has plans to add four more states in the future. “We can bring that data in as well as report that data back to the state,” Baum said. “Having that data at your fingertips and to not have to vaccinate someone twice optimizes care,” Baum said.

TEFCA and the Common Agreement

The Trusted Exchange Framework and Common Agreement, mandated by the 21st Century Cures Act, will outline a policy and technical approach to enable nationwide exchange of electronic health information across disparate health information networks, also known as HINs.

For patients, providers, developers, and HINs, TEFCA “will provide a single on-ramp to nationwide connectivity that can support secure electronic health information exchange,” according to its website. “Once finalized, TEFCA will give patients, health care providers, payers, HINs, health IT developers, and other stakeholders access to data when and where it’s needed to better support patient care.”

HINs are the central connection points within networks that would be responsible for routing all the queries or responses and messages.

“At one point, the FEHRM would have to decide which HIN to join in order to participate in TEFCA,” Baum said, adding that the office will wait until TEFCA “hits a critical mass for it to be extremely beneficial,” from the FEHRM’s point of view.

Seamless Exchange

To streamline the federal EHR end-user experience, the FEHRM, DOD and VA focused on seamless exchange—an enhancement that retrieves, de-duplicates, and synchronizes data from numerous sources, ensuring ease of use and easy access to up-to-date comprehensive information.

Seamless exchange is also part of improved data sharing and makes interoperability more efficient, Baum said.

In 2022, VA piloted seamless exchange at a clinic affiliated with the Jonathan M. Wainwright Memorial VA Medical Center in Walla Walla, Washington. The federal EHR was deployed there in March 2022.

The pilot looked at problems, allergies, procedures, immunizations, and medications in the federal EHR. “Initial metrics demonstrated the reduction of duplicate records in each of these domains by at least 99%,” Baum said.

VA is planning to expand that pilot to other clinics affiliated with the Walla Walla medical center, “and then, eventually, to all of their sites due to the success of that pilot,” Baum said. “Hopefully, based on that success, DOD will decide to implement seamless exchange enterprise wide as well,” she suggested.

“The federal EHR has the ability to view a service member and their family’s care transition between the public and private sector and provide recommendations to proactively manage care gaps in patient care to improve patient outcomes,” Baum said. “A comprehensive view of a patient’s health record is within the federal EHR—anything ranging from a recent encounter at a nearby clinic, an immunization given at the local pharmacy, or an emergency room visit in another state.”