Federal EHR Expanding to More Agencies, Connects Care at Sea

Federal agencies are expanding their use of the Federal Electronic Health Record program, with more organizations joining the system and existing participants adding capabilities to improve health care delivery, officials said Wednesday at the Health IT Summit.

Leaders from the Federal Electronic Health Modernization Office (FEHRM) and the National Oceanic and Atmospheric Administration (NOAA) highlighted recent efforts to expand and upgrade electronic health record capabilities across government.

FEHRM is a multi-agency government entity chartered to implement a single, common federal EHR system. The office is actively working with a number of federal agencies seeking to join the system.

At least 14 federal agencies are currently in various stages of negotiations to join the federal EHR program, said FEHRM CTO Lance Scott. The office currently supports EHR capabilities at the departments of War and Veterans Affairs as well as the Coast Guard, NOAA and other agencies, he said.

“We’re really happy to see it expanding,” Scott said.

Healthcare Data Exchange

FEHRM also helps operate the military’s Joint Health Information Exchange (HIE), a secure digital gateway that allows federal and civilian health care providers to share patient medical records across the country. It is the largest HIE of its kind in the country, Scott said.

To help clinicians navigate that information, FEHRM is working with AI tools that use longitudinal natural language processing. The capability allows military users to analyze records across the HIE for a variety of purposes, such as processing people returning to active service.

That process previously took staff about 10 days as they sifted through numerous documents. The automated system can analyze large amounts of medical data and identify relevant records in hours, Scott explained.

“It boils the ocean down to, ‘hey doc, you need to look at these 46 documents because these contain the terms you’re looking for.’ It’s reduced our processing time from 10 days down to about five hours,” Scott said.

Another area of progress is the Trusted Exchange Framework and Common Agreement (TEFCA), a nationwide framework designed to streamline health information sharing by connecting participating health information networks. It is one of the pillars of the Joint HIE, Scott said.

He added that transitioning to TEFCA will take time, but the shift could significantly expand health data exchange.

When it does [transition], it’ll just be an astronomical shift in data exchange,” he said.

Serving NOAA’s Unique Workforce

NOAA implemented its electronic health record in 2022. The agency’s workforce includes a unique mix of civilian employees and uniformed service members, explained Cmdr. Scott Miller, director of NOAA’s Office of Health and Health Services.

NOAA has its own uniformed service, with personnel supporting missions that include marine operations, aviation and diving.

“It’s all about operational readiness. We’re not your typical clinic where you’ll come and see us for a cold. We’re basically making sure that you’re medically ready to go out to sea to fly and to dive, and from there we’ve had various partnerships,” he said.

Because NOAA interacts with both military and civilian health systems, the federal EHR gives its personnel access to care across a range of supported federal medical facilities.

“From a health IT standpoint … we didn’t want a single NOAA EHR. We wanted to be on the broader EHR ecosystem,” Miller said.

Connecting Care at Sea

One challenge for NOAA is providing health care to personnel aboard ships and aircraft monitoring storms and other atmospheric events. Medical emergencies at sea or in the air can be particularly difficult to manage. In the past, Miller said, remote medical information was largely communicated by phone or radio.

In addition to connecting to the broader federal EHR, NOAA launched high-speed satellite internet service aboard its ships several years ago. The connectivity allows NOAA to transfer scientific data as well as health records, Miller said.

“Now, instead of talking to a patient, getting a history from a patient, going on their word, then scribbling it down, and then phoning a friend, now we’re actually talking to the patient and reviewing their comprehensive record, because now we’re connected,” he explained.

NOAA has also deployed telemedicine kits across its fleet. The video connections allow personnel at sea to consult with shore-based medical providers and transmit real-time medical data, including EKGs and digital stethoscope readings. The technology enables personnel to conduct a range of diagnostic tests in consultation with doctors and specialists.

“It’s been an absolute game changer. … We’re actually doing really advanced interventional diagnostic stuff with the shore-side consultation. It’s taking the medical sick bay on a ship … and connecting them with technology to the mainland, so now you’re no longer so isolated. You’re a part of the health care system with all the support that you would typically get at a clinic or a hospital,” Miller said.