Department of Defense and Department of Veterans Affairs interoperability of medical images and related data

(a)

In general

The Secretary of Veterans Affairs and the Secretary of Defense shall jointly adopt and use interoperable image-sharing software technology—(1)accessible by facilities of the military health service, as well as the GENESIS platform of the military health service and the Federal Electronic Health Record platform of the Department of Veterans Affairs; and(2)at each Department of Veterans Affairs and Department of Defense medical facility.(b)

Scope

The technology adopted and used under subsection (a) shall provide for interoperability between all of the following:(1)Military medical centers included in the Military Health System.(2)Department of Veterans Affairs medical facilities and clinics.(3)Non-Department providers that have entered into agreements with the Secretary of Veterans Affairs under section 1703 of title 38, United States Code.(c)

Plan

Not later than 180 days after the date of the enactment of this Act, the Secretary of Defense and the Secretary of Veterans Affairs shall provide to the Committees on Armed Services and the Committees on Veterans’ Affairs of the House of Representatives and the Senate a briefing and submit to such committees a report on the plan of the Secretaries, and an associated timeline, for achieving the full interoperability of medical images and related data between the Department of Defense and Department of Veterans Affairs in accordance with subsection (a). The plan shall include each of the following:(1)The expansion of the services provided pursuant to contracts entered into between the Secretary of Defense, the Secretary of Veterans Affairs, and application-based vendors that meet interoperability standards.(2)An assessment and comparison of the baseline medical image interoperability that exists, as of the date of the enactment of this Act, between the Department of Defense and the Department of Veterans Affairs and external partners of such departments, including—(A)non-Department of Veterans Affairs imaging providers described in section 1703(c) of title 38, United States Code; and(B)imagining providers who are described in section 199.6 of title 32 of the Code of Federal Regulations, or any successor regulation.(3)An identification of one or more licensed interoperability software technology solutions of choice that—(A)is shared by hospitals and health care providers to benefit patients before and after discharge from provider care and that is accessible to current and future providers, in compliance with applicable accessibility requirements, including mobile user interface, as established in the Information and Communication Technology and Software portions of the Revised 508 Standards under part 1194 of title 36 of the Code of Federal Regulations, or any successor regulation, and in adherence with the Web Content Accessibility Guidelines 2.1AA, as established by the World Wide Web Consortium and in effect on the date of the enactment of this Act;(B)enables the electronic medical records system of a hospital, or in the case of a Department of Veterans Affairs facility, the Federal Electronic Health Record of the Department, to interface with interoperability technology and other electronic medical records systems and providers to promote mobile connectivity between hospital systems and facilitate increased communication between hospital staff and providers that use different or distinctive online and mobile platforms and information systems when treating acute patients;(C)captures and forwards clinical data, including laboratory results and images, provider notes, historical clinical conditions, procedures, medications, cardiology testing results, and vital signs, and provides synchronous patient clinical data to health care providers regardless of geographic location;(D)provides a synchronous data exchange that is not batched or delayed, at the point the clinical data is captured and available in the electronic record system of a hospital;(E)is capable of providing proactive alerts to health care providers on their smartphones or a smart device;(F)allows both synchronous and asynchronous communication using a native smartphone application;(G)is mobile, can be used on multiple electronic devices, and includes the industry standard 39 built-in application for the two most popular operating systems and a built-in application available to all users;(H)as patient-centric communication and is tracked with date and time stamping;(I)provides interoperability to include imaging-related workflows of image exchange, sharing, and collaboration;(J)provides enterprise-wide deployment that is comparable to the size and complexity of the largest integrated health care system in the country;(K)allows a patient to manage their own health using a mobile application in alignment with wearable technology devices or the function referred to as the Share My Health Data available through the Veterans Health Administration;(L)adheres to integration standards for software applications to connect to an electronic health record system, or in the case of a Department of Veterans Affairs medical facility or a Military Health System facility, use a Federal Electronic Health Record system, as established by the Office of the National Coordinator for Health Information Technology of the Department of Health and Human Services, including—(i)Substitutable Medical Applications, Reusable Technologies on Fast Healthcare Interoperability Resources, known as SMART on FHIR, which allows third-party applications to integrate directly with electronic health records and patient portals;(ii)open authorization protocol 2.0 (OAuth2) for session authentication, which bolsters security and patient safety by only allowing authorized users with validated access to view, share, and import images and related data; and(iii)Digital Imaging and Communications in Medicine, which is the regulated standard for medical images; and(M)is cost-effective with a high return on investment that is supported by the use of artificial intelligence in the image sharing workflow.(d)

Requirements for plan

In developing the plan required under subsection (b), the Secretaries shall ensure that—(1)the software used for interoperable medical images and related data of the Departments is designed to—(A)improve health care delivery and quality by addressing the increased costs, delays, and patient burden of repeat images caused by the couriering of compact discs and DVD–ROMs as the primary mechanism for sharing patients’ medical images in the continuum of care;(B)the plan includes the development, by not later than two years after the date of the enactment of this Act, of a robust data storage platform capable of storing health data from the Department of Veterans Affairs, the military health service, and health information exchanges used by non-Department providers that have entered into agreements with the Secretary of Veterans Affairs under section 1703 of title 38, United States Code;(C)provide patient-centered care by facilitating faster diagnoses, enabling more informed decision-making and promoting better communication;(D)support more efficient use of the time of clinical and support staff and improve retention by helping to prevent burnout; and(E)promote the effective use of shared services between the Departments, including joint facilities and military treatment facilities that provide clinic space for the Department of Veterans Affairs, and in coordination with non-Department providers that have entered into agreements with the Secretary of Veterans Affairs under section 1703 of title 38, United States Code; and(2)the plan includes an implementation timeline and associated milestones, and an identification of the projected total cost.(e)

Reports

Not later than six months after the date of the submission of the report required under subsection (b), and annually months thereafter, the Secretary of Defense and the Secretary of Veterans Affairs shall jointly provide a briefing and submit to the Committees on Armed Services and the Committees on Veterans’ Affairs of the House of Representatives and the Senate on—(1)any updates to the plan included in the report required under subsection (b); and(2)metrics and quantified cost and time savings associated with using an interoperable software solution in health care that complies with the health insurance portability and accountability act privacy standards under part 160 and part 164, subpart of title 4 of the Code of Federal Regulations, as in effect on the date of the enactment of this Act.(f)

Definitions

In this section:(1)The term GENESIS means the electronic health record system known as MHS GENESIS that is used by the military health service.(2)The term military treatment facility has the meaning given such term in section 1073c of title 10, United States Code.(3)The term electronic health record means an electronic version of a patient's medical history, that—(A)is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that person's care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports;(B)automates access to information and has the potential to streamline the clinician's workflow; and(C)has the ability to support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting.