The Military Health System and the Veterans Health Administration are two of the nation’s largest and most complex health care institutions. While the missions of the two systems are unique, there are similarities between their patient populations.

Dr. Paul Cordts, the Defense Health Agency’s chief medical officer and deputy assistant director of medical affairs, addressed the ongoing collaboration between MHS and the VHA in a presentation at the annual meeting of AMSUS, the Society of Federal Health Professionals. The meeting was held in National Harbor, Maryland, in February 2024.

The joint work between the MHS and VHA can enhance patient care, advance evidence-based care into practice, improve access to disability benefits, support innovative problem solving, and enhance the patient experience.

In his presentation, Cordts outlined several areas where the MHS and VHA are working together to modernize and improve patient care.

Advancing Patient Safety

There is an opportunity for the MHS and VA to lead the nation in patient safety, said Cordts.

“One of the major initiatives has been barcoding medication administration,” said Cordts. “We can see barcoding now down to the level of the individual nurse. At the enterprise level, we barcode about 94% of the medications we administer to patients.”

BCMA technology helps prevent medication errors by verifying information, such as the right patient, the right dose, and the right drug.

He added, “VA has been doing that for a long time, but the MHS now has that capability. I can tell you how many medication errors we’ve avoided and other important information … it has been very fruitful working with this data.”

Expanding Medical Education for Providers

“The DHA has 200 graduate medical education programs in total, and 36 of those have rotations in the VA,” said Cordts.

He noted that the partnership between the agencies could help address challenges in training.

GME programs fill an important advanced education role producing and training the next generation of providers and the medical leadership of the Military Health System. GME research programs provide the basis for advancements in combat care and other MHS priorities.

“We have two GME programs with VA funded residents in our programs. We have very fine programs here, but we’re interested in expanding this collaboration. Although our programs are 100% accredited by the ACGME [Accreditation Council for Graduate Medical Education], we still have challenges with respect to case volume and complexity to support these training programs. “

Developing Joint Clinical Practice Guidelines

According to Cordts, the VA and DOD collaborated with key stakeholders on a rigorous process to update joint clinical practice guidelines (or CPGs), conducting literature reviews using standardized assessments and scoring to produce up-to-date recommendations. These efforts are designed to advance evidence-based care into practice.

“CPGs are used in health care to improve patient care as a potential solution to reduce unwarranted variations in care and to optimize outcomes for service members, their dependents, retirees, and veterans,” he said.

“We’re in the process of hardwiring 10 of the VA/DOD clinical practice guidelines into MHS GENESIS,” said Cordts. “We've created the workflow, we're making the configuration changes in MHS GENESIS, and now we will do the education and training around how to use the CPGs.”

MHS GENESIS is the Military Health System's modern electronic health record that provides a single health record for service members, veterans, and their families. The record is now operational at all military hospitals and clinics worldwide. The first joint deployment of the record, which VA calls the Federal Electronic Health Record, went live on March 9 at the only fully integrated, jointly run VA and DOD health care system in the nation, the Captain James A Lovell Federal Health Care Center in Chicago.

Cordts believes the evidence supporting the CPGs shows the impact on DOD and VA populations.

“Rock solid evidence. We've largely been unable to measure adherence to CPGs up until this point—the fact that we couldn’t see whether or not we're using evidence-based practice was a major gap in our ability to improve. Now we can measure it.”

Separating from Active Duty Programs

Cordts summarized three programs that support both service members and veterans, including:

• inTransition supports service members leaving military service who received care for mental health and/or moderate to severe traumatic brain injury within one year of their separation.
  “These service members are automatically enrolled in this program, and we have a team coordinating their care,” said Cordts. “The team makes mental health referrals to VA clinics, veteran centers, DOD clinics, TRICARE providers, and community-based providers. Every month, they contact about 8,000 transitioning service members. They also support an average of about 2,400 service members and veterans who are referred directly to the program. They provide more than 500 referrals to service members to the VA and veteran centers for follow up care.”
• The Recovery Coordination Program provides education employment initiatives.
  The program connects transitioning service members to non-funded federal internships and the National Resource Directory,” said Cordts.
• Integrated Disability Evaluation System helps determine if wounded, ill, or injured service members are fit for continued military service and provide disability benefits to service members and veterans.

Increasing VA Health Care for Veterans

Elsewhere, the VA and the DOD announced a new partnership on February 23 to allow veterans to receive care at the Fort Campbell VA Clinic inside the Blanchfield Army Community Hospital located on Fort Campbell, Tennessee. A similar partnership began at Naval Hospital Pensacola, Florida, in October 2023.

These are two of several more planned for the future across the country in a continuing effort to meet the demand for VA health care services and address challenges associated with aging facilities.

At a ribbon-cutting ceremony launching the Blanchfield partnership, Dr. Lester Martínez-López, assistant secretary of defense for health affairs, said, “Our partnership with the VA is so important (because) we share a mission to care for those who protect and have protected our country. This clearly demonstrates that shared commitment to that continuum of care that stretches from the first day of service throughout all the life of a service member long after they leave the force.”

Martínez said, “The clinic will not only benefit the patient it serves, but also strengthen the readiness of our medical providers who can maintain their skills while providing top notch care to deserving veterans. It’s truly a win-win for everyone.”