Where Interoperability is Between DoD and VA and VistA Evolution Theresa Cullen, MD, MS Chief Medical Information Officer, VHA Acting Deputy Director DoD/VA

Where Interoperability is Between DoD and VA and VistA Evolution

Theresa Cullen, MD, MSChief Medical Information Officer, VHAActing Deputy Director DoD/VA Interagency Program OfficeDirector, Health Informatics Office of Informatics and Analytics Veterans Health AdministrationDepartment of Veterans Affairs

SEPTEMBER 27, 2013

Presentati on to Open Health Tools

VETERANS HEALTH ADMINISTRATION

• Interoperability Overview• Department of Defense (DoD) / Department of

Veterans Affairs (VA) Interagency Program Office (IPO) Role in Interoperability

• Janus Joint Legacy Viewer (JLV)• Virtual Lifetime Electronic Record (VLER) Health• Veterans Health Information Systems and Technology

Architecture (VistA) Evolution

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Agenda


Interoperability Overview

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What is Interoperability?

Interoperability refers to the relationships between systems, information, and people required to provide outstanding health care and benefits for our Servicemembers and Veterans.• Systems include the infrastructure and equipment needed to store

information and move it from place to place• Information includes all the data, from all useful sources, needed for

providing and receiving care and benefits • People include clinicians and other providers, claims processors, transition

coordinators, etc., as well as the Veterans and Servicemembers providing or receiving care and benefits

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Three Key Interoperability Relationships

Relationship #1 – Technical Interoperability • Information must be reliably exchanged between multiple Systems so People in

different places and organizations can see it, use it and add to it

Relationship #2 – Semantic Interoperability • Information exchanged between Systems must have shared meaning in order for

People (assisted by computers) to use it for making care and benefits decisions

Relationship #3 – Process Interoperability • People (assisted by computers) must be able to make use of shared Information in

their local workflows and processes for providing and receiving care and benefits

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Seamless Interoperability for Care and Benefits

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Technical Interoperability Information Exchange

Shared Meaning

Workflow Continuity

Semantic Interoperability

Process Interoperability

Seamless Interoperability is Technical, Semantic and Process Interoperability together


DoD/ VA IPO Role in Interoperability

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Proposed i3P – a Foundation for Seamless Interoperability

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The integrated Electronic Health Record (iEHR) Informatics

Integration and Interoperability Platform (i3P) will be an

inherent cross-platform capability between VA and DoD health

information systems, creating a seamless, interoperable,

longitudinal health record for Servicemembers and Veterans.


What Will i3P Do?• Federate data from legacy and future DoD and VA Electronic Health Record (EHR)

and related business systems– Enables interoperability relationships between old and new health information

technology (HIT) Systems, Information and People from all critical DoD and VA health data domains

• Aggregate, store and index eHealth Exchange data used by VA and DoD providers in clinical decision making

• Facilitate decommissioning of several complicated and expensive legacy VA-DoD health data sharing mechanisms in Fiscal Year 2015-2016

• Provides a shared platform for data federation, clinical terminology, access management, patient identity, and support for clinical decision services for VA and DoD

– Enables decommissioning of Clinical/Health Data Repository (CHDR), most Bidirectional Health Information Exchange (BHIE) SHARE and Framework components, jMeadows, Medical Domain Web Services (MDWS), VistAWeb, and consolidation of DoD and VA Virtual Lifetime Electronic Records (VLER) Adapters

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Janus JLV

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Janus JLV Features

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Features• Web-based Graphical User Interface• Integrated, chronological view of VA and DoD patient

data on a single screen• Displays progress notes, problem lists, labs, vitals,

immunizations, allergies, medications, Essentris inpatient discharge summaries (DoD), and radiology

• User friendly, configurable screen layout• Easy to learn, intuitive user interface

Benefits• Simplifies review of patient records, returning valuable

time to providers• Will reduce printing, scanning , and faxing of paper

records • Designed to support frequent enhancements and

upgrades

Janus JLV provides an integrated read-only view of health data from DoD and VA sources in a common viewer.

An important stepping stone toward modernizing our VA and DoD health information systems, JLV will support care of our Wounded Warriors and Veterans by improving access to electronic patient records and reducing the need to transfer information by fax, mail, or CD.


Janus JLV Usage: May – August 2013

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May '13 June '13 July '13 Aug '130

200

400

600

800

1000

1200Janus JLV Usage Activity

Total Unique Users / Month

Total Logins / Month

Total Patients Selected / Month

Total Across all Sites


Janus JLV Proposed FY14-16 Mission and Objectives

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Janus JLV provides an integrated view of health data from DoD and VA sources in a common viewer. Janus JLV will continue to simplify the review of patient records, will reduce printing, scanning and faxing of paper records, and supports both clinical and benefit adjudication activities in the DoD and VA.

Janus JLV Mission

• Sustainment

• Complete incorporation of Block 2-4 domains as needed (may not be needed if superseded by Healthcare Management System Modernization (DHMSM) or VistA 4 viewer)

• Development as required for specific customer needs (i.e., enhancements requested by Veterans Benefit Administration (VBA) or National Guard users)

• Work to transition JLV viewer features into DoD DHMSM and VA VistA 4 applications

• Display of normalized data for seven Accelerator domains + i3P Block 1 and 2 domains as available on path to enable retirement of legacy systems

• Incorporate eHealth Exchange functionality to enable VistAWeb retirement

• Healthcare Artifact and Image Management Solution (HAIMS)/VistA Imaging viewer and doclist widgets

• Integrate with iEHR Document Management System (DMS) (including terminology service)

• User Interface and usability enhancements based on customer requirements

• Capacity for up to 40,000 concurrent users

• Expand footprint at Military Health System (MHS) Enterprise Service Operations Center (MESOC), Austin Information Technology Center (AITC) and two regional Defense Information Systems Administration (DISA) Defense Enterprise Computing Centers (DECCs) to provide for additional capacity, load balancing and fail-over.

FY14 Proposed Objectives

FY15/16 Proposed Objectives


VLER Health

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VLER Health• Presidentially directed lifetime, Electronic Health Record• “VLER Health” provides private sector electronic data• Standardized data transported per national specifications• Nationally scalable technology • High value content (C32, C32+, Consolidated Clinical Documentation Architecture)• VLER Health to provide data “to and from” • iEHR data management services

Pilot the “Direct Project”

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VETERANS HEALTH ADMINISTRATION 16

VLER Health Exchange “Query” Expansion

SuccessesSites that pre-fetch, send all data

Challenges ID matching, data quality, coded data, use of full C32, automated onboarding, and Information Technology Adaptor contracts

Pilot Site Exchange Partner DoD/VA Began ExchangeSan Diego, California Kaiser Permanente (KP) DoD/VA 12/14/09

San Diego, California San Diego Beacon VA 11/30/2011

Hampton, Virginia MedVirginia DoD/VA 9/15/10

Richmond, Virginia MedVirginia VA 3/25/11

Spokane, Washington Inland Northwest Health Services (INHS) DoD/VA 3/25/11

Asheville, North Carolina Western North Carolina Health Network (WNCHN) VA 4/4/11

Indianapolis, Indiana Indiana Health Information Exchange (IHIE) VA 8/22/11

Puget Sound, Washington MultiCare Health Systems DoD/VA 9/30/11

Buffalo, New York HEALTHeLINK VA 9/30/11

Minnesota, Minnesota Community Health Information Collaborative (CHIC) VA 9/30/11

Charleston, South Carolina South Carolina Health Information Exchange (SCHIEx) VA 10/3/11

Salt Lake City, Utah Utah Health Information Network (UHIN) VA 10/3/11

Grand Junction, Colorado Utah Health Information Network (UHIN) VA 10/3/11

Altoona, Pennsylvania Conemaugh Health System VA 4/1/12

Boise, Id Idaho Health Data Exchange VA 2/7/13

Pensacola, Florida/Biloxi, Mississippi Pensacola Health Information Exchange VA 4/24/13


VistA Evolution

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Background

• In 2013, VA and DoD Secretaries made decisions that require a change in EHR strategy

• The VA EHR will be VistA-based• Our mission has not changed

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‘to care for him who shall have borne the battle and for his widow,

and his orphan’


‘Conceptual’ representation of current EHR/HIT Landscape

VistA Standardization

VistA

CPRSiEHR

HMP

Janus JLV

eHealth

VistA Web

RDVs

Connected Health

Currently, our EHR and Health Information Technology (HIT) systems are disconnected and fragmented

This impacts our ability to deliver on the mission - excellent quality, access, satisfaction, and value

CAPRI

Current VA Landscape

Acronyms:CAPRI – Compensation and Pension Record InterchangeHMP – Health Management PlatformiEHR – integrated Electronic Health RecordJLV – Joint Legacy ViewerRDV – Remote Data Views 19

VETERANS HEALTH ADMINISTRATION 20

VistA IV is the infrastructure and open and extensible platform on which tools and services

can be integrated in support of our Veterans evolving needs and in pace with the

technological landscape.

VistA Evolution is the VHA program that will support this strategic plan through continual

investment and delivery of scalable and modular EHR and HIT products.

VistA Evolution and VistA IV


VistA IV

VistA

Connected Health

eHealth

CPRS

CAPRI

VistA Web

RDVs

HMP

Janus JLV

VistA Standardization

UX

Beginning in Fall 2013, we will analyze and synthesize existing platforms into the new platform – VistA IV

A single viewer will become the starting point for a new User Experience to support PACT, patients, and the population

DoD iEHR

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VistA Evolution

AcronymsCAPRI – Compensation and Pension Record InterchangeCPRS – Computerized Patient Record SystemDoD – Department of DefenseHMP – Health Management PlatformiEHR – integrated Electronic Health RecordJLV – Joint Legacy ViewerPACT - Patient-Aligned Care TeamsRDV – Remote Data ViewUX - User Experience


VistA Evolution Initial Operating Capability (IOC): Fiscal Year 2014• A joint VHA – VA Office of Information Technology VistA Evolution Program ‘Execution’

Office will be responsible for delivering IOC. • Delivered to at least two sites - Hampton Road and San Antonio• IOC Infrastructure and Functionality Include:

– VistA Standardization• Certify standardization of 74 VistA application routines in production

– Immunizations• Modernize VistA immunization file• Read/write/exchange clinical decision support• Bidirectional immunization sharing• Potential sources of adoption: VA Innovations, OpenCDS, IHS Resource and Patient

Management System (RPMS)– Laboratory Information System Acquisition– Clinical User Experience Tools

• ‘Google-like’ Search• HL7 Context-Aware InfoButtons• Medication Review ‘widget’

– Integration with iEHR Interoperability Platform

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Federal Partners

(DOD, IHS)

VistA IV

VBA

Standard Data Model

Inte

grat

ed A

rchi

tect

ure

and

Serv

ices

By 2017, we will have an

architecture and framework that

supports interoperability,

care coordination, meaningful use and

partnership Open

Source/Community

Partners

Care Coordination Framework

User Experience

Interoperable

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VistA Evolution 2017

Acronyms:DoD – Department of DefenseIHS – Indian Health ServiceVBA – Veterans Benefits Administration


Questions?

Contact Information:Theresa Cullen, M.D, [email protected]

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mailto:[email protected]

Documents

Where Interoperability is Between DoD and VA and VistA Evolution Theresa Cullen, MD, MS Chief Medical Information Officer, VHA Acting Deputy Director DoD/VA