big things on the horizon for

2. 2 <FILIPPI INTRODUCTION><FILIPPI INTRODUCTION>

3. JAL FHCC 3 <FILIPPI> The Captain James A. Lovell Federal Health Care Center (JAL FHCC) is the first single, fully integrated federal health care center between the VA and DoD. It is designed to improve access, quality, and cost effectiveness of health care delivery to beneficiaries of both DoD and VA. The JALFHCC initiative began in the early 2000s. It is a one of a kind demonstration project. From a command and control standpoint, it will be an integrated, single chain of command led by the VA. It will be the only VA- associated system with a readiness mission. JAL FHCC incorporates facilities and services from both the North Chicago VA Medical Center and the Naval Health Clinic Great Lakes. Services provided include medical and dental to U.S Military Veterans, Recruits, Active Duty and eligible beneficiaries, as well as Environmental and Industrial Health coverage for 13 states in Navy Region Midwest. <FILIPPI> The Captain James A. Lovell Federal Health Care Center (JAL FHCC) is the first single, fully integrated federal health care center between the VA and DoD. It is designed to improve access, quality, and cost effectiveness of health care delivery to beneficiaries of both DoD and VA. The JALFHCC initiative began in the early 2000s. It is a one of a kind demonstration project. From a command and control standpoint, it will be an integrated, single chain of command led by the VA. It will be the only VA- associated system with a readiness mission. JAL FHCC incorporates facilities and services from both the North Chicago VA Medical Center and the Naval Health Clinic Great Lakes. Services provided include medical and dental to U.S Military Veterans, Recruits, Active Duty and eligible beneficiaries, as well as Environmental and Industrial Health coverage for 13 states in Navy Region Midwest.

4. JAL FHCC Capabilities Delivered Single Patient Registration Sign on once with a DoD CAC or VA PIV Medical Single Sign-On - Find a patient one time in any application and other applications follow automatically 4 <FILIPPI> Single Patient Registration enables JAL FHCC to have a single user interface for establishing new patient records between VistA and the DoD system -lightweight service oriented architecture based approach -fully open-using open standards including HL7v2 and HL7v3 messaging implementing Integrating the Healthcare Enterprise Profiles for Patient Demographic lookup and retrieval -minimal modifications to existing legacy -leverages patient identity management capabilities of DEERS and the VHA IdM service Medical Single Sign-On -Eliminates workstations being locked to a specific user -Increases clinician instigated lock of log off by 60% -Will significantly improve the clinician workflow and shorten the amount of time necessary for clinicians to access patient information -Improves patient safety by eliminating delays of up to six minutes in accessing clinical information -Eliminates the need for workarounds which in the case of BCMA may cause improper or incorrect patient information to be entered <FILIPPI> Single Patient Registration enables JAL FHCC to have a single user interface for establishing new patient records between VistA and the DoD system -lightweight service oriented architecture based approach -fully open-using open standards including HL7v2 and HL7v3 messaging implementing Integrating the Healthcare Enterprise Profiles for Patient Demographic lookup and retrieval -minimal modifications to existing legacy -leverages patient identity management capabilities of DEERS and the VHA IdM service Medical Single Sign-On -Eliminates workstations being locked to a specific user -Increases clinician instigated lock of log off by 60% -Will significantly improve the clinician workflow and shorten the amount of time necessary for clinicians to access patient information -Improves patient safety by eliminating delays of up to six minutes in accessing clinical information -Eliminates the need for workarounds which in the case of BCMA may cause improper or incorrect patient information to be entered

5. JAL FHCC Future Capabilities Orders Portability (OP) for Laboratory and Radiology View, manage and display in a computable format Display images within either VHA of DoD imaging systems OP Pharmacy Reconcile medication and allergies for all patients; reachable 24/7 for discharge medications OP Consults Will allow consults and referral orders for processing for all patients using either DoD or VA health information system 5 <FILIPPI> Orders Portability -Staff can create orders for Lab or Rad in either DoD or VA system and this IM/IT service provided bi-directional exchange of these orders and associated results enabling consistency of patient data in each system <FILIPPI> Orders Portability -Staff can create orders for Lab or Rad in either DoD or VA system and this IM/IT service provided bi-directional exchange of these orders and associated results enabling consistency of patient data in each system

6. 6 <FILIPPI><FILIPPI>

7. JAL FHCC Challenges Complexity Systems & Networks Identity Configuration Control Change Management 7 <FILIPPI> The transition from current interoperability between DOD and VA at different locations to a state of integration of capabilities within the same compound at North Chicago has been ground breaking. The DoD VA interoperability efforts in North Chicago represents an unprecedented achievement of people, processes, and divergent security requirements to provide the IT supported clinical capability required for the safe, efficient, and effective health care at the Federal Health Care Center. Our efforts in this new arena haven�t come without growing pains. In working these interoperability issues, we�ve discovered some challenges along the way and are working through them now. This is hard work, but setting this right will be important to the other aspects of our work including VLER. <TRANSITION><FILIPPI> The transition from current interoperability between DOD and VA at different locations to a state of integration of capabilities within the same compound at North Chicago has been ground breaking. The DoD VA interoperability efforts in North Chicago represents an unprecedented achievement of people, processes, and divergent security requirements to provide the IT supported clinical capability required for the safe, efficient, and effective health care at the Federal Health Care Center. Our efforts in this new arena haven�t come without growing pains. In working these interoperability issues, we�ve discovered some challenges along the way and are working through them now. This is hard work, but setting this right will be important to the other aspects of our work including VLER. <TRANSITION>

8. VLER Concept 8 <FILIPPI> VLER Definition �VLER� is a �virtual� lifetime electronic record that results from the ability to seamlessly share, access and exchange data in order to provide comprehensive health, benefits and administrative information for Service Members, Veterans, and their beneficiaries and designees. <FILIPPI> VLER Definition �VLER� is a �virtual� lifetime electronic record that results from the ability to seamlessly share, access and exchange data in order to provide comprehensive health, benefits and administrative information for Service Members, Veterans, and their beneficiaries and designees.

9. VLER Capability Areas & Points of View 9 <FILIPPI> <<BUILD SLIDE>> VCA1: Foundational Clinical Health Data Exchange via Nationwide HIN: Clinicians Caring for Service Members & Veterans; includes private providers � VCA 2: Health Data Exchange for VBA & SSA Disability Benefits: Adjudicators Helping Service Members and Veterans � VCA 3: Data Exchange for Housing, Insurance, Education & Memorial Benefits: Benefit Providers Helping Service Members and Veterans � VCA 4: Single Virtual Access Point for Health & Benefits: Self Help for Service Members & Veterans <FILIPPI> <<BUILD SLIDE>> VCA1: Foundational Clinical Health Data Exchange via Nationwide HIN: Clinicians Caring for Service Members & Veterans; includes private providers � VCA 2: Health Data Exchange for VBA & SSA Disability Benefits: Adjudicators Helping Service Members and Veterans � VCA 3: Data Exchange for Housing, Insurance, Education & Memorial Benefits: Benefit Providers Helping Service Members and Veterans � VCA 4: Single Virtual Access Point for Health & Benefits: Self Help for Service Members & Veterans

10. VLER Phase 1A Pilot Accomplishments Tidewater Pilot Successful demonstration of capability to exchange data through NwHIN Beta testing, HHS CONNECT software On-boarding process for admitting new members to NwHIN San Diego Pilot Demonstrated health information can be exchanged using NwHIN 10 <FILIPPI><FILIPPI>

11. VLER Tidewater C32 Data Exchange 11 <FILIPPI> This is an example of the standard type of information exchanged related to a patient and available for viewing by providers across organizations. As you see here, this is an example of our information sharing with a private partner, MedVA. Across the top is your basic patient information followed by hyperlinks to different parts f the medical record and then an example of the treatment this patient has had for allergies. (For more detailed description, check with SMEs) <FILIPPI> This is an example of the standard type of information exchanged related to a patient and available for viewing by providers across organizations. As you see here, this is an example of our information sharing with a private partner, MedVA. Across the top is your basic patient information followed by hyperlinks to different parts f the medical record and then an example of the treatment this patient has had for allergies. (For more detailed description, check with SMEs)

12. Joint EHR Modernization Objectives <FILIPPI transition to CHAMBERS><FILIPPI transition to CHAMBERS>

13. Joint EHR Modernization Objectives Both Departments are working toward common objectives: Effectiveness: Provide a patient-centric health care experience Improve the quality of delivered services Ensure interoperability and data sharing between the departments Efficiency: Reduce overall cost of Health IT investments in acquisition, development and sustainment <CHAMBERS><CHAMBERS>

14. EHR Transformation Focus Sustainment Availability, Usability, Speed Establish a reasonable baseline (Theater & Garrison) Right people in the right seats Patient safety/compliance Development Engineering & Innovation Integration/Interoperability Repurposing Emerging Capabilities Functional & Technical testing labs Balance of Theater/Garrison priorities DoD/VA synchronization 14 <CHAMBERS><CHAMBERS>

15. Mission Focused EHR Way Ahead Approaches* <CHAMBERS> VA: VA has been pursuing plans for VistA modernization well over 2 years. In Oct 2009, the VA industry advisory council (IAC) chartered a working group comprised of over 40 experienced healthcare and technology professionals from IAC member companies to address the prospect of VistA Modernization. Findings were submitted to the VA on May 4 2010. Subsequently, VA plans to move to an open source, open standards model for the next generation of VistA (to be VistA 2.0). Oebr the past 5 months, VA has been pursuing continued market research, multiple requests for information to industry, product demos and EHR summits to prepare the ground work for assembling their acquisition business requirement documents DoD: During the last two years the DoD has also been working on their EHR Modernization plans. DoD has come to many of the same conclusions as the VA for the need and technical route to modernization of it�s EHR. Through an analysis of alternatives approach the DoD has been performing a multi-phase down selection of alternatives based on criteria of cost, usability, and level of meeting capability requirements as collected from clinical and business SME�s over the last 4 years. The final results of Phase 2 are expected soon. <CHAMBERS> VA: VA has been pursuing plans for VistA modernization well over 2 years. In Oct 2009, the VA industry advisory council (IAC) chartered a working group comprised of over 40 experienced healthcare and technology professionals from IAC member companies to address the prospect of VistA Modernization. Findings were submitted to the VA on May 4 2010. Subsequently, VA plans to move to an open source, open standards model for the next generation of VistA (to be VistA 2.0). Oebr the past 5 months, VA has been pursuing continued market research, multiple requests for information to industry, product demos and EHR summits to prepare the ground work for assembling their acquisition business requirement documents DoD: During the last two years the DoD has also been working on their EHR Modernization plans. DoD has come to many of the same conclusions as the VA for the need and technical route to modernization of it�s EHR. Through an analysis of alternatives approach the DoD has been performing a multi-phase down selection of alternatives based on criteria of cost, usability, and level of meeting capability requirements as collected from clinical and business SME�s over the last 4 years. The final results of Phase 2 are expected soon.

16. 16 <CHAMBERS><CHAMBERS>

17. EHR - Where We Are Now Established six interagency teams (to work the what) w/ Executive sponsors designated for each of the six Workgroups: Infrastructure and Enterprise Architecture Team. Executive Sponsors: Peter Levin (VA) and Dave DeVries (DoD) Data Interoperability Team. Executive Sponsors: Paul Tibbits (VA), Nancy Orvis (DoD) and Debbie Filippi (IPO) Business Process Team. Executive Sponsors: Doug Rosendale (VA) and Dave Wennergren (DoD) Systems Capabilities Team. Executive Sponsors: Roger Baker (VA) and George Chambers (DoD) Presentation Layer Team. Executive Sponsors: Peter Levin (VA) and Mary Ann Rockey (DoD) Mission Requirements & Performance Outcomes Team. Bob Jesse (VA) and Peach Taylor (DoD) The Good News: DoD-VA end-state design patterns are essentially identical Established six interagency teams (to work the what) w/ Executive sponsors designated for each of the six Workgroups: Infrastructure and Enterprise Architecture Team. Executive Sponsors: Peter Levin (VA) and Dave DeVries (DoD) Data Interoperability Team. Executive Sponsors: Paul Tibbits (VA), Nancy Orvis (DoD) and Debbie Filippi (IPO) Business Process Team. Executive Sponsors: Doug Rosendale (VA) and Dave Wennergren (DoD) Systems Capabilities Team. Executive Sponsors: Roger Baker (VA) and George Chambers (DoD) Presentation Layer Team. Executive Sponsors: Peter Levin (VA) and Mary Ann Rockey (DoD) Mission Requirements & Performance Outcomes Team. Bob Jesse (VA) and Peach Taylor (DoD) The Good News: DoD-VA end-state design patterns are essentially identical

18. Intuitive Interface <FILIPPI> As the Departments have been working collaboratively the teams have each noted that a single decision maker and a single improved executive structure are needed. The IPO has agreed to provide options on governance for this EHR way ahead effort. The IPO governance options for a way forward cover the programmatic, technical and functional areas and address the key tenets depicted in this slide. The final way ahead and including potential courses of actions and pros and cons associated with these courses of action are due to DoD and VA senior leadership by early February. <FILIPPI> As the Departments have been working collaboratively the teams have each noted that a single decision maker and a single improved executive structure are needed. The IPO has agreed to provide options on governance for this EHR way ahead effort. The IPO governance options for a way forward cover the programmatic, technical and functional areas and address the key tenets depicted in this slide. The final way ahead and including potential courses of actions and pros and cons associated with these courses of action are due to DoD and VA senior leadership by early February.

19. 19 <LEVIN> Blue Button Anticipated Outcomes: Improve quality and accessibility of information to Veterans and Service Members Build a sustainable collaborative approach, capacity, and tools to deliver information to Veterans and Service Members Foster cross-agency collaboration Enable a model that welcomes standards-based modular components that are easy to read, easy to use, and easy to connect to other systems (isn�t dependent upon them now, easily adapts as the market moves) Provide information in human-readable form (view/print/save) Enable data to be exported into commonly used software formats, such as spreadsheets, text files, etc. Address individual authorization for collections, uses and disclosures of information Track download activity in an immutable audit trail Help individuals make informed choices (potential benefits and risks, safe information management practices) Develop separate pathways for download requests from the individual and download requests via automated processes acting on the individual�s behalf <LEVIN> Blue Button Anticipated Outcomes: Improve quality and accessibility of information to Veterans and Service Members Build a sustainable collaborative approach, capacity, and tools to deliver information to Veterans and Service Members Foster cross-agency collaboration Enable a model that welcomes standards-based modular components that are easy to read, easy to use, and easy to connect to other systems (isn�t dependent upon them now, easily adapts as the market moves) Provide information in human-readable form (view/print/save) Enable data to be exported into commonly used software formats, such as spreadsheets, text files, etc. Address individual authorization for collections, uses and disclosures of information Track download activity in an immutable audit trail Help individuals make informed choices (potential benefits and risks, safe information management practices) Develop separate pathways for download requests from the individual and download requests via automated processes acting on the individual�s behalf

20. 20 <LEVIN><LEVIN>

21. PCAST 21 <ONDRA><ONDRA>

22. Wrap-Up Expectations for future VLER pilots and the future of the Virtual Lifetime Electronic Record Alternatives for the EHR Way Ahead Role of patients in future clinical work flow National focus on health care 22 <ONDRA transition into Q&A><ONDRA transition into Q&A>