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Where Interoperability is Between DoD and VA and VistA Evolution

Where Interoperability is Between DoD and VA and VistA Evolution. Presentation to Open Health Tools. Theresa Cullen, MD, MS Chief Medical Information Officer, VHA Acting Deputy Director DoD/VA Interagency Program Office Director, Health Informatics Office of Informatics and Analytics

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Where Interoperability is Between DoD and VA and VistA Evolution

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  1. Where Interoperability is Between DoD and VA and VistA Evolution Presentation to Open Health Tools Theresa Cullen, MD, MS Chief Medical Information Officer, VHA Acting Deputy Director DoD/VA Interagency Program Office Director, Health Informatics Office of Informatics and Analytics Veterans Health Administration Department of Veterans Affairs SEPTEMBER 27, 2013

  2. Agenda • 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

  3. Interoperability Overview

  4. 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

  5. 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

  6. Seamless Interoperability for Care and Benefits Technical Interoperability Information Exchange Semantic Interoperability Shared Meaning Process Interoperability Workflow Continuity Seamless Interoperability is Technical, Semantic and Process Interoperability together

  7. DoD/ VA IPO Role in Interoperability

  8. 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. Proposed i3P – a Foundation for Seamless Interoperability

  9. 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

  10. Janus JLV

  11. Janus JLV Features 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. • 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

  12. Janus JLV Usage: May – August 2013

  13. Janus JLV Proposed FY14-16 Mission and Objectives Janus JLV Mission • 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. FY14 Proposed Objectives • 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)/VistAImaging 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. FY15/16 Proposed Objectives • 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

  14. VLER Health

  15. 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

  16. VLER Health Exchange “Query” Expansion Successes Sites that pre-fetch, send all data Challenges ID matching, data quality, coded data, use of full C32, automated onboarding, and Information Technology Adaptor contracts

  17. VistA Evolution

  18. 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 ‘to care for him who shall have borne the battle and for his widow, and his orphan’

  19. Current VA Landscape eHealth Currently, our EHR and Health Information Technology (HIT) systems are disconnected and fragmented Connected Health Janus JLV VistA Web VistA CPRS iEHR This impacts our ability to deliver on the mission - excellent quality, access, satisfaction, and value RDVs CAPRI VistA Standardization HMP Acronyms: CAPRI – Compensation and Pension Record Interchange HMP – Health Management Platform iEHR – integrated Electronic Health Record JLV – Joint Legacy Viewer RDV – Remote Data Views ‘Conceptual’ representation of current EHR/HIT Landscape

  20. VistA Evolution and VistA IV VistA Evolution is the VHA program that will support this strategic plan through continualinvestment and delivery of scalable and modular EHR and HIT products. VistA IV is the infrastructure andopen and extensible platformon which tools and services can be integrated in support of our Veterans evolving needs and in pace with the technological landscape.

  21. VistA Evolution VistA IV Beginning in Fall 2013, we will analyze and synthesize existing platforms into the new platform – VistA IV Connected Health VistA A single viewer will become the starting point for a new User Experience to support PACT, patients, and the population CPRS RDVs HMP UX CAPRI VistA Standardization DoD Janus JLV iEHR VistA Web Acronyms CAPRI – Compensation and Pension Record Interchange CPRS – Computerized Patient Record System DoD – Department of Defense HMP – Health Management Platform iEHR – integrated Electronic Health Record JLV – Joint Legacy Viewer PACT - Patient-Aligned Care Teams RDV – Remote Data View UX - User Experience eHealth

  22. VistAEvolution Initial Operating Capability (IOC): Fiscal Year 2014 • A joint VHA – VA Office of Information Technology VistAEvolution 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 iEHRInteroperability Platform

  23. VistA Evolution 2017 VistA IV Federal Partners (DOD, IHS) By 2017, we will have an architecture and framework that supports interoperability, care coordination, meaningful use and partnership Integrated Architecture and Services User Experience VBA Interoperable Care Coordination Framework Standard Data Model Open Source/ Community Partners Acronyms: DoD – Department of Defense IHS – Indian Health Service VBA – Veterans Benefits Administration

  24. Questions? Contact Information: Theresa Cullen, M.D, M.S. Theresa.Cullen@va.gov

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