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VHA Health Information Model (VHIM) Orientation

VHA Health Information Model (VHIM) Orientation. VHIM Home Page http://vaww.va.gov/vhaea/scripts/vhim.asp. Agenda. VHA Business Drivers – The need for Health e Vet Health e Vet – The need for the VHIM What is the VHIM? How does VHIM work? What does the VHIM do for you?

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VHA Health Information Model (VHIM) Orientation

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  1. VHA Health Information Model (VHIM) Orientation VHIM Home Page http://vaww.va.gov/vhaea/scripts/vhim.asp

  2. Agenda • VHA Business Drivers – The need for HealtheVet • HealtheVet – The need for the VHIM • What is the VHIM? • How does VHIM work? • What does the VHIM do for you? • VHIM Team Organization • VHIM Team Interactions • Take-aways

  3. VHA Business Drivers • Shift from Institutional-centric data to Veteran-centric • Establish consistency in the meaning of data within VHA • Meet requirements of authoritative, longitudinal, accessible, Electronic Health Record (EHR) • Achieve interoperability with partners (DoD, CDC, Homeland Security, external providers) • Meet Federal Enterprise Architecture and Federal Health Architecture requirements

  4. VHA Business Drivers (concluded) • Align with health information standards • Increase focus on improved health outcomes, increase patient safety, increase quality and reduce wait times • Improve billing support and revenue collection • Provide robust support for analytical computing and clinical decision support • Improve privacy and security of health information

  5. Business Climate • Multiple external pressures in the Medical, Business, Legal, Technical, and Financial arenas drive a complete re-engineering of VHA’s healthcare systems • Critical requirement for consistent application of an Enterprise-wide Architecture in order to facilitate interoperability and reuse

  6. HealtheVet Characteristics • Service Oriented Architecture • “System of Systems”; not a collection of modules • Data retrieved by “asking” a service; not just by accessing a shared database • Data is an Enterprise Asset; not “owned” by a Project (e.g. Lab) or by the originating facility

  7. HealtheVet Overview getLabResult(“… <Patient VPID=123/> <LabObservation testCode=276148/> … ”) Rx Service Lab Service Nursing Service (COTS) CAIP DoD HealtheVet “Backbone” CHDR CDS Person Service VETS / SDS CDS HL7 v3 Gateway Kaiser- Perm. “<MicrobiologyObservation> <Organism code=567891/> <AntibioticSensitivityObservation antibiotic=454798 value=“>=32” units=“mcg/ml” interpretation=731974/>” HDR ADR

  8. Enter the VHIM VHIM Pharmacy Drug HealtheVet Medication Reactant Allergy Re-engineering Radiology Contrast Agent • The authoritative source for semantics and information structure for VHA. It defines the structure and content of interactions betweenservices and between VHA and external partners. • Portion of architectural strategy to ensure semantic interoperability among HealtheVet components. • Enterprise-wide initiative to guide the re-engineering of VHA’s systems

  9. What is the VHIM? • A UML model which carries definitions of crosscutting information within VHA and contains classes, their attributes and their relationships • Computationally Independent Model within MDA • Organized by domains such as Demographics, Pharmacy, etc. • Ensures harmonization with industry standards through active involvement with SDOs (HL7, NCPDP, CHI, DICOM, ASC X12) • Aligned with HL7 Reference Information Model and HL7 3.0 Vocabulary Domain

  10. VHIM – Implementation VHIM Class Diagram XML Schema Definition (XSD) Java <xs:element name="PatientIdentity" type="VaIdentity" substitutionGroup="personIdentity" /> - <xs:complexType name="PatientIdentity"> - <xs:complexContent> - <xs:extension base="PersonIdentity"> - <xs:sequence> - <xs:element name="administrativeGender" type="AdministrativeGenderCode"> - <xs:annotation> <xs:documentation>A value representing the gender (sex) of a person. The for allowable values for this field as specified by the DS DAT for Demographics are: F (Female), M (Male) and UN (unspecified).</xs:documentation> </xs:annotation> ... public interface PatientIdentity extends personSRDTs.PersonIdentity { livingSubject.AdministrativeGenderCode getAdministrativeGender(); void setAdministrativeGender(livingSubject.AdministrativeGenderCode administrativeGender); livingSubject.AdministrativeGenderCode addNewAdministrativeGender(); livingSubject.BirthTime getDateOfBirth(); void setDateOfBirth(livingSubject.BirthTime dateOfBirth); livingSubject.BirthTime addNewDateOfBirth(); ...

  11. VHIM Versions • VHIM 2.x • Consumers: FHIE, BHIE, HDR IMS • Uses OMG COAS structures / datatypes • VHIM 3.x • Consumers: HealtheVet, HDR II, CDS • Uses HL7 3.0 Datatypes; aligned with HL7 3.0 Reference Information Model (RIM)

  12. The VHIM and Enterprise Reference Terminology (ERT)

  13. The VHIM and Enterprise Reference Terminology (ERT) (concluded) Reference Terminology Information Model <<CodeSet>> <<CodeSet>> ReactantCodeSet ReactionCodeSet • Allergy domain • Reactants | 65535 • Pollen | 65534 • Bees | 65533 • Penicillin | 65532 • … • Reactions | 65531 • Rash | 65530 • Headache | 65529 • Diarrhea | 65526 • … + codeSet : Vuid = 65531 + codeSet : Vuid = 65535 <<CodedValue>> <<CodedValue>> ReactantCodedValue ReactionCodedValue + code : Vuid + code : Vuid + displayText : String + displayText : String <<Observation>> anAllergy : IntoleranceObservation + date : dateTime = 1/15/2005 + reactant : ReactantCodedValue = 65532 + reaction : ReactionCodedValue = 65530 ...

  14. VHIM Templates • Templates are a subset of the VHIM used to define service payloads • Example: From the Lab domain, we may specify ChemistryResult, MicroResult, etc. • Templates represent that information needed to define a transaction between two systems.

  15. VHIM Templates (concluded) • Templates are not limited to a single domain – they may draw from multiple domains (e.g., patient information in the Refill Request) • Expressed as one or more XML Schema Definition Language Documents (XSDs) • HIA will maintain a “Template Registry” where templates will be documented and available for re-use

  16. VHIM Team Organization

  17. VHIM Process - Roles Modeling Team Gathers Key Business Concepts Domain Models Information Requirements Domain Models Project Teams Gathers Detailed Requirements Gathers Interoperability Use Cases Inception Team Implementation Team Interoperability Requirements Provides Orientations Creates Templates

  18. VHIM Inception Team • The VHIM Inception Team is the front end of the modeling effort. • Activities include: • Provide VHIM related orientation and education to the project teams • Works with the project needs to document shared information requirements within use cases and other artifacts. • Maintain a current status of VHIM related touch points to project re-engineering teams

  19. VHIM Modeling Team Activities • Create class diagrams to support the project teams information exchange requirements. • Define information structure and relationships. • Work with ERT and DS to ensure proper semantic rigor. • Ensure alignment with relevant external standards. • Represent the project teams requirements to HL7 and other SDOs.

  20. VHIM Implementation Team • The VHIM Implementation Team comprisesthe transformation arm of the modeling effort. • Identify detailed information messaging requirements • Create and/or enhance VHIM templates to meet the needs of project teams • Construct and test the templates and placement of the templates into the template registry • Assist implementation projects with creating and testing VHIM-conformant payloads • Assist in the creation of HDR data models • Perform tooling activities that pertain to transformation of the VHIM model into implementable artifacts

  21. VHIM Contacts • Project Manager – Geff Garnhart • Inception Lead – Sherri Walter • Modeling Lead – Galen Mulrooney • Implementation Lead – Becky Reed • Quality Manager – Sherri Walter • Requirement Manager – Susan Dahlberg • Change Manager – Susan Dahlberg • Risk Mitigation Manager – Geff Garnhart • Configuration Manager – Becky Reed

  22. SDOs/Drivers DS, ETS • HL7 • X12 (HIPAA) • CHI • NCPDP • LOINC… • Terminology • Code Sets • VUID translation Project App Team • Business Reqs • Use Cases • Behavioral Model • PDM/LDM • DDL Team Interactions Unified semantics Re-usable artifacts Standardized calls Template Registry DATs VHIM Team • Stds Alignment • Class Model Architecture/Initiatives • HIA • ASIS • Common Services • / CDS SME Input Templates Model Reviews

  23. VHIM Governance • Requested changes and enhancements to the model are submitted through the VHIM Change Control process • VHIM Change Manager communicates requests to the following groups: • VHIM Stakeholder Council • Receives the requests for changes / enhancements • Harmonizes each request across known consumers to ensure against conflicts • VHIM CCB • Impacts harmonized change requests against scope, cost, schedule • VHIM Domain Leads • Impacts the complexity of the requested change from a domain perspective • VHIM Executive Steering Committee • Comprised of senior leadership in HIA and OI, makes final scoping and scheduling decisions for large impacting change requests

  24. Together, we’ll define: • Interoperable service message payload structures - what information needs to be shared / exchanged. • Messaging use cases and/or requirements (external messages), to include attributes and associations. • How these messages fit together.

  25. Communication Facilitation VHIM Conformance is a 2-way street Goal: Unified semantic approach • By aligning your application to the VHIM you will: • Better position your application for interoperability and future expansion • Enable re-use of service payload schemas, implementable java objects, and datastore schemas; thereby shortening development time • Assist in establishing the communication standard between HVV systems and services • To ensure that the VHIM meets your needs, you should: • Communicate business requirements and use cases • Identify public data - Determine what data you will need to share with (and require from) other applications.

  26. Take-Aways • The VHIM is the authoritative source for semantics and information structure for VHA • HealtheVet system-to-system communications are dependent on the VHIM • Iterative VHIM publications permit expanding content and frequent delivery while enabling a feedback loop for incorporating enhancement requests • HDR II and CDS are VHIM early adopters • Find out more here: http://vaww.va.gov/vhaea/scripts/vhim.asp • Get involved!

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