VistA Evolution and
Enterprise Health Management Platform
Region Update by
Marcia Pickard
October 8, 2014
*
Definitions: Program and Products
•
VistA Evolution is the joint Office of Information and
Technology (OIT)-Veteran Health Administration (VHA)
program to refresh VistA.
•
VistA 4 is the featured product
- Technical approach is to keep parts of current VistA and
gradually add more modern and flexible components to allow
more rapid, higher quality, less expensive addition of new
functionality.
Program
Product
Lines
VistA 4
(Clinical Systems)
VistA Evolution
Top level coordinates
among product lines
VLER
Interoperability
Population
Management &
Analytics
This product line is
pre-decisional
Patient-centric, Team-based,
2
Quality-driven
VistA 4 Product Roadmap
2014
2015
2016
2017
2018
Gen 4: Advanced systems that provide
substantial functionality for nurses,
physicians and pharmacists; have more
decision support and workflow capabilities
along with tools that permit providers to
more easily bring Evidence Based
Medicine to the point of care.
Colleague EHR
(Gartner Gen 4)
Care Coordination
Interoperability and Improved
Care Management
Core Care Management and Office of
National Coordinator (ONC) Certification
Initial Care Management
Capabilities
3
Before VistA Evolution –
The Health Informatics Initiative (hi2)
“Transform Healthcare Delivery through Health Informatics”
(Health Informatics Initiative or hi2) was created by Secretary
Shinseki in May 2010 with these missions:
•
Provide foundational Information Technology (IT) and Informatics
components for Veterans Health Administration (VHA)’s transition from a
medical model to a patient-centered model of care.
•
Build a sustainable collaborative approach, capacity, and tools to deliver
informatics solutions to transform health care delivery to Veterans
through three major projects or Workstreams.
•
Build a platform and functionality to support collaboration with VistA
Evolution and Computerized Patient Record System (CPRS) – Health
Management Platform (HMP)
Health Management Platform (HMP)
•
•
Hi2 committed to providing HMP capabilities to two sites
by Sept. 2014 (IOC carryover from iEHR milestone)
Commitment was met by production implementation of
HMP at San Diego, Hampton and San Antonio, including
these capabilities:
-
•
Google-like Search across patient records
Improved Medication Review
InfoButton links to external medical references
News Feed
Tasks
CPRS classic views
HMP currently complements but does not replace any
part of CPRS.
Enterprise Health Management Platform (eHMP)
•
Large contract award to ASMR/Agilex in September
2013 – referred to as UX (User Experience)
•
HMP code has been provided to ASMR/Agilex to serve
as the foundation for the enterprise product (eHMP).
VPR is being reused, but the UI is a new start.
•
Hi2 team has transitioned from initiative status, merging
with Dr. Nichol’s office – Health Solutions Management –
effective October 1, 2014, and will continue to contribute
code to eHMP
6
eHMP and eVPR
•
The combination of the HMP, JLV and User Experience
teams’ efforts will become Enterprise Health
Management Platform (eHMP)
•
Will become the eventual CPRS replacement
•
eHMP will be a Product that consists of multiple
components: eHMP GUI, Enterprise Virtual Patient
Record (eVPR), and Vista Exchange
•
VistA will continue to be an authoritative data store
where it is so today
7
Enterprise Health Management Platform (eHMP)
•
•
•
•
•
•
•
•
•
•
Vista Exchange
Clinical Decision Support
Context Persistence
Orders Selection Service
Orders Management
Service
Data Annotation Service
Clinical Workflow
Concept Relationship
Service
Documentation and Text
Search Service
Business Rules
Management System
eHMP Services
Middle tier Components
eHMP User
Experience
JLV View
CPRS Features
HMP IOC Features
8
ONC Certification Features
eHMP – User Experience
• eHMP will provide end user clinical encounter and care
coordination transaction capabilities, data visualization, and
decision support integration between Provider, Patient, and
System facing components and devices. Different capability
configurations will be available based on user roles. eHMP
will:
- become the eventual CPRS replacement
- maintain the joint VA/DoD JLV functionality
- provide new clinical functionality
- be used for ONC 2014 edition certification
9
VistA Exchange and eVPR
• VistA Exchange is the VistA 4 clinical application data
services engine, providing an enterprise Virtual Patient
Record service (eVPR) optimized for the enterprise
Health Management Platform (eHMP) and other point
of care applications and workflows
• eVPR includes information model binding, terminology
normalization, knowledge enrichment, and search
indexing for all available longitudinal patient record data
aggregated from VA, DoD, and exchange partner
sources.
Abstracted Architectural Roadmap
VLER
VistA Base eHMP Pop Health
2014
2015
2016
2017
2018
Cut IT funding
Advanced decision support
External applications
Scalable architecture
Add data abstraction layer
Critical fixes
Native standardized data
Better user experience
Replace some VistA applications
Enhance VistA database and some VistA applications
Standardize clinical terms
Enhance interoperability (get data from external providers)
Patient-centric, Team-based,
11
Quality-driven
eHMP FY 14-16 PSI Functional Roadmap (Proposed)
PSI-6 Nov 18 – Feb 23 ‘15
• Tasks
• CPOE
• Drug-Drug/Drug-Allergy
Interaction
• Drug-formulary Checks
• eSignatures
• Documentation
• Immunizations
• Smoking Status
• Info Presentation
• Persist user references
• User-defined views/filers
• CPRS Graphing
• Patient
Inquiry/Insurance/MHV
• T.O.C.
• Receive, Display, and
Incorporate TOC
• Create/Transmit TOC
• CDS
• Open CDS
PSI-7 Feb 24 – May 18 ‘15
• Tasks
• ePrescribing
• Documentation
• Clinical reconciliation Med reconciliation
• Info Presentation
• VistA Web Health
Summaries/Report
• VistA Imaging
• CPRS Graphing
• Reports CPRS
• T.O.C.
• Clinical Summary (AVS)
• CDS
• ONC CDS
•
•
•
•
•
PSI-8 May 19 – Aug 24 ‘15
Tasks
• Orders/Tasks
Documentation
• Amendments
• Note objects
• Free text notes & old note
objects
Info Presentation
• Image Viewer
• Printing
• CPRS Graphing
• Reports CPRS
T.O.C.
• Data Portability
• Clinical Summary (AVS)
CDS
• Patient Specific Education
• Open CDS other
• Authoring
• Concept Relationship
• Other CDS
• Workflow Management
• Care Plan Basic
eHMP FY 14-16 PSI Functional Roadmap (Proposed)
PSI-9 Aug 25 – Nov 17 ‘15
PSI-9 Continued
• Tasks
• Order sets
• Quick orders
• Order Menu
• Formulary Restricted
• ePrescribing
• Documentation
• Progress Notes
Modernization
• Documentation Kit
[Legacy/New]
o Family History
o Smoking status
o Functional Status
• Annotation*
• Encounters
• Templates, fields, objects
• Info Presentation
• VBA User
• Printing
• Reports CPRS
• Concept-driven displays
• CDS
• Clinical Reminders
Replacement – KBS help?
• Other CDS
• Concept relationship
authoring
• Workflow (CDS support)
• Care Plan
PSI-10 Nov 17 – Feb 22 ‘16
• Tasks
• Order authoring
• Order sets
• In patient meds for
Outpatient
• Documentation
• Progress Notes
Modernization
• Dialogs [Legacy/New
• Info Presentation
• Printing
• CDS
• Clinical Reminder
Translation - Contract?
• Other CDS
• Workflow (CDS support)
• Care Plan
eHMP FY 14-16 PSI Functional Roadmap (Proposed)
PSI-6 Nov 18 – Feb 23 ‘15
PSI-7 Feb 24 – May 18 ‘15
PSI-8 May 19 – Aug 24 ‘15
PSI-9 Aug 25 – Nov 17 ‘15
• VPR Sync
• Sync Overhaul
• Cache update on write-back
• Support CDS to update RPCs
• User Identity & Access
Services
• ABAC
• User Repository
• User Provisioning
• ONC Audit
• Performance
• VistA Routine Dep
• Split Resource Server
(clusters)
• Monitoring
• System Monitoring
• External Integration
• jMeadows
• NwHIN
• DoD Adapter
• VPR APIs VX Patient record
• VSA Spike
• User Identity & Access
Services
• SSO/PIV
Authentication
• Performance
• SOLR
• PEP
• Authentication
Validation in parallel
• Monitoring
• Production Level
Monitoring (similar
to JLV)
• External Integration
• jMeadows
• VSA
• DR/Failover
• 2 sites
• Performance
• Concept Searches
• Reverse Proxy
Change
• External Integration
• VSA
• DR/Failover
• Multi site
Modularity and SDK in eHMP
• Development modularity and services will exist at
multiple levels – user interface, middle tier, data levels
• Software Development Kit (SDK) will be made
available to the community.
• The SDK is comprised of:
• Application Development Kit (ADK) to drive
development of the client-side web application.
Build using JavaScript, backbone.js, marionette,
bootstrap. Resulting application is SPA, static HTML
served from web server (no J2EE server)
• Resource Development Kit (RDK) to drive the
development of service side resources (web
services) to support the web application. Build using
JavaScript, express.js. Deploy to node.js; relies on
npm for package management.
eHMP Application Development Kit (ADK)
• ADK provides mechanisms for applet developers to
• Discover the current patient
• Fetch patient data from vista exchange, can use canonical model (based on
VPR) or provide custom "view" model
• Bind data to backbone views, provide templating
• Choose preselected display paradigms (tableview, etc) and UI controls. UI style
set by application
• Create three different "size" views to support responsive / adaptive design
• ADK provides mechanisms for screen designers to
• Create a screen, choose from predefined layouts and assign applets to regions
• ADK provides for application designers
• Runtime UI shell for application. Displays current patient, current user. Provides
navigation
• Mechanism to choose the screens that are part of the application
• ADK also provides
• CI pipeline/devops for pulling applets/screen configurations from artifact
repository, compiling, packing, testing, and publishing to artifact repository.
This produces a CM-ed version of the web application (which includes specific
version of applets)
eHMP Resource Development Kit (RDK)
•
•
•
•
Resource = a single web service (e.g., save allergies)
Resource Family = collection of resources
Resource Server = deployable unit, including a family and configuration
RDK for resource developers
• Configuration of the resource family
• For each resource, specifies relative mount path and method using
standard express signature function(request, response, next)
• Specifies resource characteristics (sensitive, audit information)
• Request provides resource information about the request: url, path
parameters, query parameters, header, current user, access to RDK utility
methods, access to current resource server, configuration information, logger
• Response provides resource ability to send response: status code, json or text
body, media information
• Resources with handles to common external systems, including JDS, VistA(s),
solr search engine
eHMP Resource Development Kit (RDK)
• RDK for deployment engineers when creating a resource server
• Group resources into a logical deployment unit called a resource server.
• Specify how many processes using cluster/fork
• Deployment engineer chooses which resource family should be registered
using: (show code)
• Resource Server deployed behind a reverse proxy (apache httpd) for load
balancing
• Ability to enable: authentication, authorization/PEP, audit
• Specify logging rules, configuration, resource caching rules
• Routes calls to resources based on URL and media type (content-negotiation)
• Provides health check (binary and discrete information) based on each
resource registered. Deployment engineer can specify additional health check
rules.
• RDK also provides
• Centralized dependency management
• Automatic creation of resource directory
• CI pipeline/devops for pulling applets/screen configurations from artifact
repository, compiling, packing, testing, and publishing to artifact repository.
This produces a CM-ed version of the web application (which includes specific
version of applets)
‘Local’ VistA
READS – (VDEF, RPC and FMQL)
RPC Broker
Logical View of Patient Encounter – VistA 4 (Simplified)
RPC
CALLS
(WRITE)
eHMP
integrates
HMP/Mobile/JLV
Team – Patient - System
Remote
VistA
READS
Remote
VistA
READS
V i s t A S h a d ow
Terminology
Service
CDS Support
Services
Future Services
(ie., Orders)
(Knowledge Base)
Access
Management
Identity
Management
SFC(Ret) Smith’s Care Team
VistA
Exchange
Future Services
MHV
CDW
FHIR
VINCI
VLER DAS
DoD
Consent
Management
VA
VA Partner
DMIX / DHMSM HIE
MDR
HSDW
VA Partner
BHIE SHARE
VA Partner
CHCS
AHLTA
DHMSM
Essentris
ESB connections
(with VSA services)
DoD VLER
ADAPTER
DoD Partner
DoD Partner
CDR
DRAFT
PDTS
DoD Partner
Partners