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
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
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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
Technical Interoperability
Information Exchange
Semantic Interoperability
Shared Meaning
Process Interoperability
Workflow Continuity
Seamless Interoperability
is Technical, Semantic and Process Interoperability together
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DoD/ VA IPO Role in
Interoperability
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Proposed i3P – a Foundation for
Seamless Interoperability
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.
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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
Janus JLV provides an integrated read-only view of health data from DoD and VA
sources in a common viewer.
Features
An important stepping stone toward
modernizing our VA and DoD health
• Web-based Graphical User Interface
information systems, JLV will support
• Integrated, chronological view of VA and DoD patient
care of our Wounded Warriors and
data on a single screen
Veterans by improving access to
• Displays progress notes, problem lists, labs, vitals,
electronic patient records and reducing
the need to transfer information by fax,
immunizations, allergies, medications, Essentris
mail, or CD.
inpatient discharge summaries (DoD), and radiology
• User friendly, configurable screen layout
• Easy to learn, intuitive user interface
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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
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Janus JLV Usage: May – August 2013
Janus JLV Usage Activity
1200
1000
800
Total Unique Users / Month
Total Across
600
all Sites
Total Logins / Month
Total Patients Selected / Month
400
200
0
May '13
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June '13
July '13
Aug '13
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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)/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.
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
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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
Trusted
Agreements,
High Impact
Partnerships
Expand
eHealth
Exchange
Sites
Pilot the
“Direct
Project”
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Other Health
Information
Exchange
Scalability
through
Testing
Support
Benefits
Claims
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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
Pilot Site
Exchange Partner
DoD/VA
Began Exchange
San 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
VA
2/7/13
VA
4/24/13
Boise, Id
Idaho Health Data Exchange
Pensacola, Florida/Biloxi,
Pensacola Health Information Exchange
Mississippi
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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
‘to care for him who shall have
borne the battle and for his widow,
and his orphan’
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Current VA Landscape
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
eHealth
Connected
Health
Janus
JLV
VistA
Web
RDVs
CAPRI
iEHR
CPRS
VistA
Standardization
VistA
HMP
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‘Conceptual’ representation of current EHR/HIT Landscape
Acronyms:
CAPRI – Compensation and Pension
Record Interchange
HMP – Health Management Platform
iEHR – integrated Electronic Health
Record
JLV – Joint Legacy Viewer
RDV – Remote Data Views
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VistA Evolution and VistA IV
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 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.
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VistA Evolution
Beginning in Fall 2013, we will
analyze and synthesize existing
platforms into the new platform
– VistA IV
Connected
Health
A single viewer will become the
starting point for a new User
Experience to support PACT,
patients, and the population
VistA IV
VistA
RDVs
HMP
CAPRI
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
DoD
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iEHR
UX
Janus
JLV
VistA
Standardization
VistA
Web
CPRS
eHealth
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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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VistA Evolution 2017
Federal
Partners
(DOD, IHS)
User
Experience
VBA
Open
Source/
Community
Partners
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VistA IV
Interoperable
Care
Coordination
Framework
Integrated Architecture
and Services
By 2017, we
will have an
architecture and
framework that
supports
interoperability,
care coordination,
meaningful use and
partnership
Standard Data
Model
Acronyms:
DoD – Department of Defense
IHS – Indian Health Service
VBA – Veterans Benefits Administration
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Questions?
Contact Information:
Theresa Cullen, M.D, M.S.
Theresa.Cullen@va.gov
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