Big Things on the Horizon for Health Systems Interoperability and the Warfighter /Veteran Mrs. Debra Filippi, DoD/VA IP

1. Big Things on the Horizon for Health Systems Interoperability and the Warfighter/Veteran Mrs. Debra Filippi, DoD/VA IPO Dr. Paul Tibbits, VA Dr. George “Peach” Taylor, DoD April 15, 2011

2. Agenda • James A Lovell Federal Health Care Center (JAL FHCC) • Virtual Lifetime Electronic Record (VLER) • Interdepartmental Electronic Health Record (iEHR) Key Agreements

3. JAL FHCC • JAL FHCC Capabilities Delivered: • Single Patient Registration • Medical Single Sign-On with Context Management • JAL FHCC Future Capabilities: • Orders Portability (OP for Laboratory and Radiology) • OP Pharmacy • OP Consults

4. VLER Concept • “…both Departments will work together to define and build a system that will ultimately contain administrative and medical information from the day an individual enters military service throughout their military career, and after they leave the military” • -President Obama, April 9, 2009

5. VLER Capability Areas & Points of View VCA 4 VCA 1 VCA 3 VCA 2

6. iEHRModernization Objectives • EHR modernization efforts provide the opportunity to implement standards-based, Health IT solutions that will modernize existing Department EHR capabilities…and (provide) reduced sustainment costs.* • Effectiveness objectives: • Provide a patient-centric health care experience • Improve the quality of delivered services • Improve interoperability and data sharing between the departments • Efficiency objective: • Reduce overall cost of Health IT investments in acquisition, development and sustainment To achieve these objectives, the Departments’ modernization plans should be compatible and synchronized * “Joint Executive Council and Health Executive Council Report to Congress on Defense and Department of Veterans Affairs Medical Information Technology”

7. Architecture Common DoD-VA Requirements: HL7 EHR-S Functional Model with DoD and VA vetted Extensions (SV-4) Common DoD-VA Integrated Health Business Reference Model (OV-5) Common DoD-VA “To Be” Process Flow Model (OV-6C) Presentation Layer Team Presentation (Common GUI) Applications and Services Systems Capabilities Team VA Unique (6) DoD Unique (16) Common (Joint) Applications & Services (30) Pharmacy PersonalHealth Record Laboratory Blood Mgmt Battlefield Care Pediatrics Nursing Home Long Term Care Mission Requirements & Performance Outcomes Team Business Process Team DisabilityEvaluation InpatientOrders Mgmt EmergencyDept Care DocumentMgmt MilitaryReadiness Obstetrics Rehabilitative Care TransientOutreach Dental Care Consult &Referral Mgmt Immunization OperatingRoom Mgmt Enroute Care Veterinary PharmacyMail Order OccupationalHealth (VA) Common Interface Standards Enterprise Architecture Team Common Services Broker(includes Enterprise Service Bus (ESB) and Infrastructure Services) Common Interface Standards Common Data Centers Data Inter- operability Team Common Information Interoperability Framework (CIIF) Common Information Model, Common Terminology Model, Information Exchange Specifications, Translation Service Common Data Standards: SNOMED CT and Extensions, LOINC and RxNorm Common DoD-VA Measures of Effectiveness, Measures of Performance and key Performance Parameters Pre-decisional v2 iehr DoD Only VA Only Joint DoD/VA

8. iEHR Key Agreements • DoD and VA will continue to synchronize EHR planning activities for a joint approach to EHR modernization • The Departments have already identified many synergies and common business processes, including: • Common data standards and data center consolidation • Common clinical applications • Common user interface

9. iEHR Key Agreements Cont’d • The VA has released an RFP to evaluate open source management options, and DoD is working with the VA to identify opportunities to contribute and participate in the open source collaboration • As the open source communities mature, DoD and VA will continue to analyze open source components that fit the architectural construct for use in the future EHR