VA-IHS MOU 2010 Potential for IT Sharing

1. VA-IHS MOU 2010Potential for IT Sharing Howard Hays, MD, MSPH RPMS Investment Manager IHS Office of Information Technology CPRS Clinical Workgroup March 9, 2011

2. New VA-IHS MOU • Signed 1 OCT 2010 • Includes numerous provisions around 5 goals • Increase access to and improve quality of health care and services to the mutual benefit of both agencies. • Promote patient-centered collaboration and facilitate communication among VA IHS, American Indian and Alaska Native Veterans, Tribal facilities, and Urban Indian Clinics. • Establish effective partnerships and sharing agreements among VA headquarters and facilities, IHS headquarters and IHS, Tribal, and Urban Indian health programs in support of American Indian and Alaska Native Veterans. • Ensure that appropriate resources are identified and available to support programs for American Indian and Alaska Native Veterans. • Improve health-promotion and disease-prevention services to American Indians and Alaska Natives to address community-based wellness.

3. Specific Areas of Collaboration • Expand Tribal Veterans Representative program and training I/T/U staff re VBA • Improve coordination of care and co-management of shared patients • Enhance access especially through tele-health, tele-psychiatry, tele-pharmacy • Improve efficiency through shared contracts and purchasing agreements, pre-approved templates for local agreements, etc. • Improve delivery of care through sharing of care processes and programs.

4. Specific Areas (cont’d) • Increase cultural awareness and culturally competent care. • Increase capability and improve quality through training and workforce development – joint training initiatives, offering CME across agencies, exchange of staff for training, etc. • Enhance recruitment and retention through sharing of specialty services, joint credentialing, joint facility/service planning, etc. • Share emergency/disaster/pandemic preparedness and response.

5. Information Technology • To improve care through the development of health information technology, including the following: • Sharing of technology • Joint development of applications and technologies. • Adaptation of applications and technologies developed by one agency to permit use by the other. • Mechanisms for the exchange of funds to support this adaptation and sharing.        • Interoperability of systems to facilitate sharing of information on common patients and populations • The VA and IHS will develop processes to share information regarding planned development of applications and technologies to facilitate this collaboration. • The VA and IHS will develop standard, pre-approved language for inclusion in sharing agreements to support this collaboration.

6. VA-IHS IT Workgroup • The MOU authorizes (requires) the creation of joint workgroups to carry out the initiatives authorized under the MOU. • The VA-IHS IT Workgroup is co-chaired by: • Howard Hays, MD, MSPH (IHS) • Clayton Curtis, MD, PhD (VHA) • Other members are being sought as we speak. • Existing areas of collaboration/work are described in the following slides.

7. VA-DoD Joint Way Forward • Mandated at VA executive level to create a new EHR user interface compatible with both VistA and CHCS. • IHS not specifically involved in short-term goal, although participated in requirements meeting in January. • IHS interested in engagement with longer-term planning around common interface requirements.

8. EHR Certification & Meaningful Use • IHS has certified (pending – knock on wood) RPMS EHR for both Inpatient and Ambulatory settings per Stage 1 ONC/NIST requirements • IHS is executing a broad communication, awareness, and training program for Meaningful Use (Stage 1 and beyond) • VA has been instructed to achieve certification for VistA/CPRS and achieve MU at VA facilities. • IHS can help . . . .

9. LOINC/UCUM Implementation in IHS • Interoperability requirements specify the use of LOINC/UCUM for laboratory tests, so IHS is implementing both code sets. • Enhanced LOINC mapping utilities developed by IHS • Have developed a process for periodic updates of LOINC codes from the Regenstreif database • LOINC codes stored with Results in Lab Package • IHS lab team has been meeting with counterparts from VA – we’ll share anything we did • Reference labs don’t consistently use LOINC (yet) • Our LOINC imports from Regenstreif include Clinical LOINC codes – not used yet but potential for future utility

10. ICD-10 Development & Implementation • Both agencies are under the same mandate – ICD-10 implemented by 1 OCT 2013. • VistA and RPMS data structures are essentially the same on the back end. • Collaboration is a no-brainer, but – we have little visibility as yet into either the technical approach or implementation/training plans of the VA • We do have a single participant on the VA’s ICD-10 Integrated Project Team (IPT) • IHS is concerned about timing of the VA solution as we have many non-VA packages that will need to be developed once the core solution is defined • IHS may need to embark on our own approach – and we will probably be doing SNOMED-CT at the same time

11. CMOP • Considerable demand in IHS for CMOP services • Pilot project underway with Rapid City IHS hospital and the Leavenworth CMOP facility • Two other sites planned for this year, then broader rollout • Featured in Drug Topics, Feb 15, 2011 • www.drugtopics.modernmedicine.com

12. Standards & Terminology Services • VA has adopted centralized approaches to management of such things as drug file updates, TIU note titles, CPT/ICD and other code sets • IHS is trying to evaluate the feasibility of emulating the VA centralized approach, and the risks of not doing so (i.e. not being able to get drug file updates from VA) • Securing consultation from VA staff knowledgeable in this area has been problematic

13. VistA Imaging & VistA Rad • IHS, Tribal, and Urban facilities are using VI/VRad – 86 for scanning and 26 for DICOM to date • We have an agreement with VA for Help Desk support ($45,000) and development ($200K) • Separate contract with HP for hardware support • IHS has been pushing VA for changes, including new hardware configuration for small sites, display of IHS HRN (vs SSN), Win Server 2008 support, virtual machine environment support, Win 7 client support • VA decision regarding VistA Rad is very concerning to IHS and our Federal/Tribal hospitals

14. BCMA Implementation in IHS • IHS/Tribal hospitals need to move to BCMA for Meaningful Use (Stage 2). • Two hospitals are on prior versions of BCMA. • VA just released a BCMA patch with IHS mods • IHS is devising an implementation plan for the remaining hospitals • VA Bar Code Resource Office has offered assistance – may need an additional agreement, possible transfer of funds (a la VI)

15. FYI – RPMS Has Some Cool Stuff Too • Development for Stage 1 Meaningful Use (Ambulatory and Inpatient) – complete • iCare Panel/Population Management GUI • Care Management Event Tracking • HIV Management System • Customizable EHR GUI • GUI in development – OP Pharmacy & Reports, Scheduling, ADT, Registration • Other Medication Management features

16. Other Collaboration Possibilities • Shared Application Development • Shared GUI Development • Simplification of Legacy Application Maintenance (exp Pharmacy and Laboratory) • Pre-decisional stakeholder engagement with IHS (e.g. VistA RAD) • Others (rewrite TIU??) . . . . ?

17. Topics for Future Discussions • EHR Certification and Meaningful Use in IHS and Tribal Programs • How is RPMS different than VistA? • Medication management • Panel management & population health • Etc. • ICD(-10), SNOMED, and LOINC (oh, my!) • Others?