Virtual Lifetime Electronic Record VLER Session 915 August 10, 2010

2. Agenda Virtual Lifetime Electronic Record Virtual Lifetime Electronic Record Health Nationwide Health Information Network/Standards Status of Interoperability Pilots San Diego Hampton/Tidewater 2

5. The Next Frontier VLER will gradually replace current VA and DoD data sharingVLER will gradually replace current VA and DoD data sharing

6. Nationwide Health Information Network

7. Nationwide Health Information Network (NHIN) (cont.) The NHIN is: A collection of standards, protocols, legal agreements, specifications, and services that enable the secure exchange of health information electronically Adaptors make data available through the NHIN in standard formats The Department of Defense (DoD) and the Department of veterans Affairs (VA) use of the NHIN will help drive and establish the standards for health information exchange nationally 7

9. Why Virtual Lifetime Electronic Record ? VLER is important to Service members and Veterans at the Department of Defense (DoD) and the Department of Veterans Affairs (VA) Provides uniform, comprehensive, and convenient access to information Streamlines the data exchange Results in the Virtual Lifetime Electronic Record Decrease burden for beneficiaries to provide information Enhances quality of health care Delivers health care and benefits more efficiently Reduces costs by decreasing errors and test duplication

10. Virtual Lifetime Electronic Record Implementation Plan and Goals Sequenced to achieve staged implementation objectives Coordinated with the Department of Health and Human Services Beacon Community* grants to promote the adoption of electronic health information technology (HIT) and the exchange of health information with the private sector in specific geographic areas Accomplished in manageable segments that are well defined and aggressively time phased

11. Virtual Lifetime Electronic Record Health Communities

12. Virtual Lifetime Electronic Record Health Community Locations Create a business case to attract private sector providers through provider contract incentives, technical support, and lower costs Identify Department of Veterans Affairs (VA) and the Department of Defense (DoD) communities that have characteristics favorable to pilots with private sector contract providers Leverage success of the Virtual Lifetime Electronic Record Health Communities to attract others to participate in Nationwide Health Information Network based electronic Health Information Exchange Expand implementation of Virtual Lifetime Electronic Record

13. Phase 1b: Virtual Lifetime Electronic Record Health Community Expansion Select additional sites to assess for DoD, VA, and private sector pilots Approved the first Virtual Lifetime Electronic Record Health Community site at December 2009 Joint Executive Council (JEC) Recommended next 2 to 4 sites at the March 2010 Joint Executive Council (JEC) Begin implementation at new sites Coordinate with the Department of Health and Human Service efforts on Electronic Health Record adoption and Beacon Community effort Notify and recruit community leaders Implement Aim for production pilot implementation of the additional sites before the end of Calendar Year (CY) 2010

14. Subsequent Phases of Virtual Lifetime Electronic Record Implementation Determine private health data sharing opportunities with other federal agencies Incorporate lessons learned of previous pilots Leverage expansion from pilot projects Involve other private sector partners Modernize current electronic health systems at the Department of Defense (DoD) and the Department of Veterans Affairs (VA) to comply with Nationwide Health Information Network standards

15. Virtual Lifetime Electronic Record (VLER) Governance Groups April 21, 2010 JEC = Joint Executive Council VLER SMC - FOUO_IPO NOT RELEASABLE For best viewing, Choose Design Tab, Colors: Aspect For best viewing, Choose Design Tab, Colors: Aspect

16. Department of Veterans Affairs (VA) Case for Interoperability Veterans 3 out of 4 Veterans receive a portion of their care from a civilian private sector provider VA purchases care in most markets Electronic health data is not shared among the VA�s system and the private sector providers of care to Veterans Less than 20% private providers have adopted Electronic Health Records When American Recovery and Reinvestment Act (ARRA) stimulus results in greater adoption � issue that will need resolution 16

17. Case for Interoperability (cont.) VA has: A highly adopted (approaching 100%) Electronic Health Record (EHR) An advanced Personal Health Record, called My HealtheVet An advanced Picture Archiving and Communication Systems (PACS) Advanced Bar Code Medication Administration (BCMA) program VA will benefit from cost and quality improvements, but highest concern is enhanced safety and convenience for Veterans 17

18. Cases for Interoperability (cont.) Veterans and their families

19. Content Specification (C32) Modules Health Care Provider Insurance Provider Allergy/Drug Sensitivity Condition Medication Pregnancy Information Source Advance Directive Immunization Vital Sign Result Encounter Procedure Person Information Language Spoken Support

20. Content Specification (C32) Modules for Initial Exchange (San Diego) Health Care Provider Insurance Provider Allergy/Drug Sensitivity Condition Medication Pregnancy Information Source Advance Directive Immunization Vital Sign Result Encounter Procedure Person Information Language Spoken Support

21. Content Specification (C32) Modules for Kaiser Permanente (Med Virginia*) Health Care Provider Insurance Provider Allergy/Drug Sensitivity Condition Medication Pregnancy Information Source Support Advance Directive Immunization Vital Sign Results (labs: chemistry/hemotology) Encounter Procedure Person Information Language Spoken

22. Content Specification (C32) Modules for Kaiser Permanente, Med Virginia, Other Sites* Health Care Provider Insurance Provider Allergy/Drug Sensitivity Condition Medication Pregnancy Information Source Support Advance Directive Immunization Vital Sign Results (labs: chemistry/hemotology) Encounter Procedure Person Information Language Spoken

23. View of Summary Care of Record

24. Aggregated View of Medications

25. Aggregated Views of Allergies

26. Aggregated Views of Problems

27. Timeline 2007 Founded Federal Health Architecture CONNECT effort to fund development of the common Gateway 2008 Built the Department of Veterans Affairs (VA) Adapter Demonstrated Technical Capability in test environments 2009 Advanced to Production Pilot in San Diego with Kaiser Permanente 2010 Replicate production pilot in Hampton/Tidewater area Expand the shared data set 2011 More Virtual Lifetime Electronic Record (VLER) pilots 2012 Pilots end, full participation in Nationwide Health Information Network (NHIN)

28. Lessons Learned Patient authorization Information preservation Community and regional health exchange readiness Interoperability, semantic interoperability, data standardization, and privacy/security issues User training Coordination at the site

29. Measures of Effectiveness Evaluate health exchange From the Department of Veterans Affairs (VA) perspective From interoperability perspective Independent, non-biased evaluation Three-year competitive bid contract Summer 2010 award Apply a performance evaluation plan

30. The Next Frontier: Sharing Data Proposed Speaker: IPO The VA and the Department of Defense (DoD) currently share more data than any other systems in the world but this approach has limits and is not a long term solution I told you that DoD and VA are sharing millions and millions of records � here�s some more statistics. As of November 2009, using F-H-I-E, DoD transmitted health data on more than 5.0 million retired or discharged Service members with data dating back to 1989 to present. Of these 5.0 million patients approximately 1.8 million have presented to VA for care, treatment, or claims determination. This number grows as health information on recently separated Service members is extracted and transferred to VA on a monthly basis. With efforts beginning just prior to 2004, the B-H-I-E data exchange has grown so that as of November 2009, there are more than 3.4 million shared patients, which includes 1.6 million patients not in the FHIE repository, and over 150,805 Theater patients. FHIE/BHIE inquiries during 4th quarter FY 2009 averaged 76,950 per week. Also as of November 30, 2009, the Departments exchanged computable outpatient pharmacy and medication allergy data on over 47,9500 patients who receive healthcare from both systems. Most of the data exchanged dates back to 1989 to the present day. TRANSITION TO VAProposed Speaker: IPO The VA and the Department of Defense (DoD) currently share more data than any other systems in the world but this approach has limits and is not a long term solution I told you that DoD and VA are sharing millions and millions of records � here�s some more statistics. As of November 2009, using F-H-I-E, DoD transmitted health data on more than 5.0 million retired or discharged Service members with data dating back to 1989 to present. Of these 5.0 million patients approximately 1.8 million have presented to VA for care, treatment, or claims determination. This number grows as health information on recently separated Service members is extracted and transferred to VA on a monthly basis. With efforts beginning just prior to 2004, the B-H-I-E data exchange has grown so that as of November 2009, there are more than 3.4 million shared patients, which includes 1.6 million patients not in the FHIE repository, and over 150,805 Theater patients. FHIE/BHIE inquiries during 4th quarter FY 2009 averaged 76,950 per week. Also as of November 30, 2009, the Departments exchanged computable outpatient pharmacy and medication allergy data on over 47,9500 patients who receive healthcare from both systems. Most of the data exchanged dates back to 1989 to the present day. TRANSITION TO VA