VA-DoD Health IT Sharing: Collaboration Among Agencies

1. VA-DoD Health IT Sharing: Collaboration Among Agencies Mr. Fred McLain (VA) April 18, 2006

2. Highlights • Why We Share • VA/DoD Joint Electronic Health Records Interoperability Plan, the Path to Interoperability – FHIE to BHIE to CHDR • Other Collaborative Initiatives • Lessons Learned • Contact Information

3. Why We Share

4. Reasons to Share • Congressional & Presidential mandates and directives • Support DoD/VHA/VBA Seamless Transition Efforts • Provides transition assistance to service members, National Guard and Reserve returning from combat, i.e., Operation Iraqi Freedom and Operation Enduring Freedom, and to separating service members • Support healthcare to active dual consumers and other shared beneficiaries • Medical sharing arrangements • Joint Venture sites • Retirees • Approximately 40% of VA beneficiaries receive care from additional outside providers • VistA software is in the public domain • VistA public domain software provides for a National solution with flexibility for local innovation • VistA Office – EHR • VA’s HealthePeople program

5. The Path to Interoperability

6. VA/DoD Joint Strategic Planning Initiative • VA/DoD Joint Executive Council (JEC) • VA and DoD established the Joint Executive Committee pursuant to P.L. 108-136, Sect. 583 which directed the Committee to make strategic planning recommendations to the Secretaries • In February 2002, Committee was merged into the JEC co-chaired by the VA Deputy Secretary and the DoD Undersecretary of Defense for Personnel and Readiness • Provides joint high-level oversight and strategic planning for interagency initiatives, including health information technology • VA/DoD Joint Strategic Plan (JSP) • Strategic Goal 4:Integrated Information Sharing - Enable the efficient sharing of beneficiary data, medical records, and other information through secure and interoperable information management systems. • VA/DoD staff complete monthly reports to monitor status • JEC reviews objectives and updates JSP annually

7. VA/DoD Electronic Health Record VA/DoD Joint Electronic Health Records Interoperability (JEHRI) Plan JEHRI Overview: • Developed collaboratively by VA & DoD • Approved by the VA/DoD Joint Executive Council and signed by the Under Secretary for Health and the Assistant Secretary of Defense for Health Affairs • Roadmap to provide VA/DoD interoperability by 2006 • Two Phases • Federal Health Information Exchange “FHIE” • Clinical Data Repository/Health Data Repository “CHDR”

8. JEHRI Goals • Improve sharing of information • Adopt common standards for architecture, security, communications, data, technology, and software • Seek joint procurements and/or building of applications where appropriate • Seek opportunities for sharing existing systems and technology • Explore convergence of VA and DoD health information technology applications where feasible and within mission requirements • Develop interoperable health records anddata repositories

9. DoD/VA Interagency Initiatives DoD VA FHIE One-way, enterprise exchange of text data FHIE BHIE BHIE Bidirectional real-time exchange of text data Bidirectional real-time enterprise exchange of computable data CHDR CHDR

10. Federal Health Information Exchange (FHIE) • Successfully completes Phase I of JEHRI • One-way exchange from DoD CHCS I to VA VistA CPRS • Allows access to DoD data at the point of care by VA clinician • Successfully deployed and implemented across all VA Medical Centers • Averages over 1100 uses of FHIE/BHIE data each day • Permits sharing of demographics, laboratory data, radiology reports, outpatient Government and retail pharmacy data, allergy data, admission, disposition and transfer (ADT) data, consult reports, and coding from the Standard Ambulatory Data Record (recent addition: pre- and post-deployment data) • FHIE data are available to VBA disability claims processors through VHA/VBA interface

11. Bidirectional Health Information Exchange – (BHIE) Bridging the Gap • CHCS/VistA BHIE brings real-time, bidirectional exchange of medical information reusing FHIE infrastructure • BHIE supports the care of shared patients at joint sites • Incremental Clinical Functionality was delivered in Cycle I (October 2004). Bidirectional transmittal and display of: • Outpatient pharmacy • Allergy data • Patient Identification Correlation • Additional Clinical Functionality was delivered in Cycle II. Bidirectional transmittal and display of: • Laboratory result data • Radiology text data • Operational at all VA sites and select DoD sites

12. CHDR • Represents the development of interoperability between the Clinical Data Repository (CDR) and Health Data Repository (HDR): • Leverage CHCS II experiences and lessons learned • Provide the cornerstone for interoperability between electronic health records for DoD and VA • Next generation systems: CHCS II and HealtheVet-VistA and the centralized data repositories • Bidirectional real time exchange of computable pharmacy, allergy, demographic and laboratory data • Drug – Drug interaction checking • Drug – Drug Allergy interaction checking • Anticipated release is 2006 • Pharmacy Prototype demonstrated exchange of computable pharmacy, allergy and demographic data late in FY 04

13. CHDR - Challenges • VA and DoD: • Use different information systems • Have differences in the drugs used, drugs identified (brand name vs. generic), documentation, and treatment choices • Must exchangedata that is interpretable to the other side • 1:1 mapping is cumbersome and not transferable • Map to an agreed upon terminology standard (Use CHI standards: LOINC, SNOMED, RxNorm) • Getting to standardized data • Availability and adequacy of standards • Incomplete data vs. incorrect data

14. Other Collaborations

15. Standards • Federal Health Architecture (FHA) Initiative • Improved coordination and collaboration on national health IT solutions • Improved efficiency, standardization, reliability, and availability of comprehensive health information solutions • VA/DoD lead partners in FHA with HHS as managing partner • http://www.hhs.gov/fedhealtharch • Consolidated Health Informatics(CHI) • Recently incorporated as a workgroup under the umbrella of Federal Health Architecture • Objectives focused on adopting existing clinical vocabulary and messaging standards to enable interoperability in the Federal Enterprise Architecture • Where there are gaps or no standards try to identify new standards • Have successfully adopted over 20 common messaging and data standards that will be implemented in common IT solutions • Purchased SNOMED licenses for joint SNOMED implementation • http://www.hhs.gov/healthit/chiinitiative.html

16. Other Applications • Laboratory Data Sharing and Interoperability (LDSI): Supports the electronic ordering and results retrieval of chemistry laboratory tests between DoD and VA facilities • Enterprise Architecture: Joint VA/DoD Shared Health Architecture Plan/Charter completed a “Shared Health Architecture,” version 1.0 in December 2004 • Scheduling Interoperability: Chartered work group exploring the feasibility of creating interoperable scheduling applications • e-Health collaboration: VA/DoD shared objectives for cooperation between TRICARE Online and My HealtheVet • Credentialing: Implemented pilot study to evaluate merits of integrating VA and DoD credentialing. Pilot was successful, but business case did not support deployment.

17. Lessons Learned • Relevant to the private sector and the Office of the National Coordinator for Health Information Technology • Technical • Non-Technical • Share where we can improve continuity of care, improve safety, or add business value • Value of standards

18. FOR FURTHER INFORMATION • Mr. Cliff Freeman, MA, MS, Director, VA/DoD Health IT Sharing Program Office, Veterans Health Administration, 1335 East West Highway, Suite 3100, Silver Spring, MD 20901 (301)734-0415 (voice) (301)734-0111 (fax) Cliff.Freeman@med.va.gov Fred.McLain@med.va.gov • http://www1.va.gov/vadodhealthitsharing/