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Seamless Transition – VA/DoD

Federal Health Information Exchange (FHIE) & Bidirectional Health Information Exchange (BHIE). Seamless Transition – VA/DoD. Interoperability Showcase, HIMSS 2006 February 15, 2006. Briefing Participants. Greg Donham – Interagency Program Director, Department of Veterans Affairs

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Seamless Transition – VA/DoD

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  1. Federal Health Information Exchange (FHIE) & Bidirectional Health Information Exchange (BHIE) Seamless Transition – VA/DoD Interoperability Showcase, HIMSS 2006February 15, 2006

  2. Briefing Participants • Greg Donham – Interagency Program Director, Department of Veterans Affairs • Phil Dederer – Deputy Interagency Program Director, Department of Defense / EI/DS • John Leslie – Chief Architect Northrop Grumman IT / Military Health & Veterans Affairs

  3. Introduction of Participants Program Overview Technical Overview Questions & Answers Presentation Agenda

  4. Interagency Background • Break-through clinical effort for both Departments • OMB Exhibit 300 project, proceeding through FY2011, as part of President’s Management Agenda • High performance project management process embraces continuous improvement • Re-use of numerous processes and infrastructure

  5. Interoperability Goals • To provide the best healthcare possible to the U.S. Military and our veterans • Operate a joint system for initial one-way transfer of electronic health information from DoD to VA that contributes to veterans’ health • Provide on-demand electronic health information to assist in the compensation process • Ensure compliance with HIPAA regulations and security requirements with existing systems • Create an environment for storing very sensitive information • Use a patient-focused information technology familiar to authorized VA and DoD users

  6. VA/DoD Health IT Collaboration Goals • Improve sharing of clinically relevant health information • Seek joint procurements and/or building of applications • Seek opportunities for sharing existing systems & technology • Explore convergence of health information applications consistent with mission requirements • Develop interoperable health records and data repositories

  7. Federal Health Information Exchange (FHIE) • The Federal Health Information Exchange (FHIE), provides clinicians, at all Veterans Health Administration Facilities, with the capability to access DoD health information on separated and retired members of the Uniformed Services. • The FHIE Project is an excellent example of inter-agency collaboration that has markedly enhance the continuity of care to our nation’s veterans. • Capabilities • Provided historical extraction of laboratory, radiology, outpatient pharmacy, allergy, demographic, discharge summaries, SDAR, PDTS, and consult data on separated service members • Provides periodic (monthly) updates • Provides daily clinical data on VA beneficiaries (PATCAT – K61) receiving care at DoD MTFs • IOC achieved May 2002 • FOC achieved February 2004, Re-Certified November 2005

  8. 3.3million unique patients with clinical data** DMDC Data 4.1 million records* Correlated Patients 2.4 million unique patients registered in the VA with clinical data FHIE Repository Statistics Separated Service Members *Due to the incremental deployment of CHCS in the early 1990s, many of those who separated during that period had no entries within CHCS, therefore this number will not match the data extraction number from DMDC.

  9. DoD Historical Data in FHIE Repository(N> 142 Million HL-7 and SADR messages)(As of 3 January 2006)

  10. Bidirectional Health Information Exchange (BHIE) • Provides effective quality care at Joint Venture Sites. • Provides both the Veteran’s Health Administration (VHA) and Department of Defense (DoD) physicians access to clinical data for a patient regardless of the location of the data. • The Bidirectional Health Information Exchange (BHIE) project allows physicians, of both agencies, to view laboratory results, radiology exam results, medication profiles and allergies, in real time, for shared patients who receive care at VA & DoD facilities.

  11. BHIE Functionality • Incremental Clinical Functionality delivered in October 2004: • Bidirectional transmittal and display of Outpatient Pharmacy data • Bidirectional transmittal and display of Allergy data • Patient Identification and Correlation • Incremental Clinical Functionality delivered in May 2005: • Bidirectional transmittal and display of Surgical Pathology reports • Bidirectional transmittal and display of Cytology data • Bidirectional transmittal and display of Microbiology data • Bidirectional transmittal and display of Chemistry & Hematology data • Bidirectional transmittal and display of Lab Orders data • Bidirectional transmittal and display of Radiology report

  12. BHIE Sites Bassett ACH Madigan AMC NH Great Lakes NCA David Grant Medical Center Mike O’Callaghan Federal Hospital Elmendorf AFB Eisenhower AMC NMC San Diego NH Charleston William Beaumont AMC NH Pensacola LRMC Brooke AMC BHIE operational BHIE implementation proposed for 2nd quarter FY06 7 Host sites = 7 Medical Centers, 5 Hospitals & 50 Clinics (Access to over 880 thousand correlated patients)

  13. BHIE Intra-departmental Exchange Madigan AMC NH Great Lakes NCA Mike O’Callaghan Federal Hospital Eisenhower AMC William Beaumont AMC NMC San Diego 7 Host sites = 7 Medical Centers, 5 Hospitals & 50 Clinics (Access to over 880 thousand correlated patients)

  14. BHIE Data Access Records Returned Requests for Records DoD Military Treatment Facilities with BHIE FHIE Repository All VA Facilities Authorized Inquiry Index of where patients have records Temporary aggregate clinical record FHIE Framework VA Facility or DoD Facility Patient data delivered to Physician

  15. Brief Technical Overview

  16. High-Level FHIE Architectural Components FHIE Framework DoD VA FHIERepository MHS Data Repository CPRS Query Access HL7 Messages VistA Local VAMC VistA Local VAMC FHIE Framework VistA Gateway(Station 200) RDV VistALocalVAMC • Correlation • Information Locator • Security/Logging • Optimization • Adapter/Connector • RIM Legacy EHR Legacy EHR PIDS/Correlation Legacy EHR VA MPI

  17. High-Level FHIE/BHIE Architectural Components FHIE/BHIE Framework DoD VA MHS Data Repository HL7 Messages FHIERepository CPRS Query Access VistALINK VistA Local VAMC VistA Local VAMC FHIE Framework VistA Gateway(Station 200) RDV Legacy EHR Legacy EHR VistALocalVAMC Legacy EHR Sharing Facility HL7/ADT HL7/ADT VA IE CACHE’ WS/XML DoD Web Server • Correlation • Information Locator • Security/Logging • Optimization • Adapter/Connector • RIM PIDS/Correlation VA MPI WS/XML DoD GUI

  18. FHIE/BHIE Framework Domain Concept • Framework begins with a single domain – similar to Affinity Domains • Domain consists of a set of logical and physical components that enable the sharing and exchange of clinical information across participating care delivery systems and EHRs – data sources and repositories • Domains can be community based, regionally located and/or enterprise wide – RHIO? • Maintain an index of patient identities from multiple patient identification domains (registration systems, practice management, etc.) – PIX, PDQ • Provides Record Locator services– Registry • All clinical data, regardless of source is represented in common reference information models within a domain and is transformed to/from source and consumer. • Independently configurable adapter and connectors for records exchanges with data sources and consumers

  19. FHIE/BHIE Single Local Domain Clinical DataRepositories Retrieval Adapters Medical RecordsSystem RegistrationSystem LaboratorySystem RadiologySystem Local Domain Master Patient Index Information Locator Index Information Collector Cache Query Adapter ExternalDomain Clients

  20. FHIE/BHIE Domain Collaboration • Domains collaborate with other domains* • Domains can be distributed across networks to form the clinical record exchange information bus • Cross domain Patient Identity Correlation federation • Cross domain Record Locator services federation • Terminology translation services supported

  21. Current FHIE/BHIE Domain Configuration BHIE Data Adapters DoD Data Adapters VA Data Adapters FHIE Data Repositories Cross Domain X 0MPI Record Locator VA 0 Local Domain DoD 0 Local Domain VA PIDS Adapter VA MPI Record Locator Collector D 0 MPI Record Locator System A:VISTA System VA Cache Collector VISTA System VISTA System Collector DoD 1 Local Domain VistA Sta200 D 1MPI Record Locator :CPRS DoD EI/DSMessage Transmission Collector D 1 Cache BHIE CHCSSystems CHCSSystem 1 CHCSSystems PDTSSystem SADRSystem CHCSSystem 2 CHCSSystem 1

  22. HIMSS 2006 IHE Demo Scenario DoD MTF Primary Care Provider E.R. VA     Allscripts EPIC VistA CPRS Discharge Summary Created Referral Note Created Discharge Summary Created HXTI FHIE Repository Civilian Repository IBM  Patient goes to ER, clinician reviews DoD discharge summary and PCP’s ambulatory care notes  Patient treated at DoD MTF, Discharge Summary forwarded to FHIE Data Repository and registered Document Registry  Patient seen at the VA, Clinician reviews DoD Discharge Summary, PCP’s ambulatory care notes and Epic Discharge Summary  Patient seen by PCP who reviews DoD discharge summary

  23. HIMSS 2006 IHE Demo Scenario Primary Care Provider DoD MTF E.R. VA     EPIC Allscripts VistA CPRS Referral Note Created Discharge Summary Created Discharge Summary Created IBM Document Registry DOD Repository  Patient goes to ER, clinician reviews DoD discharge summary and PCP’s ambulatory care notes  Patient treated at DoD MTF, Discharge Summary forwarded to FHIE Data Repository after separation Civilian Repository HXTI  Patient seen at the VA, Clinician reviews DoD Discharge Summary, PCP’s ambulatory care notes and Epic Discharge Summary  Patient seen by PCP who reviews DoD discharge summary

  24. BHIE Domain Configuration HIMSS 2006 IHE XDS Adapter DoD Data Adapters VA Data Adapters BHIE Data Adapters FHIE Data Repositories IHE Local Domain IHE 0MPI Record Locator XDS Registry Collector XDS Repository Cross Domain X 0MPI Record Locator VA 0 Local Domain DoD 0 Local Domain VA PIDS Adapter VA MPI Record Locator Collector D 0 MPI Record Locator System A:VISTA System VA Cache Collector VISTA System VISTA System Collector DoD 1 Local Domain VistA Sta200 D 1MPI Record Locator :CPRS DoD EI/DSMessage Transmission Collector D 1 Cache BHIE CHCSSystems CHCSSystem 1 CHCSSystems PDTSSystem SADRSystem CHCSSystem 2 CHCSSystem 1

  25. Example IHE Connectors and Adapters XDS-MS Adapter WSBeans ebXML SOAP/XML IHE Registry & Repositories Client Access <Connection to Cross Domain> Connectors IIOP/CORBA HTTPS IIOP/CORBA HTTP Adapters PIDSAdapter SOAP/XML COASAdapter HL7 V3(Future) • Person Identification • Information Location/Collection • Security and Privacy • Terminology • Data Normalization (RIM) IHE DomainDomain Services Information Bus PIDSAdapter HL7 V2.2Adapter SQLAdapter External MPI IIOP CHSCftp ODBC EI/DS HL7 CHCS FHIE

  26. FHIE/BHIE Framework Points • Completely government owned • Standards-based messaging (HL7 2.x, CDA, NCPDP, CORBAMed, SOAP) • Custom adapters if required • Can operate fully on open source products (Linux, JBoss, Java, MySQL, etc.) • Runs on modest or completely state of the art hardware • Foundational architecture has been in production since 2003 • Extensible and evolves relatively easily (adding new data types or participants)

  27. Questions?

  28. Technical Overview

  29. BHIE Domain Configuration HIMSS 2006 IHE XDS Adapter DoD Data Adapters VA Data Adapters BHIE Data Adapters FHIE Data Repositories IHE Local Domain IHE 0MPI Record Locator XDS Registry Collector XDS Repository Cross Domain X 0MPI Record Locator VA 0 Local Domain DoD 0 Local Domain VA PIDS Adapter VA MPI Record Locator Collector D 0 MPI Record Locator System A:VISTA System VA Cache Collector VISTA System VISTA System Collector DoD 1 Local Domain VistA Sta200 D 1MPI Record Locator :CPRS DoD EI/DSMessage Transmission Collector D 1 Cache BHIE CHCSSystems CHCSSystem 1 CHCSSystems PDTSSystem SADRSystem CHCSSystem 2 CHCSSystem 1

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