Future of VistA and HealtheVet: Revolutionizing Veterans' Health

1. Current VistA Future HealtheVet-VistA Future HealthePeople-VistA Presentation to the Information Systems Advisory Committee Gary A. Christopherson, Senior Advisor to Under Secretary Robert M. Kolodner, M.D., Acting VHA CIO Veterans Health Administration, Department of Veterans Affairs

2. “VHA’s integrated health information system, including its framework for using performance measures to improve quality, is considered one of the best in the nation.” Institute of Medicine (IOM) Report, Leadership by Example: Coordinating Government Roles in Improving Health Care Quality (2002)

3. Success in supporting health delivery for millions of veterans • VistA/CPRS was & is a success • Built by “fire” of VHA collaboration • Publicly owned by VA; could be for future as well • Strong interest by public/private in using VistA • Largest integrated health info system for nation’s largest integrated health system • Helps serve 4.1 million American veterans annually • Supports: • $23+ billion nationwide health system • 1,300 care sites, incl. 163 hospitals & 800+ community & facility based clinics • 180,000 health care staff; 85,000 trainees • Considered best overall health information system

4. Nationally integrated outpatient & inpatient information system • Mostly developed & owned by VA (publicly owned) • Began as Decentralized Hospital Computer Program (DHCP; 1980s) • Transformed into VistA (1990s) • Next generation VistA (2002-20__) -- Includes HealtheVet-VistA on improved platform using modern tools & languages following enterprise architecture • National software w/ local flexibility/innovation: • Innovation developed locally & enterprise wide • Standard packages distributed enterprise wide, e.g. latest version of CPRS (January 2002)

5. CLINICAL PATIENT RECORD VISTA SOFTWARE PACKAGES VOLUNTARY SERVICE ACCOUNTS RECEIVABLE REHAB MEDICINE LIBRARY MEDICAL VistA IMAGING RECORDS NURSING TRACKING ADMISSION DISCHARGE TRANSFER INTEGRATED DATABASE RADIOLOGY PERSONS PATIENT FUNDS BLOOD BANK PROBLEM LIST PATIENTS DRUGS RPC BROKER SOCIAL WORK MAILMAN LABORATORY COMPUTERIZED PATIENT RECORD SYSTEM (CPRS) MENTAL HEALTH DEVICE TASK MANAGER KERNEL WARDS MANAGER DENTAL LAB RESULTS ENGINEERING USER MENU MANAGER SURGERY SECURITY VA FILEMAN ONCOLOGY HEALTH SUMMARY BAR CODE MEDICATION ADMINISTRATION PRESCRIPTIONS INVENTORY DIETETICS INPATIENT PHARMACY IMAGES MEDICINE TEXT INTEGRATION UTILITIES(TIU) WOMEN’S HEALTH OUTPATIENT PHARMACY MEDICAL CARE COST RECOVERY INTEGRATED FUNDS CONTROL ACCOUNTING & PROCUREMENT SCHED-ULING CONSULTS / RESULT TRACKING • Sites of Care • Clinics • Hospitals • Nursing Homes • Domiciliaries • Home/Workplace AUTHORIZATION SUBSCRIPTION UTILITY (ASU) CLINICAL REMINDERS VISTA INFORMATION SYSTEM

8. VistA - Why change? • Not lose functionality we have • Strengthen VistA • Move to person & data focus • Move to standardized, fully sharable health data • Modernize & replace older systems • Ensure documentation on application programs • Move to modern technologies • Increase flexibility to respond to future health needs • Lower cost of maintenance • Support our future health system

10. Dimensions of complexity Scope – home, clinic, hospital, nursing home Functionality – highest & growing Oversight – VA, OMB, Congress, VSO, etc Partners – VA, VHA, Other Fed, Other Public, Private HealtheVet Strategy HealthePeople Strategy Size – $23+B (health care) & $1B (IT) annually Veterans served – over 4 million annually Sites of care – over 1,300 nationwide Data element & standards - many Resources – 180+k staff + contractors

11. BP/ Ideal H&IT Population Based [community, VISN, nation] Care Coordination BP/ Ideal H&IT BP/ Ideal H&IT BP/ Ideal H&IT Care Coordination Person Based BP/ Ideal H&IT BP/ Ideal H&IT Status – Well, Acute Illness, Chronic Illness, Custodial BP/ Ideal H&IT BP/ Ideal H&IT Max Accessibility Max Health/Ability VA Health System – Best Practices & Ideal Max Affordability Max Satisfaction Max Quality Maximize Veterans Health/Ability & Satisfaction Ambula- tory care Inpatient care Nursing home care Community care Episode Based Domicili- ary care eHealth

12. HealtheVet – strategy overview

13. VistA to HealtheVet (incl. HealtheVet –VistA) VistA Legacy (Maintenance/Enhancement until “Retirement”) [Current – 2005] ... 2000 2001 2002 2003 2004 2005 2006 2007 Enterprise Architecture Strong Project Management VistA Imaging Fee Billing High Performance Network/Infrastructure Secure systems/infrastructure Health Data Repository HealtheVet-VistA (Person/Data-Centric Next Generation VistA) (2005- ) Scheduling High Performance Workforce Pharmacy Laboratory

14. HealtheVet (Veterans health info system, including VistA) OneVA [VBA, NCA, Staff Offices] My HealtheVet [virtual health record] Veteran Input & Output Information & Education System (“e” communications/transactions) Registration, Enrollment & Eligibility System (input/output) Health Provider System (input/output) Registration, Enrollment, Eligibility Database [OneVA/Health] Health Data Repository [Health] Health Data System (input/output) Non-VA Health & Information Environment Security Architecture Data Quality Infrastructure Financial Database [OneVA/Health] Management & Financial System (input/output) Support resources for person Decision/learning support for provider

15. S S S S S S S S S S NextGeneration HealtheVet-VistA - High Performance Info System Components/Links/Standards Outside health organizations VA organizations IE My HealtheVet [web site, virtual health record, trusted information, self - reported information, IE IE link to other health “e” communications/ transactions providers] Registration, Enrollment Management & & Eligibility System Financial System Health Provider (including clinical Interface) & Data System Database/ Standards Database/ Standards Database/ Standards Blood System Laboratory System Scheduling System System Pharmacy System Billing System Enrollment System Provider Payment Radiology System EHR

16. S S S S My HealtheVet / My HealthePeople Other health organi-zations Electronic Health Record System My HealtheVet / HealthePeople [Personal Health Record System] “health in a box” on PC and/or web site via community, health, non-health, government Software & Hardware Database/ Standards • Health Record • Access to health records • Sharing health records • Self-entered health record • Services • Checking/filling prescriptions • Checking/confirming/making appointments • Checking/paying co-payments • Participating in support groups • Health decision support • Health self-assessment • Messaging with health provider • Diagnostic/therapeutic tools • Reminders • “Checking in” • Safety services/tools • Links to other health sites • Information • Trusted information Person Primary health provider Electronic Health Record System (e.g. VistA) Software & Hardware Database/ Standards

18. Improved health & “paperless” • Standards • Data • Communications • --------------------- • Health Info Systems • Electronic Health Records Systems (EHRs) • Personal Health Record Systems (PHRs) • Info Exchange Adoption by health organizations & persons of affordable, high quality & standards-based EHRs, PHRs & Health Info Exchange Improved Health Paperless (IOM) 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

19. Toward standards & high performance info systems

20. Toward standards & high performance info systems

21. S S S S HealthePeople Virtual Health System - EHRs, PHRs, Health Info Exchange (IE) & Standards (S) Population/ Community Health provider ElectronicHealth Record Systems (EHR) IE Person Non health org Personal Health Record Systems (PHR) Person IE IE Elec-tronic Systems IE Other health org EHRs & Other Health Info Systems

22. S S S S S S S S S S HealthePeople - EHRs, PHRs, Health Info Exchange & Standards PHR (e.g., My HealthePeople) [web site, virtual health record, trusted information, self reported information, link to other health providers] IE Outside health organizations w/ EHRs IE IE “e” communications/ transactions Registration, Enrollment Management & & Eligibility System Financial System Health Provider (including clinical Interface) & Data System Database/ Standards Database/ Standards Database/ Standards Blood System Laboratory System Scheduling System System Pharmacy System Billing System Enrollment System Provider Payment Radiology System EHR

23. Personal Health Record Systems (PHR) Personal Health Record Systems (PHR) (e.g. My HealthePeople) Personal Health Record Systems (PHR) Electronic Health Record Systems (EHR) Person (home) Health providers P • Health Record • Access to health records • Share health records • Self-entered health record • Services • Check/fill prescriptions • Check/confirm/make appointments • Check/pay co-payments • Participate in support groups • Health decision support • Health self-assessment • Message with health provider • Diagnostic/therapeutic tools • Reminders • “Check in” • Safety services/tools • Links to other health sites • Information • Trusted information IE IE P P P P IE IE EHRs & Other Health Info Systems Elec- tronic Systems Person (external service) Person (provider sponsored) P IE A&A Person ID P – Person IE – Internet-based exchange, including components below EHR – High function & interoperable Person Health ID – a) Voluntary or b) Provider Assigned (Bilateral) A&A – Authorization & authentication controlled by person Interface – Capability for exchange (send & receive/use Search – Search tool for finding records held by persons/organizations S [HL7] Inter-face Search

24. HealthePeople Virtual Health System - Health Info Exchange (IE) Bilateral Multilateral Personal Health Record Systems (PHR) Electronic Health Record Systems (EHR) Person Electronic Health Record Systems (EHR) Health providers Primary health provider P IE IE A&A P IE Personal Health Record Systems (PHR) P P P P Person P IE IE IE IE P EHRs & Other Health Info Systems EHRs & Other Health Info Systems Elec- tronic Systems Other health org P Non-health org Other health org IE P – Person IE – Internet-based exchange, including components below EHR – High function & interoperable Person Health ID – a) Voluntary or b) Provider Assigned (Bilateral) A&A – Authorization & authentication controlled by person Interface – Capability for exchange (send & receive/use Search – Search tool for finding records held by persons/organizations A&A Person ID S [HL7] Inter-face Search

25. Health Information Standards Development/Adoption

26. VA, DoD, IHS individual/joint adoption Convergence Consolidated Health Informatics (CHI) HealthePeople(Fed) • National -- Public/Private • Individual (e.g. Kaiser Permanente) • Joint (Connect. Health, eHealth, NCVHS, SDOs, …) HealthePeople DoD CHCS II VA HealtheVet/HealthePeople-VistA IHS (to HealthePeople-VistA) HealthePeople(Fed) Public/Private (CMS, VA, AHRQ, NHII, AAFP, health providers, payers, regulators, private sector vendors, persons/consumers) Convergence HealthePeople National standards & high performance systems Improved Health Via National Health Information Standards Info Exchange / Sharing High Performance Health Info Systems Personal Health Record Systems Health Information Systems Standards 2001 2010

27. Back-up Slides

28. Terms