Embracing the Virtual Health System: Transforming Healthcare with Electronic Records

1. January 27, 2004 Moving to a “Virtual Health System” Presentation to World Health Care Congress Gary A. Christopherson Senior Advisor to the Under Secretary Veterans Health Administration, Department of Veterans Affairs

2. 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

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

4. Toward a “Virtual Health System” • EHRs – • Provide financial incentives • Strongly encourage private sector vendors to make available affordable, high quality, standards-based EHRs • Strongly encourage provider-based efforts like AAFP • Continue to improve HealthePeople-VistA & make available • PHRs – • Strongly encourage public/private sector to work together to develop & make available PHRs for persons • EHR/PHR Info Exchange (IE) – • Strongly encourage public & private sector to work together to develop & make available national “exchange” solution • Standards – • Consolidated Health Informatics as federal leadership • Strongly encourage public/private development/adoption of national standards

5. “Virtual Health System” – VA Role • VA push EHRs, PHRs, EHR/PHR Info Exchange & Standards in Federal and nationwide • EHRs – VA • Current -- VistA electronic health record system • Next generation -- HealtheVet-VistA • Public version -- HealthePeople-VistA • PHRs – VA • My HealtheVet • EHR/PHR Info Exchange (IE) – VA • Federal Health Information Exchange with DoD • Electronic Health Records Interoperability (HealthePeople (Federal) with DoD • Standards – VA • Adoption of VA-wide standards • Adoption of standards between VA and DoD and VA and IHS • Consolidated Health Informatics

6. Electronic Health Record Systems (EHR)

7. S S S S S S S S S S Electronic Health Record Systems (EHR) (w/ PHRs, EHR/PHR 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

8. “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)

10. HealtheVet – strategy overview

11. 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

12. Personal Health Record Systems (PHR)

13. Personal Health Record Systems (PHR) (e.g. My HealthePeople) Personal Health Record Systems (PHR) Person (community) “health in a box” on PC and/or web site via community, health, non-health, government • Health Record • Access to health records • Share health records • Self-entered health record • Services • Health programs • 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 Health providers Electronic Health Record Systems (EHR) IE P IE P P P P IE IE EHRs & Other Health Info Systems Person (external service) Elec- tronic Systems Person (provider sponsored) P Personal Health Record Systems (PHR)

14. Person Primary health provider Electronic Health Record System (e.g. VistA) My HealtheVet/HealthePeople Personal Health Record System (PHR) • Health Record • Access to health records • Share health records • Self-entered health record • Services (Interactive) • Check/fill prescriptions • Check/confirm/make appointments • Check/pay co-payments • Participate in support groups / group services • Health decision support • Health self-assessment • Message with health provider • Diagnostic/therapeutic tools • Reminders • “Check in” • Safety services/tools • Link to other health sites • Information • Trusted information “health in a box” on PC and/or web site via community, health, non-health, government Other health provider Electronic Health Record System S S S My HealtheVet/HealthePeople PHR Person

15. EHR/PHR Health Information Exchange

16. Electronic Health Record Systems (EHR) Health providers Electronic Health Record Systems (EHR) Health providers Personal Health Record Systems (PHR) Person P IE IE IE P P P P P IE IE EHRs & Other Health Info Systems Elec- tronic Systems Non-health org Other health org P IE AAA Search S Inter-face Person ID EHR/PHR Info Exchange (IE) - Multilateral P – Person IE – Internet-based exchange, including components below EHR – High function & interoperable Person Health ID – a) Voluntary (Multilateral) or b) Provider Assigned (Bilateral) AAA – Authorization & authentication & accountability, controlled by person Interface – Capability for exchange (send & receive/use) Search – Tool for finding/requesting records held by persons/organizations S – Standards, e.g. HL7

17. Computerized Health Records (FY 2005+) DoD CHCS II Software VA HealtheVet-VistA Software HealthePeople (Federal) Joint, Shared Software DoD CHCS II Clinical Data Repository VA HealtheVet-VistA Health Data Repository VA/DoD Exchange HealthePeople (Fed.) Data Standards (standardized across MHS/VHA) HealthePeople (Fed.) Data Standards (standardized across VHA/MHS) Federal Data, Communications, Security Standards Standards – Jointly use data, communications, architecture, security, technical, software standards; federal standards& potential national standards across public/private sector Software – VA/DoD/Joint high performance software Databases – Separate; enterprise-wide w/i each agency Hardware – Separate; mix of enterprise & local w/i each agency Exchange – Two-way VA/DoD

18. Health Information Standards

19. Health Information Standards Development/Adoption

20. Health Information Standards

21. 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, HIMSS, NCVHS, SDOs, …) HealthePeople DoD CHCS II VA HealtheVetHealthePeople-VistA IHS (upgraded RPMS) HealthePeople(Fed) Public/Private (NHII, CMS, VA, health providers/ payers/regulators, private sector vendors) Convergence HealthePeople National standards & high performance systems National Health Information Standards Info Exchange / Sharing High Performance Health Info Systems Personal Health Record Systems Health Information Systems Standards 2001 2010

22. “Electrifying” 1/7th of US Economy

23. Back-up slides

25. 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: • $26+ 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

26. Drivers for health • Maximize health/abilities • Maximize satisfaction • Maximize quality • Maximize accessibility/portability • Maximize affordability • Maximize patient safety (defects/errors to zero) • Minimize time between disability/illness & maximized function/health (time to zero) • Minimize inconvenience (inconvenience to zero) • Maximize security & privacy

27. BP/ Ideal H&IT Population Based [community, region, 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 Health Systems – Best Practices & Ideal Max Affordability Max Satisfaction Max Quality Maximize Health/Ability & Satisfaction Ambula- tory care Inpatient care Nursing home care Community care Episode Based Domicili- ary care eHealth