1. Department of Veterans Affairs eHMP Overview for Shepherd University Keith Michael and Cynthia Bias January 19, 2016

2. Agenda Overview eHMP Conceptual Architecture eHMP Logical Platform
The VA and healthcare mission
Our program and challenges
eHMP
Technologies
eHMP Conceptual Architecture
eHMP Logical Platform
eHMP Development Tools
Why does all this matter to me?
KRM Partnership
Previous Shepherd student working on eHMP
Capstone
January 19, 2016
VA Internal Use Only

3. VA and the Health Care Mission
Department of Veterans Affairs
Health, Benefits, Memorial
Veterans Health Administration
Over 1300 points of care locations (Medical Centers, Outpatient Clinics, Nursing Homes, etc)
80% of US Clinicians Intern at VA
26 Million Veterans over 9 Million active patients
VA Integrated System Technology Architecture (VISTA)
131 VistA Hosts deployed across the nation
Computerized Patient Record System (CPRS)
Industry First – Many Awards
Bar Code Medication Administration (BCMA)
Hundreds of additional interconnected Applications
Local Installations, local variations, local repositories
January 19, 2016
VA Internal Use Only

4. Vista Evolution Program and Challenges
VA and Department of Defense (DoD) Partnership
Vista Evolution
Interoperability with DoD and community
Electronic record vs. Point of Care Application
Data vs. Actionable Information
Clinical Interface, Ancillaries, Research, Analytics
Challenges
Gathering data from all VA sites
Data from Department of Defense (DoD)
Data from the Private Sector
Lack of common data and technology standards
Lack of consistent technology tools and services
Goals
Improve interoperability with DoD and other healthcare partners to provide information VA clinicians can act upon
Enhance VistA to support a patient-centric, goal oriented, team-based health care delivery model
Establish a robust Information Technology (IT) architecture to underpin current usage and future innovation
January 19, 2016
VA Internal Use Only

5. What is eHMP?
Enterprise Health Management Platform (eHMP) is the infrastructure and user interface that will eventually replace Computerized Patient Record System (CPRS) as VA’s primary point of care application
A critical cornerstone project under the VistA Evolution Program
Being designed as an Event Driven Open Platform
Combines current decentralized and new centralized concepts and tools
Iterative agile based development cycles
Web based centralized user interface
Centralized Technology Platform
Re-usable services and engines
Both centralized and decentralized data repositories
Business Continuity and Contingency requirements
Both Green Field and Legacy
Two point of care applications running simultaneously
Patient Safety is critical
Development and deployment are much more complex
January 19, 2016
VA Internal Use Only

6. Current Data Domains Allergies Appointments Consults
CPT (billing centric info)
Procedures
Documents
Patient Education
Examinations
Health Factors
Imaging
Immunizations
Lab Results (chemistry, cytology, electron microscopy, microbiology, surgical pathology, anatomical pathology)
Medications (inpatient, outpatient, IV)
Observations
Orders
Patient Demographics
Purpose of Visit
Problem List
Patient Treatment File (workload)
Skin Test
Surgeries
Visits
Vitals
January 19, 2016
VA Internal Use Only

7. Technology/Standards being used for eHMP
Web – Javascript, Backbone.js, Bootstrap.js, Marionette
Middle Web service Tier – Node.js, Express.js, EWD.js
Security/Identity/Access - SAML, XACML, Node Rules, Transport, File, Disk and Software Encryption
Data – NoSQL and Relational DB (OracleDB, Mongo, Intersystems Cache, JSON Doc Store, SolR)
Logical Data Model (VPR, FHIR)
Clinical Decision Support – FHIR, Open CDS, ICE/CAT,
Business Process Rules and Workflow- Red Hat JBOSS, BPMN, jBPM and jBRMS engines, Software compliers to incorporate standardized content for external sources
January 19, 2016
VA Internal Use Only

8. eHMP Conceptual Architecture
Workspace
UI/UX Framework
User Configurable Workspaces
Alert & Notification Framework
Configuration Based UI Rendering
Common UI Components
Workspace
Applet Repository
Allergies
Medications
Notes
Vitals
Labs
Consults
BPMN/Configuration Based Activity Management
Composable Business Rules & Activity Framework
Business Domain Agnostic Components
OpenSource/COTS Based (JBoss BPM & Drools)
Composite Services
CDS
Engine
Activity
Mgmt.
Business
Rules
Engine
Team
Mgmt.
Orders
Mgmt.
Data Layer
Aggregated Patient Data Across All Vista Instances
Optimized Data Synchronization Process
Normalized & Enriched Data
Highly Performant Data Cache
SolR Data Store for Optimized Text Search
VistA Write-Back Through Exposed RPC
JDS
Normalize
Map
Enrich
CDS
Rules
State
SolR
VA & External Rules Content
COTS / OpenSource Components
VA Custom Component
VA Specific Interfaces
Authoritative Data
RPC
RPC
RPC
DAS
DoD
VistA
VistA
VistA
January 19, 2016
VA Internal Use Only

9. eHMP Logical Platform Architecture
This is the overall eHMP architecture
Next two slides split this diagram (TOP and BOTTOM) for easy viewing
Everything in blue represents VistA Exchange and its components
Everything in grey represents everything external to VistA exchange 9
January 19, 2016
VA Internal Use Only

10. DEMO
January 19, 2016
VA Internal Use Only

11. eHMP Software Development Kit (SDK)
Provides a framework for adding incremental functionality to eHMP by creating new applets and server resources
SDK
VistA Exchange
RDK
ADK
January 19, 2016
VA Internal Use Only

12. How is this Relevant to Me?
Benefits to an eHMP Capstone Project
Education
Exposure to real life challenges and opportunities
Learn and understand new technologies
Resume
Experience with modern tools in use today
Actual development, documentation, and presentation experience
Leads to potential internships (KRM, Accenture, HP, etc…)
Job Hunting
Impressive interview discussion
Actual code for review (GitHub)
Income
Potential higher starting salary based on knowledge and experience
Career Path
Demonstrated creativity, problem solving, and commitment
January 19, 2016
VA Internal Use Only

13. Proud Sponsors of ShepRobo Fest 2016!
Woman-owned small business based in Shepherdstown, West Virginia.
Software Development
Network Security and Engineering
HIPAA and Health Information Technology
Government Solutions (VistA / RPMS / MyHealtheVet)
Open Source Experts
More than 25 years of healthcare data systems experience.
KRM has worked on healthcare initiatives for organizations such as the Department of Veterans Affairs, West Virginia Department of Health and Human Resources, and Shepherd University. Additionally, KRM provides networking and HIPAA security assessments as well as information technology consulting.
Proud Sponsors of ShepRobo Fest 2016!

14. KRM Student Intern Program
Founded in 2003 with Shepherd University with the objective of finding a way for business, academia, and government to work cohesively within the IT and security fields in the Eastern Panhandle of W.Va.
Originally provided internships to the VA, Office of Information and Cyber Security (OCIS), at the Network and Security Operations Center (NSOC) in Martinsburg.
Scaled back in 2009 when the NSOC contract was awarded to another vendor.
Re-engaging in 2013 with an emphasis on health IT application development and network security.
Looking for a few qualified interns to join KRM in the fulfillment of health IT projects.

15. eHMP from Code in Flight
KRM has taken the code-in-flight version of eHMP, made it work,
created install scripts, and released to the open source community:

16. Questions
January 19, 2016
VA Internal Use Only