Enhancing Health Data Interoperability Between the DoD, VA, and their Private Sector Partners Dr. Lauren Thompson, Director, DoD/VA IPO November 30, 2017

Distribution Statement A: Approved for Public Release. Disclosures Presenter has no interest to disclose. AMSUS and PESG staff have no interest to disclose. This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with AMSUS. PESG, AMSUS, planning committee members and all accrediting organizations do not support or endorse any product or service mentioned in this activity. DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

Distribution Statement A: Approved for Public Release. CE/CME Credit If you would like to receive continuing education credit for this activity, please visit: http://amsus.cds.pesgce.com DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

Distribution Statement A: Approved for Public Release. Learning Objectives At the conclusion of this activity, the participant will be able to: Provide an overview of the DoD/ VA Interagency Program Office Discuss current data sharing initiatives between DoD, VA, and their private sector partners Discuss the ongoing collaboration with industry partners to serve the unique needs of service members, veterans, and their families DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

9.4M Eligible Beneficiaries 24M Eligible Beneficiaries DoD/VA Landscape 1,100+ Care Locations Includes care locations on ships and submarines 9.4M Eligible Beneficiaries Primarily cares for the younger, active duty population and their families 101M Annual Visits* 60% Private Sector Care *Source: ‘Evaluation of the Tricare Program: Access, Cost, and Quality; Fiscal Year 2017 Report to Congress’ 1,400+ Care Locations Includes care locations in each state 24M Eligible Beneficiaries Primarily cares for a population with long-term medical claims 6.26M Annual Visits** 30% Private Sector Care **Source: VA Benefits & Health Care Utilization Pocket Card at http://www.va.gov/vetdata/docs/pocketcards/fy2017q4.pdf DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

Value of Interoperability Achieving interoperability is essential to the Department of Defense and Department of Veteran Affairs’ ability to efficiently improve healthcare for active duty military, veterans, and beneficiaries. DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

History of the DoD/VA IPO December 2007 The NDAA for FY 2008 directs DoD/VA to develop a fully interoperable electronic healthcare system and establish the IPO. January 2009 Pursuant to FY 2008 NDAA, the IPO completes its charter and articulates its mission and functions with respect to attaining interoperable electronic health data. March 2011 The Secretaries of Defense and VA instructed DoD/VA to develop a new single, joint integrated electronic health record (iEHR). February 2013 Departments decide to change course and pursue the modernization of individual systems, which included the decision of the DoD to replace its current AHLTA system and VA to modernize its existing VistA health information system. December 2013 The IPO was re-chartered to lead DoD/VA efforts to implement national health data standards for interoperability, and to establish, monitor and approve clinical and technical standards to integration of health data between the two Departments and the private sector. DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

Distribution Statement A: Approved for Public Release. IPO Today “The purpose of the Office shall be to jointly oversee and monitor the efforts of the Department of Defense and the Department of Veterans Affairs in implementing national health data standards for interoperability and act as the single point of accountability for identifying, monitoring, and approving the clinical and technical data standards and profiles to ensure seamless integration of health data between the two Departments and private health care providers. The Office shall support national interoperability efforts by closely collaborating with the Office of the National Coordinator for Health Information Technology.” — IPO Charter, March 2016 DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

Where We Fit Office of Information Technology Department of Veterans Affairs Secretary of Defense Under Secretary of Defense (USD) for Acquisition, Technology, and Logistics USD for Personnel and Readiness Office of Information Technology Program Executive Office DoD Healthcare Management Systems (PEO DHMS) Assistant Secretary of Defense (ASD), Health Affairs Defense Health Agency (DHA) DoD/VA Interagency Program Office (IPO) Health Data Standards DoD Healthcare Management System Modernization (DHMSM) Modernized EHR Joint Operational Medicine Information Systems (JOMIS) Operational Medicine IT DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

DoD and VA: Interoperability Today 16M+ Correlated Patients 415K+ DoD and VA Clinicians 1.5M Data Elements Exchanged Daily DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

Current DoD-VA Health Data Interoperability Allergies & Medications CDR CHDR HDR Service Treatment Record HAIMS VBMS Health Record Display DES JLV DAS Many other systems, including civilian hospitals DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

DoD and VA JLV Expansion In 2013, the Departments deployed the Joint Legacy Viewer (JLV) to nine pilot sites, providing an integrated view of DoD and VA clinical information. Today, there are more than 415,000 total JLV users from DoD, VHA, and VBA. **At the end of the third quarter of 2017, there were 88,345 total DoD JLV users; 315,199 total VHA JLV users; 16,069 total VBA JLV users; and 331,268 total VA JLV users; with a combined total of 419,613 DoD and JLV users. This is improving the quality of care our beneficiaries receive and clinicians from both DoD and VA have stated the impact this is having on a daily basis. For example: -A DoD clinician from Naval Medical Center San Diego stated: “JLV is improving the value of healthcare we provide to our beneficiaries by preventing extra tests that are done because we don’t have [the information readily] available.” -A Medical Board Physician at Walter Reed stated “JLV saved the day this morning for a Soldier getting most of his care at a VA in Colorado – we had no idea about the severity of his illness unless we reviewed the VA notes.” -A Rating Veterans Service Representative in Salt Lake City stated “the time saved in finding this information on JLV is minutes vs. days, weeks and sometime months” DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

Distribution Statement A: Approved for Public Release. External Partner Map DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

Distribution Statement A: Approved for Public Release. The Way Forward DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

MHS GENESIS Deployment Initial Deployment Inpatient Deployment Full Deployment February 2017 Summer & Fall 2017 Target 2022 MHS GENESIS deployment commenced at Fairchild Air Force Base Deployment continued at Naval Hospital Oak Harbor, Naval Hospital Bremerton, and Madigan Army Medical Center Wave deployment to all Military Treatment Facilities and Dental Treatment Facilities Training and Change Management Activities DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

VA Modernization Strategy “…I have decided that VA will adopt the same EHR system as DoD, now known as MHS GENESIS, which at its core consists of Cerner Millennium. VA’s adoption of the same EHR system as DoD will ultimately result in all patient data residing in one common system and enable seamless care between the Departments without the manual and electronic exchange and reconciliation of data between two separate systems.” — U.S. Secretary of Veterans Affairs Dr. David J. Shulkin, June 2017 DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

Enhancing Interoperability JOINT MODERNIZATION & INTEROPABILITY HUB Joint Modernization & Interoperability Hub: Encourage and enable collaboration across the Department of Defense (DoD), Department of Veterans Affairs’ (VA), and other federal partners by serving as a central resource for joint modernization and interoperability efforts Provide clinical support and subject matter expertise to enable the Departments to address common data sharing issues Interagency Coordination: Provide guidance and oversight as DoD and VA enhance their interoperability and modernization efforts Develop and monitor outcome-oriented and health data interoperability (HDI) metrics Provide data quality assurance by monitoring and reporting DoD and VA’s use of and compliance with IPO-approved health data terminology standards Standards & Technology: Research, evaluate, and provide technical guidance to DoD, VA, and other public and private partners on current and emerging standards Coordinate and collaborate with The Office of the National Coordinator for Health Information Technology (ONC), industry , and other Standards Development Organizations Develop interoperability use case framework and clinical interoperability scenarios INTERAGENCY COORDINATION STANDARDS & TECHNOLOGY DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

Distribution Statement A: Approved for Public Release. HDI Metrics Dashboard DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

Outcome-Oriented Metrics Roadmap “Our approach to identify and define measures, assess data source feasibility, conduct data collection and analysis, and initiate a measurement methodology that quantitatively describes the impact of interoperability on healthcare outcomes.” DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

Outcome-Oriented Metrics: Conceptual View Identify Metrics Assess & Evaluate Generate Joint HDS Workgroups Outcome-Oriented Metric(s) Interoperability Metrics Health Joint HDS Workgroup Readiness Population Transition of Care Transition of Care SSM/IDES IDES/SSM Patient Empowerment Process Improvement Patient Centric Example of outcome focused areas Quality of Care Recommend outcome-oriented metrics for inclusion into metric monitoring and reporting Assess and conduct feasibility of candidate metrics Cost Efficiency Identify potential candidate metrics based on use cases DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

Distribution Statement A: Approved for Public Release. Collaboration HDI Standards Lifecycle DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

Distribution Statement A: Approved for Public Release. Questions? DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.

Distribution Statement A: Approved for Public Release. Learn More www.health.mil/dhms www.oit.va.gov/org/ipo dha.ncr.peo-ipo.mbx.ipo@mail.mil @DoD_EHR @DeptVetAffairs Defense Healthcare Management Systems U.S. Department of Veterans Affairs DoD/VA IPO November 2017 Distribution Statement A: Approved for Public Release.