VistA Evolution Community Briefing January 26, 2015 Dr. Aaron Drew Senior Enterprise Solutions Architect Office of Information and Technology (OI&T) U.S. Department of Veterans Affairs (VA)

VistA Evolution Community Briefing Overview Two topics Interoperability Enterprise Health Management Platform (eHMP) There will not be any time for questions and answers. Please direct all questions to matthew.schultz@va.gov

VistA Evolution Community Briefing: Welcoming Remarks Presented by Dr. Aaron Drew

VistA Evolution Community Briefing: Interoperability A key objective of the VistA Evolution Program is to enhance cross-Agency (DoD/VA) interoperability by providing all clinically relevant data at the point of care for Veterans. Improved interoperability will enhance communication among VA health care partners by ensuring that authorized beneficiary and medical data are accessible, usable, shared, secured and sufficient to meet the needs of Veterans and their care team in real-time. Timely access to all clinically relevant patient records, regardless of the institution that provided the care, is critical in order for Veterans to have efficient, safe and effective care coordination. Enhanced interoperability will also allow provide the foundation for better clinical decision support, which providers will use to improve Veterans’ health. The overarching goal of VistA Interoperability is to enable more efficient clinical workflows and improved patient care.

VistA Evolution Community Briefing: eHMP The next evolution of VistA requires a world-class, open, modular, and extensible user experience. eHMP will develop a new web-based clinical application that migrates the current functionality in VistA’s existing user interface, Computerized Patient Record System (CPRS). eHMP will leverage and integrate the enhanced graphical user interface, standards-based data, and core clinical applications deployed during the User Experience project, Joint Legacy Viewer (JLV), and Health Informatics Initiative (Hi2).

VistA Evolution Community Briefing: Interoperability Presented by Dr. David Parker, MD

Interoperability: FY14 NDAA Interoperability Requirements VA Interoperability: A standards-based Electronic Health Record (EHR) with integrated display of data. VA will meet the requirements of Public Law 113-066 (P.L. 113-066), SECTION 713 – “ELECTRONIC HEALTH RECORDS OF THE DEPARTMENT OF DEFENSE AND THE DEPARTMENT OF VETERANS AFFAIRS,” of the National Defense Authorization Act (NDAA) for Fiscal Year (FY) 2014 by December 31, 2016, by achieving an interoperable EHR with an integrated display of data with the Department of Defense (DoD) and private providers. The interoperable EHR will provide all relevant heath care data of DoD and Veterans Affairs (VA), computable in near real time and complying with the national standards and architectural requirements identified by the IPO, in collaboration with Office of the National Coordinator (ONC) for Health Information Technology (HIT) of the Department of Health and Human Services (HHS). Requirements: DoD/VA interoperable standards based EHR with integrated display of data (NDAA 2014 Sec 713 (b)(1)) Ensure the continued support and compatibility of the interoperability platform (NDAA 2014 Sec 713 (b)(2)) All relevant health care data of both Departments’ EHR systems shall be computable in near real-time and comply with, and able to evolve with, existing national standards and use proven life-cycle sustainment planning (NDAA 2014 Sec 713 (c)(3) (a) (b) (d) Sec 713 (g) (1)) Achieve Gartner Generation 3 EHR (NDAA 2014 Sec 713 (c) (4)) Additional principles where feasible, VA’s interoperable EHR will also: Will comply with the requirements, where practical, of the Joint Executive Committee (JEC) (NDAA 2014 Sec 713 (c) (1)) Create an authoritative health data source with standardized input, which can be used by multiple providers (NDAA 2014 Sec 713 (c) (5) (a)) Enable patients to download, or otherwise receive electronically, health care records (NDAA 2014 Sec 713 (c) (5) (b)) Enable patients to upload health care records and allow DoD/VA medical providers access to such records (NDAA 2014 Sec 713 (c) (5) (c))

Interoperability: Joint Interoperability Efforts VA’s interoperability efforts are being coordinated with DoD, the DoD/VA Interagency Program Office (IPO) and Office of the National Coordinator for Health Information Technology (ONC): DoD – Defense Health Agency (DHA), Defense Healthcare Management Systems (DHMS) Program Executive Office, Defense Medical Information Exchange (DMIX) Program Office, Defense Healthcare Management Systems Modernization (DHMSM) Program Office VistA Evolution Interoperability Plan (VEIP) Currently being updated and pending release to Veterans Affairs Intranet Quorum (VAIQ), a portal for obtaining document concurrence, upon Senior Leadership approval. Participants: VA (OI&T, VHA), DoD/DHA/DMIX, DoD/DHA, DoD/VA IPO The VEIP and its high-level summary are in alignment with the DoD/VA IPO’s : Joint Interoperability Plan (JIP) Health Information Interoperability Technical Package (I2TP) Health Data Interoperability Management Plan (H-DIMP)

Interoperability: Strategy and Steps VistA Evolution Interoperability Capabilities are being achieved within the overarching VistA Evolution product delivery schedule. The path to interoperability evolves and builds upon existing interoperability to satisfy the FY 2014 NDAA directive to provide “seamless electronic sharing of medical health data” between the Departments by December 31, 2016. Interoperability is a path of continual improvement and a permanent commitment, not an end-state. Continued work as new health discoveries are made, new use cases are identified, and as interoperability standards evolve over time

Interoperability: Approach VistA Evolution capabilities requires that we modernize VA’s Interoperability infrastructure. We are modernizing the legacy Health Information Exchange (HIE) interoperability infrastructure using a proactive systematic process approach: Technical, and Functional Reviews of the legacy interoperability infrastructure Identifying systems for decommissioning or are in need of functional and technical enhancements Close coordination with Clinical Informaticists with regards to national standards

Interoperability: Capability Transitions Legacy Viewers eHMP (+ JLV Interim) Legacy Interoperability Components VistA Evolution Interoperability Components Local Data Formats & Terminologies National Standards

Interoperability: Feature Set Capabilities VE Feature Set (1, 2, 3 or 4) Product Name or Deliverable Delivery Date 1 Enterprise Messaging Infrastructure (eMI) Delivered August 2014 1 & 2 NDAA FY14 Joint Legacy Viewer (JLV) Release Delivered October 2014 Enhancements September 2015 2 VistA Site Standardization Phase II Delivered December 2014 New DoD/VA Gateway (Connection to DoD’s Med-COI) Enterprise Health Management Platform (eHMP) Initial Release v1.1 Consolidated Clinical Document Architecture (C-CDA) July 2015 VistA Site Standardization Phase III September 2015 2 & 3 VistA Exchange September 2014 – December 2016 3 VIE Transition to eMI December 2016 FileMan Enhancements Completion of NDAA FY14 interoperability requirements December 31, 2016 Data & Terminology Standardization October 2014 – Ongoing based on new standards 4 Interoperability of digital radiological images to include HAIMS January 2015 - December 2016

Interoperability: Feature Set Capabilities VE Feature Set (1, 2, 3 or 4) Product Name or Deliverable Delivery Date 1 Enterprise Messaging Infrastructure (eMI) Delivered August 2014 1 & 2 NDAA FY14 Joint Legacy Viewer (JLV) Release Delivered October 2014 Enhancements September 2015 2 VistA Site Standardization Phase II Delivered December 2014 New DoD/VA Gateway (Connection to DoD’s Med-COI) Enterprise Health Management Platform (eHMP) Initial Release v1.1 Consolidated Clinical Document Architecture (C-CDA) July 2015 VistA Site Standardization Phase III September 2015 2 & 3 VistA Exchange September 2014 – December 2016 3 VIE Transition to eMI December 2016 FileMan Enhancements Completion of NDAA FY14 interoperability requirements December 31, 2016 Data & Terminology Standardization October 2014 – Ongoing based on new standards 4 Interoperability of digital radiological images to include HAIMS January 2015 - December 2016 Interoperability Infrastructure Components National Standards Viewers & Apps

Interoperability: Schedule

Interoperability: Roadmap, FY14-FY16 Milestone Complete Upcoming Milestone (*) Denotes Tentative Dates IOC Delivered (Sep 30) NDAA 2014 signed by President Obama (Dec 26) Prioritize data domains (Feb 28) System Data needs to be computable in real-time in VistA and AHLTA (Oct 1) Stage 1 – Analysis Stage 1 Complete (Jun 27)* Stage 2 – Correction Stage 2 Begins (Dec 17)* Stage 3 - Implementation Stage 3 Begins (Jun 3)* Stage 2 Complete (Nov 28)* Stage 3 Complete (May 29)* Stage 4 – Sustainment Stage 4 Begins (Nov 18)* Stage 4 Complete (May 22, 2020)* JLV Go Live at San Antonio (Jul 31) JLV Go Live at Hampton (May 9) Go Live w/ Context Mgmt. Feature (Sept 3) Integration of JLV’s functionality to eHMP (TENTATIVE – early FY 15)* Minimal Development and Sustainment through FY18 Direct v1.0 Release (Feb 27) HealtheConnections Go Live in Production (Mar 17) Exchange 2011 Specification Certification with HealtheWay (Aug 26) Exchange Increment 1 Milestone 2 (Apr 12) Direct Release 1 Production (Mar 26) Direct v.1.4 Release (Mar 18) Exchange Increment 3 (Nov)* Exchange Increment 4 (Jan)* VLER DAS v5.0 (Walgreens Immunization ingestion) (Aug 22) VLER DAS Ver 4.5 (Large Data Streaming) (Apr 25) Sustainment eMI: ESB Test & Implementation eMI: Maintenance, Migration / Integration of Business Capability ESB Deployment Data Term. and Standardization: Continue identification, adoption and implementation of interoperability standards in conjunction with the IPO and DoD NDAA FY 14 Interoperability Complete Dec 31 2016 Rls 1 Rls 2 Rls 3 Integrate HAIMS images and artifacts Deadlines as stated in 2014 NDAA Data Domains: Stage 1 - Analysis Stage 2 - Correction Stage 3 - Implement Stage 4 - Sustainment JLV VLER Health Direct and VLER Health Exchange DAS (Formerly known as VLER DAS) BHIE (Technical Interop.) & CHDR (Semantic Interop.) VE PS3: eMI, Data & Terminology Standardization, VistA Exchange

VistA Evolution Community Update: Enterprise Health Management Platform (eHMP) Mr. Keith Michael, eHMP Lead Architect/Product Manager Ms. Betsy Green , eHMP Project Manager Dr. Paul Nichol, MD, Deputy Chief Informatics Officer, Veterans Health Administration

eHMP Architecture The eHMP architecture is displayed in the next slide.

Calendar Year 2015-2016 eHMP Development Timeline* eHMP Schedule eHMP initial release (eHMP v1.1) accommodates the implementation of foundational infrastructure and patient synchronization. Subsequent releases will provide additional and more robust functionality and will be implemented nationally across the VA The graphic below provides the CY15 dev schedule for eHMP. OSEHRA code drops are expected after sufficient testing is complete on code for each eHMP version. Calendar Year 2015-2016 eHMP Development Timeline* *This timeline is in a planning phase and subject to change

eHMP Clinical Experience

VistA Evolution Community Briefing Please direct all questions to: matthew.schultz@va.gov