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

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

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

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

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

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

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

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

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

DEMO January 19, 2016 VA Internal Use Only

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

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

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!

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.

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: https://github.com/KRMAssociatesInc/eHMP

Questions January 19, 2016 VA Internal Use Only