1. Opening slide
3:00 PM, EST

2. Welcome to the OSEHRA Innovation Webinar VA-PALS Project Overview
Ricardo Avila
CEO
Paraxial, LLC
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Frederick D.S. Marshall
Executive Director
VISTA Expertise Network

3. VA Partnership to Increase Access to Lung Screening
Project PI: Drew Moghanaki, MD, MPH
Clinical co-PI: Claudia Henschke, PhD, MD
Technical co-PI: Rick Avila, MS
Sponsored by the Bristol-Myers Squibb Foundation and the VA Office of Rural Health

4. Lung Cancer

5. Low Dose CT Lung Cancer Screening
Since 2015:
Annual Low Dose CT Screening is Reimbursed For Those at High Risk

6. Lung Cancer Screening Benefit
Late-Stage Lung Cancer
Early Lung Cancer
5mm Squamous Cell Carcinoma
[R. Gottlieb, Roswell Park Cancer Institute]
[Dr. Javier Zulueta, University of Navarra]
~5% five year survival
~85% five year survival

8. Main Objectives Implementation
Introduce the IELCAP management system at 10 VA medical centers
Supported by VA Office of Rural Health & VA Quality Enhancement Research Initiative
Quality Assurance
Establish a centralized QA program for LDCT interpretations
Supported by VA National Radiology Program
Research Evaluation
Does the IELCAP system cause a stage shift within VA?
IRB approved at Richmond VAMC

11. Main Software Components
Lung Cancer Screening Management
Integrate I-ELCAP Management System in VistA
CPRS
Web Interface
High Risk Population Extraction
Performance Reporting and Dashboard
Quality Assurance Systems
Including Unit Testing, Documentation, Regulations…

12. VA-PALS IT Team

13. OSEHRA Webinar VA-PALS Project Technical Overview
Rick Marshall VA-PALS · Vista Expertise Network
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14. Vista Expertise Network Mission
VA-PALS Mission
to increase access to safe and effective
lung screening programs that save lives
Vista Expertise Network Mission
to improve people’s health by changing the way medical software is developed, distributed, and supported
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15. 1 · VA-PALS & The Golden Pair
Software engineering driven by medical science & practice.
The importance of:
I-ELCAP & Mt. Sinai (
VA Office of Rural Health (
VAs Phoenix, Houston, & the VA Beta Test Sites
Future VA & Non-VA Software Users
Immersing software engineers in the medical science.
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16. 2 · VA-PALS & I-ELCAP Functional Goals
Implement I-ELCAP Protocols for:
1. Screening: find patients w/early-stage lung cancer
2. Treatment: support specialized treatment
3. Research: support improvement of I-ELCAP protocols
4. Quality Assurance: verify VA-PALS is meeting its goals
Rich streams of computable data needed.
Integration w/VA clinical workflows.
Introduction of workflow for new ELCAP Coordinator.
Codeset standardization to support data aggregation.
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17. 3 · VA-PALS Project: Three Years
Year One: I-ELCAP system v17.0 at Phoenix & Houston
Vista ELCAP v18.0 system developed
OSEHRA Certification
Deployment at Phoenix & Houston
Year Two: Vista ELCAP v19.0 system developed
Deployment at 10–11 VA sites
Year Three: national rollout
Maintenance, training, & support
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18. Screening Applications Management - IELCAP (SAMI) v18
4 · Vista ELCAP: Year One
Screening Applications Management - IELCAP (SAMI) v18
1. Re-engineering I-ELCAP inside Vista
2. Integrating I-ELCAP protocols w/Vista Workflow
3. Web & mobile UIs atop our own Vista files & routines:
Light HTML-first, Javascript-second architecture
Heavier Javascript-first, HTML-second architecture
4. CPRS, Registration, Scheduling, et al
5. Dialog mode & silent mode for testing & for other uis
6. Engineering infrastructure & Standards compliance
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19. 5 · VA-PALS & Modern Vista Development
Future-proofing: application, system, & user interfaces
Data Interchange: standardizing terminology
Modern, readable, sustainable programming style
Version control: Git, KIDS, & support tools
Unit tests: M-Unit
Performance metrics: M-Meter
OSEHRA: community-facing development
VA-PALS working group: user-driven development
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20. 6 · VA-PALS & Standards Compliance
VA agile software-lifecycle policy: VIP
Database administration (DBA) & integration (DBIA) rules
VA & IHS programming standards & conventions (SAC)
Privacy & security rules
508 Compliance
Documentation Standards
VA Architecture Guidelines
OSEHRA Certification
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21. Questions?
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22. Thank You!
819 North 49th Street, Suite 203 Seattle, Washington
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23. Thank You for Attending the OSEHRA Innovation Webinar!
Join us for a special October 3rd Webinar in conjunction with National Health IT Week:
Open Source Tools for Electronic Clinical Quality Measures
Presenters:
David Hill
Principal Software Systems Engineer
The MITRE Corporation
Peter Li
Director of Engineering and Infrastructure
OSEHRA