1. 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)

2. 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

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

4. 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.

5. 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).

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

7. 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 (P.L ), 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))

8. 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)

9. 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

10. 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

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

12. 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 December 2016

13. 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 December 2016
Interoperability Infrastructure Components
National Standards
Viewers & Apps

14. Interoperability: Schedule

15. 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
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

16. 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

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

19. 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 eHMP Development Timeline*
*This timeline is in a planning phase and subject to change

20. eHMP Clinical Experience

21. VistA Evolution Community Briefing
Please direct all questions to: