FAQ about the VHA Health Information Technology program in FY06 IHS Tech Conference Albuquerque, NM...

FAQ about the VHA FAQ about the VHA Health Information Health Information

Technology program in Technology program in FY06FY06

IHS Tech ConferenceIHS Tech ConferenceAlbuquerque, NMAlbuquerque, NMJune 20-23, 2006June 20-23, 2006

Clayton Curtis MD PhDClayton Curtis MD PhDVHA-IHS Interagency LiaisonVHA-IHS Interagency Liaison

VHA Office of InformationVHA Office of Information

6/20/20066/20/2006 Clayton Curtis MD PhDClayton Curtis MD PhD 22

Why should I care Why should I care what’s happening in what’s happening in

VHA?VHA?


VHA and IHS have a VHA and IHS have a history…history…

VHA and IHS have a 20-year partnership in VHA and IHS have a 20-year partnership in large-scale clinical computing; VHA’s large-scale clinical computing; VHA’s technology was adopted in 1984, and the technology was adopted in 1984, and the first MOU was negotiated in 1986first MOU was negotiated in 1986

VHA and IHS have large Federal “health VHA and IHS have large Federal “health care chain” deployments of a care chain” deployments of a comprehensive clinical information systemcomprehensive clinical information system

VHA and IHS are both influenced by Federal VHA and IHS are both influenced by Federal initiatives including FHA and ONCHITinitiatives including FHA and ONCHIT


But time has marched on…But time has marched on… RPMS began as an offshoot of DHCP in RPMS began as an offshoot of DHCP in

19841984 VHA and IHS have both undergone major VHA and IHS have both undergone major

organizational change (VHA: integrated organizational change (VHA: integrated service delivery networks; IHS: tribal service delivery networks; IHS: tribal compacting and program expansion)compacting and program expansion)

VHA and IHS have slowly diverged due VHA and IHS have slowly diverged due to different priorities and interests; that to different priorities and interests; that has impacted IHS ability to absorb new has impacted IHS ability to absorb new releases of VHA packages and leverage releases of VHA packages and leverage VHA investmentVHA investment


And here we are today…And here we are today… IHS has identified migration to electronic IHS has identified migration to electronic

records and closer approximation to records and closer approximation to core VistA packages as major initiativescore VistA packages as major initiatives

IHS has migrated to a component-based IHS has migrated to a component-based GUI framework for electronic records GUI framework for electronic records (ViewCentric / EHR – 26 live sites)(ViewCentric / EHR – 26 live sites)

VHA and IHS staff are working to get VHA and IHS staff are working to get EHR pilot sites (and, eventually) all sites EHR pilot sites (and, eventually) all sites in synch with current releases of core in synch with current releases of core VHA packagesVHA packages

VHA is undertaking a major change in VHA is undertaking a major change in the technology base for VistA, and re-the technology base for VistA, and re-engineering major applications engineering major applications (Health(HealtheeVet VistA)Vet VistA)


Soooo…Soooo… Back to FY06 Back to FY06


FY06: The Year of FY06: The Year of Extraordinary ChangesExtraordinary Changes

New Congressional oversight committeeNew Congressional oversight committee New VHA CIO, departure of VA CIONew VHA CIO, departure of VA CIO Budget cutsBudget cuts Congressional requirement for Congressional requirement for

reorganization of VA ITreorganization of VA IT Congressional “hold” on funds for Congressional “hold” on funds for

HealtheVet program pending HealtheVet program pending reorganizationreorganization


What happened to the What happened to the VHA IT budget?VHA IT budget?


Non-pay funding requests of $395M (“dream Non-pay funding requests of $395M (“dream number”), limitation to level of OMB number”), limitation to level of OMB submissions of $323M, funding to a lower level submissions of $323M, funding to a lower level of $135Mof $135M

Cuts translated into a strategic pause that is Cuts translated into a strategic pause that is allowing development of stronger allowing development of stronger programmatic and engineering underpinnings programmatic and engineering underpinnings for HeVfor HeV

Congressionally mandated split between IT Congressionally mandated split between IT and non-IT funds, no ability to convert without and non-IT funds, no ability to convert without Congressional approvalCongressional approval

Delay in HeV development (including CPRS Delay in HeV development (including CPRS and other clinical projects) related to loss of and other clinical projects) related to loss of funding for contract development resourcesfunding for contract development resources


HealthHealtheeVet Budget Reductions Vet Budget Reductions (FY 06) (FY 06)

FY06 Ranking Guidance from Leadership:FY06 Ranking Guidance from Leadership: 1.1. Sustaining Current Baseline VistA Application OpsSustaining Current Baseline VistA Application Ops2.2. Patient SafetyPatient Safety3.3. Critical SW Improvement For Identified Medical IssuesCritical SW Improvement For Identified Medical Issues4.4. Clinical Improvements For Accreditation And Efficient Care DeliveryClinical Improvements For Accreditation And Efficient Care Delivery5.5. DOD Seamless TransitionDOD Seamless Transition6.6. Presidential And Secretary's Priorities/Congressional MandatesPresidential And Secretary's Priorities/Congressional Mandates7.7. Efficient Financial Processing Efficient Financial Processing

Dev Budget Reduction (Overview) Development Reductions (Actuals) Ops & Maint. Reductions (Actuals)


What’s this about a VA What’s this about a VA IT reorganization?IT reorganization?


Congressionally-mandated reorganization of Congressionally-mandated reorganization of IT at the Department level, with budget IT at the Department level, with budget control and accountability vested in the VA control and accountability vested in the VA CIOCIO

Distinction between “operations” and Distinction between “operations” and “development”“development” all “operations” staff detailed to VA IT organization all “operations” staff detailed to VA IT organization

in preparation for permanent reassignmentin preparation for permanent reassignment ““development” staff and activities remaining with development” staff and activities remaining with

AdministrationsAdministrations New structure for overall program New structure for overall program

managementmanagement Shift to project implementation drawing on Shift to project implementation drawing on

competency-based development organizationcompetency-based development organization


HealthHealtheeVet (HeV) Systems Vet (HeV) Systems Development OrganizationDevelopment Organization

HPMO has overall responsibility for Systems-of-Systems integration and total program performance with oversight responsibility for Program

Managers executing on-performance, on-cost, and on-schedule!

HPMO has overall responsibility for Systems-of-Systems integration and total program performance with oversight responsibility for Program

Managers executing on-performance, on-cost, and on-schedule!


Project ManagersProgram/Projects Analysts

PROGRAM OFFICE for

Health Provider SystemsProgram Manager

RESOURCE PROVIDERS

Systems, Network & Software Engineering Development Competencies

Selected Portfolio Health Program w/ Assigned Projects (Sample)

Systems Engineering

Software Engineering

Network Engineering

Database Management

Security Management

Clinical Procedures

Scheduling

Computerized Patient RecordSystems(CPRS)

Health Data Repository(HDR)

LaboratoryRadiology

Nursing

Pharmacy

ASSIGNED PROJECTS (Incomplete)

Functions Drawn From The Organization:Business / Financial Management Specialists

HR Specialists

VistA Imaging


HealthHealtheeVet FY 06 Project Re-Vet FY 06 Project Re-DefinitionDefinition

2005 2006 2007 2008 2009 2010 2011 2012

Program Readiness

Design Readiness

Technical Readiness

Services Readiness

Business Readiness

Decommission Legacy System

Legacy Sustainment

HeV Sustainment

Budget

Gen - B Gen - C Gen - D Gen - E


What’s the story on What’s the story on the VA data theft the VA data theft that’s been in the that’s been in the

news?news?


Laptop stolen from home of employee with VA Laptop stolen from home of employee with VA (not VHA) Office of Policy and Planning.(not VHA) Office of Policy and Planning.

Laptop contained demographic information on Laptop contained demographic information on a large number of veterans and active duty a large number of veterans and active duty personnel (due to DoD notification of status to personnel (due to DoD notification of status to VHA). No clinical data involved.VHA). No clinical data involved.

Remediation measures include accelerated Remediation measures include accelerated privacy / security training, letter from privacy / security training, letter from Secretary to veterans; recall of laptops and Secretary to veterans; recall of laptops and encryption of hard drive anticipated. Employee encryption of hard drive anticipated. Employee and supervisor terminated.and supervisor terminated.

Cost to VHA for VA-level problem is significant; Cost to VHA for VA-level problem is significant; some project funds being diverted.some project funds being diverted.

PR cost – public and Congress – is perhaps the PR cost – public and Congress – is perhaps the worst outcome. Inaccurate and misleading worst outcome. Inaccurate and misleading posts on the internet are harmful.posts on the internet are harmful.


What’s up with CPRS What’s up with CPRS development?development?


Decision made to skip “rehost” phase and move on Decision made to skip “rehost” phase and move on with re-engineeringwith re-engineering

Alternatives to HeV Desktop framework being Alternatives to HeV Desktop framework being evaluatedevaluated

Virtual Patient Record developed to simplify access Virtual Patient Record developed to simplify access to data in GUI clientto data in GUI client

Consolidating and synthesizing information from Consolidating and synthesizing information from the problem list meeting, the earlier document the problem list meeting, the earlier document meetings, and PCS retreats as models are created meetings, and PCS retreats as models are created for CPRS-R.for CPRS-R.

Focusing on problem oriented charting and Focusing on problem oriented charting and beginning some straw man mockups.beginning some straw man mockups.

Writing "spikes" - slices through the layers of Writing "spikes" - slices through the layers of technology to test out architectural assumptions technology to test out architectural assumptions and to gather evidence to help identify acceptable and to gather evidence to help identify acceptable technical approaches. This has resulted in technical approaches. This has resulted in significant simplification over what was planned for significant simplification over what was planned for re-host.re-host.


Is there anything Is there anything tangible going on with tangible going on with

HeV?HeV?


• App Dev. Process Security• CPRS-R• HeV Foundations

* Reengineering effort refers to FY06only. Numerous other applicationswill be rehosted in the future.

HealthHealtheeVet-VistA Projects – Vet-VistA Projects – FY06FY06

Data Standardization

Common Services

Reengineering

• Problem List • Clinical Documents• Immunizations• Radiology• Orders• Encounters• Adverse Reactions• Lab LDSI Support

• Person Service- Demographics• Person Service-Identity Management• Delivery Service• Standard Data Service• Administrative Data Repository (ADR)• ADR Data Migration• National Provider Identifier

Projects, on completion, provide incremental & immediate benefits to HealtheVet current and future capability

Projects, on completion, provide incremental & immediate benefits to HealtheVet current and future capability

- The establishment of data standards across all

VHA sites to ensure system interoperability and

exchange of compatible information with other

Federal and private health care providers.

• Lab – Phase I & II• Pharmacy Phase II• Field Support & Standard Maint.• Project Mgmt. & ODC• Clinical Procedures

- A “service oriented” architecture – similar

software functions in different applications

are isolated and streamlined so they can

be coded once and reused many times.

- Reengineering is the movement of the existing M-based applications into the HealtheVet-VistA (HVV) architecture and data structures. This work is the heart of the move to HVV. There are approximately 65 existing VistA applications that must be reengineered.

OneVA InterfaceOneVA Interface

Current Architecture

Future Architecture


HEV: 100-day ProjectsHEV: 100-day Projects

Pilots for agile development in new Pilots for agile development in new technologytechnology

Prototype for HeV development Prototype for HeV development practicespractices

IHS involvement plannedIHS involvement planned


Introducing Agile Development to Introducing Agile Development to VHAVHA

Agile Projects for VHA:• Fixed time, resources, e.g., 25 staff, 6 months.• Working software in short cycles, e.g. 3 weeks.• On-going coordination of business and technical.• Disciplined planning, performance, and reporting.• Business value delivered.• Compliance with and contribution to new HealtheVet enterprise architecture.• Contribution to repeatable processes.

Initiate Agile Development• Demonstration projects to establish viral growth.• Candidate projects from VHA business owners, selected for low cost/risk and high benefit, for business and technical value.• Subsequent projects extend business coverage, architecture and process.

Agile projects support business processes by delivering software in short cycles.


Initial Agile Demonstration Initial Agile Demonstration ProjectsProjects

Emergency Department• Summary: provides physicians and nurses with patient status for delivery of care, and provides department management with oversight.• Status: Well-defined need; active user community; current facility-based pilots provide project definition.• Business Value: improves quality of care, resource use, and performance measurement.• Technical Value: establishes workflow, business rules, services for legacy access, UI standards, 508 compliance.• Process Value: establishes responsive engagement of OI with business owners, sponsors and users for a project with demonstrated scope.

Patient Handoff• Summary: supports planning, performance and reporting of handoffs of patients, e.g. between shifts, staff, departments, units, and in/out of VHA.• Status: established need and NCPS-based user community.• Business Value: improves patient safety under JCAHO standard.• Technical Value: extends use of workflow and business rules; establishes standards for security; establishes services for COTS integration.• Process Value: extends OI/business process engagement to project definition.


HEV: Progress on HDRHEV: Progress on HDR Allergies, outpatient pharmacy, vitals (1B) now in HDRAllergies, outpatient pharmacy, vitals (1B) now in HDR Lab is the next domain to be extracted; target is 10/06 Lab is the next domain to be extracted; target is 10/06 HDR Data Warehouse now contains outpatient HDR Data Warehouse now contains outpatient

pharmacy and vitals. Allergies is the next domain to pharmacy and vitals. Allergies is the next domain to populate the data warehouse, followed by Lab at the populate the data warehouse, followed by Lab at the end of ‘06 end of ‘06

Clinical Delivery Service for national HDR II now Clinical Delivery Service for national HDR II now working on Iteration 6. This iteration will help create a working on Iteration 6. This iteration will help create a model for the CDS product that is sufficiently model for the CDS product that is sufficiently extensible to meet the majority of future CDS extensible to meet the majority of future CDS functional requirements.functional requirements.


Has there been any Has there been any progress in IHS use of progress in IHS use of

VistA Imaging?VistA Imaging?


Project agreement signed May, 2006Project agreement signed May, 2006 Sets ground rules for use in IHSSets ground rules for use in IHS Makes IHS a distributor of VistA Imaging as a Makes IHS a distributor of VistA Imaging as a

medical devicemedical device Provides funding for VHA support of alpha Provides funding for VHA support of alpha

implementations in FY06implementations in FY06 Initial VistA Imaging test site Initial VistA Imaging test site

implementedimplemented GIMC planning VistA RAD GIMC planning VistA RAD

implementation; informational meeting implementation; informational meeting held at PIMCheld at PIMC

(BTW: DoD just announced it is adopting (BTW: DoD just announced it is adopting VistA Imaging for AHLTA)VistA Imaging for AHLTA)


What about Bar Code What about Bar Code Medication Medication

Administration?Administration?


IHS is developing a patch for BCMA that IHS is developing a patch for BCMA that will allow use of other than SSN for will allow use of other than SSN for patient identifierpatient identifier Parameterizes code for use outside VHAParameterizes code for use outside VHA Supports Health Record Number as identifierSupports Health Record Number as identifier Supports alternative header text in displays Supports alternative header text in displays

and reportsand reports Software Requirements Specification and Software Requirements Specification and

System Design Document developed and System Design Document developed and reviewed by VHAreviewed by VHA

Development and testing should begin Development and testing should begin soonsoon


How are IHS and VHA How are IHS and VHA developer developer

communities communities engaging?engaging?


Emails, calls on specific topics (e.g., NPI, Emails, calls on specific topics (e.g., NPI, BCMA patch for IHS HRN)BCMA patch for IHS HRN)

IHS presence at Tech Talk IHS presence at Tech Talk 2006http://vista.med.va.gov/techconf/202006http://vista.med.va.gov/techconf/2006/06/

Sample of topicsSample of topics Moving From VistA to HeVMoving From VistA to HeV Five Essential Differences Between System of System Five Essential Differences Between System of System

Development and Traditional System DevelopmentDevelopment and Traditional System Development The New Competency-aligned OrganizationThe New Competency-aligned Organization M and Java: Move to Object Oriented TechnologiesM and Java: Move to Object Oriented Technologies M Editor for EclipseM Editor for Eclipse Section 508Section 508 Identity Management - the Master Patient Index (MPI) and Identity Management - the Master Patient Index (MPI) and

BeyondBeyond Human Factors Engineering PrinciplesHuman Factors Engineering Principles HIA Enterprise Solution Architecture & Architecture HIA Enterprise Solution Architecture & Architecture

Assurance ProgramsAssurance Programs SOA and How It Applies to HealtheVetSOA and How It Applies to HealtheVet CDS for reengineered applicationsCDS for reengineered applications Automated Installation of Linux for Oracle & WebLogicAutomated Installation of Linux for Oracle & WebLogic Don't Drown in the Flood of ChangeDon't Drown in the Flood of Change

Engagement in 100-day projects Engagement in 100-day projects (pending)(pending)


What’s the state of What’s the state of VHA-IHS network VHA-IHS network interconnection?interconnection?


VHA-IHS VPN tunnel operatingVHA-IHS VPN tunnel operating Basically IHS->VHA only (special DNS, ACL)Basically IHS->VHA only (special DNS, ACL) Links to selected sites posted on Links to selected sites posted on

collaboration site (vhacollaboration.ihs.gov)collaboration site (vhacollaboration.ihs.gov) Sites include development sites, training Sites include development sites, training

materials (VeHU/Camp CPRS), organizational materials (VeHU/Camp CPRS), organizational sites, and moresites, and more

Currently, specifically NOT for clinical dataCurrently, specifically NOT for clinical data Work starting on agreements to support Work starting on agreements to support

applications involving clinical dataapplications involving clinical data Consolidated Mail Out Pharmacy (CMOP)Consolidated Mail Out Pharmacy (CMOP) Lab servicesLab services Remote radiology interpretationRemote radiology interpretation


Whatever happened to Whatever happened to VistA Office EHR?VistA Office EHR?


VistA Office EHR and CMSVistA Office EHR and CMS

““Through the VistA-Office Electronic Health Record Through the VistA-Office Electronic Health Record (EHR) project, CMS is working with the Veterans (EHR) project, CMS is working with the Veterans Health Affairs (VHA) to transfer health information Health Affairs (VHA) to transfer health information technology to the private sector. CMS is funding and technology to the private sector. CMS is funding and collaborating with VHA and other key federal collaborating with VHA and other key federal agencies on the development of a VistA-Office EHR agencies on the development of a VistA-Office EHR version of the VHA's hospital VistA system for use in version of the VHA's hospital VistA system for use in clinics and physician offices. An overriding goal of clinics and physician offices. An overriding goal of VistA-Office EHR is to stimulate the broader adoption VistA-Office EHR is to stimulate the broader adoption and effective use of EHRs by making a robust, and effective use of EHRs by making a robust, flexible EHR product available in the public domain.”flexible EHR product available in the public domain.”

From the CMS project website: www.cms.hhs.gov/quality/pfqi.asp


Project timetableProject timetable In mid-March, CMS provided VOE Beta Version 1.0 to In mid-March, CMS provided VOE Beta Version 1.0 to

five qualified vendors, for installation at ten test five qualified vendors, for installation at ten test sites.sites.

In May, another contractor began work on an In May, another contractor began work on an independent evaluation.independent evaluation.

The results of a gap analysis between VOE Beta The results of a gap analysis between VOE Beta Version 1.0 and the HHS interoperability standards Version 1.0 and the HHS interoperability standards are due to CMS on June 22nd. Results of the are due to CMS on June 22nd. Results of the independent evaluation are due to CMS on independent evaluation are due to CMS on December 1st.December 1st.

The Beta test is scheduled to conclude at the end of The Beta test is scheduled to conclude at the end of January 2007. Decisions on release / deployment January 2007. Decisions on release / deployment will follow.will follow.


What’s happened with What’s happened with MyHealthMyHealtheeVet?Vet?


Iterative Implementation Releases:

Pt Education Content

November 2003

Registration of Pts

Health Tools

VA Services

Personalization

Prescription Refill

Self-Entered Information

Food Journal

Activity Journal

Self-Entered Metrics

User-Centered Design

Patient Provider Messaging

Future Releases

November 2004 – November 2005

Two Major Releases – CY06

Delegation

MHV is on track…MHV is on track…

Pulse Oximetry

Graphing

Family & Past Medical Health Histories

VistA EHR

Calendaring

Treatment Plans


Memorial day 2006 releaseMemorial day 2006 release

Create Graphs – Ability for patients to Create Graphs – Ability for patients to generate simple visual graphs of their generate simple visual graphs of their health readings. Patients can select health health readings. Patients can select health readings they would like to see graphed.readings they would like to see graphed.

Create Health Histories – Patients have an Create Health Histories – Patients have an area to record personal and family health area to record personal and family health histories. Patients can share health histories. Patients can share health histories with their health care providers.histories with their health care providers.

Create a Doctor Sheet – A comprehensive Create a Doctor Sheet – A comprehensive view of the entire patient’s health history in view of the entire patient’s health history in a summary view that can be printed out a summary view that can be printed out and taken to appointments.and taken to appointments.


My HealthMy HealtheeVet Vet UsageUsage

Total visits exceed 4,000,000Total visits exceed 4,000,000– 2005 = MHV 1,000,000 visits in ~ 8 months2005 = MHV 1,000,000 visits in ~ 8 months– 2006 = MHV 1,000,000 visits in ~ 2 months2006 = MHV 1,000,000 visits in ~ 2 months– 500,000 prescription refills in 4 months500,000 prescription refills in 4 months


What’s the What’s the bottom line?bottom line?


VHA is staying the course…VHA is staying the course…

Reorganization expected to result in Reorganization expected to result in better alignment of development better alignment of development with clinical business priorities and to with clinical business priorities and to meet Congressional expectations for meet Congressional expectations for control and accountabilitycontrol and accountability

HeV timelines extended, but strategy HeV timelines extended, but strategy remains the same.remains the same.

Dedication to strategic partnership Dedication to strategic partnership with IHS remains unchanged.with IHS remains unchanged.


More More Questions?Questions?

[email protected]

FAQ about the VHA Health Information Technology program in FY06 IHS Tech Conference Albuquerque, NM...

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