HEALTH INFORMATION VHA Health Information Model (VHIM) Orientation VHIM Home Page .

HEALTH INFORMATION

H E A L T H I N F O R M A T I O N

VHA Health Information Model (VHIM) Orientation

VHIM Home Pagehttp://vaww.va.gov/vhaea/scripts/vhim.asp

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HEALTH INFORMATION

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Agenda

VHA Business Drivers – The need for HealtheVet

HealtheVet – The need for the VHIM What is the VHIM? How does VHIM work? What does the VHIM do for you? VHIM Team Organization VHIM Team Interactions Take-aways


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VHA Business Drivers

Shift from Institutional-centric data to Veteran-centric

Establish consistency in the meaning of data within VHA

Meet requirements of authoritative, longitudinal, accessible, Electronic Health Record (EHR)

Achieve interoperability with partners (DoD, CDC, Homeland Security, external providers)

Meet Federal Enterprise Architecture and Federal Health Architecture requirements


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VHA Business Drivers (concluded)

Align with health information standards

Increase focus on improved health outcomes, increase patient safety, increase quality and reduce wait times

Improve billing support and revenue collection

Provide robust support for analytical computing and clinical decision support

Improve privacy and security of health information


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Business Climate

Multiple external pressures in the Medical, Business, Legal, Technical, and Financial arenas drive a complete re-engineering of VHA’s healthcare systems

Critical requirement for consistent application of an Enterprise-wide Architecture in order to facilitate interoperability and reuse


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HealtheVet Characteristics

• “System of Systems”; not a collection of modules

• Service Oriented Architecture; not Client/Server– Data retrieved by “asking” a service; not

just by accessing a shared database

• Data is an Enterprise Asset; not “owned” by a Project (e.g. Lab) or by the originating facility


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HealtheVet Overview (concluded)

HealtheVet “Backbone”

RxService

LabService

NursingService(COTS)

DoD

Kaiser-Perm.

CAIP

CHDR

CDS

getLabResult(“… <Patient VPID=123/> <LabObservation testCode=276148/> … ”)

CDS Gateway

PersonService

VETS /SDS

HDR ADR

“<MicrobiologyObservation> <Organism code=567891/> <AntibioticSensitivityObservation antibiotic=454798 value=“>=32” units=“mcg/ml” interpretation=731974/>”


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Enter the VHIM

The authoritative source for semantics and information structure for VHA. It defines the structure and content of interactions between services and between VHA and external partners.

Portion of architectural strategy to ensure semantic interoperability among HealtheVet components.

Enterprise-wide initiative to guide the re-engineering of VHA’s systems

Drug

Reactant MedicationHealtheVet

Pharmacy

Radiology

Re-engineering

Contrast Agent

Allergy

VHIM


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What is the VHIM?

A UML model which carries definitions of crosscutting information within VHA and contains classes, their attributes and their relationships


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Computationally Independent Model within MDA

Organized by domains such as Demographics, Pharmacy, etc.

Ensures harmonization with industry standards through active involvement with SDOs (HL7, NCPDP, CHI, DICOM, ASC X12)

Aligned with HL7 Reference Information Model and HL7 3.0 Vocabulary Domain

What is the VHIM (concluded)


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VHIM Versions

VHIM 2.x Consumers: FHIE, HDR IMS, CHDR, BHIE Uses OMG COAS structures / datatypes

VHIM 3.x Consumers: HealtheVet, HDR II, CDS Uses HL7 3.0 Datatypes; aligned with HL7 3.0 Reference

Information Model (RIM)

VHIM 3.0 VHIM 3.1 VHIM 3.2 VHIM 3.3

Published: 1/31/05 Published: 4/30/05 Published: 9/30/05 Target: 01/31/06

Allergies Encounter Adverse Reaction

Reporting Dental

Person Demographics Imaging Compensation & Pension

Exam Event Capture

Pharmacy Laboratory Consults HealtheVet Billing

Vital Signs Orders Health Factors Home Based Primary Care

Problem List Immunization & Skin Test Nutritional & Food Service

(Dietetics) TIU (Clinical Documents) Laboratory Patient Education

Mental Health Prosthetics

Surgery Women’s Health


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The VHIM and Enterprise Reference Terminology (ERT)

Code

+ codingSystem : String = "2.16.840.1.113883.6.233"

(from Entity)

CountryCodeSet+ codeSet : String = "7654321"

CountryCodedValue+ code : String+ displayName : String

Address+ streetLine1 : String+ streetLine2 : String+ city : String+ state : StateCodedValue+ postalCode : String+ country : CountryCodedValue

StateCodeSet+ codeSet : String = "1234567"

StateCodedValue+ code : String+ displayName : String


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The VHIM and Enterprise Reference Terminology (ERT) (concluded)

• Allergy domain– Reactants | 300

• Pollen | 301• Bees | 302• Penicillin | 303• …

– Reactions | 400• Rash | 401• Headache | 402• Diarrhea | 403• …

anAllergy : IntoleranceObservation+ date : dateTime = 1/15/2005+ reactant : ReactantCodedValue = 303+ reaction : ReactionCodedValue = 401...

<<Observation>>

ReactantCodeSet+ codeSet : Vuid = 300

<<CodeSet>>

ReactionCodeSet+ codeSet : Vuid = 400

<<CodeSet>>

ReactantCodedValue+ code : Vuid+ displayText : String

<<CodedValue>>

ReactionCodedValue+ code : Vuid+ displayText : String

<<CodedValue>>

Reference Terminology Information Model


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VHIM – Implementation

<xs:element name="PatientIdentity" type="VaIdentity" substitutionGroup="personIdentity" />

- <xs:complexType name="PatientIdentity">

- <xs:complexContent>

- <xs:extension base="PersonIdentity">

- <xs:sequence>

- <xs:element name="administrativeGender" type="AdministrativeGenderCode">

- <xs:annotation>

<xs:documentation>A value representing the gender (sex) of a person. The for allowable values for this field as specified by the DS DAT for Demographics are: F (Female), M (Male) and UN (unspecified).</xs:documentation>

</xs:annotation>

...

PatientIdentity

+ administrativeGender : AdministrativeGenderCode+ dateOfBirth : BirthTime+ legalId : LegalId+ legalname : Name

Encounter

...

Patient

...

public interface PatientIdentity extends personSRDTs.PersonIdentity

{

livingSubject.AdministrativeGenderCode getAdministrativeGender();

void setAdministrativeGender(livingSubject.AdministrativeGenderCode administrativeGender);

livingSubject.AdministrativeGenderCode addNewAdministrativeGender();

livingSubject.BirthTime getDateOfBirth();

void setDateOfBirth(livingSubject.BirthTime dateOfBirth);

livingSubject.BirthTime addNewDateOfBirth();

...

JavaXML Schema Definition (XSD)

VHIM Class Diagram


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VHIM Templates

Templates are a subset of the VHIM used to define payloads Example: From the Pharmacy domain, we

may specify InPatientOrder, OutPatientOrder, RefillRequest, etc.

Templates represent that information needed to define a transaction between two systems.


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VHIM Templates (concluded)

Templates are not limited to a single domain – they may draw from multiple domains (e.g., patient information in the Refill Request)

Expressed as one or more XML Schema Documents (XSDs)

HIA will maintain a “Template Registry” where templates will be documented and available for re-use

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VHIM Team Organization


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VHIM Process - Roles

Project Teams

Inception Team

Modeling Team

Implementation Team

Provides Orientations

Gathers Interoperability Use Cases

InformationRequirements

InteroperabilityRequirements Creates

Templates

Gathers Detailed Requirements

DomainModels


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VHIM Inception Team

The VHIM Inception Team is the front end of the modeling effort.

Activities include: Provide VHIM related orientation and education to

the project teams

Analyze project needs and assist the project teams in properly documenting use cases and requirements

Maintain a current status of VHIM related touch points to project re-engineering teams


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VHIM Modeling Team Activities

Create class diagrams to support the project teams information exchange requirements. Define information structure and relationships.

Work with ERT and DS to ensure proper semantic rigor.

Ensure alignment with relevant external standards.

Represent the project teams requirements to HL7 and other SDOs.


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VHIM Implementation Team

The VHIM Implementation Team comprises the transformation arm of the modeling effort. Identify detailed information messaging requirements Create and/or enhance VHIM templates to meet the needs

of project teams Construct and test the templates and placement of the

templates into the template registry Assist implementation projects with creating and testing

VHIM-conformant payloads Assist in the creation of VHIM-based logical and physical

data models for HDR Perform tooling activities that pertain to transformation of the

VHIM model into implementable artifacts


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VHIM Contacts

Project Manager – Geff Garnhart Inception Lead – Sherri Walter Modeling Lead – Galen Mulrooney Implementation Lead – Becky Reed Quality Manager – Sherri Walter Requirement Manager – Susan Dahlberg Change Manager – Susan Dahlberg Risk Mitigation Manager – Geff Garnhart Configuration Manager – Becky Reed

Albany OIFO

need to complete


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Team Interactions

VHIM Team•Stds Alignment• Class Model Project App Team

• Business Reqs• Use Cases• Behavioral Model•PDM/LDM•DDL

SME Input Templates Model Reviews

DS, ETS• Terminology• Code Sets• VUID translation

Unified semantics Re-usable artifacts Standardized calls Template Registry

SDOs/Drivers• HL7• X12 (HIPAA)• CHI• NCPDP• LOINC…

DATs

Architecture/Initiatives

• HIA• ASIS• Common Services / CDS


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Project Teams in Scope for VHIM Inception 1.0

VHIM

HDR

CDS CLiO

My HealtheVet

Person Service

FHIE

BHIE

DSI

Home Telehealth

Lab Re-Engineering

Pharmacy Re-Engineering

HealtheVet Billing

Please note: These are the projects that we have had contact with. This is not a complete list and will grow over time


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VHIM Changes / Enhancements

Requested changes and enhancements to the model are submitted through the VHIM Change Control process

VHIM Change Manager communicates requests to the following groups:

VHIM Stakeholder Council Receives the requests for changes / enhancements Harmonizes each request across known consumers to ensure against

conflicts VHIM CCB

Impacts harmonized change requests against scope, cost, schedule VHIM Domain Leads

Impacts the complexity of the requested change from a domain perspective

VHIM Executive Steering Committee Comprised of senior leadership in HIA and OI, makes final scoping and

scheduling decisions for large impacting change requests


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Together, we’ll define:

Interoperable service message payload structures - what information needs to be shared / exchanged.

Messaging use cases and/or requirements (external messages), to include attributes and associations.

How these messages fit together.


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Communication Facilitation

VHIM Conformance is a 2-way streetGoal: Unified semantic approach

By aligning your application to the VHIM you will: Assist in establishing the communication standard between HVV

systems and services Better position your application for future expansion and

interoperability Enable re-use of datastore schemas, messaging payload

standards and implementable java objects thereby shortening development time

To ensure that the VHIM meets your needs, you should: Communicate business requirements and use cases Identify public data - Determine what data you will need to share

with (and require from) other applications.


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Take Aways

• The VHIM is the authoritative source for semantics and information structure for VHA

• HealtheVet system-to-system communications are dependent on the VHIM

• Iterative VHIM publications permit expanding content and frequent delivery while enabling a feedback loop for incorporating enhancement requests

• HDR II and CDS are VHIM early adopters• Find out more here:

http://vaww.va.gov/vhaea/scripts/vhim.asp• Get involved!

HEALTH INFORMATION VHA Health Information Model (VHIM) Orientation VHIM Home Page .

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