dod/va information management/information technology update lois kellett cliff freeman 2007 joint...
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DoD/VA Information Management/Information
Technology Update
Lois KellettCliff Freeman
2007 Joint Venture ConferenceMarch 7, 2007
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Topics
• Federal Health Information Exchange (FHIE)• Deployment Health Assessments• Bidirectional Health Information Exchange
(BHIE)• Clinical Data Repository/Health Data
Repository (CHDR)• Laboratory Data Sharing Initiative (LDSI)• Joint Inpatient Collaboration
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Path to Interoperability
BHIE• 2-way
• Local exchange
• Text data
• Real-time
FHIE• 1-way
• Enterprise exchange
• Text data
CHDR• 2-way
• Enterprise exchange
• Computable data
• Real-time
BHIE
Bidirectional Health
Information Exchange
FHIE
Federal Health
Information Exchange
CHDR
Clinical Data
Repository/ Health Data Repository
Interoperable Electronic
Health Records
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Federal Health Information Exchange (FHIE)
Supports monthly, 1-time transfer of electronic health information from DoD to VA at the point of a Service member’s separation
One-way, enterprise exchange of text data
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FHIE Statistics
• 3.7 million patients• 51.8 million lab results• 8.6 million radiology reports• 52.2 million pharmacy records• 52.2 million standard ambulatory data records• 1.6 million consultation reports• Over 2.2 million separated Service members
have presented to the VA
As of January 31, 2006
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Deployment Health Assessments
• Enables VA healthcare providers to access Pre- and Post-Deployment Health Assessments (PPHDAs) and Post-Deployment Health Reassessments (PDHRAs) on separated Service members and demobilized Reserve and National Guard members – 1.5 million forms on 640,000 individuals – PPHDAs and PDHRAs transmitted monthly– PDHRAs transmitted weekly for individuals referred
to VA for care or evaluation
As of January 31, 2007
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Bidirectional Health Information Exchange (BHIE)
Enables real-time sharing of electronic health information between DoD and VA for shared patients
Two-way, DoD BHIE sites and all of VA exchange of text data
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BHIE Statistics
As of January 31, 2006
• Real-time exchange of readable data– Patients treated in both DoD and VA– Data includes allergies, outpatient pharmacy,
demographics, lab results, and radiology reports
• Operational at…– All VA sites– 14 DoD medical centers– 17 DoD hospitals– More than 170 DoD outlying clinics
• Over 9,900 weekly FHIE/BHIE queries (1st Qtr FY 2007)
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BHIE Operational Sites
BHIE Operational
BHIE Implementations Planned During FY2007
NCA
Brooke AMC Wilford Hall
LRMC
Mike O’Callaghan Federal Hospital
David Grant MC
Bassett ACH
Elmendorf AFB
Madigan AMC
NHC Great Lakes
Eisenhower AMC NH Charleston
Tripler AMC
William Beaumont AMCNMC San DiegoNH Camp Pendleton
NH Camp LejeuneWomack AMC
NH Pensacola
Darnall ACH MacDill AFB
NH Jacksonville
NH Groton
NH Corpus Christi
Wright-Patterson AFB
Martin ACH
NH LemooreNMC Portsmouth
Minot AFB
BHIE-CIS Operational
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BHIE Enhancements
• Inpatient Document Sharing– Current: Discharge summaries– Future: Operative notes/ inpatient consultations
• Site-independent data pulled from CDR• Allergies, outpatient pharmacy, demographics, lab
results, and radiology reports (3rd Quarter FY 2007)
• Clinical notes, procedures, problems
• Vital signs
• Scanned/imported documents/images
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Clinical Data Repository/Health Data Repository (CHDR)
Supports interoperability between DoD’s Clinical Data Repository (CDR) & VA’s Health Data Repository (HDR)
Two-way, Enterprise exchange,
Computable data
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CHDR Status
• Standardized, computable data– Outpatient Rx, medication allergies– Supports drug-drug and drug-allergy checks
using data from both DoD and VA
• Operational at…– William Beaumont AMC and El Paso VA– Eisenhower AMC and Augusta VA– NH Pensacola and VA Gulf Coast– Madigan AMC and VA Puget Sound– NHC Great Lakes and North Chicago VA– NH San Diego and VA San Diego
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Laboratory Data Sharing Initiative (LDSI)
Supports bidirectional electronic order entry and results retrieval of chemistry laboratory tests with either DoD or VA acting as a reference lab for the
other agency
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LDSI Workflow Diagram
Clinician Places Order
Lab Accessions Order
Lab Verifies Results
Lab Generates & Sends Shipping List
Receive Shipping List
Enter Results
COLLECTION LABORATORY REFERENCE LABORATORY
HL7 Message
HL7 Message
HL7 Message
HL7 Message
Acknowledge Receipt of Specimens
Mail-in Register Patient
Lab/Clinicians Generate Reports
Results
Auto-Generate Lab Order/AccessionPerform Testing
ShippingOrders/
Accessions
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LDSI Status
• Available for use throughout DoD and VA• Used daily where one Department serves as a
reference lab for the other• Currently testing addition of lab anatomic
pathology (AP) and microbiology orders and results
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LDSI Operational Sites
LDSI Operational
LDSI Implementation Planned in FY2007
Brooke AMC/VA South Texas HCS
Mike O’Callaghan Federal Hospital/ VA Southern Nevada HCS
Bassett ACH
NHC Great Lakes/North Chicago VA MC
Tripler AMC/VA Pacific Island HCS
William Beaumont AMC/ El Paso VA HCS
NMC San DiegoNH Pensacola/VA Gulf Coast HCS
NH Jacksonville
SA North Central Fed Clinic/Wilford Hall MC
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Joint Inpatient Collaboration
• AHLTA, the DoD ambulatory electronic health record, is in place worldwide
• DoD is planning to enhance its inpatient automation capabilities by expanding its electronic health (EHR) record to include inpatient care
• Vista, the VA outpatient, ambulatory, and inpatient EHR, is deployed across all VA
• VA is planning to modernize its EHR, including the inpatient component
• Traditionally, DoD/VA IT sharing has been through systems interfaces
• Unique opportunity to explore a “born seamless” approach for an inpatient EHR
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Joint Inpatient Collaboration
Most of DoD and VA inpatient healthcare is similar
BattlefieldCare
DomiciliaryCare
Acute Care Hospitals&
Medical Centers
VADoD
A few specialties
e.g.,pediatrics
A few specialties
e.g.,domiciliary
Most healthcare specialties
VADoD
Healthcare Specialties
Healthcare Venues
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Joint Inpatient Collaboration
• Medical records must follow the Service member through venues of care within DoD & between DoD and VA
• Joint approach to an inpatient electronic health record will better support the continuum of care between DoD and VA
BattlefieldCare
Theater Hospital
CommunityHospital
MedicalCenter
Long-Term&
Home HealthCare
Medical Clinic