Joint Interoperability Initiative of the Department of Veterans Affairs & Department of Defense

Joint Interoperability Initiative of the Department of Veterans Affairs

& Department of Defense

Lemuel DizonNorthwestern University

HIT 405Interoperability, Standards and Integration

VisionDepartment of Defense (DoD)

Military Health System (MHS)

Armed Forces Health Longitudinal

Application AHLTA

Department of Veterans Affairs (VA)

Veterans Health Administration (VHA)

Veterans Health Information System

and Technology Architecture VistA

AHLTA VistA

Share Health Data

Interoperability

Scenario

Scope of the ProblemCongressional Mandate – NDAA 2008

Deadline –September 2009

Strengths Limitations Capabilities

VistA ArchitectureApplication View

Health Data Repository

BCMAVistA Imaging

VI Viewer

CPOE Clinical Notes

Medication, Pharmacy, Laboratory, Nursing, Diagnostics, Dietary

CPRS

VistA ArchitectureComputerized Patient Record System (CPRS)

Computerized Order Entry (CPOE)

Bar Code Medication Administration (BCMA)

VistA Imaging-image management system-multimedia data-DICOM, PACS-EKG’s, pathology images, gastroenterology(endoscopic) images, laparoscopic images, scanned paperwork

VistA Image

Architecture AHLTASystem View

Application Platform Entity

EE Interface

Consult Tracking, Order Entry, Lexicon, DEERS, Security, MPI/MPL, Immunization

AP Interface

People, Information Interchange, Communication

AHLTA Architecture

Application Software Entities-Consult Tracking-Order Entry-Lexicon-Immunizations-Defense Enrollment and Eligibility Reporting System-Security-Master Patient Index/Master Patient Locator

AHLTA ArchitectureApplication Program Interface

Application Platform Entity

External Environment Interface

External Environment-People-Information Interchange-Communication

AHLTA Note

AHLTA Note

DoD/VA Integration Note

DoD/VA Integration Note

DoD/VA Integration Note

DoD/VA Integration Note

DoD/VA Integration Note

Standards

MUMPS Massachusetts General Hospital Utility Multi-Programming System

-healthcare-hierarchical database-ANSI standards X11.1-1995-ISO standard 11756-1992-ISO/IEC 11756-1999 language standard-ISO/IEC 15851-1999 Open MUMPS Interconnect-ISO/IEC 15852-1999 MUMPS Windowing Application Programmers Interface

StandardsContinuity of Care Record (CCR)Continuity of Care Document (CCD)

Bi-directional HL7 messages

VistA communicates EMRs

Mirth open source

Information Models

Interoperability ObjectivesVA and DoD

Objective Description

Refine social history data Data that describe hazardous activities and use of tobacco and alcohol

Share physical exam data Physical exam process when separates from active duty

Demonstrate initial gateway operation Operation of secure network gateways for joint health information sharing

Expand questionnaires and self assessment tools

Viewable to VA from DoD

Expand DoD inpatient medical records system

Expand to at least one additional site in each military medical department

Demonstrate initial document scanning DoD to demonstrate and share with VA

Integration Issues

Interoperability Architecture DevelopmentProgramming Language Shared StandardCCR/CCDLegacy Systems of VistALarge Scale Project

AnalysisSystem Architecture Not Developed

Project Management Structure Not in Placed

Project Management Plan Lacking

RecommendationArchitecture for an electronic interface

Select a Lead Entity

Project Management Organization (PMO)

Conclusion & Implication

Expectations: Falls short

Valuable Lessons: Success Vs. Failure

NHIE