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Captain James A. Lovell Federal Health Care Center VeHU

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Captain James A. Lovell Federal Health Care Center VeHU Session #250 Mr. Patrick Sullivan, FACHE CAPT Norman Lee, M.C. CDR Margaret Beaubien Dr. Douglas Rosendale, FACS – PowerPoint PPT presentation

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Title: Captain James A. Lovell Federal Health Care Center VeHU


1
Captain James A. Lovell Federal Health Care
Center
  • VeHU Session 250

Mr. Patrick Sullivan, FACHE CAPT Norman Lee,
M.C. CDR Margaret Beaubien Dr. Douglas Rosendale,
FACS 12 August 2010
Ver 6
2
Briefing Agenda
  • Introductions and Video
  • Complexity and Challenges in Creating the First
    Ever FHCC
  • Interagency Requirements Life Cycle Management
  • Interagency Software Solutions
  • Interagency Lessons Learned
  • FHCC Architecture

3
(No Transcript)
4
Captain James A Lovell Federal Health Care
Center Organizational Chart
  • Joint Executive Council (JEC)
  • Health Executive Council (HEC)

Advisory Board
NME BUMED
VA Director (SES) Navy Deputy (O6)
VHA VISN 12
Stakeholders Advisory Council
Dental Services
Patient Services
Patient Care
Facility Support
Resources
Fleet Medicine
Mgmt. Auth. From Executive
Agreement (EA) Communication and EA
Compliance Operational Line of
Authority Military
Reporting Relationship Accountability
5
Complexity
  • Provide students with an understanding of the
    complexity of the many information management
    issues involved in creating the first FHCC
  • VAMC Senior Executives View
  • Naval Health Clinic Commanding Officers View
  • US Navy Bureau of Medicine and Surgery View
  • Office of Health Information View

6
Interagency Solutions
  • All solutions created for the FHCC will be
    exportable to other VA/DoD locations
  • Show participants EHRs business architecture
    approaches for the FHCC
  • Once these solutions are implemented, the
    presenters will address plans to export
    technology and processes

7
Patient Registration
  • Goal Single Patient Registration process
    populates both systems to render patient an
    Active Dual Consumer (ADC)
  • ADC facilitates CHDR exchange of computable
    medication and allergy data between systems
    enhances patient safety

8
Medical Single Sign-On
  • Two products Sentillion CareFx
  • Method enter user name and password once
    clinical applications are made available without
    further need to sign in to each program
    individually
  • Context Management selecting a patient results
    in presentation of data from various applications
    (iMed consent, VistA, CHCS, etc.) for that same
    patient when opening another clinical application

9
Laboratory Orders Portability
  • CPRS/VistA and AHLTA/CHCS systems
  • Medical Single Sign-On with context management
  • check View Alerts in CPRS
  • Review New Results in AHLTA
  • Bar coding
  • Leveraging LDSI

10
Radiology Orders Portability
  • East Campus (Branch Clinics)
  • Basic X-rays ordered through CHCS
  • West Campus (New Ambulatory Care Addition)
  • CPRS/VistA Imaging/PACS
  • Medical Single Sign-On with Context Management

11
Consults Orders Portability
  • Manual workaround contingency
  • Exchange of scanned consult documents - Medical
    Single Sign-On with Context Management

12
Pharmacy Orders Portability
  • Allergies Portability CHDR/BHIE
  • Medications Portability
  • - synchronized computable longitudinal
  • - reconciliation
  • Generation of two Rx s
  • Clearing Warnings in other system
  • Initial Operating Capability Workaround

13
Interagency Requirements Life Cycle
  • Educate students about the demands of interagency
    work and revealing techniques of interagency
    requirements life-cycle management
  • Joint Incentive Funds (JIF)
  • Interagency Business Requirements Documentation
    (BRD)
  • Testing and User Acceptance

14
Interagency Lessons Learned
  • Purpose
  • Collect both positive and negative experiences to
    repeat desirable outcomes and avoid undesirable
    outcomes
  • Lessons Learned are
  • continuously collected
  • accepted from all involved with the FHCC
  • maintained as a living document

15
Key Lessons Learned
  • Designate lead entity with final decision making
    authority and establish a clear line of
    interagency authority
  • Direct communication between local
    executives/stakeholders and with VHA and DoD
    leadership needs to be deliberate and planned in
    order to be effective
  • Ensure information presented is appropriate for
    needs of intended audience
  • Discuss Joint functional and technical issues
    early on in the project with greater frequency to
    resolve issues needing clarification

16
More Key Lessons Learned
  • Quarterly meetings provide a great venue for
    updating local executive leadership
  • All documents must be reviewed by a
    technical/business editor to ensure language is
    clear and conveys accurate information
  • Dissemination of a Weekly Situation Report will
    ensure that local Subject Matter Experts (SMEs)
    and Point of Contacts (POCs) are aware of planned
    activities and events
  • Access to key technical representatives is
    essential to quickly clarify project issues

17
Two Electronic Health Record Systems
  • A Quick Historical Recap/Stage-Setter
  • The Veterans Health Administration (VHA) and the
    Department of Defense Military Health Services
    (DoD/MHS) have been working electronic health
    record IT issues TOGETHER for decades
  • The VA/VHA currently uses Veterans Health
    Information Systems and Technology Architecture
    (VistA)/Computerized Patient Record System
    (CPRS), and the DoD/MHS uses Armed Forces Health
    Longitudinal Technology Application
    (AHLTA)/Composite Health Care System (CHCS)
  • Both Departments have come to rely on their own
    Electronic Health Record Systems and utilize them
    everyday, and have some elements of their
    systems, in some areas of the Nation working
    together
  • This working-together effort has resulted in
    products such as the Bi-Directional Health
    Information Exchange (BHIE), and the Clinical and
    Health Data Repositories (CHDR), and has resulted
    in full interoperability for healthcare delivery
    between the two Departments

18
Veterans Health Care for the Future
19
The Solution Simplified Multi-Tiered/layered,
De-coupled Architecture
APPLICATION PRESENTATION LAYER/TIER
(CPRS) User Interface (AHLTA)
Critical Enterprise Design Key--ESB
Service Broker
SERVICES MIDDLE-LAYER/TIER
DATA LAYER/TIER
Data Access Layer (DAL)
VistA
AHLTA Clin Data Repository
Personal Health Records
Other Data Records
20
A Transition Architecture What It Is
  • Provides a methodology to systematically
    transition Legacy/2-Tiered to Multi-Tiered,
    modular architecture
  • Web-based, open architecture viewer
  • Fix once, deploy everywhere, like iPhone apps
  • Maintains functionality and enhances VistA and
    AHLTA
  • Provides seamless access to existing VistA/AHLTA
    data and functionality
  • Minimal training required
  • There are VA/VHA products and services already in
    use with this architecture, and a transition
    architecture can pave the way toward new
    generation HealtheVet

21
Approach (Cont.) Transition Strategy Legacy
to AViVA Transition Architecture
22
Project/Enterprise Functionality Fitted onto
Transition Framework Architecture (Build-out to
ESB)
VA/VHA Business Lines
VHA VA-DoD Health IT Projects
Modular Layers/ Tiers
23
Business Services Orchestration
EMR-x
EMR-y
ESB Services Terminology Identity Security D
ecision Support
Services Terminology Identity Security Decisi
on Support
Services Terminology Identity Security Decisi
on Support
24
Transactional Data Orchestration (Pharmacy)
CPRS
AHLTA
VA/VHA
DoD/MHS

A
D
A
D
Service Broker
Service Broker
R
S
R
S
Pharmacy
Pharmacy
VistA (L)
CHCS (L)
Clinical/ Health Data Repository (CHDR)
Health Data Repository
Clinical Data Repository
(N)
(N)
N- National
L- Local
25
The Interagency Solution ESBs Leveraging NHIN
VA/VHA
DoD/MHS
NHIN
CPRS
AHLTA
APPLICATION PRESENTATION LAYER
NHIN Adaptor
NHIN Adaptor
Enterprise Service Bus (ESB) Service Broker
Enterprise Service Bus (ESB) Service Broker
SERVICES MIDDLE LAYER
Critical Enterprise Design Key--ESB
DATA LAYER/TIER
Data Access Layer (DAL)
Data Access Layer (DAL)
Clinical/Health Data Repository (CHDR)
VistA (L)
AnalyticsCDW
Personal Health Record
Other Data Record
Analytics M2
AHLTA (N) Clin Data Repository
Personal Health Record
Other Data Record
26
Future Capabilities
  • Clinical Decision Support (standard guideline
    support)
  • Device Interoperability (Systems Context)
  • Wearable agents monitoring sensors (shirts
    and pdas)
  • Predictive Modeling ( analytics across clinical
    risks)
  • Artificial Intelligence (means make the computer
    work for you)

27
Summary/Conclusion
  • BOTTOMLINE We CAN and ARE doing this!
  • Solid, well-organized IM/IT Program Management
    Accountability System based project effort
    between VA partnering successfully with DoD,
    making the Nations first Federal Health Care
    Center a reality, then exporting to other Joint
    Venture Sites
  • Bringing the Legacy Systems of VA VistA/CPRS,
    AHLTA/CHCS, and Middle-Tier/Services Layer
    Architecture TOGETHER for the best benefits for
    all Veterans, Servicemembers and their
    beneficiaries, and in-use for Veterans Health
    Administration, Veterans Benefits Administration,
    National Cemetery Administration and all DoD
    Military Services
  • Smart/Agile/Positive interagency relationships,
    breaking apart old architectures, improving
    business processes, and focused,
    joint/dual-agency development make it possible
  • Its ALL ABOUT
    --- Our Mission.Their Future !

28
Readying Warriors and Caring for Heroes
29
Want to learn more ?
  • Visit Active Duty Navy
  • and VA personnel
  • at booth 432 in the exhibit hall
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