VHA OI Emerging Health Technologies Sampler

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VHA OI Emerging Health Technologies Sampler
Presented to VA Information Resource Center
(VIReC) November 17, 2008
Jim Demetriades Nancy Wilck Emerging Health
Technologies
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Presentation Outline

• Emerging Health Technologies Overview
• Clinical Wiki Pilot
• Point of Care Device Technology Assessments
• Collaborative Innovation
• Electronic Health Record System Visioning

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Emerging Health Technologies Overview

• Organization VHA Office of Information start-up
  chartered in October 2006
• Purpose to sense and extend VHAs information
  technology horizon through the application and
  introduction of technologies and practices
• Approach to provide evidence of healthcare
  technology value via high-level studies, proofs
  of concept, pilots to help inform both strategic
  and tactical planning
• Focus 3-5 year future window

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Presentation Outline

• Emerging Health Technologies Overview
• Clinical Wiki Pilot
• Point of Care Device Technology Assessments
• Collaborative Innovation
• Electronic Health Record System Visioning

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Clinical Wiki Pilot

• Working with Office of Information and Technology
  (OIT) to establish a formal clinical wiki pilot
  inside VA
• Intend to assess VHA interest in and viability of
  this technology
• Premise is clinicians and allied health
  professionals will utilize wiki technology to
  freely share clinical knowledge with colleagues
• Contributes to larger goal of assessing Web 2.0
  social networking

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Anticipated Wiki Benefits

• Will encourage collective creation of knowledge
  within VHA and ensure its availability to
  interested persons
• Viewed as credible information source and provide
  immediate relevance to VHA clinicians
• Attract wide range of clinical users including
  nurses, researchers, residents, medical and
  allied health students

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Clinical Wiki Pilot (cont)

• Initial wiki environment will use same feature
  set as found in the open source technology
  powering Wikipedia.com
• Will support both general and specialized
  communities (portals) and availability of
  discussion areas, news and event postings
• Will require contributor authentication and
  attribution
• Expect pilot to be available early next quarter

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Presentation Outline

• Emerging Health Technologies Overview
• Clinical Wiki Pilot
• Point of Care Device Technology Assessments
• Collaborative Innovation
• Electronic Health Record System Visioning

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Point of Care (POC) Device Assessment Program

• Purpose Examine the use of information
  technology products for use by VHA clinicians at
  the point of care
• POC device definition Information technology
  (IT) products with user interfaces (e.g. hand
  held, mobile, wireless, laptop, thin/thick client
  devices) that can access VAs VistA computer
  system and / or other information sources
• What is excluded diagnostic and therapeutic
  biomedical devices

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POC Device Assessment Approach

• Approach
• Define POC device reference model (framework)
• For a particular setting (e.g. clinic, ward, long
  term care) and role (primary care doc, nurse,
  specialist) identify and prioritize devices of
  high interest
• Engage clinicians in conducting assessments
  (tablet PCs will be first examined)
• Provide opportunity for diverse collaboration
  with other teams (e.g. security, patient safety,
  etc.)

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POC Device Assessment Program (cont)

• Publish a series of on-line Consumer Reports
  like articles.
• Program will serve as information resource for
  sites looking at devices
• Focus is on technology and not products
• Acquisition recommendations are out of scope.
• Timeframe Contract award to develop methodology
  and framework expected in Dec. 2008

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Presentation Outline

• Emerging Health Technologies Overview
• Clinical Wiki Pilot
• Point of Care Device Technology Assessments
• Collaborative Innovation
• Electronic Health Record System Visioning

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Collaborative Innovation Definition

• Collaborative Innovation
• Self-organizing groups of highly motivated
  individuals working together towards a common
  goal .
• Peter A. Gloor, Carey Heckman, Fillia Makedon

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Our Focus The Intersection
Collaborative Innovation happens here
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Innovation Sandbox Description

• The Innovation Sandbox is much more than a
  software development environment. It is also a
  virtual space for people to collaborate,
  innovate, and develop ideas and requirements
• The Sandbox is a geographically limitless
  solution to the historic challenge of locally
  bound development efforts
• The Sandbox is intended for anyone wishing to
  contribute ideas to VistA development

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Collaborative Innovation Initial Accomplishments

• VHA Informatics and Data Management Committee
  (IDMC) charge
• Early 2007
• Propose a way to preserve innovation, minimizing
  IT re-organization challenges
• Cross organizational workgroup
• Chartered May 2007
• Stakeholders from field, OIT and OI
• Innovation Concept of Operations (CONOPS)
• Presented and approved for pilot by IDMC Sept
  2007
• Industry review and comment Gartner, Perot
  Systems, EDS, Microsoft, IBM

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Collaborative Innovation Goals

• Perpetuate local innovation in support of mission
  needs
• Strengthen early idea sharing
• Encourage communities of interest
• Increase collaboration
• Eliminate redundancy
• Rapidly deploy innovative software which adheres
  to national development standards

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Collaborative Innovation Principles

• Access is easy and open to all
• The Sandbox is structured to allow ideas and work
  products to be freely shared
• There is a well-defined path for mainstreaming
  innovative creations into production
• Failures are expected and accepted as a cost of
  being innovative
• Sandbox governance promotes process consistency,
  simplicity, and reuse

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User Experience

• Receive general innovation news
• Access resource libraries
• Discover or create birds of a feather
  communities
• Contribute ideas and collaborate in shaping
  business requirements
• The more technically inclined can initiate
  software projects
• Innovation ideas or requirements may be submitted
  to the New Service Request (NSR) process
• Applications that meet high-bar exit criteria
  for national business value, OIT programming
  standards and infrastructure capacity may be
  fast-tracked within the NSR process

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Market Survey

• Contract awarded to survey market for toolset
• final recommendations received in March 2008 and
  refreshed in August 2008
• The market is clearly emerging and volatile
• No single solution meets our wants
• Current thinking bridge two commercial products
• one strong in idea and community management
• a second to provide a solid development
  environment

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Collaborative Innovation Current and Future Plans

• In progress now
• Bench validation of candidate products
• Development of functional requirements for
  Sandbox environment
• In the queue
• Pilot approach decision
• Acquisition/installation
• Initial live testing (pilot)
• Transition planning

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Presentation Outline

• Emerging Health Technologies Overview
• Clinical Wiki Pilot
• Point of Care Device Technology Assessments
• Collaborative Innovation
• Electronic Health Record System Visioning

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Definition of EHR-S

• EHR-S includes all clinically related systems or
  applications such Computerized Patient Record
  Systems (CPRS) and radiology, lab, scheduling,
  and pharmacy packages
• Medical devices and national data bases such as
  Decision Support System (DSS) and the
  Administrative Data Repository (ADR) are not part
  of the EHR-S although the need to interface with
  them will be a key characteristic of it

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EHR-S Visioning Objective

• Want to define shared vision for next
  generation EHR-S
• Called shared because products of meetings
  become basis for vision document that will be
  available for broad community review and
  contribution
• Will seek to make shared vision an authoritative
  document
• Will serve as roadmap for VHA as it defines
  capabilities and priorities for future
  development efforts

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EHR-S Visioning Approach

• Facilitating a series of meetings with key EHR-S
  stakeholders
• Final meeting will begin tomorrow with allied
  health, research, education, and academic
  affiliations
• VHA stakeholders (e.g., Veteran Service
  Organizations (VSO) and healthcare partners
  (e.g., DoD and IHS) will be briefed
• Vision document will be iterated and available
  for contributions from larger VHA community
• Look for draft vision in January

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EHR-S Visioning How You Can Contribute

• Participate in development of the shared vision
• Contact the VIReC Help Desk at virec_at_va.gov for
  the VA Intranet address
• Propose additional guiding principles if needed
• Propose capabilities the EHR-S must provide to
  support your line of business (remembering that
  it is first and foremost a clinical tool)
• Encourage your co-workers and colleagues to
  contribute to the shared vision

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Contacts for Additional Information

• Jim Demetriades
• Jim.Demetriades_at_va.gov
• 518-449-0627
• Nancy Wilck
• Nancy.Wilck_at_va.gov
• 703-927-8880

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Discussion
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Supplemental Material

• This material supplements the formal briefing.
  Feel free to contact us if you have questions on
  any of it.

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EHR-S Guiding Principles

• Participants in the visioning meetings developed
  the following EHR-S Guiding Principles statement
  
• In building the EHR-S of the future
• VHA will define its content, functionality and
  performance requirements.
• Clinicians will lead and collaborate with other
  stakeholders in the continuous evolution of the
  system.
• The EHR-S of the future will support and enable
  VHAs missions, with specific focus on patient
  safety and quality of care, by
• Being patient-centric
• Facilitating knowledge discovery, accommodating
  innovation and changes in health care practice
  and information needs
• Providing a framework to identify and promote use
  of best practices and innovation, in both patient
  care and informatics
• Reducing undesirable variation through support
  for consistent approaches to common tasks
• Supporting standardization at the core and
  diversity at the periphery
• Enhancing communication internal and external to
  VHA, among clinicians and with patients, across
  organizations and the continuum of care and
• Promoting the efficiency and effectiveness of
  clinical staff.

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EHR-S Capabilities

• Participants in the visioning meetings determined
  that the EHR-S must have the following
  characteristics
• Be flexible, modular, and integrated
• Promote data standardization, data quality,
  information and data reuse capture the data once
  and use it many times
• Support context-driven views, giving the right
  information at the right time
• Provide access to data for all users, including
  people with disabilities (e.g., access from
  numerous places with numerous devices)
• Manage the patient's composite record including
  longitudinal patient views (internal source,
  format, location, identity)
• Be context, role, and event aware
• Be instrumented to support user efficiencies
• Promote the wellness of the veteran population

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EHR-S Capabilities (cont)

• Provide both prescriptive and assistive real-time
  clinical decision support
• Be configurable with standard defaults
• Enable support care team collaboration (any
  handoffsinternal/external)
• Support data input from multiple sources
  (devices) and locations
• Be easy to navigate and comprehend
• Provide multiple information horizons, arranged
  by cognitively significant context, and provide
  multiple-level views and abstractions.
• Incorporate transportable tools, templates,
  lists, orders, and pathways
• Provide ability to manage workflow
• Must ensure complete, computationally correct,
  dynamic records.
• Facilitate a user interface in which provision of
  care is compatible with care eligibility

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Profile of Attendees at EHR-S Visioning Sessions
To Date

• Medical Doctors (24)
• Registered Nurses (8)
• Clinical Pharmacists (2)
• Psychologist (1)
• PhD. (2)
• Clinical Applications Coordinator (1)
• Experts in
• Clinical Decision Support (1)
• Cognitive Engineering (1)
• Data Quality (3)
• Enterprise Portfolio Management (2)
• Health Eligibility (1)
• Health Information Management (1)
• Information Management (2)
• National Data Systems (1)
• Privacy (1)
• Section 508 (1)
• Security (2)