Health Data Repository: The Creation of a National Database What Will it Mean to You

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Health Data Repository The Creation of a
National Database -What Will it Mean to You?

• Gloria Smith
• Program Manager Repositories
• Health Data Systems
• Clyde Miller
• Project Manager
• Health Data Repository

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WHAT is the Health Data Repository (HDR)?

• Set of databases containing clinical health data
  and a service to read, write, update and change
  the clinical data

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HDR

• Obtains clinical data from VistA and
  re-engineered clinical applications
• Currently resides on one national platform with
  the possibility for additional national or
  regional platforms in the future to ensure
  optimal performance

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The Importance of a Data Repository

• Enhances sharing and interoperability of clinical
  data
• VA facilities
• VA and DoD data exchange
• VA and other agencies such as CDC and IHS in the
  future
• Supports delivery of care
• Regardless of patients current location, OR
• Location of where patient has been treated in the
  past
• Used by health care providers to facilitate
  longitudinal patient-centric care
• Stores patient-centric clinical data in a
  computable format that can be used by other
  applications for analytical purposes
• Designed to store clinical data from VA and
  non-VA sources

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The Importance of a Data Repository

• Serves as the authoritative data store for
  clinical data from all VistA sites
• Once all consumers of a specific set of data are
  using the HDR
• Serves as a platform for new reengineered
  clinical applications
• Key to the HealtheVet strategy

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The Creation History of the Health Data
Repository (HDR)

• 1999
• Analysis project
• 2001
• HDR project approved by National Leadership Board
  (NLB)
• 2002
• First Office of Management and Budget (OMB)
  Exhibit 300 submitted
• Business owners identified
• Staff hired
• Scope of HDR project defined
• Health Data Repository Limited to health data
  required to support the reengineering of the
  computerized record system
• Administrative Data Repository (planned)
• Financial Data Repository (planned)
• Contract awarded to build an HDR prototype

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The Creation of the Health Data Repository

• 2003
• Prototype Built
• Based on a Commercial Off-the Shelf (COTS)
  product
• Pharmacy and allergies were first mapping
  attempts
• Mapping of VA terms to entries in the COTS
  product data dictionary
• Lessons Learned From Prototype
• COTS product was limited to outpatient care
• Data dictionary was Intellectual Property and not
  open-source
• Mapping was costly, resource intensive and very
  time consuming

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The Creation of the Health Data Repository

• 2004
• Negotiations to make the data dictionary open
  source failed
• Prototype contract was not renewed
• Build decision was made
• Included in build decision was staffing of
  Enterprise Terminology Services (ETS) and Data
  Standardization (DS) program
• DS role propose data standards
• ETS role deploy standard code sets to the field
• HDR role
• acquire point forward data in HDR interim
  database
• acquire point backward data in HDR historical
  database
• build an end-state database on Veterans Health
  Information Model (VHIM)-based platform

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The Creation of the Health Data Repository

• 2004
• Authority to Operate Received
• HDR Deployed the Interim Messaging Solution (IMS)
  database populated with Vitals
• 2005
• Allergies added to IMS
• Outpatient Pharmacy added to IMS

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The Creation of the Health Data Repository

• HDR Project consists of 4 Databases and a Data
  Service
• Interim Messaging Solution (IMS)
• Serves as a transition to the definitive HDR
  implementation and currently stores coded
  clinical data in a messaging format (HL7) for
  three clinical domains Vitals, Allergies,
  Pharmacy
• Historical (HX)
• Stores historical or point backward legacy data
  for three domains

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The Creation of the Health Data Repository

• HDR Data Warehouse
• Contains ALL clinical data from the HDR-IMS and
  HDR-HX in a dimensional database that is
  optimized for loading into other non-patient
  care-giving systems
• Makes HDR data accessible to other systems for
  aggregation, research and analysis while
  maintaining optimal response for clinical
  end-users using CDS
• HDRII
• The definitive HDR based on the Veterans Health
  Information Model (VHIM)
• A relational database

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The Creation of the Health Data Repository

• Clinical Data Service (CDS)
• Gateway to the HDR all access to HDR goes
  through CDS
• CDS extracts requested data from the HDR and
  delivers it to the client applications
• When HDR II is operational, CDS will provide
  write as well as read service to HDR clients

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The Creation of the Health Data Repository

• 2007
• New Functionality
• Remote Data Interoperability
• Drug/Drug Order Check
• Drug/Allergy Order Checks
• HDR added support for two additional clients
• VistAWeb
• Home Telehealth

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The Challenges in Creation of the HDR

• New technology that is more complex than expected
• Unexpected data issues
• Project dependencies that must be coordinated
• Scope Creep
• Management of data not compliant with messaging
  standards

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TO BE Health Data Repository (HDRII)

• Replaces HDR IMS
• Provides data persistence for records for at
  least 75 years past last recorded patient
  interaction
• Optimizes performance to balance needs for quick
  data retrieval and long-term persistence
• Persists computable and non-computable data

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What Does HDR II Offer Over HDR IMS?

• Supports Implements Veterans Health Information
  Model (VHIM)
• HDR is key in the central information data model
  that will take patient care coupled with
  electronic patient records into the next
  generation
• Use of the model supports
• Consistency of data terms and meanings
• Better data quality, data completeness,
  computability and accessibility to a standard
  that is above what is on the market today
• Better transformation of data between the VA and
  other industry standards
• Improved Intra and Inter Operability of our data

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What Does HDR II Offer Over HDR IMS?

• Performance designed around patient centric
  queries
• A true relational database instead of just an HL7
  message storage framework
• Improved performance than previous systems

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HDR (Simplified) Data Going In
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HDR (Simplified) Data Coming Out
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Accomplishments During Past Year

• Design Phase Completed
• Construction of the TO BE Health
• Data Repository (HDRII) Near Completion
• 2.0 Mimics IMS and implements VHIM
• 2.1 includes the addition of Lab

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Accomplishments During Past Year

• Migration of Data from IMS to HDRII in
  preparation for production
• Extensively tested
• 72 Million Messages Tested
• 13 error messages reported (all the same)
• 5 fold improvement in the ability to read and
  write data from the databases

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Validating Data Quality Performance

• Quality and Performance Assurance
• Independent reviews
• Data quality check
• Data movement
• Independent Validation and Verification
• Optimal performance check

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Compatible VistA HDR Dev Processes

• Rigorous testing in all phases of development
  and release
• Ensures software quality

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System Availability

• Implemented On-site 24x7x365 coverage at the Data
  Center
• Developed a Plan for a Standby System
• Developed a Plan for Disaster Recovery

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Next Steps

• Migration of data from HDR IMS to HDRII
• National Deployment of HDRII 2.0
• Implementation of Lab domain (CHEM/HEM) into the
  HDRII National Deployment of HDRII 2.1
• Retirement of IMS
• Planning for the addition of future domains

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How Can YOU Make the HDR Successful?

• Help keep the HDR and VistA in synch by
• Reporting data integrity issues to local Clinical
  Application Coordinator (CAC) and/or IT
  Representative
• Ensuring data changes are made using nationally
  released applications

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Summary

• There is a central repository that supports
• Sharing of data
• Interoperability of data
• Longitudinal data
• Order checks against all patient allergies and
  prescriptions
• Platform for HeV applications

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