VistA Legacy to VistA HealtheVet Transition Plan Office of Information and Technology Office of Ente

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VistA Legacy to VistA HealtheVetTransition
Plan Office of Information and
TechnologyOffice of Enterprise
DevelopmentProgram Executive Office for Veteran
Health IT
Jackie Gill August 21, 2007
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Topics

• The VisionVHAs Objectives for Health Care
• The ProcessUse of Enterprise Architecture Model
• The ProductVistA HealtheVet Transition Plan
• Next Steps

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Topics

• The VisionVHAs Objectives for Health Care
• The ProcessUse of Enterprise Architecture Model
• The ProductVistA HealtheVet Transition Plan
• Next Steps

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VA Health IT Setting the Benchmark
How VA hospitals became the best Time
magazine, 8/27/06
The best medical care in the U.S. Business
Week, 7/17/06
Technology has transformed the VA Fortune
Magazine, 5/11/06
Model for health care nationwide. NBC Nightly
News, 3/15/06
Top-notch health care U.S. News and World
Report, 7/10/05
They've adopted a culture of patient safety and
quality that is pervasive. The centerpiece of
that culture is VistA, the VA's much praised
electronic medical-records system. Business
Week July 17, 2006
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VA Health IT Setting the Benchmark

• Documents (Progress Notes, Discharge Summaries,
  Reports)
• 906,000,000.. 640,000 each workday
• Orders
• 1.7 Billion.... 960,000 each workday
• Images
• 641,700,000 913,000 each workday
• Medications Administeredwith the Bar Code
  Medication Administration (BCMA) system
• 885,000,000 620,000 each workday

Statistics as of March 2007
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VHA Objectives for Health Care

• Current VistA World Class System
• Delivers a complete hospital information system
  to include
• the EHR, Imaging, Bar Code Medication
  Administration
• Its fast, extensible has most of the
  functionality users currently want.
• But
• Includes 100 applications in 128 systems at 113
  sites
• Decentralized application and data bases are
  hospital-centric
• Does not easily accommodate mandated changes -
  HIPAA, etc,
• Does not provide a national EHR for todays
  mobile population, and
• Is built on dated architecture with minimal
  documentation hard to
• modify, expensive to maintain and knowledgeable
  Mumps programmers are dwindling.

• VistA-HealtheVet Health Care Environment
• Patient-centered / Directed
• Complete medical record available anywhere
• Accurate, fast health information
• Interdisciplinary clinical care
• Clinical, patient decision support
• Open / robust systems architecture
• Pre-emptive care for veterans Virtual patient
• Support for comprehensive outcomes research
• Integrating web-based capability where feasible
• Reduced Infrastructure Cost

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Challenges in Transition to VistA HeV

• HeV Concept Solid, Past Efforts at Implementing
  Ran into Challenges
• In 2005, VHA Requested CMU SEI Assessment
• Following Recommendations Were Made
• Define the HeV Vision and the Transition Path
• Constitute Proper Integrated HeV Program
  Governance
• Institute Effective, Standard Practices
• Manage to Realistic, Changing Program/Technical
  Options and Risks
• Develop a Framework to Meet HeV Program Lifecycle
  Needs
• Severe Budget Reductions in FY06/FY07 Forced
  Restructure
• Content Removed
• Schedule Milestones Pushed Out
• Entire Development Plan Revamped

VistA-HeV FY06 Development Budget
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Topics

• The VisionVHAs Objectives for Health Care
• The ProcessUse of Enterprise Architecture Model
• The ProductVistA HealtheVet Transition Plan
• Next Steps

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Reason for Using Enterprise Architecture

• Provides a Model for Managing Transition
• EA Provides a Big Picture View Across the
  Organization
• Captures the Mission, Supporting Information, and
  Technologies to Perform the Mission
• Links Technology Investments to the Overall
  Mission and Objectives
• Includes As-Is Architecture, To-Be Architecture,
  and Transition Plan
• Addresses New Technologies and Changing Mission
  Needs
• Provides Method for Implementing Two of the SEI
  Recommendations
• Define the HeV Vision and the Transition Path
• Develop a Framework to Meet HeV Program Lifecycle
  Needs
• Its Required by OMB
• Agencies are expected to architect first, and
  then use the architecture to guide and inform
  information technology (IT) investment planning
  and implementation
• Federal Enterprise Architecture Practice Guide

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Federal Enterprise Architecture Framework
Vision, Mission, Objectives, Goals Performance
Measures
Business Lines, Business Services, Functions,
Processes Business Reference Model
Semantic Models, Logical Data Models, Physical
Data models Data Reference Model
Software Applications, Web Services, Messaging
Service Service Reference Model
Technical Standards, Departmental Standards,
etc Technical Reference Model
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Health Segment Responsibilities by Layer
Strategy

• Lead for Each Layer Responsible for Developing
  Artifacts

VHA
PRM
Business
BRM
Information Data
OIT OED
DRM
4th PILLAR
Applications Services
SRM
Technology Infrastructure
OIT OI
5th PILLAR
TRM
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Topics

• The VisionVHAs Objectives for Health Care
• The ProcessUse of Enterprise Architecture Model
• The ProductVistA HealtheVet Transition Plan
• Next Steps

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VistAs Current Development Strategy

• For VistA Legacy
• Annual, fixed investment that will be prioritized
  yearly
• Used to address critical capabilities and patient
  safety Issues
• For VistA-HealtheVet
• Phased transition in-line with budget and program
  executability / risk
• First phases target development of software
  infrastructure
• Common software services such as security,
  identity management, alerts and audits
• Design data stores implementation of regional
  data processing centers
• Hardware and networking required to run
  HealtheVet
• Robust capability for testing
• Subsequent phases target the implementation of
  clinical and administrative capabilities

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Initial vs. Full Operating Capability

• In Building HeV Plan, Common Question Arose
  When is a Capability Completely Transitioned?
• Propose Adopting Use of Terms Initial Operating
  Capability (IOC) and Full Operating Capability
  (FOC)
• Initial Operating Capability
• Replicates All Necessary Functions from VistA
  Legacy
• Meets Some, But not All, HeV Architectural
  Requirements
• Deployed to at Least One Field Site
• Full Operating Capability
• Meets All Requirements Identified at Beginning of
  Transition (i.e. Requirements Identified When
  Program Completed Milestone I)
• Meets All HeV Architectural Requirements
• Deployed to All Field Sites

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HeV Transition Phase I

• Primary Capability in Development
• Build Common Services and Testing Capabilities
• Health and Administrative Data Repositories
  (HDR/ADR)
• Identity Management
• Security
• Messaging Interface Services
• Standards Terminology Services
• Transition Application Modules
• Enrollment
• Scheduling
• Major Milestones
• FY07 IOC
• FY07 Enrollment Beta National Release
  Scheduling Alpha Release
• FY08 Scheduling Beta National Release
• FY12 FOC

Milestone dates assume consistent levels of
funding
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HeV Transition Phase II

• Primary Capability in Development
• Continue Building Out Common Services
• Transition Application Modules
• Laboratory
• Pharmacy
• CCDSS (CPRS Re-Engineering)
• Major Milestones
• FY08 IOC
• FY08 Deploy Pharmacy Drug Dosage Checking (PEPS
  .5)
• FY09 Deploy Pharmacy Drug Dosage Checking (PEPS
  1.0)
• FY10 Begin National Fielding of Laboratory
• FY11 Begin National Fielding Re-Engineered
  Pharmacy for HeV
• FY15 FOC

Milestone dates assume consistent levels of
funding
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VISTA SOFTWARE PACKAGES
VistA IMAGING
REHABMEDICINE
VOLUNTARY SERVICE
MEDICAL RECORDS TRAINING
ENROLLMENT
ACCOUNTS RECEIVABLE
ADMISSION DISCHARGE TRANSFER
LIBRARY
PATIENT FUNDS
NURSING
INTEGRATED DATABASE
PERSONS
RADIOLOGY
PATIENTS
LABORATORY
COMPUTERIZED PATIENT RECORD SYSTEM (CPRS GUI)
BLOOD BANK
DENTAL
RPC BROKER
PROBLEM LIST
DRUGS
MAILMAN
WARDS
TASK MANAGER
SOCIAL WORK
SURGERY
MANAGER
KERNEL
BAR CODE MEDICATION ADMINISTRATION
SPINAL CORD INJURY
MENU MANAGER
LAB RESULTS
SECURITY
VA FILEMAN
MENTAL HEALTH
PRESCRIPTIONS
MEDICINE
TEXT INTEGRATION UTILITIES (TIU)
INVENTORY
WOMENS HEALTH
ENGINEERING
IMAGES
BLIND REHAB
ONCOLOGY
HEALTH SUMMARY
SCHEDULING
DIETETICS
MEDICAL CARE COST RECOVERY
INTEGRATED FUNDS CONTROL ACCOUNTING PROCUREMENT
AUTHORIZATION SUBSCRIPTION UTILITY (ASU)
INPATIENT PHARMACY
OUTPATIENT PHARMACY
CLINICAL REMINDERS
CONSULT / RESULT TRACKING
EMERGING TECHNOLOGY My HealtheVet Home
Telehealth Health IT Sharing
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VistA HeV Architecture
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Phase I Integrated Schedule
Beta
National
Enrollment (ESR)
Alpha
Beta
National
Scheduling (RSA)
Release w/RSA
Person Services
Release w/ESR
RSA
Organization Services
Testing
National
FATKAAT
Security
National
Development
Test
Messaging
HDR-IMS National
HDR II National
HDR-LAB
HDR-CDS
HDR
Pre Production Phase I
Testing Services
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Phase I Integrated Schedule
Beta
National
Enrollment (ESR)
Alpha
Beta
National
Scheduling (RSA)
PERSON SERVICES IDENTITY MANAGEMENT Enumerates
and maintain person identities of both patients
and non-patients. Implements business service
components to provide for retrieval, validation,
entry, and editing of person demographic data
elements and re-engineers functionality to
support HeV standards and technology
modernization.
Release w/RSA
Person Services
Release w/ESR
RSA
Organization Services
Testing
National
FATKAAT
Security
National
Development
Test
Messaging
HDR-IMS National
HDR II National
HDR-LAB
HDR-CDS
HDR
Pre Production Phase I
Testing Services
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Phase I Integrated Schedule
Beta
National
Enrollment (ESR)
Alpha
Beta
National
Scheduling (RSA)
ORGANIZATION SERVICES Provide administrative
application to support capture and maintenance of
VHA Organizations (VAMCs, CBOCs, CMOPs, and
Outpatient Pharmacies) to be enumerated with
National Provider Identifier values.
Release w/RSA
Person Services
Release w/ESR
RSA
Organization Services
Testing
National
FATKAAT
Security
National
Development
Test
Messaging
HDR-IMS National
HDR II National
HDR-LAB
HDR-CDS
HDR
Pre Production Phase I
Testing Services
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Phase I Integrated Schedule
Beta
National
Enrollment (ESR)
Alpha
Beta
National
Scheduling (RSA)
SECURITY FatKAAT Provide authentication,
authorization and audit of HealtheVet
Applications using Fat-Client Kernel
Authentication/Authorization Tool (FatKAAT).
Release w/RSA
Person Services
Release w/ESR
RSA
Organization Services
Testing
National
FATKAAT
Security
National
Development
Test
Messaging
HDR-IMS National
HDR II National
HDR-LAB
HDR-CDS
HDR
Pre Production Phase I
Testing Services
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Phase I Integrated Schedule
Beta
National
Enrollment (ESR)
Alpha
Beta
National
Scheduling (RSA)
Release w/RSA
Person Services
Release w/ESR
RSA
Organization Services
Testing
National
FATKAAT
Security
National
Development
Test
Messaging
HDR-IMS National
HDR II National
HDR-LAB
HDR-CDS
HDR
Pre Production Phase I
Testing Services
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Phase I Integrated Schedule
Beta
National
Enrollment (ESR)
Alpha
Beta
National
Scheduling (RSA)
Release w/RSA
Person Services
Release w/ESR
RSA
Organization Services
Testing
National
FATKAAT
Security
National
Development
Test
Messaging
HDR-IMS National
HDR II National
HDR-LAB
HDR-CDS
HDR
Pre Production Phase I
Testing Services
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Phase I Integrated Schedule
Beta
National
Enrollment (ESR)
Alpha
Beta
National
Scheduling (RSA)
Release w/RSA
Person Services
Release w/ESR
RSA
Organization Services
Testing
National
FATKAAT
Security
National
Development
Test
Messaging
HDR-IMS National
HDR II National
HDR-LAB
HDR-CDS
HDR
Pre Production Phase I
Testing Services
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Phase I Integrated Schedule
Beta
National
Enrollment (ESR)
Alpha
Beta
National
Scheduling (RSA)
Release w/RSA
Person Services
Release w/ESR
RSA
Organization Services
Testing
National
FATKAAT
Security
National
Development
Test
Messaging
HDR-IMS National
HDR II National
HDR-LAB
HDR-CDS
HDR
Pre Production Phase I
Testing Services
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Phase I Integrated Schedule
Beta
National
Enrollment (ESR)
Alpha
Beta
National
Scheduling (RSA)
Release w/RSA
Person Services
Release w/ESR
RSA
Organization Services
Testing
National
FATKAAT
Security
National
Development
Test
Messaging
HDR-IMS National
HDR II National
HDR-LAB
HDR-CDS
HDR
Pre Production Phase I
Testing Services
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Phase II Integrated Schedule
Beta
National
Enrollment (ESR)
Alpha
Beta
National
Scheduling (RSA)
Prototype
Alpha
National
Beta
Laboratory
IVV
Beta
National
Dose Checking
Pharmacy
Alpha
National
Beta
Re-Engineering
Project Deferred
CPRS/CCDSS
National
Release w/RSA
Person Services
National 09/2012
Release w/ESR
RSA
Organization Services
EOL
Testing
National
FATKAAT
Security
RSA Beta Testing
Active Directory
National
Development
Test
Messaging
HDR-IMS National
HDR II National
HDR-LAB
HDR and CDS Local Deployed
HDR-CDS
HDR
Pre Production Phase I
Final Pre Production
Development Env
Pre Production Phase II Integration
Testing Services
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Topics

• The VisionVHAs Objectives for Health Care
• The ProcessUse of Enterprise Architecture Model
• The ProductVistA HealtheVet Transition Plan
• Next Steps

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Core Elements of HealtheVet
VISTA SOFTWARE PACKAGES
VistA IMAGING
REHABMEDICINE
VOLUNTARY SERVICE
MEDICAL RECORDS TRAINING
ENROLLMENT
ACCOUNTS RECEIVABLE
ADMISSION DISCHARGE TRANSFER
LIBRARY
PATIENT FUNDS
NURSING
INTEGRATED DATABASE
PERSONS
RADIOLOGY
PATIENTS
LABORATORY
COMPUTERIZED PATIENT RECORD SYSTEM (CPRS GUI)
BLOOD BANK
DENTAL
RPC BROKER
PROBLEM LIST
DRUGS
MAILMAN
WARDS
TASK MANAGER
SOCIAL WORK
SURGERY
MANAGER
KERNEL
BAR CODE MEDICATION ADMINISTRATION
SPINAL CORD INJURY
MENU MANAGER
LAB RESULTS
SECURITY
VA FILEMAN
MENTAL HEALTH
PRESCRIPTIONS
MEDICINE
TEXT INTEGRATION UTILITIES (TIU)
INVENTORY
WOMENS HEALTH
ENGINEERING
IMAGES
BLIND REHAB
ONCOLOGY
HEALTH SUMMARY
SCHEDULING
DIETETICS
MEDICAL CARE COST RECOVERY
INTEGRATED FUNDS CONTROL ACCOUNTING PROCUREMENT
AUTHORIZATION SUBSCRIPTION UTILITY (ASU)
INPATIENT PHARMACY
OUTPATIENT PHARMACY
CLINICAL REMINDERS
CONSULT / RESULT TRACKING
EMERGING TECHNOLOGY My HealtheVet Home
Telehealth Health IT Sharing
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HEALTHeVET PORTFOLIO
Operations Management Application
Monitoring Device Manager System Monitoring
Emerging Technologies Home Telehealth Health IT
Sharing
COMPUTERIZED CARE DELIVERY SUPPORT SYSTEM
Adverse Reaction Tracking
Authorization/ Subscription Utility
Womens Health
Vitals/Measurements
eGov DFAS FLITE HR Shared Services Center
Voluntary Service System
Enhanced VA/DoD Seamless Care
Veterans Personal Finance System (VPFS)
Automated Info Collection System
Text Integration Utilities
Joint Inpatient Electronic Health Record
My HealtheVet
Surgery
ASISTS
Standardization And Terminology Services
Bar Code Expansion Project
Remote Order Entry System
National/Regional Database Stores
Spinal Cord Dysfunction
Beneficiary Travel
Administrative Data Repository
Health Data Repository
Blind Rehabilitation
Care Management
Social Work
Progress Notes
Workload Management
Clinical Data Warehouse
Archive Service
CAPRI (AMIE)
RISE
Workflow Engine
Clinical Case Registries
Security
Audit Service
Problem List
Release of Information (DSSI)
Dental Record Manager
Common Services
Enrollment Application System
Business Rules Engine
Person Service
Scheduling
Radiology/Nuclear Medicine
Employee Health Record
Clinical Decision Support
Outpatient Clinical Care
Organization Service
Deployment Toolkit
QUASAR Audiology Speech Analysis
Messaging/ Enterprise Service Bus
Fee Basis
HeV Desktop
Laboratory
Clinical Device Connectivity
Home Based Primary Care
PIMS
Order Entry/ Results Reporting
Prosthetics
Primary Care Management Module
Report Writer
Imaging System
Pharmacy
Clinical Procedures
Order Check Expert
Incident Reporting
Police Security
Patient Advocate Tracking System (PATS)
Incomplete Record Tracking
Clinical Reminders
Intake/Output
Nutrition And Food Service
Library
Ophthalmology
Mental Health
LEGEND
Oncology
Nursing Service
Consult/Request Tracking
Phase 1
Implant Management
Phase 2
Discharge Summary
Healthcare Acquired Infection
Influenza Surveillance
Phase 3
Health Summary
DoD Systems Bed Contingency Interfaces to AHLTA
Phase 4
Emergency Room
Phase 5
Credentials Tracking VetPro
Phase 6
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QUESTIONS
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BACKUP
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Health EA Strategy Layer
VA Strategic Plan
VA Publications
Strategy

• VA Strategic Plan is Primary Guide
  forTransitioning Health Care
• Other Source Documents
• VA CIO Priorities, Especially in Areas of
  Security
• VA/DoD Joint Electronic Health Plan
  Interoperability (JEHRI) Plan
• Health Standards Groups such as Healthcare
  Information Technology Standards Panel (HITSP)

Business
Information Data
Applications Services
Technology Infrastructure
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Health EA Business Layer

• For Patient-Centric Care, Five Areas Selected for
  Business Process Improvement
• Veteran Enrollment
• Appointing
• Laboratory Analysis
• Drug Prescription Management
• Clinician Care Delivery
• Implementing New Business Processes Drove
  Changesin IT Systems, Resulted in First Phase of
  Transition to VistA HeV
• ESR Enrollment System Re-Engineering
• RSA Re-Engineered Scheduling Application
• LSRP Laboratory System Re-Engineering Project
• PRE Pharmacy Re-Engineering
• CPRS Clinical Patient Record System
• Actual Investment in Transition is Determined
  byAnnual Prioritization of Requirements
• Based on Metrics from Strategic Plan
• VHA Seeks Balanced Investment Between
  CriticalUpgrades to Legacy and Investment in
  FutureCapabilities of VistA HeV

Strategy
Business
Information Data
Applications Services
Technology Infrastructure
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Health EA Information Data Layer

• Implement Single Logical View of Patient
• Accessible from Any VA Medical Facility
• For Veteran, Accessible via Internet
• Use HL7 as Standard for Messaging, Extend as
  Necessary for Internal VA Use
• Use Data Standardization to Implement
  Interoperability
• Supports Seamless Transition with DoD
• Supports Eventual Sharing of Data Across Entire
  HealthCare Community
• Use Iterative Development, Incremental Delivery
• Avoids Risks of Big Bang Approach
• Delivers Some Capability Now, Not All Capability
  Later
• Gradual Transition fromFacility-Centric to
  Patient-Centric Access

Strategy
Business
Information Data
Applications Services
Technology Infrastructure
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Health EA Application and Services Layer

• Employ a Service Oriented Architecture
• Iterative Development, Incremental Delivery
• Goal is to Develop and Release Capabilities in
  Six Month Intervals
• Avoids Risks of Big Bang Approach
• Delivers Some Capability Now, Not All Capability
  Later
• Gradual Transition from Facilities-Centric to
  Patient-Centric
• Employ Multiple Techniques for Transitioning
  Modules
• Wrap Interface to Legacy Code, Re-Use as a
  Service inVistA HeV
• Re-Host Rewrite Modules Using LegacyBusiness
  Logic
• Re-Engineer Rewrite Modules in Response toNew
  Business Processes
• Make/Buy Decisions Based on Best Value to VA
• Decision on Whether to Use in House Development
  or Contract for a Module Will be Based on
  Business Case Analysis
• Factors for Consideration in Analysis are
  Performance, Cost, Schedule, Risk, Contribution
  to Health Community

Strategy
Business
Information Data
Applications Services
Technology Infrastructure
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Health EA Application and Services Layer

• Open Systems
• Interfaces between Applications and Modules will
  be Controlled via ICDs
• Open Source Code
• Government Developed Source Code will be Made
  Available to the Public Domain
• Security
• Begin with User Authentication, Incrementally
  Improve Securityto Include Role-based Access,
  Auditable Transactions, Etc.
• Device Independence
• Device Independence will be Implemented in
  PhasesThroughout the Transition
• VA Enterprise Architecture
• As Part of IT Re-Alignment, VA Reviewing
  ItsApproach to One VA Services
• VistA will Move to One VA Services asThey Become
  Available
• In Interim, VistA HeV will Continue Use
  ofServices Developed for Health IT

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Health EA Application and Services Layer

• VistA HeV Applications Must Meet the Following
  Minimum Requirements for National Release
• Functionality Replicate All the Functionality of
  the VistA Legacy Application
• Service Oriented Architecture
• Provide Services via Enterprise Messaging
• Utilize Common Services Available in VistA HeV
  Environment
• 508 Compliance by National Release
• Security Support User Authentication
• Device Independence Browser/Client Platform
  Independence
• Multilingual Support
• English is Only Language Required to
  SupportClinicians and Administrators
• Multi-Lingual Required for Patient Instructions
• Services Accessed Directly by Veterans(e.g. My
  HealtheVet) Must Support Multi-Lingual
• Common GUI All Services will be Availablefrom a
  Single User Interface
• Threshold Requirements Can Only beWaived with
  Approval of VHA and VA CIO

40
Health EA Technology Infrastructure Layer

• Technologies
• VA Enterprise Architect Defines Technical
  Standards for Department
• Maintained in Technical Reference Model (TRM)
• Provides Department Policy
• Provides List of Allowed Hardware and Software
  Technologies
• For Health, A Segment TRM Will be Maintained
• Derived from VA TRM
• Restricted to Technologies Approved by Department
  TRM
• Provides Phased Implementation
• Development Tools
• Single Development Environment will be Used
• Specified in the Health Segment TRM
• Hardware and Networking
• VA Pursuing Long Term Strategy of
  LocatingServers at Regional Data Processing
  Centers
• VistA Working Towards Centralized Systemwith
  Regional Replications