DoD/VA Information Management/Information

Technology Update

Lois KellettCliff Freeman

2007 Joint Venture ConferenceMarch 7, 2007

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Topics

• Federal Health Information Exchange (FHIE)• Deployment Health Assessments• Bidirectional Health Information Exchange

(BHIE)• Clinical Data Repository/Health Data

Repository (CHDR)• Laboratory Data Sharing Initiative (LDSI)• Joint Inpatient Collaboration

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Path to Interoperability

BHIE• 2-way

• Local exchange

• Text data

• Real-time

FHIE• 1-way

• Enterprise exchange

• Text data

CHDR• 2-way

• Enterprise exchange

• Computable data

• Real-time

BHIE

Bidirectional Health

Information Exchange

FHIE

Federal Health

Information Exchange

CHDR

Clinical Data

Repository/ Health Data Repository

Interoperable Electronic

Health Records

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Federal Health Information Exchange (FHIE)

Supports monthly, 1-time transfer of electronic health information from DoD to VA at the point of a Service member’s separation

One-way, enterprise exchange of text data

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FHIE Statistics

• 3.7 million patients• 51.8 million lab results• 8.6 million radiology reports• 52.2 million pharmacy records• 52.2 million standard ambulatory data records• 1.6 million consultation reports• Over 2.2 million separated Service members

have presented to the VA

As of January 31, 2006

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Deployment Health Assessments

• Enables VA healthcare providers to access Pre- and Post-Deployment Health Assessments (PPHDAs) and Post-Deployment Health Reassessments (PDHRAs) on separated Service members and demobilized Reserve and National Guard members – 1.5 million forms on 640,000 individuals – PPHDAs and PDHRAs transmitted monthly– PDHRAs transmitted weekly for individuals referred

to VA for care or evaluation

As of January 31, 2007

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Bidirectional Health Information Exchange (BHIE)

Enables real-time sharing of electronic health information between DoD and VA for shared patients

Two-way, DoD BHIE sites and all of VA exchange of text data

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BHIE Statistics

As of January 31, 2006

• Real-time exchange of readable data– Patients treated in both DoD and VA– Data includes allergies, outpatient pharmacy,

demographics, lab results, and radiology reports

• Operational at…– All VA sites– 14 DoD medical centers– 17 DoD hospitals– More than 170 DoD outlying clinics

• Over 9,900 weekly FHIE/BHIE queries (1st Qtr FY 2007)

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BHIE Operational Sites

BHIE Operational

BHIE Implementations Planned During FY2007

NCA

Brooke AMC Wilford Hall

LRMC

Mike O’Callaghan Federal Hospital

David Grant MC

Bassett ACH

Elmendorf AFB

Madigan AMC

NHC Great Lakes

Eisenhower AMC NH Charleston

Tripler AMC

William Beaumont AMCNMC San DiegoNH Camp Pendleton

NH Camp LejeuneWomack AMC

NH Pensacola

Darnall ACH MacDill AFB

NH Jacksonville

NH Groton

NH Corpus Christi

Wright-Patterson AFB

Martin ACH

NH LemooreNMC Portsmouth

Minot AFB

BHIE-CIS Operational

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BHIE – DoD View

DOD clinician

signs on to SHARE

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BHIE – DoD View

Outpatient Medication List

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BHIE – DoD View

Detail review of Cipro order

placed in VA

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BHIE – VA View

VA clinician signs on to

VistA CPRS

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BHIE – VA View

VA Clinician views Tibia/Fibula

radiology report from DoD entered

at Landstuhl

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BHIE Enhancements

• Inpatient Document Sharing– Current: Discharge summaries– Future: Operative notes/ inpatient consultations

• Site-independent data pulled from CDR• Allergies, outpatient pharmacy, demographics, lab

results, and radiology reports (3rd Quarter FY 2007)

• Clinical notes, procedures, problems

• Vital signs

• Scanned/imported documents/images

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BHIE – DoD Inpatient Documentation View

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Clinical Data Repository/Health Data Repository (CHDR)

Supports interoperability between DoD’s Clinical Data Repository (CDR) & VA’s Health Data Repository (HDR)

Two-way, Enterprise exchange,

Computable data

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CHDR Status

• Standardized, computable data– Outpatient Rx, medication allergies– Supports drug-drug and drug-allergy checks

using data from both DoD and VA

• Operational at…– William Beaumont AMC and El Paso VA– Eisenhower AMC and Augusta VA– NH Pensacola and VA Gulf Coast– Madigan AMC and VA Puget Sound– NHC Great Lakes and North Chicago VA– NH San Diego and VA San Diego

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Laboratory Data Sharing Initiative (LDSI)

Supports bidirectional electronic order entry and results retrieval of chemistry laboratory tests with either DoD or VA acting as a reference lab for the

other agency

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LDSI Workflow Diagram

Clinician Places Order

Lab Accessions Order

Lab Verifies Results

Lab Generates & Sends Shipping List

Receive Shipping List

Enter Results

COLLECTION LABORATORY REFERENCE LABORATORY

HL7 Message

HL7 Message

HL7 Message

HL7 Message

Acknowledge Receipt of Specimens

Mail-in Register Patient

Lab/Clinicians Generate Reports

Results

Auto-Generate Lab Order/AccessionPerform Testing

ShippingOrders/

Accessions

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LDSI Status

• Available for use throughout DoD and VA• Used daily where one Department serves as a

reference lab for the other• Currently testing addition of lab anatomic

pathology (AP) and microbiology orders and results

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LDSI Operational Sites

LDSI Operational

LDSI Implementation Planned in FY2007

Brooke AMC/VA South Texas HCS

Mike O’Callaghan Federal Hospital/ VA Southern Nevada HCS

Bassett ACH

NHC Great Lakes/North Chicago VA MC

Tripler AMC/VA Pacific Island HCS

William Beaumont AMC/ El Paso VA HCS

NMC San DiegoNH Pensacola/VA Gulf Coast HCS

NH Jacksonville

SA North Central Fed Clinic/Wilford Hall MC

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Joint Inpatient Collaboration

• AHLTA, the DoD ambulatory electronic health record, is in place worldwide

• DoD is planning to enhance its inpatient automation capabilities by expanding its electronic health (EHR) record to include inpatient care

• Vista, the VA outpatient, ambulatory, and inpatient EHR, is deployed across all VA

• VA is planning to modernize its EHR, including the inpatient component

• Traditionally, DoD/VA IT sharing has been through systems interfaces

• Unique opportunity to explore a “born seamless” approach for an inpatient EHR

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Joint Inpatient Collaboration

Most of DoD and VA inpatient healthcare is similar

BattlefieldCare

DomiciliaryCare

Acute Care Hospitals&

Medical Centers

VADoD

A few specialties

e.g.,pediatrics

A few specialties

e.g.,domiciliary

Most healthcare specialties

VADoD

Healthcare Specialties

Healthcare Venues

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Joint Inpatient Collaboration

• Medical records must follow the Service member through venues of care within DoD & between DoD and VA

• Joint approach to an inpatient electronic health record will better support the continuum of care between DoD and VA

BattlefieldCare

Theater Hospital

CommunityHospital

MedicalCenter

Long-Term&

Home HealthCare

Medical Clinic

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Discussion and Questions