# Presentation: 753570

## VistA Legacy to VistA HealtheVetTransition Plan Office of Information and TechnologyOffice of Enterprise DevelopmentProgram Executive Office for Veteran Health IT

**Jackie Gill**
***August 21, 2007***

## The VisionVHA’s Objectives for Health Care

The ProcessUse of Enterprise Architecture Model 

The ProductVistA HealtheVet Transition Plan

Next Steps

*The Process*Use of Enterprise Architecture Model
*The Product*VistA Health*e*Vet Transition Plan
*Next Steps*

**Topics**

## The VisionVHA’s Objectives for Health Care

The ProcessUse of Enterprise Architecture Model 

The ProductVistA HealtheVet Transition Plan

Next Steps

*The Process*Use of Enterprise Architecture Model
*The Product*VistA Health*e*Vet Transition Plan
*Next Steps*

**Topics**

##  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

## 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 Administeredwith the Bar Code Medication Administration (BCMA) system
885,000,000......... +620,000 each workday

**906,000,000**........ **+640,000 each workday**
**Orders**
**1.7 Billion**.......... **+960,000 each workday**
**Images**
**641,700,000**......... **+913,000 each workday**
**Medications Administered**with the Bar Code** **Medication Administration (BCMA) system
**885,000,000**......... **+620,000 each workday**

*Statistics as of March 2007*

** ****VA Health IT: Setting the Benchmark**

## VHA Objectives for Health Care

-  Delivers a complete hospital information system to include
-    the EHR, Imaging, Bar Code Medication Administration...
-  It’s 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 today’s mobile population, and
-  Is built on dated architecture with minimal documentation; hard to
-   modify, expensive to maintain and knowledgeable Mumps programmers are dwindling.

**VHA Objectives for Health Care**

- ...

_**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**

**Notes:**
Two primary HealtheVet Program Goals are: (1) to provide affordable “world class” support capability to our veterans, and (2) to ensure that the basic system infrastructure can support current and future system requirements.  The challenge will be to continue to deliver expected “World Class” service while seamlessly transferring to the new systems.
The benefits and rewards for program success, however, are immense.   The direct benefits of creating a more nimble, cost-effective IT environment will be an increase in the proportion of allocated funds available for direct patient care and/or a significant increase in the number of veterans that can be covered by the VA health care system.
Additionally, the enhanced system will give VA greater flexibility in meeting legislative requirements and Congressional mandates, responding to national emergencies, and implementing new health care models and veterans services.
Finally, an estimated 40% of veterans treated at VA each year also receive care from non-VA physicians. HealtheVet will foster greater interaction with our health care partners by: 
Establishing interoperability with the DOD and private-sector health systems, promoting continuity of care as service members transition from active-duty to veteran status, and increasing opportunities for sharing health information and clinical resources (e.g., pharmacies, co-located clinics); 
Supporting VA’s participation in the creation of a National Health Information Network (NHIN), as directed by the President, to exchange health data privately and securely;
Supporting bio-surveillance activities and population health reporting to federal (e.g., NIH, CDC), state, and local health partners, and
Reinforcing VA’s on-going involvement in collaborative standards activities with private- and public-sector partners (e.g., as a founding partner of Consolidated Health Informatics (CHI)) and in leadership roles in Standards Development Organizations (SDOs)).

## Challenges in Transition to VistA HeV

**H**_***e***_**V Concept Solid, Past Efforts at Implementing Ran into Challenges**
**In 2005, VHA Requested CMU SEI Assessment **
**Following Recommendations Were Made**
**Define the H**_***e***_**V 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 H**_***e***_**V Program Lifecycle Needs**
**Severe Budget Reductions in FY06/FY07 Forced Restructure**
**Content Removed**
**Schedule Milestones ****Pushed Out**
**Entire Development ****Plan Revamped**

**VistA-H**_***e***_**V FY06 Development Budget**

## The VisionVHA’s Objectives for Health Care

The ProcessUse of Enterprise Architecture Model 

The ProductVistA HealtheVet Transition Plan

Next Steps

***The Process*****Use of Enterprise Architecture Model **
*The Product*VistA Health*e*Vet Transition Plan
*Next Steps*

**Topics**

## 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 H**_***e***_**V Vision and the Transition Path**
**Develop a Framework to Meet HeV Program Lifecycle Needs**
**It’s 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***

## Federal Enterprise Architecture Framework

**Federal Enterprise Architecture Framework**

- Technical Standards, Departmental Standards, etc
**Technical Reference Model**

- 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**

## Health Segment Responsibilities by Layer

**OI&T:**
**O&I**

**VHA**

**Health Segment Responsibilities by Layer**

**OI&T:**
**OED**

**Strategy**

**Business**

**PRM**

**BRM**

**Applications & Services**

**Technology Infrastructure**

**SRM**

**TRM**

**Information & Data**

**DRM**

- Lead for Each Layer Responsible for Developing Artifacts

**5****th**
**PILLAR**

**4****th**
**PILLAR**

**Notes:**
Strategy and Business Layer Artifacts/Guiding Documents
 VA Strategic Plan
 VA EA Executive Perspective
 VHA Strategic Plan
 Clinical Info Systems in VHA: Vision for the Future
Information and Data/Applications and Services Artifacts
 Sequencing Plan
 Transition Plan
 Technical Reference Model
 All VHIT architecture documents available on VHIT website for review

## The VisionVHA’s Objectives for Health Care

The ProcessUse of Enterprise Architecture Model 

The ProductVistA HealtheVet Transition Plan

Next Steps

*The Process*Use of Enterprise Architecture Model
***The Product*****VistA Health*****e*****Vet Transition Plan**
*Next Steps*

**Topics**

## VistA’s 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-Health**_***e***_**Vet **
**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 Health**_***e***_**Vet**
**Robust capability for testing**
** ****Subsequent phases target the implementation of clinical and administrative capabilities**

## 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

**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**

**Initial vs. Full Operating Capability**

## 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***

## 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***

## INTEGRATED DATABASE

**SECURITY**

**MAILMAN**

**MANAGER**

**MENU **
**MANAGER**

**RPC**
**BROKER**

**TASK**
**MANAGER**

**VA **
**FILEMAN**

**INTEGRATED DATABASE**

**KERNEL**

**VISTA SOFTWARE PACKAGES**

**REHAB****MEDICINE**

**ACCOUNTS**
**RECEIVABLE**

**LIBRARY**

**NURSING**

**RADIOLOGY**

**BLOOD**
**BANK**

**SOCIAL**
**WORK**

**MENTAL**
**HEALTH**

**ENGINEERING**

**ONCOLOGY**

**DIETETICS**

**INPATIENT**
**PHARMACY**

**OUTPATIENT**
**PHARMACY**

**MEDICAL**
**CARE**
**COST**
**RECOVERY**

**SCHEDULING**

**WOMEN’S**
**HEALTH**

**MEDICINE**

**BAR CODE**
**MEDICATION**
**ADMINISTRATION**

**SURGERY**

**DENTAL**

**LABORATORY**

**PATIENT**
**FUNDS**

**ADMISSION**
**DISCHARGE**
**TRANSFER**

**MEDICAL**
**RECORDS**
**TRAINING**

**VOLUNTARY**
**SERVICE**

**INTEGRATED**
**FUNDS**
**CONTROL**
**ACCOUNTING &**
**PROCUREMENT**

**ENROLLMENT**

**PROBLEM**
**LIST**

**HEALTH**
**SUMMARY**

**CLINICAL**
**REMINDERS**

**CONSULT /**
**RESULT TRACKING**

**AUTHORIZATION**
**SUBSCRIPTION**
**UTILITY (ASU)**

**TEXT**
**INTEGRATION**
**UTILITIES (TIU)**

**COMPUTERIZED**
**PATIENT**
**RECORD**
**SYSTEM**
**(CPRS GUI)**

**VistA**
**IMAGING**

**WARDS**

**DRUGS**

**PERSONS**

**INVENTORY**

**PRESCRIPTIONS**

**IMAGES**

**LAB **
**RESULTS**

**PATIENTS**

**BLIND**
**REHAB**

**SPINAL CORD**
**INJURY**

**EMERGING TECHNOLOGY**
**My Health**_***e***_**Vet**
**Home Telehealth**
**Health IT Sharing**

## VistA HeV Architecture

## Phase I: Integrated Schedule

**Scheduling (RSA)**

**Alpha**

**Beta**

**National**

**Beta**

**National**

**Person Services**

**Organization Services**

**Security **

**Messaging**

**HDR**

**Testing Services**

**Enrollment (ESR)**

**Release w/RSA**

**RSA**

**Testing**

**National**

**Development**

**Test**

**National**

**Pre Production**
**Phase I**

**Release w/ESR**

**HDR-IMS**
** ****National**

**HDR-LAB**

**HDR-CDS**

**HDR II **
**National**

**FATKAAT**

**Phase I: Integrated Schedule**

## Phase I: Integrated Schedule

**Scheduling (RSA)**

**Alpha**

**Beta**

**National**

**Beta**

**National**

**Person Services**

**Organization Services**

**Security **

**Messaging**

**HDR**

**Testing Services**

**Enrollment (ESR)**

**Release w/RSA**

**RSA**

**Testing**

**National**

**Development**

**Test**

**National**

**Pre Production**
**Phase I**

**Release w/ESR**

**HDR-IMS**
** ****National**

**HDR-LAB**

**HDR-CDS**

**HDR II **
**National**

**FATKAAT**

**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. **

**Phase I: Integrated Schedule**

## Phase I: Integrated Schedule

**Scheduling (RSA)**

**Alpha**

**Beta**

**National**

**Beta**

**National**

**Person Services**

**Organization Services**

**Security **

**Messaging**

**HDR**

**Testing Services**

**Enrollment (ESR)**

**Release w/RSA**

**RSA**

**Testing**

**National**

**Development**

**Test**

**National**

**Pre Production**
**Phase I**

**Release w/ESR**

**HDR-IMS**
** ****National**

**HDR-LAB**

**HDR-CDS**

**HDR II **
**National**

**FATKAAT**

**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. **

**Phase I: Integrated Schedule**

## Phase I: Integrated Schedule

**Scheduling (RSA)**

**Alpha**

**Beta**

**National**

**Beta**

**National**

**Person Services**

**Organization Services**

**Security **

**Messaging**

**HDR**

**Testing Services**

**Enrollment (ESR)**

**Release w/RSA**

**RSA**

**Testing**

**National**

**Development**

**Test**

**National**

**Pre Production**
**Phase I**

**Release w/ESR**

**HDR-IMS**
** ****National**

**HDR-LAB**

**HDR-CDS**

**HDR II **
**National**

**FATKAAT**

**SECURITY: *****FatKAAT***
**Provide authentication, authorization and audit of HealtheVet Applications using Fat-Client Kernel Authentication/Authorization Tool (FatKAAT).**

**Phase I: Integrated Schedule**

## Phase I: Integrated Schedule

**Scheduling (RSA)**

**Alpha**

**Beta**

**National**

**Beta**

**National**

**Person Services**

**Organization Services**

**Security **

**Messaging**

**HDR**

**Testing Services**

**Enrollment (ESR)**

**Release w/RSA**

**RSA**

**Testing**

**National**

**Development**

**Test**

**National**

**Pre Production**
**Phase I**

**Release w/ESR**

**HDR-IMS**
** ****National**

**HDR-LAB**

**HDR-CDS**

**HDR II **
**National**

**FATKAAT**

**Phase I: Integrated Schedule**

## Phase I: Integrated Schedule

**Scheduling (RSA)**

**Alpha**

**Beta**

**National**

**Beta**

**National**

**Person Services**

**Organization Services**

**Security **

**Messaging**

**HDR**

**Testing Services**

**Enrollment (ESR)**

**Release w/RSA**

**RSA**

**Testing**

**National**

**Development**

**Test**

**National**

**Pre Production**
**Phase I**

**Release w/ESR**

**HDR-IMS**
** ****National**

**HDR-LAB**

**HDR-CDS**

**HDR II **
**National**

**FATKAAT**

**Phase I: Integrated Schedule**

## Phase I: Integrated Schedule

**Scheduling (RSA)**

**Alpha**

**Beta**

**National**

**Beta**

**National**

**Person Services**

**Organization Services**

**Security **

**Messaging**

**HDR**

**Testing Services**

**Enrollment (ESR)**

**Release w/RSA**

**RSA**

**Testing**

**National**

**Development**

**Test**

**National**

**Pre Production**
**Phase I**

**Release w/ESR**

**HDR-IMS**
** ****National**

**HDR-LAB**

**HDR-CDS**

**HDR II **
**National**

**FATKAAT**

**Phase I: Integrated Schedule**

## Phase I: Integrated Schedule

**Scheduling (RSA)**

**Alpha**

**Beta**

**National**

**Beta**

**National**

**Person Services**

**Organization Services**

**Security **

**Messaging**

**HDR**

**Testing Services**

**Enrollment (ESR)**

**Release w/RSA**

**RSA**

**Testing**

**National**

**Development**

**Test**

**National**

**Pre Production**
**Phase I**

**Release w/ESR**

**HDR-IMS**
** ****National**

**HDR-LAB**

**HDR-CDS**

**HDR II **
**National**

**FATKAAT**

**Phase I: Integrated Schedule**

## Phase I: Integrated Schedule

**Scheduling (RSA)**

**Alpha**

**Beta**

**National**

**Beta**

**National**

**Person Services**

**Organization Services**

**Security **

**Messaging**

**HDR**

**Testing Services**

**Enrollment (ESR)**

**Release w/RSA**

**RSA**

**Testing**

**National**

**Development**

**Test**

**National**

**Pre Production**
**Phase I**

**Release w/ESR**

**HDR-IMS**
** ****National**

**HDR-LAB**

**HDR-CDS**

**HDR II **
**National**

**FATKAAT**

**Phase I: Integrated Schedule**

## Phase II: Integrated Schedule

**Scheduling (RSA)**

**Alpha**

**Beta**

**National**

**Laboratory**

**Pharmacy**

**Beta**

**National**

**Prototype**

**Alpha**

**National**

**Beta**

**CPRS/CCDSS**

**IVV**

**Beta**

**National**

**Dose Checking**

**Re-Engineering**

**Person Services**

**Organization Services**

**Security **

**Messaging**

**HDR**

**Testing Services**

**Enrollment (ESR)**

**Project Deferred**

**Alpha**

**National**

**Beta**

**Release w/RSA**

**RSA**

**National**
**09/2012**

**Testing**

**National**

**Development**

**Test**

**National**

**Pre Production**
**Phase I**

**Pre Production**
** ****Phase II & Integration**

**Release w/ESR**

**National**

**HDR-IMS**
** ****National**

**HDR-LAB**

**HDR-CDS**

**HDR II **
**National**

**Final **
**Pre Production**

**HDR and CDS Local Deployed**

**Active Directory**

**EOL**

**FATKAAT**

**Development **
**Env**

**RSA Beta Testing**

**Phase II: Integrated Schedule**

## The VisionVHA’s Objectives for Health Care

The ProcessUse of Enterprise Architecture Model 

The ProductVistA HealtheVet Transition Plan

Next Steps

*The Process*Use of Enterprise Architecture Model
*The Product*VistA Health*e*Vet Transition Plan
*Next Steps*

**Topics**

## Core Elements of HealtheVet

**SECURITY**

**MAILMAN**

**MANAGER**

**MENU **
**MANAGER**

**RPC**
**BROKER**

**TASK**
**MANAGER**

**VA **
**FILEMAN**

**INTEGRATED DATABASE**

**KERNEL**

**VISTA SOFTWARE PACKAGES**

**REHAB****MEDICINE**

**ACCOUNTS**
**RECEIVABLE**

**LIBRARY**

**NURSING**

**RADIOLOGY**

**BLOOD**
**BANK**

**SOCIAL**
**WORK**

**MENTAL**
**HEALTH**

**ENGINEERING**

**ONCOLOGY**

**DIETETICS**

**INPATIENT**
**PHARMACY**

**OUTPATIENT**
**PHARMACY**

**MEDICAL**
**CARE**
**COST**
**RECOVERY**

**SCHEDULING**

**WOMEN’S**
**HEALTH**

**MEDICINE**

**BAR CODE**
**MEDICATION**
**ADMINISTRATION**

**SURGERY**

**DENTAL**

**LABORATORY**

**PATIENT**
**FUNDS**

**ADMISSION**
**DISCHARGE**
**TRANSFER**

**MEDICAL**
**RECORDS**
**TRAINING**

**VOLUNTARY**
**SERVICE**

**INTEGRATED**
**FUNDS**
**CONTROL**
**ACCOUNTING &**
**PROCUREMENT**

**ENROLLMENT**

**PROBLEM**
**LIST**

**HEALTH**
**SUMMARY**

**CLINICAL**
**REMINDERS**

**CONSULT /**
**RESULT TRACKING**

**AUTHORIZATION**
**SUBSCRIPTION**
**UTILITY (ASU)**

**TEXT**
**INTEGRATION**
**UTILITIES (TIU)**

**COMPUTERIZED**
**PATIENT**
**RECORD**
**SYSTEM**
**(CPRS GUI)**

**VistA**
**IMAGING**

**WARDS**

**DRUGS**

**PERSONS**

**INVENTORY**

**PRESCRIPTIONS**

**IMAGES**

**LAB **
**RESULTS**

**PATIENTS**

**BLIND**
**REHAB**

**SPINAL CORD**
**INJURY**

**EMERGING TECHNOLOGY**
**My Health**_***e***_**Vet**
**Home Telehealth**
**Health IT Sharing**

**Core Elements of HealtheVet**

## HEALTHeVET PORTFOLIO

**Security**

**Archive**
**Service**

**Organization**
**Service**

**Audit**
**Service**

**Deployment**
**Toolkit**

**Common**
**Services**

**HEALTHeVET PORTFOLIO**

- Social Work

- Primary Care
- Management
- Module

- Voluntary
- Service
- System

- Imaging
- System

- Surgery

- Spinal
- Cord
- Dysfunction

- Release of
- Information
- (DSSI)

- Radiology/Nuclear
- Medicine

- Prosthetics

- Police &
- Security

- Oncology

- Nutrition
- And
- Food
- Service

- Nursing
- Service

- Mental
- Health

- Library

- Veterans Personal
- Finance
- System
- (VPFS)

- Incident
- Reporting

- Home Based
- Primary Care

- Dental
- Record Manager

- Fee Basis

- CAPRI
- (AMIE)

- Blind
- Rehabilitation

- ASISTS

**Credentials Tracking**
- VetPro

**HeV**
**Desktop**

**Messaging/**
**Enterprise **
**Service**
**Bus**

**Administrative**
**Data**
**Repository**

**Enrollment**
**Application**
**System**

**Laboratory**

**Pharmacy**

**PIMS**

**Scheduling**

**Workload**
**Management**

- Ophthalmology

- QUASAR Audiology & Speech Analysis

- Adverse Reaction
- Tracking

- Authorization/
- Subscription
- Utility

- Automated
- Info Collection
- System

- Bar Code
- Expansion
- Project

- Care
- Management

- Clinical
- Case
- Registries

- Clinical
- Decision
- Support

- Clinical
- Device
- Connectivity

- Clinical
- Procedures

- Clinical
- Reminders

- Consult/Request
- Tracking

- Discharge
- Summary

- Emergency
- Room

- Employee
- Health Record

- Health Summary

- Healthcare
-  Acquired
- Infection &
-  Influenza
- Surveillance

- Implant
- Management

- Intake/Output

- Standardization
- And Terminology
- Services

- Order Check
- Expert

- Order Entry/
- Results Reporting

- Outpatient
- Clinical
- Care

- Problem
- List

- Progress
- Notes

- Remote Order
- Entry System

- Text Integration
- Utilities

- Vitals/Measurements

- Women’s Health

_**Operations & Management**_
- Application Monitoring
- Device Manager
- System Monitoring

_**DoD Systems**_
- Bed Contingency
- Interfaces to AHLTA

_**Emerging Technologies**_
- Home Telehealth
- Health IT Sharing

_**eGov**_
- DFAS
- FLITE
- HR Shared Services Center

_**National/Regional Database Stores**_

- RISE

**Health Data**
**Repository**

- COMPUTERIZED CARE DELIVERY SUPPORT SYSTEM

- Patient
- Advocate
- Tracking
-  System
-     (PATS)

- Beneficiary
- Travel

- Incomplete
- Record Tracking

**LEGEND**

- Phase 1

- Phase 2

- Phase 3

- Phase 5

- Phase 4

- Phase 6

**Business**
**Rules **
**Engine**

**Workflow**
**Engine**

**Clinical Data**
**Warehouse**

**Report **
**Writer**

**Person**
**Service**

- Enhanced
- VA/DoD
- Seamless
- Care

- Joint
- Inpatient
- Electronic
- Health
- Record

- My
- Health_e_Vet

## QUESTIONS

## BACKUP

## Health EA: Strategy Layer

- 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)**

**Strategy**

**Business**

**Applications & Services**

**Technology Infrastructure**

**Information & Data**

**VA Strategic Plan**

**VA Publications**

## 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 H_*e*_V
**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 Critical****Upgrades to Legacy and Investment in Future****Capabilities of VistA H**_***e***_**V**

**Strategy**

**Business**

**Applications & Services**

**Technology Infrastructure**

**Information & Data**

## 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 Health****Care Community**
- Use Iterative Development, Incremental Delivery
**Avoids Risks of “Big Bang” Approach**
**Delivers Some Capability Now, Not All Capability Later**
**Gradual Transition from****Facility-Centric to Patient-Centric Access**

**Strategy**

**Business**

**Applications & Services**

**Technology Infrastructure**

**Information & Data**

## 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 in****VistA H**_***e***_**V**
**Re-Host: Rewrite Modules Using Legacy****Business Logic**
**Re-Engineer: Rewrite Modules in Response to****New 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**

**Applications & Services**

**Technology Infrastructure**

**Information & Data**

## 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 Security****to Include Role-based Access, Auditable Transactions, Etc.**
- Device Independence
**Device Independence will be Implemented in Phases****Throughout the Transition**
- VA Enterprise Architecture
**As Part of IT Re-Alignment, VA Reviewing Its****Approach to One VA Services**
**VistA will Move to One VA Services as****They Become Available**
**In Interim, VistA H**_***e***_**V will Continue Use of****Services Developed for Health IT**

## Health EA: Application and Services Layer

- VistA H_*e*_V 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 H**_***e***_**V Environment**
**508: Compliance by National Release**
**Security: Support User Authentication**
**Device Independence: Browser/Client Platform Independence**
**Multilingual Support:**
**English is Only Language Required to Support****Clinicians 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 Available****from a Single User Interface**
- Threshold Requirements Can Only beWaived with Approval of VHA and VA CIO

## 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 Locating****Servers at Regional Data Processing Centers**
**VistA Working Towards Centralized System****with Regional Replications**

**Notes:**
Under development tools – a single development environment or do you mean a single configuration – there are development systems at each of the OIFO are you proposing to merge them all and have development done on a single system? – or is this for the rational stuff