# Presentation: 351247

## 140 “Understanding Your HDR Storyboard” 

- Clyde Miller, Project Manager
- Bo Dagnall, Project Lead

## Health Data Repository

- HDR is in the “business” of managing data that is:
*Clinical*
*Patient-centric*
*Part of VHA Electronic Health Record (EHR)*
*Shareable *or *Viewable*
- Patient-centric, clinical viewable data that is part of the VHA EHR is organized into *records*
- _Record_: a logical grouping of data related to the same event

## Veterans

**Patient123 likes to travel**

## Patient Records Today

- VA Medical Center 1

- VA Medical Center 2

- VA Medical Center 3

***Patient123’s medical records dispersed across points of care***

## Patient Records Dispersed

- VA Medical Center 1

- VA Medical Center 2

- VA Medical Center 3

- Allergy to Penicillin

- Allergy to Cats

- Allergy to PCNAllergy to Cats

***Patient123 has allergies to ***
***Cats****** and to ******Penicillin******. However, his allergy records are dispersed across different medical centers***

## Problem with Dispersed Records

**Joe’s allergy to Penicillin was only known at VAMC1. As a result, when Joe received care at VAMC2, penicillin was ordered without the system having the capability to inform the clinician that Joe was allergic. **
***The adverse reaction to penicillin observed for Joe at VAMC2 was a serious patient safety issue!***

## Enter the HDR

- Health Data
- Repository

- The HDR Consolidates Records from all VA Medical Centers

## Problem: Inconsistent Records

- Health Data Repository

- Same concept from different medical centers is represented different ways. HDR treats them as different allergies

- A query for “Penicillin allergy” returns “Allergy to Penicillin”, but not “Allergy to PCN”.

## Enter Data Standardization

- VA Medical Center 1

- VA Medical Center 2

- VA Medical Center 3

- Allergy to Penicillin (1008)

- Allergy to Cats (7221)

- Allergy to PCN (1008)Allergy to Cats (7221)

- VUIDs applied to make data standardized across all points of care

## Solution: Standardized Data in HDR

- Health Data Repository

| Allergy Code | Local Text | Location |
| --- | --- | --- |
| 1008 | Penicillin | VAMC 1 |
| 7221 | Cats | VAMC 2 |
| 1008 | PCN | VAMC 3 |
| 7221 | Cats | VAMC 3 |

- A query for “Penicillin allergy” now returns “Allergy to Penicillin” **AND** “Allergy to PCN”.

## Back to Joe Veteran

**With the HDR capable of supporting order checks, Joe’s allergy record to Penicillin entered at VAMC1 was also available at VAMC2. As a result, when Joe received care at VAMC2, the order for penicillin resulted in an alert notifying the clinician that Joe has an allergy to penicillin.**
***An adverse reaction to penicillin was avoided and there was no serious patient safety issue!***

## HDR Operations

- New allergy to
- bee stings
- recorded at
- VAMC 4

**C**
**R**
**U**
**D**

- reate

- ead

- pdate

- elete

- Retrieve all
- allergy records
- for VAMC 3

- Update record:
- change bee
- sting to pollen

- Delete allergy
- to pollen

| Allergy 
Code | Local 
Text | Location |
| --- | --- | --- |
| 1008 | PCN | VAMC 3 |
| 7221 | Cats | VAMC 3 |

- Health Data Repository

| Allergy Code | Local Text | Location |
| --- | --- | --- |
| 1008 | Penicillin | VAMC 1 |
| 7221 | Cats | VAMC 2 |
| 1008 | PCN | VAMC 3 |
| 7221 | Cats | VAMC 3 |

| Allergy Code | Local Text | Location |
| --- | --- | --- |
| 1008 | Penicillin | VAMC 1 |
| 7221 | Cats | VAMC 2 |
| 1008 | PCN | VAMC 3 |
| 7221 | Cats | VAMC 3 |
| 66271 | Bee sting | VAMC 4 |

| Allergy Code | Local Text | Location |
| --- | --- | --- |
| 1008 | Penicillin | VAMC 1 |
| 7221 | Cats | VAMC 2 |
| 1008 | PCN | VAMC 3 |
| 7221 | Cats | VAMC 3 |
| 66271 | Bee sting | VAMC 4 |

| Allergy Code | Local Text | Location |
| --- | --- | --- |
| 1008 | Penicillin | VAMC 1 |
| 7221 | Cats | VAMC 2 |
| 1008 | PCN | VAMC 3 |
| 7221 | Cats | VAMC 3 |
| 9362 | Pollen | VAMC 4 |

| Allergy Code | Local Text | Location |
| --- | --- | --- |
| 1008 | Penicillin | VAMC 1 |
| 7221 | Cats | VAMC 2 |
| 1008 | PCN | VAMC 3 |
| 7221 | Cats | VAMC 3 |
| 9362 | Pollen | VAMC 4 |

***NOTE: All data changes are recorded in the data change log***

## Common Uses of the HDR

- Facilitate intra-VHA clinical record portability

- Department of Defense

- Support data exchange with external agencies

- Convenient data aggregation for research

## HDR Optimization

**F**
**R**
**O**
**N**
**T**
**E**
**N****D**

**B****A**
**C**
**K**
**E**
**N****D**

- Support on-demand, real-time data access using concise queries

- Support resource-intensive data access for analytics or extractions

## HDR Deployment

**HDR  National**
- Master HDR containing all patient’s clinical records

**HDR  Local(s)**
- Regional HDRs containing the clinical records needed for that region

## HDR Components

**The HDR is actually a collection of several databases **
**and applications that control the data**

## HDR IMS

- Both a database and a data management framework
- Proof of concept
- “Day forward” data
- Not relational – HL7 (except Lab)
- Allergies, Vitals, Outpatient Pharmacy, Lab (Chem/Hem)

## HDR Historical

- Both a database and a data extraction framework
- “Day backwards” data
- Data extractor reused by ADR, STS, others
- Relational schema
- Allergies, Vitals, Outpatient Pharmacy (Lab soon)

## HDR Data Warehouse

- The “backend” of the HDR
- Stores copy of data from other HDR databases
- Dimensional schema
- Supports data intensive queries and data feeds
- Allergies, Vitals
- Other domains to follow

## HDR II & CDS

- Future HDR system
- HDR II is the database
- CDS is the data service
- Relational Schema
- Based on HeV architecture
- VHA Health Information Model
- VHIM defines content
- VHIM defines data structure
- VHIM defines data semantics
- VHIM conformant messaging
- VHIM based schema

## HDR Versions

| Version | Components | Dates | Data |
| --- | --- | --- | --- |
| HDR National Version 1 | HDR IMS
CDS N. v1 
HDR Hx
HDR DW | Now | Allergies, Vitals, Outpatient Rx, Lab (Chem/Hem) |
| HDR National Version 2 | HDR II National
CDS N. v2
HDR Hx
HDR DW | Feb. 2008 | Allergies, Vitals, Outpatient Rx, Lab, TIU
Others as standardized and modeled in the VHIM |
| HDR Local | HDR II Local
CDS Local
HDR Hx
HDR DW | 2009 | Same as HDR National v2 |

## HDR Major Releases

- HDR Local

- HDR Local

- HDR National
- Version 2

- HDR National
- Version 2

- HDR National
- Version 1

- HDR National
- Version 1

- HDR Local

- HDR Local

- HDR Local

**1.**

**2.**

**3.**

## HDR National v1

- database stores the clinical data
- sent from VA Medical Centers once
- the VistA systems are configured to
- send data to the HDR.

- The HDR Historical (Hx) databases store the
- clinical data collected at VAMCs prior to the
- VistA systems being configured to send
- data to HDR IMS. The data is first stored in
- the staging database so that the data can
- be inspected and “relationalized”.

- IMS
- Database

- CDS Nat v1

- Hx Production
- Database

- Hx Staging
- Database

- Hx DataLoader

- DW Extract Transform Load

- IMS Framework

- Data Extractor

- DW
- Database

- The IMS Framework controls the input and
- output of clinical data coming into and out of
- the HDR IMS database.

- Clinical Data Service (CDS) National version 1
- provides a read-only API for VHA applications
- to query clinical data. CDS combines data
- from the HDR IMS and HDR Hx databases.

- The HDR Data Warehouse (DW) Extract,
- Transform and Load (ETL) process takes
- data from the HDR IMS and HDR Hx
- databases and stores it in a database
- optimized for resource intensive queries. This is the “back-end” of the HDR.

- The Data Extractor extracts clinical data from
- The VistA systems at the VAMCs and stores
- a copy in the HDR Hx staging database. Extractions are done as batch operations.

## HDR Nv1 – Data In

- CDS Nat v1

- DW Extract Transform Load

- IMS Framework

- Hx DataLoader

- Data Extractor

- Hx Staging
- Database

- New Clinical Data
- (Event based)

- Preexisting
- Clinical Data
- (One-time)

- DW
- Database

- IMS
- Database

- Hx Production
- Database

- Load HDR
- “Back End”
- (Daily)

***HDR National***
***Version 1***

**VAMCs**

## HDR Nv1 – Data Out

- CDS Nat v1

- DW Extract Transform Load

- IMS Framework

- Hx DataLoader

- Data Extractor

- Hx Staging
- Database

- Clinical Data
- Query
- (Real-time)

- Clinical Data
- Feed
- (Off-line)

***HDR National***
***Version 1***

**QUERY**

- IMS
- Database

- Hx Production
- Database

- DW
- Database

**VAMCs**

## HDR National v2

- database stores the clinical data
- sent from VA Medical Centers once
- the VistA systems are configured to
- send data to the HDR.

- The HDR Historical (Hx) databases store the
- clinical data collected at VAMCs prior to the
- VistA systems being configured to send
- data to HDR IMS. The data is first stored in
- the staging database so that the data can
- be inspected and “relationalized”.

- HDR National v2

- HDR IINational

- CDS National Version 2

- Hx Production
- Database

- Hx Staging
- Database

- Hx DataLoader

- DW Extract Transform Load

- Data Extractor

- DW
- Database

- The IMS Framework controls the input and
- output of clinical data coming into and out of
- the HDR IMS database.

- Clinical Data Service (CDS) National version 1
- provides a read-only API for VHA applications
- to query clinical data. CDS combines data
- from the HDR IMS and HDR Hx databases.

- The HDR Data Warehouse (DW) Extract,
- Transform and Load (ETL) process takes
- data from the HDR IMS and HDR Hx
- databases and stores it in a database
- optimized for resource intensive queries. This is the “back-end” of the HDR.

- The HDR II National database is the replacement for the HDR IMS (interim) database. Data will be stored relationallyallowing for greater query flexibility.

- CDS National Version 2 provides a read and write interface for data in the HDR II database and a  read-only interface for HDR Hx data. CDS v2 supports a rich query syntax basedon the VHA Health Information Model (VHIM).

## HDR Nv2 - Data In

- DW Extract Transform Load

- Hx DataLoader

- Data Extractor

- Hx Staging
- Database

- New Clinical Data
- (Event based)

- Preexisting
- Clinical Data
- (One-time)

- DW
- Database

- Hx Production
- Database

- Load HDR
- “Back End”
- (Daily)

***HDR National***
***Version 2***

- One-time batch data load

- HDR IMS

**VAMCs**

- CDS National v2

- HDR II
- National

**Reengineered**
**Applications**

## HDR Nv2 – Data Out

- DW Extract Transform Load

- Hx DataLoader

- Data Extractor

- Hx Staging
- Database

- Clinical Data
- Query
- (Real-time)

- Clinical Data
- Feed
- (Off-line)

***HDR National***
***Version 2***

**QUERY**

- DW
- Database

**VAMCs**

**QUERY**

- Hx Production
- Database

- CDS National v2

- HDR II
- National

**Reengineered**
**Applications**

## Adding HDR Local

***HDR National***
***Version 2***

- DW
- Database

- HDR Hx

***HDR Local***

***HDR Local***

**Data Added To National**

- Data copied to Local as needed

**Data Added To Local**

- Data copied to National automatically

- Data copied to Other Local as needed

- CDS National v2

- HDR II
- National

- CDS Local

- HDR II
- Local

- CDS Local

- HDR II
- Local

## Q & A

- Questions?