# Presentation: 272773

## Current VistA 

- Gary A. Christopherson, Senior Advisor to Under Secretary
- Robert M. Kolodner, M.D., Acting VHA CIO
- Veterans Health Administration, Department of Veterans Affairs

- Current VistA
- 	Future Health_***e***_Vet-VistA
- 		Future Health_***e***_People-VistA

- Presentation to the Information Systems Advisory Committee

## “VHA’s integrated 

- “VHA’s integrated
- health information system,
- including its framework for using performance measures to improve quality, is considered one of the best in the nation.”
- Institute of Medicine (IOM) Report, _Leadership by Example: Coordinating Government Roles in Improving Health Care Quality_ (2002)

## VistA/CPRS was & is a success 
Built by “fire” of VHA collaboration
Publicly owned by VA; could be for future as well
Strong interest by public/private in using VistA
Largest integrated health info system for nation’s largest integrated health system
Helps serve 4.1 million American veterans annually
Supports:
$23+ billion nationwide health system
1,300 care sites, incl. 163 hospitals & 800+ community & facility based clinics
180,000 health care staff; 85,000 trainees
Considered best overall health information system

- Built by “fire” of VHA collaboration
- Publicly owned by VA; could be for future as well
- Strong interest by public/private in using VistA
**Largest integrated health info system for nation’s largest integrated health system**
**Helps serve 4.1 million American veterans annually**
**Supports:**
- $23+ billion nationwide health system
- 1,300 care sites, incl. 163 hospitals & 800+ community & facility based clinics
- 180,000 health care staff; 85,000 trainees
**Considered best overall health information system**

**Success in supporting health delivery for millions of veterans**** **

## Mostly developed & owned by VA (publicly owned)
Began as Decentralized Hospital Computer Program (DHCP; 1980s)
Transformed into VistA (1990s)
Next generation VistA (2002-20__) -- Includes HealtheVet-VistA on improved platform using modern tools & languages following enterprise architecture
National software w/ local flexibility/innovation: 
Innovation developed locally & enterprise wide
Standard packages distributed enterprise wide, e.g. latest version of CPRS (January 2002)

- Began as Decentralized Hospital Computer Program (DHCP; 1980s)
- Transformed into VistA (1990s)
- Next generation VistA (2002-20__) -- Includes Health_***e***_Vet-VistA on improved platform using modern tools & languages following enterprise architecture
**National software w/ local flexibility/innovation: **
- Innovation developed locally & enterprise wide
- Standard packages distributed enterprise wide, e.g. latest version of CPRS (January 2002)

**Nationally integrated outpatient & inpatient information system **

## VISTA 

***V*****IST*****A***** **
**INFORMATION **
**SYSTEM**

**USER**

**SECURITY**

- MAILMAN

**DEVICE **

**MANAGER**

**MENU **
**MANAGER**

**RPC**
**BROKER**

**INTEGRATED DATABASE**** **** **

- PATIENTS

- WARDS

- DRUGS

- PERSONS

- INVENTORY

- PRESCRIPTIONS

- IMAGES

- LAB
- RESULTS

**VISTA SOFTWARE PACKAGES**

**SCHED-ULING**

**INPATIENT**
**PHARMACY**

**LABORATORY**

**SURGERY**

**MEDICINE**

**SOCIAL WORK**

**DENTAL**

**ENGINEERING**

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

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

**DIETETICS**

**MENTAL**
**HEALTH**

**HEALTH**
**SUMMARY**

**NURSING**

**LIBRARY**

**PATIENT**
**FUNDS**

**MEDICAL**

**RECORDS**

**TRACKING**

**ACCOUNTS**
**RECEIVABLE**

**VOLUNTARY**
**SERVICE**

**REHAB**
**MEDICINE**

**RADIOLOGY**

**ONCOLOGY**

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

**KERNEL**

**TASK**
**MANAGER**

-      **VA **
**FILEMAN**

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

**OUTPATIENT**
**PHARMACY**

**CLINICAL PATIENT RECORD**

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

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

**WOMEN’S**
**HEALTH**

- BLOOD BANK

**PROBLEM **
**LIST**

**VistA**
**IMAGING**

- CONSULTS /
- RESULT
- TRACKING

- CLINICAL
- REMINDERS

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

_**Sites of Care**_
- Clinics
- Hospitals
- Nursing  Homes
- Domiciliaries
- Home/Workplace

## Slide 6

## Slide 7

## Not lose functionality we have 
Strengthen VistA
Move to person & data focus
Move to standardized, fully sharable health data
Modernize & replace older systems
Ensure documentation on application programs
Move to modern technologies
Increase flexibility to respond to future health needs
Lower cost of maintenance
Support our future health system

**Strengthen VistA**
- Move to person & data focus
- Move to standardized, fully sharable health data
- Modernize & replace older systems
- Ensure documentation on application programs
- Move to modern technologies
- Increase flexibility to respond to future health needs
- Lower cost of maintenance
**Support our future health system**

- VistA - Why change?

## Slide 9

## Dimensions of complexity

**Scope – home, clinic, **
**hospital, nursing home**

**Size – $23+B **
**(health care)**
**& $1B (IT) **
**annually**

**Sites of care – **
**over 1,300 **
**nationwide**

**Health**_***e***_**People Strategy**

**Functionality – **
**highest & growing**

**Oversight – VA, OMB, **
**Congress, VSO, etc**

**  ****Health**_***e***_**Vet **
**  ****Strategy**

**Resources – **
**180+k staff **
**+ contractors**

**Partners – VA, VHA, Other **
**Fed, Other Public, Private**

**Data element **
**& standards**
** ****- many**

**Veterans served**
** – ****over 4 million**
** ****annually**

**Dimensions of complexity**

## Maximize Veterans Health/Ability & Satisfaction

**eHealth**

**Community**
** ****care**

**Nursing **
**home **
**care**

**Inpatient **
**care**

**Ambula-**
**tory care**

**Domicili-**
**ary care**

**Episode**
**Based**

## HealtheVet – strategy overview

| Moves from facility-centric to person/data-centric
Uses national, person-focused health data repository for production & management/analysis/research
Builds on, enhances & utilizes VistA 
Moves from legacy VistA to HealtheVet-Vista
Uses best, appropriate modern technology
Programming, software, hardware, networking
Moves “core” applications to run “enterprise-wide” 
Standardizes core data & communications 
Enhances the five major systems
Regis./eligibility/enrollment, health data, provider, management/ financial, “e” commun./transactions
Enhances cross-cutting
Security/privacy, architecture, data quality/standards, infrastructure, enterprise system/resources management |
| --- |

## VistA to HealtheVet (incl. HealtheVet –VistA)

**VistA Imaging**

**Fee****	**

**Billing**

**Pharmacy**

**Laboratory**

**Health Data Repository**

**VistA to Health**_***e***_**Vet ****(incl. Health**_***e***_**Vet –VistA)**

**Secure systems/infrastructure**

**Enterprise Architecture**
**Strong Project Management**

- ...  2000  2001  2002  2003  2004  2005  2006  2007

**High Performance Network/Infrastructure**

**Health**_***e***_**Vet-VistA**
**(Person/Data-Centric Next Generation VistA) (2005-  )**

**High Performance Workforce**

**Scheduling**

## HealtheVet (Veterans health info system, including VistA)

**Health Data Repository [Health]**

**Registration, Enrollment, Eligibility Database [OneVA/Health]**

**Financial Database [OneVA/Health]**

**Health Provider System (input/output)**

**Management & Financial System (input/output)**

**Registration, Enrollment & Eligibility System (input/output)**

**Health**_***e***_**Vet ****(Veterans health info system, including VistA)**

**Information & Education System (“e” communications/transactions)**

**OneVA [VBA, NCA, Staff Offices]**

**Non-VA Health & Information Environment**

**Health Data System (input/output)**

***Veteran Input & Output***

**My Health**_***e***_**Vet**
**[virtual health record]**

**Support resources for person     Decision/learning support for provider**

**Security   Architecture   Data Quality   Infrastructure**

## IE

**Management & **

**Financial System**

**Health Provider (including clinical **
**Interface) & Data **
**System**

**Registration, Enrollment **

**& Eligibility System**

**Database/**
**Standards**

**“****e” communications/ **
**transactions **

**Billing System**

**Provider Payment **

**System**

**Pharmacy System**

**Laboratory System**

**Radiology System**

**Enrollment System**

**Scheduling System**

**Blood System**

**Outside health organizations**
**VA organizations**

**Database/**
**Standards**

**Database/**
**Standards**

**IE**

**IE**

**IE**

**EHR**

**My Health**_***e***_***Vet***

**[web site, virtual health **

**record, trusted information, **

**self**

**-**

**reported information, **

**link to other health **

**providers]**

**NextGeneration Health**_***e***_**Vet-VistA  - High Performance Info System Components/Links/Standards**

## My HealtheVet / My HealthePeople

**Other **
**health  **
**organi-zations**

**My Health**_***e***_**Vet / My Health**_***e***_**People**

**My Health**_***e***_**Vet / Health**_***e***_**People**
**[Personal Health Record System]**

_**“**__**health in a box” on PC and/or web site via community, health, non-health, government**_

**Electronic Health Record System (e.g. VistA)**

**Database/**
**Standards**

**Primary **
**health**
**provider**

**Software & **
**Hardware**

**Person**

_**Health Record**_
**Access to health records**
**Sharing health records**
**Self-entered health record**
_**Services**_
**Checking/filling prescriptions**
**Checking/confirming/making appointments**
**Checking/paying co-payments**
**Participating in support groups**
**Health decision support**
**Health self-assessment**
**Messaging with health provider**
**Diagnostic/therapeutic tools**
**Reminders**
**“****Checking in”**
**Safety services/tools**
**Links to other health sites**
_**Information**_
**Trusted information**

**Electronic Health Record System**

**Database/**
**Standards**

**Software & **
**Hardware**

## Slide 17

## Improved

- 2001   2002   2003   2004   2005   2006  2007   2008   2009  2010

- Standards
- Data
- Communications
- ---------------------
- Health Info Systems
- Electronic Health Records Systems (EHRs)
- Personal Health Record Systems (PHRs)
- Info Exchange

**Improved**
**Health**
**Paperless (IOM)**

**Improved health & “paperless”**

- Adoption by health organizations & persons of affordable, high quality & standards-based EHRs, PHRs & Health Info Exchange

## Toward standards & high performance info systems

| VA push EHRs, PHRs, Health Information Exchange & Standards in Federal and nationwide
EHRs – VA 
Current -- VistA electronic health record system
Next generation -- HealtheVet-VistA
Public version -- HealthePeople-VistA
PHRs – VA
My HealtheVet
Health Information Exchange (IE) – VA
Federal Health Information Exchange with DoD
Electronic Health Records Interoperability (HealthePeople (Federal) with DoD
Standards – VA
Adoption of VA-wide standards
Adoption of standards between VA and DoD and VA and IHS
Consolidated Health Informatics |
| --- |

## Toward standards & high performance info systems

| EHRs – 
Provide financial incentives
Strongly encourage private sector vendors to make available affordable, high quality, standards-based EHRs 
Strongly encourage provider-based efforts like AAFP 
Continue to improve HealthePeople-VistA & make available
PHRs – 
Strongly encourage public/private sector to work together to develop & make available PHRs for persons
Health Information Exchange (IE) – 
Strongly encourage public & private sector to work together to develop & make available national “exchange” solution
Standards – 
Consolidated Health Informatics as federal leadership
Strongly encourage public/private development/adoption of national standards |
| --- |

## Person

**P****erson**

**Health**_***e***_**People Virtual Health System  - EHRs, PHRs, **
**Health Info Exchange (IE) & Standards (S)**

**Personal **
**Health **
**Record **
**Systems **
**(PHR)**

**Person**

**Non health org**

**Elec-tronic **
**Systems**

**Other health org**

**EHRs & Other Health Info Systems**

- Population/ Community

**Health**
**provider**

**ElectronicHealth Record Systems (EHR)**

**IE**

**IE**

**IE**

**IE**

## IE

**Management & **

**Financial System**

**Health Provider (including clinical **
**Interface) & Data **
**System**

**Registration, Enrollment **

**& Eligibility System**

**Database/**
**Standards**

**“****e” communications/ **
**transactions **

**Billing System**

**Provider Payment **

**System**

**Pharmacy System**

**Laboratory System**

**Radiology System**

**Enrollment System**

**Scheduling System**

**Blood System**

**Outside health **

**organizations**
**w/ EHRs**

**PHR **
**(e.g., My Health**_***e***_**People)**
**[web site, virtual health record, trusted information, self reported information, **
**link to other health providers]**

**Health**_***e***_**People  - **
**EHRs, PHRs, Health Info Exchange & Standards**

**Database/**
**Standards**

**Database/**
**Standards**

**IE**

**IE**

**IE**

**EHR**

## Personal Health Record Systems (PHR)

**Personal Health Record Systems (PHR)**

**Personal Health Record Systems (PHR) (e.g. My Health**_***e***_**People)**

_**Health Record**_
**Access to health records**
**Share health records**
**Self-entered health record**
_**Services**_
**Check/fill prescriptions**
**Check/confirm/make appointments**
**Check/pay co-payments**
**Participate in support groups**
**Health decision support**
**Health self-assessment**
**Message with health provider**
**Diagnostic/therapeutic tools**
**Reminders**
**“****Check in”**
**Safety services/tools**
**Links to other health sites**
_**Information**_
**Trusted information**

**Health **
**providers**

**Electronic Health Record Systems (EHR)**

**Person**
**(provider**
**sponsored)**

**EHRs & Other Health **
**Info Systems**

**Person**
**(home)**

**Personal Health Record Systems (PHR)**

**Person**
**(external**
**service)**

**Elec-**
**tronic Systems **

**P**

**P**

**P**

**P**

**P**

**P**

**IE**

**IE**

**IE**

**IE**

**IE**

**S**
**[****HL7****]**

**A&A**

**Person ID**

**Search**

**Inter-face**

**P – **Person
**IE – **Internet-based exchange, including components below
**EHR – **High function & interoperable
**Person Health ID  – **a) Voluntary or b) Provider Assigned (Bilateral)** **
**A&A – **Authorization & authentication controlled by person
**Interface – **Capability for exchange (send & receive/use
**Search – **Search tool for finding records held by persons/organizations

## HealthePeople Virtual Health System  - 

**A&A**

**Health**_***e***_**People Virtual Health System  - **
**Health Info Exchange (IE)**

**Primary health **
**provider**

**Electronic Health Record Systems (EHR)**

**Other health org**

**Personal Health Record Systems (PHR)**

- Bilateral

**P – **Person
**IE – **Internet-based exchange, including components below
**EHR – **High function & interoperable
**Person Health ID  – **a) Voluntary or b) Provider Assigned (Bilateral)** **
**A&A – **Authorization & authentication controlled by person
**Interface – **Capability for exchange (send & receive/use
**Search – **Search tool for finding records held by persons/organizations

**Health **
**providers**

**Electronic Health Record Systems (EHR)**

**Other health org**

**EHRs & Other Health **
**Info Systems**

- Multilateral

**Person**

**Personal Health Record Systems (PHR)**

**Non-health org**

**Elec-**
**tronic Systems **

**EHRs & Other Health **
**Info Systems**

**Person**

**IE**

**S**
**[****HL7****]**

**A&A**

**Person ID**

**Search**

**Inter-face**

**P**

**P**

**P**

**P**

**P**

**P**

**P**

**P**

**P**

**IE**

**IE**

**IE**

**IE**

**IE**

**IE**

**IE**

## Health Information Standards Development/Adoption

| NCVHS – 
Strongly encourages development/adoption of standards in public & private sectors
Standards Development Organizations – 
Many efforts underway to develop standards
Federal Agencies – 
VA, DoD & IHS agree individually to standardize
VA/DoD & VA/IHS agree to standardize across agencies
Consolidated Health Informatics – 
Joint effort led by HHS, VA & DoD
1st five standards adopted
Working on total of 24 domains, incl. 6 active workgroups |
| --- |

## National standards & high performance systems

**2001**

**2010**

**Improved **_**Health Via**_
**National Health Information Standards**
**Info Exchange**
**/ Sharing**
**High Performance **
**Health Info Systems**
**Personal Health Record Systems**

**Health Information**
**Systems                        Standards**

## Back-up Slides

## Terms

| 
HealtheVet – VHA effort to modernize & enhance its current information system, incl. enhanced CPRS, health data repository, scheduling, billing, fee, VistA imaging, pharmacy, laboratory, “My HealtheVet”.  HealtheVet-VistA is the name for the next generation of VistA.
HealthePeople – joint efforts with other federal, public & private sector organizations with respect to national standards, high performance systems & sharing information (when appropriate/authorized). HealthePeople-VistA is the name for VistA when it used outside VA.
HealthePeople (Federal) – joint efforts by VA, DoD & HHS/IHS with respect to data standardization, joint build/procurement, sharing software & potential software convergence. |
| --- |