# Presentation: 765702

## VA/DoD Health Data Interoperability:Current State and Planned Incremental Improvements

## 
JEHRI – The governing plan and long range strategy to achieve interoperability of electronic health data between VA and DoD  

OMB approved the Plan in April 2002

The VA Under Secretary for Health and the DoD Assistant Secretary of Defense, Health Affairs, signed the Executive Decision Memorandum implementing JEHRI  

Oversight of Plan is provided by the Health Executive Council (HEC) and the Joint Executive Council (JEC)

Regularly scheduled meetings of the HEC and JEC keep members apprised of progress and issues 

**JEHRI – The governing plan and long range strategy to achieve interoperability of electronic health data between VA and DoD  **
**OMB approved the Plan in April 2002**
**The VA Under Secretary for Health and the DoD Assistant Secretary of Defense, Health Affairs, signed the Executive Decision Memorandum implementing JEHRI  **
**Oversight of Plan is provided by the Health Executive Council (HEC) and the Joint Executive Council (JEC)**
**Regularly scheduled meetings of the HEC and JEC keep members apprised of progress and issues **

**Joint Electronic Health Records Interoperability Plan (JEHRI) – HealthePeople (Federal)**

## The Path to Interoperability

**The Path to Interoperability**

*Interoperable Electronic Health Records*

- One-way DoD to VA

- Bidirectional sharing of text data

- Bidirectional sharing of computable data

**Notes:**
 Not duplicative, but complimentary
 Meet different needs
 These systems work together

## Federal Health Information Exchange

- 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***

## Federal Health Information Exchange

**Approximately four million unique patients**
**Lab results**
**Radiology reports**
**Pharmacy records**
**Standard ambulatory data records**
**Consultation reports**
**Approximately one-half of separated Service members have presented to the VA**

*As of  July 2006*

**Notes:**
  VA providers access DoD data using Remote Data Views in VistA/CPRS or VistA-Web
 Also includes
 Allergy data
 Consult reports
 Limited number of discharge summaries
 Numbers increase monthly

## Pre-/Post-Deployment Health Assessments and Reassessments

-  **FHIE enables VA health care providers to access Pre-**
**    ****and Post-Deployment Health Assessments on separated  **
**    ****Service members and on Reserve and National Guard **
**    ****members who have been deployed and are now**
**    ****demobilized (DD Forms 2795 and 2796)**
***   ***
**DoD is now sending Post-Deployment Health Reassessments                                                        (PDHRA) to VA health care providers using FHIE.  VA anticipates completing the work necessary to view them in the 2****nd**** Quarter FY07 (DD Form 2900)**

## Pre-/Post-Deployment Health Assessments

**Assessments transferred from DoD to the Federal Health Information Exchange data repository**
**Historical data pull of 400,000 assessments completed July 2005**
**Monthly data transfer started in September 2005**
**VA began retrieving the data in December 2005**
**Added PPDHA for demobilized Reserve and National Guard in March 2006 **

*As of  July 2006*

**Notes:**
 Pre– and Post – Deployment Health Assessments:
 March 2006 added Reserve and National Guard – very important to VA – 2 years of eligibility for VA care following deployment
 Period of demobilization for the historical data pull  for demobilized Reserve and National Guard was Nov 2003 – Jan 2006

## Post-Deployment Health Reassessment

**Historical data pull completed July 2006**
**Historical data transfer completed 1****st**** Qtr FY 2007**
**Monthly and weekly data transfer for individuals referred to VA for care will begin 2****nd**** Qtr FY 2007**
**VA began retrieving the PDHRA data 2nd Qtr FY 2007**

*As of August 2006*

**Notes:**
 Historic data pull completed the week of July 17
 Weekly data pull will sort on “question 10” (recommended action) and pull those who have been referred to VA for care

## Bidirectional Health Information Exchange

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

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

## Bidirectional Health Information Exchange

**Current types of data exchanged: allergy, outpatient pharmacy, demographic, laboratory, and radiology **
**Approximately 8,200 FHIE-BHIE queries/week **
**Data from DoD BHIE sites available to all VA sites and most large DoD sites**

**Notes:**
 DoD sites with BHIE with all of VA 
 View of the data – after the encounter, data just in original systems – not written or stored somewhere else
 Shared patients 
 Correlation – first name, last name, SSN, DOB, gender 
 If correlated, can view the data
 Inpatient documentation from sites with Clinical Information System available to VA  to view 
 Tested at MAMC in July 2006 (VA discharge summaries available to DoD to view as well)
  Will roll out to other DoD sites with CIS (schedule being worked with Services)

 CHDR-BHIE Interface development will accelerate available data to VA (pull data from CDR)
 First Release (anticipated in 2nd Quarter FY 2007) will include: 
 Outpatient pharmacy
 Radiology results
 Laboratory results
 Allergies
 Plan to add additional data elements in FY07 (pending funding) including
 Encounters/clinical notes
  Procedures
  Problems
  Vitals
  Scanned an Imported documents an images
  Family history, social history, other history
  Questionnaires and forms

 Provides the path for bidirectional data from VA  to DoD as well  – for example on Reserve and Guard who are re-mobilized and return to Active Duty, but received care from VA while demobilized 

 Anticipate this will answer a lot of the demand for data exchange from our sites that are doing a significant amount of DoD/VA sharing

## BHIE/CHDR Interface

**Interface will allow viewable access of information between all DoD  sites and all VA sites for shared patients**
**AHLTA implementation was completed November 2006 at all 138 sites**
**Release 1: Allergies, Outpatient Medications (including PDTS), Laboratory Results (Chemistry and Hematology), and Radiology scheduled for 3****rd**** Qtr FY 2007**
**Release 2: Encounters/Clinical Notes, Procedures, Problems, and Pre/Post Deployment Health Assessments/Reassessment Surveys -  pending VA funding (2****nd**** Qtr FY 2008)**
**Release 3: Vitals and scanned/imported documents/images -  pending VA funding (3d Qtr FY 2008)**

## Clinical Data Repository/Health Data Repository

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

***Two-way, enterprise exchange of computable data***

## The Clinical Data Repository/Health Data Repository (CHDR)

**Represents the development of interoperability between the DoD Clinical Data Repository (CDR) and Health VA Data Repository (HDR):**
**Leverage DoD AHLTA experiences and lessons learned**
**Provide the cornerstone for interoperability between electronic health records for DoD and VA**
**Bidirectional real time exchange of computable pharmacy, allergy, demographic and laboratory data **
**Phase 2, Release 1**
**Drug – Drug interaction checking**
**Drug – Drug Allergy interaction checking**
**Phase 2, Release 2**
**Lab (Chemistry & Hematology)**
**	**
**Pharmacy Prototype demonstrated exchange of computable pharmacy, allergy and demographic data late in FY 04**
**CHDR successfully demonstrated to VHA and Military Health System Chief Information Officers in January 2006 **
**As of March 2007, Completed deployment at El Paso, Augusta, Pensacola, Puget Sound, Chicago, San Diego, and Las Vegas.**

## Laboratory Data Sharing Interoperability 

- Supports the 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

**Notes:**
 Electronic order from VA to DoD, results sent back electronically – or DoD to VA

## Laboratory Data Sharing Interoperability

**LDSI National Defense Authorization Act (NDAA) demonstration sites**
**El Paso, Texas **
**Operational January 2005**
**San Antonio, Texas **
**Operational  August 2005**
**Utilizing adopted standards from the federal Consolidated Health Informatics (CHI) initiative to add functionality to support anatomic pathology and microbiology tests (LOINC & SNOMED-CT)**
**Currently testing in El Paso and will begin testing in 2****nd**** Qtr FY 2007 in San Antonio**

**Notes:**
 El Paso total = 8255 tests (22 of 40 mapped tests)
 San Antonio total = 1734 tests (7 of 7 mapped tests)

## Other Initiatives

- Inpatient documentation
**Began bidirectional exchange of inpatient discharge summaries from CIS through the BHIE framework at  Madigan Army Medical Center and the VA Puget Sound Health Care System in July 2006**
**Planning is in progress for deployment to additional DoD sites in FY 2007**
**Under study:  adding other types of inpatient documentation, such as operative notes and inpatient consults.  Currently examining cost, feasibility, and schedule**
**Image sharing**
**Planning pilot test for El Paso in FY 2007 as expansion to NDAA Demonstration.  First phase: share “reference quality” images.  Later phase: share “diagnostic quality” images.  If successful, will proliferate solution to other sites**
**Scanning DoD paper health records: **
**Less of a problem as automated systems are implemented**
**Scanning pilot at WRAMC to transmit DoD medical records of seriously injured OEF/OIF soldiers transferred to VA polytrauma centers in development.  Technical solution to send, store, and display records is being researched.  Business processes are now in place**

## Other Initiatives (Cont)

**Joint VA/DoD Inpatient Electronic Health Record Feasibility Study**
- VA has been widely recognized for its outstanding electronic health record VistA
- VistA supports ambulatory care plus a segmentable, but integrated inpatient care capability
- VA is modernizing VistA, including inpatient functionality
- VA and DoD will explore a “born seamless” approach for a joint inpatient Electronic Health Record by conducting a joint feasibility study
- The feasibility study will:
- Identify areas of commonality and uniqueness
- Document and assess inpatient clinical processes, workflows, and requirements
- Document benefits and impacts on timelines and costs for deploying a common inpatient electronic health record solution
- Develop the business case analysis
**                          **

## Currently sharing most available clinically pertinent electronic health data
Successful implementation of one-way and bidirectional transfer of viewable text data using FHIE and BHIE
Successful implementation the transfer of pre- and post- deployment health assessments and reassessments  
Successful implementation of bidirectional transfer of computable data using CHDR interface 
Successful implementation and expansion of the laboratory orders portability application, Laboratory Data Sharing Interoperability 
Utilizing CHI-adopted standards to implement joint applications that share standardized data (e.g., CHDR and LDSI)
Comprehensive strategy in place to share remaining available data (e.g., inpatient data)

- Successful implementation of one-way and bidirectional transfer of viewable text data using FHIE and BHIE
- Successful implementation the transfer of pre- and post- deployment health assessments and reassessments
- Successful implementation of bidirectional transfer of computable data using CHDR interface
- Successful implementation and expansion of the laboratory orders portability application, Laboratory Data Sharing Interoperability** **
**Utilizing CHI-adopted standards to implement joint applications that share standardized data (e.g., CHDR and LDSI)**
**Comprehensive strategy in place to share remaining available data (e.g., inpatient data)**

**Summary of JEHRI Accomplishments**