# Presentation: 765703

## VA/DoD Health Information Sharing

***Mr. Cliff Freeman***
***VA/DoD Health IT Sharing Program ***
*** ******2006***

## Highlights

- VA/DoD Joint Electronic Health Records Interoperability Plan – Overview
- The Path to Interoperability, FHIE to BHIE to CHDR
- Other Ongoing Integration Efforts

## VA/DoD Joint Electronic Health Records Interoperability Plan –Overarching Strategy

## VA/DoD Electronic Health Record

**Joint Electronic Health Records Interoperability (JEHRI) Plan Overview:**
- Developed collaboratively by VA & DoD
- Approved by the VA/DoD Joint Executive Council (JEC) and signed by the VA Under Secretary for Health (USH) and DoD Assistant Secretary of Defense, Health Affairs (ASD(HA))
- Approved by OMB
- Provides the roadmap to achieve VA/DoD interoperability
- Two Phases
- Phase I – One way electronic data exchange
- Phase II – Bidirectional and computable data exchange

***VA/DoD Electronic Health Record***

## JEHRI Goals: 

Improve sharing of information

Adopt common standards for architecture, security, communications, data, technology and software

Seek joint procurements and/or building of applications where appropriate

Seek opportunities for sharing existing systems and technology

Explore convergence of VA and DoD health information technology applications where feasible and within mission requirements

Develop interoperable health records and data repositories

** **
- Improve sharing of information
- Adopt common standards for architecture, security, communications, data, technology and software
- Seek joint procurements and/or building of applications where appropriate
- Seek opportunities for sharing existing systems and technology
- Explore convergence of VA and DoD health information technology applications where feasible and within mission requirements
- Develop interoperable health records and data repositories

***VA/DoD Electronic Health Record***

## The Path to VA/DoD Interoperability

## DoD/VA Interagency Initiatives

- DoD

- VA

**One-way, enterprise **
**exchange of text data**

**Bidirectional  real-time**
**exchange of text data**

**Bidirectional real-time enterprise **
**exchange of computable data**

**FHIE**

**BHIE**

**BHIE**

**CHDR**

**CHDR**

**FHIE**

## Federal Health Information Exchange (FHIE)Information Sharing in Operation

## Federal Health Information Exchange (FHIE)

- Successfully completes Phase I of JEHRI – operational at all VA medical centers since 2002
- One-way data transmission from DoD CHCS I  to VA VistA CPRS
- Allows access to DoD data at the point of care by VA clinician
- Successfully deployed and implemented across all VA Medical Centers
- Averages over 1100 uses of FHIE/BHIE data each week (as of March 2006)
- Permits VHA clinicians and VBA disability claims processors to view historical DoD data:  Demographics, Laboratory data, Radiology reports, Outpatient Government and Retail Pharmacy data, Allergy data, Admission, Disposition and Transfer (ADT) data, Consult Reports, and coding from the Standard Ambulatory Data Record

## Federal Health Information ExchangeInteroperability Accomplishment

- VA accesses health information through CPRS Remote Data View at the point of care
- FHIE is fully operational at every VA medical center
- DoD has transmitted data to the FHIE repository on approximately 3.3M  unique patients *****
- VA has provided care or treatment to over 2M of the unique patients using FHIE data *****

- * As of March 2006

## Pre & Post Deployment Health Assessment Data 

- Re-used FHIE architecture to support the ability of VA clinicians to use CPRS to view pre- and post-deployment health assessment (PPDHA) data on separated Service members
- Operational in VA since December 2005
- DoD has transmitted over 1.2M PPDHA on more than 512,000 individuals who are  separated Service members and Reserve and National Guard Members who have been deployed and are now demobilized
- DoD continues to send monthly updates provided to VA containing data on separating Service members and demobilized Reserve and National Guard Members
- Analysis underway for delivery of DoD Post Deployment Health Reassessment data in the same manner

## CHCS-VistABidirectional Health Information Exchange (BHIE)Bridging the Gap

## Bidirectional Health Information Exchange (BHIE)

- BHIE brings real-time, bidirectional exchange of medical information reusing FHIE infrastructure between CHCS and VistA CPRS
- BHIE supports the care of shared patients at joint sites
- Incremental Clinical Functionality was delivered in Cycle I (October 2004).  Bidirectional transmittal and display of:
- Outpatient pharmacy
- Allergy data
- Patient Identification Correlation
- Additional Clinical Functionality was delivered in Cycle II.  Bidirectional transmittal and display of:
- Laboratory result data
- Radiology text data
- Operational at all VA sites and select DoD sites

## BHIE DoD Sites: Current and Future

*BHIE DoD Sites: Current and Future*

**BHIE operational**

**BHIE implementations planned during FY2006 **

**NCA**

**Brooke AMC**

**LRMC**

**Mike O’Callaghan Federal Hospital**

**David Grant FMC**

**Bassett ACH**

**Elmendorf AFB**

**Madigan AMC**

**NH Great Lakes**

**Eisenhower AMC**

**NH Charleston**

**8 DoD host sites = 8 DoD Medical Centers,  5 DoD Hospitals & 50 DoD Clinics as of March 2006   **

**Tripler AMC**

**William Beaumont AMC**

**NMC San Diego**

**NH Camp Pendleton**

**NH Camp Lejeune**

**Womack AMC**

**NH Pensacola**

**Darnall ACH**

## The Clinical Data Repository/Health Data Repository (CHDR) – The Interoperable Health Record 

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

- Represents the development of interoperability between the Clinical Data Repository (CDR) and Health Data Repository (HDR):
- Leverage DoD CHCS II/AHLTA experiences and lessons learned
- Provide the cornerstone for interoperability between electronic health records for DoD and VA
- Next generation systems: AHLTA and Health_*e*_Vet
- Bidirectional real time exchange of computable pharmacy, allergy, demographic and laboratory data
- Drug – Drug interaction checking
- Drug – Drug Allergy interaction checking
- 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
- Anticipated release into production environment is summer 2006 between William Beaumont Army Medical Center and VA El Paso Health Care System, El Paso, TX
- Uses standardized data and terminology code sets to achieve computable data exchange

## Other  Ongoing VA/DoD Integration Efforts

**Laboratory Data Sharing and Interoperability (LDSI):** Supports the electronic ordering and results retrieval of chemistry laboratory tests between DoD and VA facilities
**Enterprise Architecture:** Joint VA/DoD Shared Health Architecture Plan/Charter    completed a “Shared Health Architecture,” version 1.0 in December 2004
**Scheduling Interoperability:** Chartered work group exploring the feasibility of creating                    interoperable scheduling applications
**e-Health collaboration**:  VA/DoD shared objectives for cooperation between TRICARE Online and My Health_*e*_Vet