# Presentation: 356162

## Collaborative Strategy

**Collaborative Strategy**
**To Greatly Improve Health**

##  HealthePeople is a 

- collaborative strategy
- for increasing availability
- and use of ...
- high performance health systems
- high performance, interoperable health information systems
- ...to greatly improve health for people in the U.S and in other nations.

## Collaborative Strategy

-  **Health Systems:**
- Adopt national outcome-based standards (quality, accessibility, affordability, satisfaction) for high performance health systems.
- Greatly improve availability of high performance health systems for eHealth, home/workplace care, ambulatory care, inpatient care, nursing home care & domiciliary care.
**Health Information Systems:**
- Adopt national health data, communications & architecture standards for high performance health information systems.
- Greatly improve affordability, availability and interoperability of high performance health information systems to support high quality, accessible and affordable health care for people in the U.S and in other nations.

**Collaborative Strategy**
** ****To Greatly Improve Health**

## Future health – will be very different

-   Threats - environmental hazards, infectious diseases, chem/bio and conventional weapons
-   Prevention takes its rightful role
-   Maximizing abilities for all
-   Most care in the home & workplace
-   Hands-free information input/output
-   Interventions - biotech, genetics, diagnostics, pharmaceuticals, nanotechnology & much more

## Future information – will be very different

- Technology no longer a major limiting factor
- Power to know "everything"
- Power to move information at the "speed of light"
- Power to protect privacy or destroy it
- Power to secure or fail to secure information

## How will the future health/ information nexus be different?

-   Privacy, security, portability are essential
-   Information technology support what “users” need
-   Genetic code held by beneficiary
-   Whole health record, across time & providers, held by beneficiary
-   Full information available & entered during care across providers
-   Beneficiary has as much diagnostic/treatment information as most sophisticated provider
-   Beneficiary empowerment through information

## Ideal Health Systems

**Ideal Health Systems**

## Veterans Health System

***Military Service***

***Veteran/Retired***

***Home/Employment***

***Care Episode***

**Quality Assurance**

_**Home / **_
_**Workplace Health**_

**Health Surveillance**
**Preventive Measures**
**Education**
**Evaluation/Treatment**
**Rehabilitation**
**Information**

**National Veterans Policy**

**Health**
**Risks**

**VA Benefits**

**Military Health System**

**US Health System**

**VA Health – Goals, Strategic Principles, Outcomes, Leadership/Management, Benefits, Culture/Environment, Resources, Information, History**

**Occupational Environment**

**“****Home” Environment**

**Research & Development**

**Veterans Health System**

***Deceased***

## VHA Strategic Principles

**Provide a defined, comprehensive set of benefits and services to all enrolled veterans within an integrated healthcare delivery system.**
**Strategically maintain primary, secondary, tertiary and long-term care capacity to ensure that we can meet the service related and unique needs of veterans.**
**Be the coordinator and integrator of the majority of health care services provided to enrolled veterans.**
**Optimize the availability and efficient use of resources and services.**
**Reduce the variability in access, cost, quality and satisfaction across the system.**
**Make health care decisions with enrolled veterans under our care on the basis of medical need.**
**Promote a work environment that attracts and retains quality employees.**
**Support open enrollment to the extent resources allow, using cost sharing mechanisms and limiting enrollment of lower priority veterans to balance demand with available resources.**
**Serve as a national resource for teaching and research, aligned with the veteran health care mission.**

**VHA Strategic Principles**

## Dimensions of complexity

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

**Size – 1/7th **
**(health care)**
**of GDP; 1/6****th**** by 2007**

**Care sites – **
**many, many **
**thousands **
**nationwide**

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

**Functionality – need **
**high performance**

**Oversight – Payers, Regulators, Agency, OMB, Congress, Consumers, etc**

**Resources – **
**3+M nurses, physicians, pharmacists**

**Partners – Private, VHA, HHS, DoD, Other Fed, Other Public, Other Countries**

**Data elements (many, many) **
**& standards (many?)**

**People Served**
** – ****288+ million**
** ****annually**

**Dimensions of complexity**

## VHA

**VHA**

- VHA Services & Integrated Health System(s)

_**Individual Services**_

**VISN**

**Community**

- eHealth

- Home care

- Nursing home care

- Inpatient care

- Ambulatory care

- Domiciliary care

**+HIS**

**+HIS**

**+HIS**

**+HIS**

**+HIS**

**+HIS**

**+HIS**

**+HIS**

**+HIS**

## Questions:  

- As VHA in the future works to move toward the ideal health system, we are interested in current best practices with respect to inpatient care, ambulatory care, home/workplace care, eHealth, nursing home and domiciliary care. Key to it being a “best practice” is how well it performs with respect to outcomes.
- With respect to integrated health systems (local or VISN), if you have or know someone who has a “best practice” for either of these systems, we would like to get more information about them. Key to it being a “best practice” is how well it performs with respect to outcomes.

- “Best Practices”  for Moving Toward Ideal Systems

## VHA Services & Integrated Health System(s) – Best Practices

**Current**
**Best**
**Practices**

_**Individual Services**_

- eHealth

- Home care

- Nursing home care

- Inpatient care

- Ambulatory care

- Domiciliary care

**Community**

**VISN**

**VHA**

## VHA Services & Integrated Health System(s) – Ideal Systems

**Ideal Health Systems**

_**Individual Services**_

- eHealth

- Home care

- Nursing home care

- Inpatient care

- Ambulatory care

- Domiciliary care

**Community**

**VISN**

**VHA**

## Drivers for health

- Health & abilities to the max
- Satisfaction to the max
- Affordability to the max
- Quality to the max
- Patient safety to the max; system “defects” to zero
- Time to zero
- Inconvenience to zero
- Portability to the max
- Security & privacy to the max

## VHA

**VHA**

- Integrated Health Service/System Support for  Outcomes

_**Individual Services**_

**Local**

- eHealth

- Home care

- Nursing home care

- Inpatient care

- Ambulatory care

- Domiciliary care

**VISN**

**Max **
**Health**

**Max Satisfaction**

**Min Inconvenience**

**Max Affordability**

**Max **
**Quality**

## Drive toward the “ideal”

**Drive toward the “ideal”**

**Now - operate current high performance health system(s) **

**Near Term – develop interim & minor modification of ****current health system(s) in context of ideal**

**Mid Term- develop ****new & major modification of health system(s) in context of ideal**

**Long Term – achieve ideal health system(s)**

- 2002           2003            2004           2005           2006           2007

## Ideal

***Ideal***
***New / ***
***Major Mod***
***Interim / ***
***Minor Mod***
***Current***

**Toward “ideal” health systems**

***Long Term***
***Mid Term***
***Near Term***
***Now***

***Ideal***

## Toward “ideal” health systems

***Ideal***
***New / ***
***Major Mod***
***Interim / ***
***Minor Mod***
***Current***

**Toward “ideal” health systems**

***Ideal***

**  ****Outcomes**

**Strategic Principles**

**          ****Goals**

- To what extent will health system(s) achieve ...

**          ****Mission**

## Ideal Health Information Systems

**Ideal Health Information Systems**

## Potential interoperable, shared, standards-based high performance systems

| Shared, interoperable, full, open, modular health info systems for prevention & acute care in health systems, hospitals, clinics, home/work:
Registration/eligibility/enrollment, health data, provider, management/financial & “e” communications/transactions
W/ person’s access to record & supportive resources
W/ clinical reminders, decision support, safety support
W/ security, architecture, data quality, infrastructure
Low cost or free, esp for public agencies & those serving poor/near poor |
| --- |
| Standardization of:
Data (elements & definitions)
Communications (information sharing)
Architecture |
| My HealthePeople virtual, secure personal health portal:
Health record from providers
Person’s notes
Access to trusted, supportive resources
Messages between provider & patient
Scheduling appointments; prescription refills |

- Security
- Systems
- Technical

## Toward “ideal” health info systems

***Ideal***
***New / ***
***Major Mod***
***Interim / ***
***Minor Mod***
***Current***

**Toward “ideal” health info systems**

***Long Term***
***Mid Term***
***Near Term***
***Now***

***Ideal***

## Next Generation Strategy

- Health_***e***_Vet - VistA
- Operate current generation VistA
- Develop, implement & operate Health_***e***_Vet-VistA
- Develop, implement & operate Next Generation Health_***e***_Vet-VistA as open source, componentized high performance system with partners
- Health_***e***_People
- Push development & adoption of health information standards
- Push availability & use of public/private sector high performance health information systems, including next generation Health_***e***_Vet-VistA used externally as Health_***e***_People-VistA

## Next Generation HealtheVet-VistA  - High Performance Info System Components/Links/Standards/OpenSource

**Management & **

**Financial System**

**Health Provider (including clinical **
**interface, e.g. CPRS/CHCSII/ RPMS) & 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**

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

**[web site, virtual health **

**record, trusted information, **

**self**

**-**

**reported information, **

**link to other health **

**providers]**

**Next Generation Health**_***e***_**Vet-VistA  - High Performance Info System Components/Links/Standards/OpenSource**

**Database/**
**Standards**

**Database/**
**Standards**

## HealthePeople  - High Performance Information Systems Components/Links/Standards/OpenSource

**Management & **

**Financial System**

**Health Provider (including clinical **
**Interface, e.g. CPRS/CHCSII/ ****RPMS) & 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**

**My Health**_***e***_**People**

**[web site, virtual health **

**record, trusted information, **

**self**

**-**

**reported information, **

**link to other health **

**providers]**

**Health**_***e***_**People  - High Performance Information Systems Components/Links/Standards/OpenSource**

**Database/**
**Standards**

**Database/**
**Standards**

## HealthePeople – High Performance Health Information Systems

**Health Data Repository**

**Registration, Enrollment, Eligibility Database**

**Financial Database**

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

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

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

**Health**_***e***_**People**** – High Performance Health Information Systems**

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

**Public/Private Health & Information Environment**

***Person’s Input & Output***

**Security   Architecture   Data Quality   Infrastructure**

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

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

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

## Potential sequence of standards & high performance systems

**Potential sequence of standards & high performance systems**

**National Standards**
** ****&**
** **
**High Performance **
**Health Information Systems**

**K-P & Other Public/Private**

**Standards – **Separate.  Work begun on standards.
**Systems – **Separate.  Work begun on enhanced systems by each agency.  Joint efforts begun.
**Exchange – **One-way from DoD to VA via FHIE/GCPR.

- Convergence

- Convergence

**Phase 1 (FY2000-01)              Phase 2 (develop enhanced systems &                          Phase 3 (national standards;**
**                                                  ****standards; begin sharing/convergence)                          high performance systems)**

**DoD CHCS II**

**IHS (upgraded RPMS)**

**K-P & Other Public/Private (enhanced)**

**Standards – **Jointly develop/set/use data, communications, architecture, security, technical, system standards.
**Systems – **Develop/use model information systems.
- Continuing enhanced system development by each agency.  Joint procurement/build, sharing, standards when applicable.
**Exchange – **Two way VA/DoD; two way VA/IHS.

**Standards – **Nationally accepted standards.
**Systems – **High performance, interoperable systems.
**Exchange – **Two way amongst partners.

**2001**

**2010**

**DoD CHCS I**

**IHS RPMS**

**Health**_***e***_**People(Fed)**

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

**VA Health**_***e***_**Vet/VistA**

**VA VistA**

## Have no doubt, we all intend to be the best

-   Challenge the rest of the US health system and information system
-   Bring together the power and speed of 1/6 of national economy and fastest growing segments
-   To veterans health system and all its people, looking for collaboration, partnership and a shared future** **
-   To public & private sectors, looking for innovation, partnership, common ground
-   Need your help; hope that we can count on you

## “To maintain and improve 

***“******To maintain and improve ***
***the health and well being of ***
***all Americans.”***

## Back-up Slides

## Dimensions of complexity

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

**Size – $22B **
**(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**

## Slide 32

|  |  | Health Info Systems | Health Systems |
| --- | --- | --- | --- |
| HealtheVet | VA only
HIS only | x
 | -- |
| HealthePeople | US+
HIS
Hlth Systems | x | x
 |