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VHA OI Emerging Health Technologies Sampler

Presented to:

VA  Information Resource Center (VIReC) 

November 17, 2008

Jim Demetriades

Nancy Wilck

Emerging Health Technologies

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Presentation Outline	

Emerging Health Technologies Overview

Clinical Wiki Pilot

Point of Care Device Technology Assessments

Collaborative Innovation

Electronic Health Record System Visioning

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Emerging Health Technologies Overview	

Organization: VHA Office of Information start-up chartered in October 2006

Purpose: to sense and extend VHA’s information technology horizon through the application and introduction of technologies and practices

Approach: to provide evidence of healthcare technology value via high-level studies, proofs of concept, pilots to help inform both strategic and tactical planning

Focus: 3-5 year future window

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Presentation Outline	

Emerging Health Technologies Overview

Clinical Wiki Pilot

Point of Care Device Technology Assessments

Collaborative Innovation

Electronic Health Record System Visioning

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Clinical Wiki Pilot

Working with Office of Information and Technology (OI&T) to establish a formal clinical wiki pilot inside VA

Intend to assess VHA interest in and viability of this technology

Premise is clinicians and allied health professionals will utilize wiki technology to freely share clinical knowledge with colleagues

Contributes to larger goal of assessing Web 2.0 ‘social networking’

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Anticipated Wiki Benefits

Will encourage collective creation of knowledge within VHA and ensure its availability to interested persons

Viewed as credible information source and provide immediate relevance to VHA clinicians

Attract wide range of clinical users including nurses, researchers, residents, medical and allied health students

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Clinical Wiki Pilot (con’t)

Initial wiki environment will use same feature set as found in the open source technology powering Wikipedia.com

Will support both general and specialized communities (portals) and availability of discussion areas, news and event postings

Will require contributor authentication and attribution

Expect pilot to be available early next quarter

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Presentation Outline	

Emerging Health Technologies Overview

Clinical Wiki Pilot

Point of Care Device Technology Assessments

Collaborative Innovation

Electronic Health Record System Visioning

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Point of Care (POC) Device Assessment Program

Purpose: Examine the use of information technology products for use by VHA clinicians at the point of care

POC device definition: Information technology (IT) products with user interfaces (e.g. hand held, mobile, wireless, laptop, thin/thick client devices) that can access VA’s VistA computer system and / or other information sources 

What is excluded: diagnostic and therapeutic biomedical devices

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POC Device Assessment Approach
        - Approach: 
        - Define POC device reference model (framework)
        - For a particular setting (e.g. clinic, ward, long term care) and role (primary care doc, nurse, specialist) identify and prioritize devices of high interest
        - Engage clinicians in conducting assessments (tablet PCs will be first examined)
        - Provide opportunity for diverse collaboration with other teams (e.g. security, patient safety, etc.)

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POC Device Assessment Program (con’t)
        - Publish a series of on-line ‘Consumer Reports’ like articles.
        - Program will serve as information resource for sites looking at devices
        - Focus is on technology and not products
        - Acquisition recommendations are out of scope.
        - Timeframe: Contract award to develop methodology and framework expected in Dec. 2008

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Presentation Outline	

Emerging Health Technologies Overview

Clinical Wiki Pilot

Point of Care Device Technology Assessments

Collaborative Innovation

Electronic Health Record System Visioning

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Collaborative Innovation Definition

Collaborative Innovation

	“Self-organizing groups of highly motivated individuals working together towards a common goal ....” 

		–Peter A. Gloor, Carey Heckman, Fillia Makedon

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Our Focus: The Intersection

Collaborative Innovation happens here

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Innovation Sandbox Description
        - The Innovation Sandbox is much more than a software development environment.  It is also a virtual space for people to collaborate, innovate, and develop ideas and requirements
        - The Sandbox is a geographically limitless solution to the historic challenge of locally bound development efforts
        - The Sandbox is intended for anyone wishing to contribute ideas to VistA development

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Collaborative Innovation Initial Accomplishments
        - VHA Informatics and Data Management Committee (IDMC) charge 
        - Early 2007 
        - Propose a way to preserve innovation, minimizing IT re-organization challenges
        - Cross organizational workgroup
        - Chartered May 2007
        - Stakeholders from field, OI&T and OI
        - Innovation Concept of Operations (CONOPS)
        - Presented and approved for pilot by IDMC Sept 2007
        - Industry review and comment: Gartner, Perot Systems, EDS, Microsoft, IBM

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Collaborative Innovation Goals
        - Perpetuate local innovation in support of mission needs
        - Strengthen early idea sharing
        - Encourage communities of interest
        - Increase collaboration
        - Eliminate redundancy
        - Rapidly deploy innovative software which adheres to national development standards

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Collaborative Innovation Principles
        - Access is easy and open to all
        - The Sandbox is structured to allow ideas and work products to be freely shared 
        - There is a well-defined path for mainstreaming innovative creations into production
        - Failures are expected and accepted as a cost of being innovative
        - Sandbox governance promotes process consistency, simplicity, and reuse

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User Experience
        - Receive general innovation news
        - Access resource libraries
        - Discover or create ‘birds of a feather’ communities
        - Contribute ideas and collaborate in shaping business requirements
        - The more technically inclined can initiate software projects
        - Innovation ideas or requirements may be submitted to the New Service Request (NSR) process
        - Applications that meet ‘high-bar’ exit criteria for national business value, OI&T programming standards and infrastructure capacity may be fast-tracked within the NSR process

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Market Survey
        - Contract awarded to survey market for toolset
        -  final recommendations received in March 2008 and refreshed in August 2008
        - The market is clearly emerging and volatile
        - No single solution meets our wants
        - Current thinking: bridge two commercial products
        - one strong in idea and community management
        - a second to provide a solid development environment

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Collaborative Innovation Current and Future Plans
        - In progress now
        - “Bench” validation of candidate products
        - Development of functional requirements for Sandbox environment
        - In the queue
        - Pilot approach decision
        - Acquisition/installation
        - Initial live testing (pilot)
        - Transition planning

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Presentation Outline	

Emerging Health Technologies Overview

Clinical Wiki Pilot

Point of Care Device Technology Assessments

Collaborative Innovation

Electronic Health Record System Visioning

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Definition of EHR-S
        - EHR-S includes all clinically related systems or applications such Computerized Patient Record Systems (CPRS) and radiology, lab, scheduling, and pharmacy packages 
        - Medical devices and national data bases such as Decision Support System (DSS) and the Administrative Data Repository (ADR) are not part of the EHR-S although the need to interface with them will be a key characteristic of it

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EHR-S Visioning Objective
        - Want to define ‘shared vision’ for next generation EHR-S
        - Called ‘shared’ because products of meetings become basis for vision document that will be available for broad community review and contribution
        - Will seek to make shared vision an authoritative document
        - Will serve as roadmap for VHA as it defines capabilities and priorities for future development efforts

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EHR-S Visioning Approach
        - Facilitating a series of meetings with key EHR-S stakeholders
        - Final meeting will begin tomorrow with allied health, research, education, and academic affiliations
        - VHA stakeholders (e.g., Veteran Service Organizations (VSO) and healthcare partners (e.g., DoD and IHS) will be briefed
        - Vision document will be iterated and available for contributions from larger VHA community
        - Look for draft vision in January

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EHR-S Visioning: How You Can Contribute
        - Participate in development of the shared vision:
        - Contact the VIReC Help Desk at  virec@va.gov  for the VA Intranet address
        - Propose additional guiding principles if needed
        - Propose capabilities the EHR-S must provide to support your line of business (remembering that it is first and foremost a clinical tool)
        - Encourage your co-workers and colleagues to contribute to the shared vision

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Contacts for Additional Information	

Jim Demetriades

Jim.Demetriades@va.gov

518-449-0627

Nancy Wilck

Nancy.Wilck@va.gov

703-927-8880

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Discussion

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Supplemental Material

	This material supplements the formal briefing.  Feel free to contact us if you have questions on any of it.

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EHR-S Guiding Principles

Participants in the visioning meetings developed the following EHR-S Guiding Principles statement: 
        - In building the EHR-S of the future:
        - VHA will define its content, functionality and performance requirements.
        - Clinicians will lead and collaborate with other stakeholders in the continuous evolution of the system.
        - The EHR-S of the future will support and enable VHA’s missions, with specific focus on patient safety and quality of care, by:
        - Being patient-centric;
        - Facilitating knowledge discovery, accommodating innovation and changes in health care practice and information needs;
        - Providing a framework to identify and promote use of best practices and innovation, in both patient care and informatics;
        - Reducing undesirable variation through support for consistent approaches to common tasks;
        - Supporting standardization at the core and diversity at the periphery;
        - Enhancing communication internal and external to VHA, among clinicians and with patients, across organizations and the continuum of care; and
        - Promoting the efficiency and effectiveness of clinical staff.

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EHR-S Capabilities

Participants in the visioning meetings determined that the EHR-S must have the following characteristics:
        - Be flexible, modular, and integrated
        - Promote data standardization, data quality, information and data reuse; capture the data once and use it many times
        - Support context-driven views, giving the right information at the right time
        - Provide access to data for all users, including people with disabilities (e.g., access from numerous places with numerous devices)
        - Manage the patient's composite record including longitudinal patient views (internal source, format, location, identity) 
        - Be context, role, and event aware
        - Be instrumented to support user efficiencies
        - Promote the wellness of the veteran population

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EHR-S Capabilities (con’t)
        - Provide both prescriptive and assistive real-time clinical decision support
        - Be configurable with standard defaults
        - Enable support care team collaboration (any handoffs—internal/external)
        - Support data input from multiple sources (devices) and locations
        - Be easy to navigate and comprehend
        - Provide multiple information horizons, arranged by cognitively significant context, and provide multiple-level views and abstractions. 
        - Incorporate transportable tools, templates, lists, orders, and pathways
        - Provide ability to manage workflow 
        - Must ensure complete, computationally correct, dynamic records.
        - Facilitate a user interface in which provision of care is compatible with care eligibility

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Profile of Attendees at EHR-S Visioning Sessions To Date
        - Medical Doctors (24)
        - Registered Nurses (8)
        - Clinical Pharmacists (2)
        - Psychologist (1)
        - PhD. (2)
        - Clinical Applications Coordinator (1)
        - Experts in:
        - Clinical Decision Support (1)
        - Cognitive Engineering (1)
        - Data Quality (3)
        - Enterprise Portfolio Management (2)
        - Health Eligibility (1)
        - Health Information Management (1)
        - Information Management (2)
        - National Data Systems (1)
        - Privacy (1)
        - Section 508 (1)
        - Security (2)