VistA Evolution 

Program Vision and 

Associated Knowledge 

Gaps: 

HSRD Cyberseminar

3 April 2014

OIA Health Informatics: Health Solutions Management

Merry Ward, MS, PhD

VistA Evolution Research and Development Manager

Brenna Long, MS

VistA Evolution Associate VHA Program Manager

Jonathan Nebeker, MD, MS

Associate Chief Medical Informatics Officer
OFFICE OF INFORMATION AND TECHNOLOGY

POLL 1

Where do you work? Choose one. 

• VHA employee

• VA OIT

• VHA contractor

• Federal employee, not VA

• Non-Federal 

1 
OFFICE OF INFORMATION AND TECHNOLOGY 2 

Objectives

• Share the VistA Evolution Program’s (VE) vision 

and plan for next generation VistA/CPRS 

• Share known gaps in knowledge, and 

• Engage the Health Services Research community 

in the VE. 
OFFICE OF INFORMATION AND TECHNOLOGY

Research in VistA Evolution

Merry Ward Merry.Ward@va.gov

VistA Evolution Program

Jonathan Nebeker

VistA Evolution Program Structure

Brenna Long

3 

Overview
OFFICE OF INFORMATION AND TECHNOLOGY

Role. Choose all that apply

• Health care provider

• Researcher/scientist 

• VACO program office 

• Informatics researcher

• None of the above

4 

POLL 2
OFFICE OF INFORMATION AND TECHNOLOGY

Research in VistA Evolution

Merry Ward Merry.Ward@va.gov

VistA Evolution Program

Jonathan Nebeker

VistA Evolution Program Structure

Brenna Long

5 

Overview
OFFICE OF INFORMATION AND TECHNOLOGY 6 

Evolving from patient record system to health management
OFFICE OF INFORMATION AND TECHNOLOGY

Research Needs: Theoretically Driven Evidence-Based 

Models

7 

Just a few examples of what need to know to build 

better systems: 

 Cognitive Processing

• Understand complex cognitive processing across 

domains and across individual and social systems 

• Theories and models for organizing and presenting data 

and knowledge to facilitate deep cognitive processing.

Knowledge Management and Engineering

• “N of 1” data analytics across time and conditions

 

Research Methods Development

• Apply system data to develop novel and efficient 

methods for determining efficacy, effectiveness, and 

safety, as well as learning, surveillance and 

knowledge/best practice maintenance. 
OFFICE OF INFORMATION AND TECHNOLOGY

Role of research

• Drive VistA Evolution Program (VE) with forward thinking, 

visionary research

• Apply theoretical social and cognitive models to informatics 

development 

• Fill knowledge gaps with empirical knowledge

• Elucidate knowledge gaps

8 
OFFICE OF INFORMATION AND TECHNOLOGY

Communications

 Merry Ward

– Merry.ward@va.gov

– 202 701 0852 or 919 977 5385

Join the new Listserv

VA_HEALTH_INFORMATICS-L@LISTSERV.VA.GOV

Schedule a session

– Call or email me to schedule a session: research teams, centers, COINs

9 
OFFICE OF INFORMATION AND TECHNOLOGY

Research in VistA Evolution

Merry Ward

VistA Evolution Program

Jonathan Nebeker

VistA Evolution Program Structure

Brenna Long

10

Overview
OFFICE OF INFORMATION AND TECHNOLOGY

VistA Evolution. Choose one. 

• Had not heard of VistA Evolution Program until I saw this 

Cyberseminar 

• Had heard of, but am not very familiar with VistA Evolution

• Have prior understanding of VistA Evolution Program 

• Engaged with VistA Evolution or VistA Evolution program 

development 

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Poll 3 
OFFICE OF INFORMATION AND TECHNOLOGY

VistA Evolution 

• Vista Evolution is a VA Program lead jointly by 

the Office of Information and Technology (OIT) 

and the Veterans Health Administration (VHA).

• The VistA Evolution program will modernize 

VistA to serve business needs and to support 

clinical and infrastructure content to fulfill the 

objective to deploy an EHR, with seamless 

electronic sharing of medical health data with 

DoD and private providers, and an integrated 

data display

• The first VistA Evolution product, VistA 4 

provides the infrastructure and open, extensible 

platform on which tools and services can be 

integrated in support of Veterans’ evolving 

needs, in pace with the technological landscape

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Decentralized Hospital 

Computer Program (DHCP)

Computerized Patient 

Record System (CPRS)

“Gold Disk” version of VistA

VistA 4 is the next evolution 

of open-standards-based, 

extensible VistA

V1 

V2 

V3 

V4 

History of VistA
OFFICE OF INFORMATION AND TECHNOLOGY

Improve Value of Healthcare 

• One shared care plan

• Task- and goal-based 

communication 

• Distributed decision 

making 

• Population 

management 

TeamBased 

• Explicit link to patient 

goals and preferences

• Plans tailored to 

patient goals 

• Shared decision 

making and 

management 

PatientCentered 

• Transactional 

collection of rich 

clinical data that links 

resources to activities 

and goals to outcomes

• Support “Lean-type” 

management 

QualityDriven

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• Fill gaps to support care coordination and Patient Aligned Care Teams
OFFICE OF INFORMATION AND TECHNOLOGY

VistA Evolution – VistA 4 Product Vision 

14

Federal 

Partners 

(DOD, IHS)

Acronyms:

DoD – Department of Defense

IHS – Indian Health Service

VBA – Veterans Benefits Administration

 VBA

Standard Data 

Model

By 2017, we will have an architecture and framework that supports 

interoperability, care coordination, meaningful use and partnership.

Open 

Source/

Community 

Partners

Care 

Coordination 

Framework

User 

Experience

VLER and IPO – 

defined 

interoperability 

standards
OFFICE OF INFORMATION AND TECHNOLOGY

VistA Evolution Road Map 

15

DATE DOCUMENT TYPE/STATUS

2014

Initial Care Management 

Capabilities

2015

Core Care Management

2016

Interoperability and 

Improved Clinical 

Capabilities

2017

Care Coordination

2018

Colleague EHR 

(Gartner Gen 4)

Advanced UI Tools

VA/DoD Information 

Sharing (via Joint Legacy 

Viewer) 

Back-end Immunization 

Modules

VistA Standardization

Integration of DoD and 

external provider data

Clinical Improvements 

for Patient-safety , 

Decision Support, 

Communication, and 

Population Health

A new, ONC certified, 

EHR platform at alpha 

sites

Enterprise deployment 

of view-only enterprise 

Health Management 

Platform (eHMP) 

Meaningful, real-time 

exchange of 

information with DoD

and external providers

Broad deployment of 

eHMP (ONC Certified)

Initial deployment of 

Laboratory Information 

System (LIS) to 2 sites

Clinical improvements 

to include patient goals, 

enhancements to 

pharmacy and radiology

Full scale deployment 

of Laboratory 

Information System (50 

VAMC/year) 

Enterprise-wide 

deployment of eHMP

Clinical improvements 

including 

planning tools that 

support patientcentered care plans and 

improved 

communication tools

Delivery of all new VistA 

4 capabilities 

throughout the 

enterprise

Laboratory Information 

System (50 VAMC/year

Completion of care 

coordination and 

quality management 

capabilities consistent 

with Gartner Gen4
OFFICE OF INFORMATION AND TECHNOLOGY

HMP: Medication Review, Infobuttons, Search

Notional/Source: HMP

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OFFICE OF INFORMATION AND TECHNOLOGY

VistA 4 Product Vision, FY 17 

17

• Support for care coordination: patient-centric, team-based care with 

capabilities for quality improvement

• New user experience with multifaceted support for understanding and 

decisions that speed use of EHR and improve quality of clinical reasoning

• Pharmacy management, laboratory information systems and radiology 

enhancements

• Meaningful Use demonstration & EHR certification

• Capability for technical, semantic and process interoperability

Radiology Protocoling

Patient Secure Messaging

Provider Secure Messaging

ePrescribing

Structured Data Capture

Medication Reconciliation

Annotation 

Patient Lists
OFFICE OF INFORMATION AND TECHNOLOGY

VistA 4 Metrics

• Quantifiable metrics will be established to evaluate Program effectiveness and 

specific benefits, such as: 

– Enhanced functionality with technical applications/capabilities

• Allow the care team to more efficiently assess and diagnosis each patient, proactively 

identifying care options through population analytics 

– Improved operational efficiency

• Increase throughput by reducing inefficiencies in workflow and improving care coordination 

– Better Care Quality 

• A comprehensive care plan designed for each patient will enhance health outcomes 

– Improved patient safety

• Upgraded applications to reduce patient safety events 

– Improved cost savings 

• Reduce duplicative tests and administrative overhead 

• Improved customer satisfaction

• Effective preventative care will result in an enhanced patient experience, with not only better 

outcomes but also less time spent in a care facility 

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OFFICE OF INFORMATION AND TECHNOLOGY

Decision and Cognitive Support:

Clinical Semantic Web

19
OFFICE OF INFORMATION AND TECHNOLOGY

Decision and Cognitive Support:

Active User Interface with Semantic Web

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OFFICE OF INFORMATION AND TECHNOLOGY

Decision and Cognitive Support:

Theory driven, evidence based

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OFFICE OF INFORMATION AND TECHNOLOGY

Activity Management and Lean

• Templated processes

• Explicitly match resources to 

tasks

• Sequence tasks

• Resolve conflicts with goals 

and preferences

• Analyze outcomes to refine 

templates and policies

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OFFICE OF INFORMATION AND TECHNOLOGY

Activity Management:

Explicit Processes & Task-based Communication

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OFFICE OF INFORMATION AND TECHNOLOGY

Activity Management

How this looks to clinicians

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OFFICE OF INFORMATION AND TECHNOLOGY

Examples of what we need help with

• Metrics aka Key Performance Indicators

– Work with Product Effectiveness and our office

• Decision and Cognitive Support

– Structured data entry

– Translation of theory to design & theory-driven evaluation

– Content: Knowledgebases and ontologies

– Simulation at patient and population levels

– Goal setting

– Guideline deconfliction

• Activity Management & Business Process Engineering

– N of 1 trials

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OFFICE OF INFORMATION AND TECHNOLOGY

Research in VistA Evolution

Merry Ward

VistA Evolution Program

Jonathan Nebeker

VistA Evolution Program Structure

Brenna Long

26

Overview
OFFICE OF INFORMATION AND TECHNOLOGY

Communication

IPTs and governance structure is under development. POC for engagement 

with IPTs brenna.long@va.gov

VistA Evolution Communication SharePoint site: http://go.va.gov/iq2a

VistA Evolution Dashboard

– Distributed weekly via email

– Forum For Us (https://vaforumfor.us/docs/DOC-6166) 

– VistA Evolution SharePoint Site (http://go.va.gov/vista_evolution) 

VistA Evolution on ForumForUS

– For access, email brenna.long@va.gov or juan.torrez@va.gov 

Research 

– Merry Ward, Ph.D. merry.ward@va.gov (202) 701-0852 

• VistA Evolution Research and Development Manager

• VA_HEALTH_INFORMATICS-L@LISTSERV.VA.GOV

•

•

•

•

•

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OFFICE OF INFORMATION AND TECHNOLOGY

Product Management: Feature Driven Design Process

• Allows for substantial upfront design and iteration and evolution in development

• This is needed to deliver features requiring highly refined design for UI and UX 

controls, layout and interaction

•Identify Vision

•Identify Projects and 

Teams

•Create Models

Envision

•Determine user needs 

from real, actual 

users

•Develop user 

personas and 

scenarios

•Investigate pain 

points in current 

system

•Investigate options 

for meeting user 

needs

•Investigate process 

tooling 

Speculate

•Organize user needs into 

Features and Feature 

Groups

•Develop multiple designs 

for Features

•Design and test Throw Away 

prototypes with real users

•Create lightweight Real 

prototypes of the best 

designs 

•Adds/Cuts on selected 

designs

•Create lightweight specs for 

development

Explore

•Write code and 

implement specs

•Test features for 

code quality 

•Test features 

against scenarios 

with real users

•Integrate with 

other Feature 

Groups and System

Adapt •Deliver product

•Pass along key 

lessons

•Celebrate

Close
OFFICE OF INFORMATION AND TECHNOLOGY

Thank you! Are there any questions? 

 

Merry Ward, Merry.Ward@va.gov 

Jonathan Nebeker, Jonathan.Nebeker@va.gov 

Brenna Long, Brenna.Long@va.gov

VA_HEALTH_INFORMATICS-L@LISTSERV.VA.GOV

29
VistA Evolution 

Program Vision and 

Associated Knowledge 

Gaps: 

HSRD Cyberseminar

3 April 2014

OIA Health Informatics: Health Solutions Management

Merry Ward, MS, PhD

VistA Evolution Research and Development Manager

Brenna Long, MS

VistA Evolution Program Specialist

Jonathan Nebeker, MD, MS

Associate Chief Medical Informatics 
OFFICE OF INFORMATION AND TECHNOLOGY

• Backup slides

31
OFFICE OF INFORMATION AND TECHNOLOGY

Description of Basic Information Objects

Object Category Description

Condition/Health Concern Traditionally called problems, this category also includes ill-defined issues and other non-medical issues 

that may be patient-specific barriers to effective healthcare.

Observation A directly observed or calculated finding. Implies a data-collection procedure that is associated with 

resources. Subtypes: 

• Quantitative — Measureable as continuous, interval, or ordered value;

• Qualitative — Expressed as categorical value.

Goal Goals have target ranges that can be ascertained as being met. Preferences help determine relative value 

of goals. Goal subtypes roughly map to healthcare stakeholders:

• Medical goals pertain to observations that the patient cannot perceive or is not a direct 

determinant of quality of life. Examples are blood pressure or cardiac risk.

• Functional goals pertain to outcomes that patients perceive and directly pertain to functional 

status and quality of life. They can also be aspirations. Examples are pain levels, maximizing 

lifespan, maximizing quality of life, and minimizing cost to patient.

• Society goals pertain to public health and public policy. Examples are herd immunity or reduction 

in healthcare expenditures.

• Payer goals are not typically considered now in the practice of medicine. The notable exception is 

readiness for duty in DoD.

• Health-system goals. Examples are minimizing costs to the system, maximizing reimbursement, or 

training clinicians.

Intervention Represent resources and activity for changing patient’s health concerns. Some interventions are 

facilitators of others.

Physiological/Psycho-social 

Effect

This is the mechanism by which interventions affect patient health and healthcare. This concept is part of 

National Drug File Reference Terminology. It helps with causal modeling of healthcare processes and links 

interventions to observations. For many displays, this object category will be hidden from the user.

32