Name of Organization: ___________________________________________________________ Physical Address of Organization: _______________________________________________________ Primary POC: _____________________________ Telephone: ________________________________ Requirements # Readiness Survey Question Partner Answer Does your organization collect patients’ Social Security Number (SSN)? VA collects Social Security Number (SSN) and uses this trait as its primary identity matching trait. If yes, will you send the full SSN as an identity matching trait in the Patient Discovery (PD) message? VA currently sends the following traits to its partners to be used in identity matching: SSN Name: first, middle, and last name Gender Date of Birth Address (Address, City, State, Zip) Phone Number If No, do at 50% of patients in your Master Patient Index (MPI) have a full SSN that will be sent in the Patient Discovery Message? VA has found that organizations that do not send a full SSN (9 digits without dashes) in the PD message will have a 20% chance of matching patients with the VA. Organizations sending the full SSN in the PD message increase the patient matching probability to 90% or greater. The VA cannot guarantee acceptance of a partner that cannot send a full SSN in the PD message along with First Name, Last Name, Date Of Birth, and Gender as matching traits. Yes (Collect SSN) No Yes (Send full SSN) No How many patients are currently in your MPI?
At the time of “go-live” with VA indicate in the below the content modules you will be populating in production, when sending a C32 to the VA. # Content Module Sent by VA to Partner if Available Displayable by VA if sent by Partner Available from Your Organization Advance Directive N N Allergy / Drug Sensitivity Y Y Comment Y Y Condition /Problem Y Y Encounter Y Y 5a. Contains Inpatient Entries N Y 5b. Contains Outpatient Entries Y Y Healthcare Provider Y Y Immunization Y Y Information Source Y Y Insurance Provider N N Language Spoken N Y Medication – Prescription and Non-Prescription Y Y 11a. Contains Inpatient Medication Entries N Y 11b. Contains Outpatient Medication Entries Y Y 11c. Contains Self-Reported (e.g. OTC) Medication Entries Y Y Person Information Y Y Plan of Care N N Pregnancy N N Procedure Y Y Support Y Y Vital Sign Y Y Results (Chemistry/Hematology) Y Y # Readiness Survey Question Partner Answer 10. Will your organization send C62s? Will send C62s to VA
Title: VLER Health Partner Integration Manager Email: Curtus.browning@va.gov Phone: 919-201-3272 Phone: 3. Please provide the test outage alerts of contact for eHealth Exchange: Primary Secondary Name: David Seitz Title: VLER Health Partner Integration Project Manager Email: Phone: Primary Name: Title: Email: Phone: Secondary Name: Title: Email: Phone: 4. Please provide the production outage alerts of contact for eHealth Exchange: Primary Secondary Name: David Seitz Title: VLER Health Partner Integration Project Manager Email: Phone: Primary Name: Title: Email: Phone: Secondary Name: Title: 5. Please provide clinical data (CCD content) point of contact: Name: Omar Bouhaddou Title: VLER Health Business Analyst Email: omar.bouhaddou@va.gov Phone: 858-832-1310 Name: Title: Phone: 6. Please provide identity management and patient matching point of contact: Name: Kimberly Womack Name: Title:
Complete and pass eHealth Exchange Participant Testing with CCHIT Acquire Certificate Enter production OID and endpoints in production UDDI Yes, VA onboarded in 2009 2. Have you signed the Data Use and Reciprocal Support Agreement If not, when is that scheduled to Yes, VA signed the DURSA in 2009. Yes No (Not yet signed) Expected signing: 3. Which version of the specifications have you or will you certify your HIE on? VA is certified on the 2010 specifications with the plan to certify on the 2011 specifications mid to late 2014. 2010 2011 Both 4. If you are certifying or will certify on 2010 specifications, when do you plan on upgrading to 2011 specifications? VA upgrade is planned for mid to late 2014. Date upgrade planned: 5. Does your organization own your OIDs? If not, who owns it? Yes, the VA owns its OIDs. Yes No If no, who: 6. Has your organization registered your OIDS/endpoints in the HealtheWay Test UDDI and Production UDDI? Yes, VA has registered its OIDs and end points in the HealtheWay Test UDDI and Production UDDI Registered in HealtheWay Test UDDI? Yes No Registered in HealtheWay Production UDDI? Yes No Consent Model/Policies of Organization # Readiness Survey Question Partner Answer Consent Model/Policies 1. If you use the ‘Opt-in” Consent model, what are the current and