Opening slide 3:00 PM, EST

Welcome to the OSEHRA Innovation Webinar VA-PALS Project Overview Ricardo Avila CEO Paraxial, LLC Opening slide Frederick D.S. Marshall Executive Director VISTA Expertise Network

VA Partnership to Increase Access to Lung Screening Project PI: Drew Moghanaki, MD, MPH Clinical co-PI: Claudia Henschke, PhD, MD Technical co-PI: Rick Avila, MS Sponsored by the Bristol-Myers Squibb Foundation and the VA Office of Rural Health

Lung Cancer

Low Dose CT Lung Cancer Screening Since 2015: Annual Low Dose CT Screening is Reimbursed For Those at High Risk

Lung Cancer Screening Benefit Late-Stage Lung Cancer Early Lung Cancer 5mm Squamous Cell Carcinoma [R. Gottlieb, Roswell Park Cancer Institute] [Dr. Javier Zulueta, University of Navarra] ~5% five year survival ~85% five year survival

Main Objectives Implementation Introduce the IELCAP management system at 10 VA medical centers Supported by VA Office of Rural Health & VA Quality Enhancement Research Initiative Quality Assurance Establish a centralized QA program for LDCT interpretations Supported by VA National Radiology Program Research Evaluation Does the IELCAP system cause a stage shift within VA? IRB approved at Richmond VAMC

Main Software Components Lung Cancer Screening Management Integrate I-ELCAP Management System in VistA CPRS Web Interface High Risk Population Extraction Performance Reporting and Dashboard Quality Assurance Systems Including Unit Testing, Documentation, Regulations…

VA-PALS IT Team

OSEHRA Webinar VA-PALS Project Technical Overview Rick Marshall VA-PALS · Vista Expertise Network Opening slide

Vista Expertise Network Mission VA-PALS Mission to increase access to safe and effective lung screening programs that save lives Vista Expertise Network Mission to improve people’s health by changing the way medical software is developed, distributed, and supported Opening slide

1 · VA-PALS & The Golden Pair Software engineering driven by medical science & practice.   The importance of: I-ELCAP & Mt. Sinai (http://ielcap.org) VA Office of Rural Health (https://www.ruralhealth.va.gov) VAs Phoenix, Houston, & the VA Beta Test Sites Future VA & Non-VA Software Users Immersing software engineers in the medical science. Opening slide

2 · VA-PALS & I-ELCAP Functional Goals Implement I-ELCAP Protocols for: 1. Screening: find patients w/early-stage lung cancer 2. Treatment: support specialized treatment 3. Research: support improvement of I-ELCAP protocols 4. Quality Assurance: verify VA-PALS is meeting its goals Rich streams of computable data needed. Integration w/VA clinical workflows. Introduction of workflow for new ELCAP Coordinator. Codeset standardization to support data aggregation. Opening slide

3 · VA-PALS Project: Three Years Year One: I-ELCAP system v17.0 at Phoenix & Houston Vista ELCAP v18.0 system developed OSEHRA Certification Deployment at Phoenix & Houston Year Two: Vista ELCAP v19.0 system developed Deployment at 10–11 VA sites Year Three: national rollout Maintenance, training, & support Opening slide

Screening Applications Management - IELCAP (SAMI) v18 4 · Vista ELCAP: Year One Screening Applications Management - IELCAP (SAMI) v18 1. Re-engineering I-ELCAP inside Vista 2. Integrating I-ELCAP protocols w/Vista Workflow 3. Web & mobile UIs atop our own Vista files & routines: Light HTML-first, Javascript-second architecture Heavier Javascript-first, HTML-second architecture 4. CPRS, Registration, Scheduling, et al 5. Dialog mode & silent mode for testing & for other uis 6. Engineering infrastructure & Standards compliance Opening slide

5 · VA-PALS & Modern Vista Development Future-proofing: application, system, & user interfaces Data Interchange: standardizing terminology Modern, readable, sustainable programming style Version control: Git, KIDS, & support tools Unit tests: M-Unit Performance metrics: M-Meter OSEHRA: community-facing development VA-PALS working group: user-driven development Opening slide

6 · VA-PALS & Standards Compliance VA agile software-lifecycle policy: VIP Database administration (DBA) & integration (DBIA) rules VA & IHS programming standards & conventions (SAC) Privacy & security rules 508 Compliance Documentation Standards VA Architecture Guidelines OSEHRA Certification Opening slide

Questions? Opening slide

Thank You! rick.marshall@vistaexpertise.net 819 North 49th Street, Suite 203 Seattle, Washington 98103 1-206-465-5765 Opening slide

Thank You for Attending the OSEHRA Innovation Webinar! Join us for a special October 3rd Webinar in conjunction with National Health IT Week: Open Source Tools for Electronic Clinical Quality Measures Presenters: David Hill Principal Software Systems Engineer The MITRE Corporation Peter Li Director of Engineering and Infrastructure OSEHRA