Future HealtheVet-VistA Future HealthePeople-VistA Current VistA Future HealtheVet-VistA Future HealthePeople-VistA Presentation to the Information Systems Advisory Committee Gary A. Christopherson, Senior Advisor to Under Secretary Robert M. Kolodner, M.D., Acting VHA CIO Veterans Health Administration, Department of Veterans Affairs

health information system, “VHA’s integrated health information system, including its framework for using performance measures to improve quality, is considered one of the best in the nation.” Institute of Medicine (IOM) Report, Leadership by Example: Coordinating Government Roles in Improving Health Care Quality (2002)

Success in supporting health delivery for millions of veterans VistA/CPRS was & is a success Built by “fire” of VHA collaboration Publicly owned by VA; could be for future as well Strong interest by public/private in using VistA Largest integrated health info system for nation’s largest integrated health system Helps serve 4.1 million American veterans annually Supports: $23+ billion nationwide health system 1,300 care sites, incl. 163 hospitals & 800+ community & facility based clinics 180,000 health care staff; 85,000 trainees Considered best overall health information system

Nationally integrated outpatient & inpatient information system Mostly developed & owned by VA (publicly owned) Began as Decentralized Hospital Computer Program (DHCP; 1980s) Transformed into VistA (1990s) Next generation VistA (2002-20__) -- Includes HealtheVet-VistA on improved platform using modern tools & languages following enterprise architecture National software w/ local flexibility/innovation: Innovation developed locally & enterprise wide Standard packages distributed enterprise wide, e.g. latest version of CPRS (January 2002)

VISTA INFORMATION SYSTEM Sites of Care Clinics Hospitals Nursing Homes CLINICAL PATIENT RECORD VISTA SOFTWARE PACKAGES VOLUNTARY SERVICE REHAB MEDICINE ACCOUNTS RECEIVABLE LIBRARY VistA IMAGING MEDICAL RECORDS NURSING ADMISSION DISCHARGE TRANSFER TRACKING INTEGRATED DATABASE RADIOLOGY PERSONS PATIENT FUNDS BLOOD BANK PATIENTS PROBLEM LIST DRUGS RPC BROKER SOCIAL WORK MAILMAN LABORATORY COMPUTERIZED PATIENT RECORD SYSTEM (CPRS) DEVICE MENTAL HEALTH TASK MANAGER WARDS KERNEL DENTAL MANAGER LAB RESULTS USER ENGINEERING MENU MANAGER SURGERY SECURITY VA FILEMAN ONCOLOGY HEALTH SUMMARY BAR CODE MEDICATION ADMINISTRATION PRESCRIPTIONS INVENTORY DIETETICS INPATIENT PHARMACY IMAGES TEXT INTEGRATION UTILITIES (TIU) MEDICINE WOMEN’S HEALTH OUTPATIENT PHARMACY MEDICAL CARE COST RECOVERY INTEGRATED FUNDS CONTROL ACCOUNTING & PROCUREMENT SCHED-ULING Sites of Care Clinics Hospitals Nursing Homes Domiciliaries Home/Workplace CONSULTS / RESULT TRACKING AUTHORIZATION SUBSCRIPTION UTILITY (ASU) CLINICAL REMINDERS VISTA INFORMATION SYSTEM

VistA - Why change? Not lose functionality we have Strengthen VistA Move to person & data focus Move to standardized, fully sharable health data Modernize & replace older systems Ensure documentation on application programs Move to modern technologies Increase flexibility to respond to future health needs Lower cost of maintenance Support our future health system

Dimensions of complexity Scope – home, clinic, hospital, nursing home Functionality – highest & growing Oversight – VA, OMB, Congress, VSO, etc Partners – VA, VHA, Other Fed, Other Public, Private HealtheVet Strategy HealthePeople Strategy Size – $23+B (health care) & $1B (IT) annually Veterans served – over 4 million annually Sites of care – over 1,300 nationwide Resources – 180+k staff + contractors Data element & standards - many

Maximize Veterans Health/Ability & Satisfaction BP/ Ideal H&IT Population Based [community, VISN, nation] Care Coordination Person Based Care Coordination Ambula- tory care Inpatient care Nursing home care Community care Status – Well, Acute Illness, Chronic Illness, Custodial Episode Based Domicili- ary care eHealth Max Health/Ability Max Satisfaction Max Accessibility Max Affordability Max Quality VA Health System – Best Practices & Ideal

HealtheVet – strategy overview Moves from facility-centric to person/data-centric Uses national, person-focused health data repository for production & management/analysis/research Builds on, enhances & utilizes VistA Moves from legacy VistA to HealtheVet-Vista Uses best, appropriate modern technology Programming, software, hardware, networking Moves “core” applications to run “enterprise-wide” Standardizes core data & communications Enhances the five major systems Regis./eligibility/enrollment, health data, provider, management/ financial, “e” commun./transactions Enhances cross-cutting Security/privacy, architecture, data quality/standards, infrastructure, enterprise system/resources management

VistA to HealtheVet (incl. HealtheVet –VistA) VistA Legacy (Maintenance/Enhancement until “Retirement”) [Current – 2005] ... 2000 2001 2002 2003 2004 2005 2006 2007 Enterprise Architecture Strong Project Management VistA Imaging Fee Billing High Performance Network/Infrastructure Secure systems/infrastructure Health Data Repository HealtheVet-VistA (Person/Data-Centric Next Generation VistA) (2005- ) Scheduling High Performance Workforce Pharmacy Laboratory

HealtheVet (Veterans health info system, including VistA) OneVA [VBA, NCA, Staff Offices] My HealtheVet [virtual health record] Veteran Input & Output Information & Education System (“e” communications/transactions) Registration, Enrollment & Eligibility System (input/output) Health Provider System (input/output) Registration, Enrollment, Eligibility Database [OneVA/Health] Health Data Repository [Health] Health Data System (input/output) Non-VA Health & Information Environment Security Architecture Data Quality Infrastructure Financial Database [OneVA/Health] Management & Financial System (input/output) Support resources for person Decision/learning support for provider

NextGeneration HealtheVet-VistA - High Performance Info System Components/Links/Standards Outside health organizations VA organizations IE My HealtheVet S S [web site, virtual health record, trusted information, self - reported information, IE IE link to other health “e” communications/ transactions providers] S S S Registration, Enrollment Management & & Eligibility System Financial System Health Provider (including clinical Interface) & Data System Database/ Standards S S Database/ Standards Database/ Standards S S S Enrollment System Laboratory System Pharmacy System Radiology System Scheduling System Blood System Billing System Provider Payment System EHR

My HealtheVet / My HealthePeople Other health organi-zations Electronic Health Record System My HealtheVet / HealthePeople [Personal Health Record System] “health in a box” on PC and/or web site via community, health, non-health, government Software & Hardware Database/ Standards Health Record Access to health records Sharing health records Self-entered health record Services Checking/filling prescriptions Checking/confirming/making appointments Checking/paying co-payments Participating in support groups Health decision support Health self-assessment Messaging with health provider Diagnostic/therapeutic tools Reminders “Checking in” Safety services/tools Links to other health sites Information Trusted information S S Person S S Primary health provider Electronic Health Record System (e.g. VistA) Software & Hardware Database/ Standards

--------------------- Improved health & “paperless” Standards Data Communications --------------------- Health Info Systems Electronic Health Records Systems (EHRs) Personal Health Record Systems (PHRs) Info Exchange Adoption by health organizations & persons of affordable, high quality & standards-based EHRs, PHRs & Health Info Exchange Improved Health Paperless (IOM) 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Toward standards & high performance info systems VA push EHRs, PHRs, Health Information Exchange & Standards in Federal and nationwide EHRs – VA Current -- VistA electronic health record system Next generation -- HealtheVet-VistA Public version -- HealthePeople-VistA PHRs – VA My HealtheVet Health Information Exchange (IE) – VA Federal Health Information Exchange with DoD Electronic Health Records Interoperability (HealthePeople (Federal) with DoD Standards – VA Adoption of VA-wide standards Adoption of standards between VA and DoD and VA and IHS Consolidated Health Informatics

Toward standards & high performance info systems EHRs – Provide financial incentives Strongly encourage private sector vendors to make available affordable, high quality, standards-based EHRs Strongly encourage provider-based efforts like AAFP Continue to improve HealthePeople-VistA & make available PHRs – Strongly encourage public/private sector to work together to develop & make available PHRs for persons Health Information Exchange (IE) – Strongly encourage public & private sector to work together to develop & make available national “exchange” solution Standards – Consolidated Health Informatics as federal leadership Strongly encourage public/private development/adoption of national standards

Population/ Community HealthePeople Virtual Health System - EHRs, PHRs, Health Info Exchange (IE) & Standards (S) Population/ Community Health provider ElectronicHealth Record Systems (EHR) IE S Person Non health org Personal Health Record Systems (PHR) Person S IE S IE Elec-tronic Systems IE S Other health org EHRs & Other Health Info Systems

IE S S IE IE S S S S S S S S HealthePeople - EHRs, PHRs, Health Info Exchange & Standards PHR (e.g., My HealthePeople) [web site, virtual health record, trusted information, self reported information, link to other health providers] IE S S Outside health organizations w/ EHRs IE IE “e” communications/ transactions S S S Registration, Enrollment Management & & Eligibility System Financial System Health Provider (including clinical Interface) & Data System Database/ Standards S S Database/ Standards Database/ Standards S S S Enrollment System Laboratory System Pharmacy System Radiology System Scheduling System Blood System Billing System Provider Payment System EHR

Personal Health Record Systems (PHR) Personal Health Record Systems (PHR) (e.g. My HealthePeople) Electronic Health Record Systems (EHR) Personal Health Record Systems (PHR) Health providers Person (home) P Health Record Access to health records Share health records Self-entered health record Services Check/fill prescriptions Check/confirm/make appointments Check/pay co-payments Participate in support groups Health decision support Health self-assessment Message with health provider Diagnostic/therapeutic tools Reminders “Check in” Safety services/tools Links to other health sites Information Trusted information IE IE P P P P IE IE EHRs & Other Health Info Systems Elec- tronic Systems Person (provider sponsored) P Person (external service) IE A&A Person ID P – Person IE – Internet-based exchange, including components below EHR – High function & interoperable Person Health ID – a) Voluntary or b) Provider Assigned (Bilateral) A&A – Authorization & authentication controlled by person Interface – Capability for exchange (send & receive/use Search – Search tool for finding records held by persons/organizations S [HL7] Inter-face Search

HealthePeople Virtual Health System - Health Info Exchange (IE) Bilateral Multilateral Electronic Health Record Systems (EHR) Personal Health Record Systems (PHR) Electronic Health Record Systems (EHR) Health providers Person Primary health provider P IE IE A&A P IE Personal Health Record Systems (PHR) Person P P P P P IE IE IE IE P EHRs & Other Health Info Systems EHRs & Other Health Info Systems Other health org Other health org P Non-health org Elec- tronic Systems IE P – Person IE – Internet-based exchange, including components below EHR – High function & interoperable Person Health ID – a) Voluntary or b) Provider Assigned (Bilateral) A&A – Authorization & authentication controlled by person Interface – Capability for exchange (send & receive/use Search – Search tool for finding records held by persons/organizations A&A Person ID S [HL7] Inter-face Search

Health Information Standards Development/Adoption NCVHS – Strongly encourages development/adoption of standards in public & private sectors Standards Development Organizations – Many efforts underway to develop standards Federal Agencies – VA, DoD & IHS agree individually to standardize VA/DoD & VA/IHS agree to standardize across agencies Consolidated Health Informatics – Joint effort led by HHS, VA & DoD 1st five standards adopted Working on total of 24 domains, incl. 6 active workgroups

National standards & high performance systems Convergence VA, DoD, IHS individual/joint adoption National -- Public/Private Individual (e.g. Kaiser Permanente) Joint (Connect. Health, eHealth, NCVHS, SDOs, …) HealthePeople(Fed) HealthePeople Consolidated Health Informatics (CHI) Improved Health Via National Health Information Standards Info Exchange / Sharing High Performance Health Info Systems Personal Health Record Systems Systems Standards Health Information Convergence DoD CHCS II IHS (to HealthePeople-VistA) Public/Private (CMS, VA, AHRQ, NHII, AAFP, health providers, payers, regulators, private sector vendors, persons/consumers) HealthePeople(Fed) HealthePeople VA HealtheVet/HealthePeople-VistA 2001 2010

Back-up Slides

Terms HealtheVet – VHA effort to modernize & enhance its current information system, incl. enhanced CPRS, health data repository, scheduling, billing, fee, VistA imaging, pharmacy, laboratory, “My HealtheVet”. HealtheVet-VistA is the name for the next generation of VistA. HealthePeople – joint efforts with other federal, public & private sector organizations with respect to national standards, high performance systems & sharing information (when appropriate/authorized). HealthePeople-VistA is the name for VistA when it used outside VA. HealthePeople (Federal) – joint efforts by VA, DoD & HHS/IHS with respect to data standardization, joint build/procurement, sharing software & potential software convergence.