“Medically Ready Force…Ready Medical Force” Use of the LOINC Document Ontology with the DoD Military Health System Ms. Nancy OrvisMHS Director Business Architecture, Standards, and Interoperability Mr. Russell OttDeloitte Consulting September 3,

“Medically Ready Force…Ready Medical Force” What is the Health Artifact and Image Management Solution (HAIMS)? Provides Department of Defense (DoD) and Department of Veterans Affairs (VA) health care providers global visibility and access to artifacts and images (A&I) generated during the health care delivery process Integrates with DoD’s current electronic health record (EHR) and supports the exchange of A&I with the Department of Veterans Health Administration (VHA) – As of 2 Dec 2013, HAIMS/VHA interface had shared over 26,345 A&I Designated as the system of record to store the digitized Service Treatment Record (STR) upon service member separation, and make it electronically retrievable by the Veterans Benefits Administration (VBA) – As of June 2014, 60,000 STRs made available to the VA via HAIMS repository MHS has 9.6M beneficiaries potentially served by HAIMS – All Active Duty and recently separated Active Duty personnel will have their legal health record stored in HAIMS 2

“Medically Ready Force…Ready Medical Force” HAIMS DocTypes: Current State HAIMS is an aggregator of information and hub for data sharing. – Some content is locally stored within HAIMS – Some content is stored as a metadata reference to other systems (e.g., PACS) Strategic direction is to attempt to standardize our Document Type framework using the LOINC Document Ontology and encourage other provider organizations to do the same. HAIMS Document Type schema: – 98 total current Document Types 56 Codes from LOINC Document Ontology 32 LOINC codes not in the Ontology 10 DoD-specific codes 3

“Medically Ready Force…Ready Medical Force” Addition of Reserve documents The Army Reserve has its own documentation repository Recently we performed a mapping effort to the LOINC Document Ontology with the following results: Started with 150 unique forms Mapped down to 37 Document Types – 25 Codes from LOINC Document Ontology – 10 LOINC codes not in the Ontology – 2 Concepts where LOINC codes need to be requested – 0 MHS-specific codes (with examples) 4

“Medically Ready Force…Ready Medical Force” Requests for LOINC Clinical Committee Add new LOINC codes Add specified LOINC codes into the Document Ontology 5 HAIMS Description Summary - Profile Encounter Note - E&M of Tuberculosis HAIMS DescriptionLOINC CodeLOINC Long Description Dental - X-ray Dental X-rays and other images (not DICOM) Encounter Note - Immunization History of immunization Narrative Encounter Note - Occupational Exposure History of occupational exposure Narrative Encounter Note - Transfusions History of blood transfusion Narrative Procedure Note - EEG EEG study Procedure Note - EKG EKG study Procedure Note - Gynecologic Cytology Cytology Cervical or vaginal smear or scraping study Procedure Note - Laboratory Laboratory report Procedure Note - Pathology Pathology Procedure Note Procedure Note - Spirometry Spirometry study

“Medically Ready Force…Ready Medical Force” Next Steps DoD is planning to perform a full review of LOINC codes in use within HAIMS and present additional requests at the next Clinical Committee Meeting – Specific focus is the 32 LOINC codes not in the Ontology and the 10 DoD-specific codes 6

“Medically Ready Force…Ready Medical Force” Questions/Discussion 7 Nancy Russell