Blue Button Extension - Medical Imaging Stage 1 Sprint 0 Review Session May 3, 2012

Sprint 0 Review April 23 rd to May 3 rd (9 working days) –Small Sprints lead to better planning in terms of workload per Sprint Objectives: Planning/Prep for rest of Stage 1 development –Baseline requirements and User Stories (in preparation for Sprints 1+) –Set up VMs and development/testing tool suite –Begin Prototype Specification Document 2

Sprint 0 Review (contd.) 7 User Stories (all technical, based on objectives) –Broken into 58 tasks amongst the team –100% Completion 3

Wireframes Minor updates: Changed procedure names to be more realistic Updated report thumbnail in Preview Minor updates: Changed procedure names to be more realistic Updated report thumbnail in Preview

Banner 5 The prototype banner has the same look as the current MHV banner. Differences include: Added image to banner to distinguish it from the regular site Login is supported from Home or Personal Information Only the Personal Information > Download My Data Tab is functional All other tabs on the banner, and links on Home pages are non-functional All modifications are limited to the pages within Download My Data.

Page Flow 6 My Download Request Search for My Radiology Reports and Images Available Radiology Reports and Images Preview Radiology Reports and Images After selecting the option to download radiology reports and images, the list of available reports (up to 10) is displayed. New pages are added to preview radiology reports and images. Login DOWNLOAD MY DATA (optional)

Home Page 7 Login and Download My Data are the only functional parts on this page

Personal Info Page – not logged in 8 Login is the only functional part on this page

Download My Data – My Download Request 9 New option for downloading. In the prototype, other options are not selectable. All pages have the same header and tab selections. (Not shown on other pages.)

Available Radiology Reports and Images 10 Summary of reports found. (Initial search finds the 10 most recent available radiology reports.) If either “Images & Report” or “Report Only” option is selected, the browser will prompt for what to do with the download. Each row in the table corresponds to a report and associated images. Data is downloaded directly from this page. Adjust Search timeframe. (See next slide.)

Search for My Radiology Reports and Images 11 Specify the start and end dates. Initial start date is set to oldest date displayed on previous result page. End date is set to one year after the start date.

Available Radiology Reports and Images 12 When the user specifies a search timeframe, the results are displayed with paging options (if applicable).

Preview 13 Thumbnail images are provided for each image and the report. Selecting a thumbnail displays a larger version of the image. (See next slide) Generates and downloads a PDF with all selected items. ToDo: Add page controls … for multiple images (1 of 10) Preview

Preview (contd.) 14 Selected image is displayed in larger form. Close controls at bottom of image. Img 001

Radiology Report Fields

GFI: VA Radiology Blue Button Output Fields 16 FIELDDESCRIPTION ProcedureDisplays procedure name i.e., Knee 2 views RadiologistVerifying Physician who verified and signed the report Requesting Physician Name of requesting physician ImpressionImpression text for recorded procedure (free text) ReportReport text for recorded procedure (free text) LocationFacility (Global Requirement) Date/TimeRecorded on date/time Fields to be displayed in the Blue Button output.

Sample: Blue Button Prototype Output (PDF) 17

Sample: Blue Button Radiology Report Output (Text) MY HEALTHEVET PERSONAL HEALTH INFORMATION *************CONFIDENTIAL************* Produced by the VA Blue Button Medical Imaging Prototype 11 Apr 1800 This summary is a copy of information from the Blue Button Medical Imaging prototype for your (test patient) data from the My HealtheVet Personal Health Record Blue Button feature. Your summary contains a copy of test data information from the VA Sandbox test database of VA medical records as accessed from the My HealtheVet Blue Button prototype for Medical Imaging. Name: MHVVETERAN, ONE A Date of Birth: 1 Mar RADIOLOGY REPORTS Recorded on: 11 Apr 1800 At: Washington VAMC Procedure: SPINE LUMBOSACRAL MIN 2 VIEWS Report: LUMBOSACRALSPINE Findings: This exam is compared to the exam done November 13, Since that time, the six nonrib lumbar-type vertebrae remain in near-anatomic position. There is mild anterior wedging of L1 and L3. Osteophytes are seen at L1, L2, L3, L4, L5 and L6. There is mild disk space narrowing seen at L4-L5, L5-L6 and L6-S1. Impression: Mild diffuse degenerative changes of the spine, unchanged from the previous exam. Radiologist: PROVIDER,THREE Requesting Physician: PROVIDER,ONE END MY HEALTHEVET PERSONAL HEALTH INFORMATION

Report Fields 19 BHIE Data Viewer in AHLTA Rad Report fields displayed DoD AHLTA Rad Report fields displayed VA CPRS Rad Report fields displayed Proposed Blue Button Medical Imaging Prototype Output Rad Report fields to display Facility NameFacility At (refers to location) Exam Date/TimeEvent Date Exam Date/Time Recorded on (refers to date/time) Procedure nameProcedure Procedure Name Procedure Reason for Order Reason for Study Exam Number Transcription Date/Time Provider (ordering) Requesting Physician Result Code (normal, abnormal) Report StatusStatus Clinical History Impression Report (includes Impression) Report Text ("Impression") Report (can include dues "Findings" and "Technique") Report Interpreted By Approved By Radiologist Approved Date/Time

System Design Key diagrams from in-progress SDD: Application Context High Level Application Design Hardware Architecture Software Architecture Software Detailed Design Key diagrams from in-progress SDD: Application Context High Level Application Design Hardware Architecture Software Architecture Software Detailed Design

Conceptual Design Application Context Highlights BBMI’s external interfaces Note: as a standalone prototype, no direct i/f with MHV data 21

Conceptual Design High Level Application Design Identifies major components and relationships 22

System Architecture “Hardware” Architecture Virtual machines within VA Innovations Sandbox 23

System Architecture Software Architecture Overall system software and organization 24

Detailed Design Software Detailed Design Identifies major software components Will be expanded through Agile development 25

26 Back-up Slides

Stage 1 – Sequence – Download Report 27

Stage 1 – Sequence – Download Images 28

29  Makes transition from Stage 1’s physical portability to electronic portability by providing a full-capability solution that demonstrates a Veteran’s ability to select and securely share their full resolution (DICOM) chest x-ray images and accompanying radiology reports with external caregivers via through Direct secure messaging service and the Large File Image transfer (LiFT) Service  Reports are small enough to be packaged within the , but LiFT allows a secure link to a cache image for when the provider decides to download the DICOM image (instead of automatically uploading it in their inbox message and clogging their network) Technical Approach: Stage 2 (last 6 months)