1. Project AViVA A Web-Based Electronic Health Record Based on Apollo, MDWS, and VistA March 8, 2010 Peter L. Levin Senior Advisor to the Secretary & Chief Technology Officer US Department of Veterans Affairs 1

2. VA’s Healthcare IT Challenges: Burdensome maintenance and oversight: –VA maintains VistA on tens of thousands of computers –VistA upgrades are hard to deploy –Difficult to enhance or respond to regulatory changes –Hard to find knowledgeable staff in outdated 20+ technology Customized exchanges between complex systems: –Information exchange is impeded by proprietary platforms 2

3. Inadequate user interface: –VistA permits only sequential views of records –Information is location-based rather than patient-based Requires extensive user training: – Current menus and commands are not intuitive Outdated programming environments: –MUMPS and Delphi are highly specialized and rarely used –Monolithic, not modular, not component based –No standards 3 VA’s Healthcare IT Challenges (cont’d)

4. How do we overcome these challenges? By building a system that can… − be easily understood by a variety of users − can easily scale with our Veteran population − accommodate multiple development teams − achieve a high standard for availability and reliability − integrate electronic records from multiple sources These are the design specifications for AViVA 4

5. AViVA Benefit : Web Based Deploy in a single location instead of 150,000 Easier bug fixes Faster release cycles Modular platform leads to better extensibility Higher quality of care from more meaningful display of data. Higher quality of care from more meaningful display of data. 5

6. AViVA Benefit: Data Access Data is immediately available from all networked repositories (VA, DoD, NHIN, etc) A complete record is provided proactively Training time is significantly reduced 6 Secure access to longitudinal data from a variety of disparate resources Secure access to longitudinal data from a variety of disparate resources

7. AViVA Benefit: Scalable and Reusable AViVA is scalable –low marginal cost to grow user and patient population AViVA is modular –easy to update component capability or extend use models AViVA is efficient –its data access methods can be reused in any application AViVA is current –it’s built on modern programming languages and frameworks 7 Promotes innovation, wider use, larger impact

8. AViVA: A Platform for Refactoring VistA Provides a methodology to systematically migrate VistA to a more modular architecture Standards Based: –NHIN, HL7, DICOM, SNOMED Web-based: fix once, deploy everywhere 8 A method to migrate VistA to a standards-based and web-enabled platform A method to migrate VistA to a standards-based and web-enabled platform

9. AViVA Roadmap Open-architecture/standards-based/NHIN-compliant by design VISTAVISTA MDWSMDWS WEBSERVERWEBSERVER APOLLOAPOLLO BROKAHBROKAH WEBSERVERWEBSERVER Nationwide Health Information Network Components from ANOTHA can be attached to BROKAH or even directly to VISTA ANOTHAANOTHA

10. Current Status AViVA working prototype delivered on Jan 4 Web based Access to VA and DoD data Scalable and reusable foundation New search functionality not available in VistA Project Management and Accountability System (PMAS) approved 10