1. 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

2. 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)

3. 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

4. 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 ( __) -- 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)

5. 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

8. 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

10. 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

11. 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

12. 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

13. VistA to HealtheVet (incl. HealtheVet –VistA)
VistA Legacy (Maintenance/Enhancement until “Retirement”) [Current – 2005]
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) ( )
Scheduling
High Performance Workforce
Pharmacy
Laboratory

14. 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

15. 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

16. 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

18. ---------------------
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)

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. Back-up Slides

28. 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.