1. VA Design Patterns Briefing and VistA Evolution Update: Questions and Answers

2. Question: Would like to get more information on HSPC and the specs that they have discussed. Answer: For more information on HSPC, please contact Reggie Humphries (Reginald.Humphries@va.gov), 540-969-9410.Reginald.Humphries@va.gov

3. VA Design Patterns Briefing and VistA Evolution Update: Questions and Answers Question: What does “Enterprise-wide secure FileMan access expand/enhance single character use,” mean? Answer: FileMan security would be enhanced in such a manner as to provide tiered capabilities / access or introduce additional limitations beyond the single key currently used. Question: In Enterprise Fileman, when you do updates to a database, how do you detect and mitigate deadlock in the distributed database? Because Database 101 says it will be there. Answer: There are several options being discussed at this time. Additionally VA will plan to solicit feedback regarding the best way to do this. Question: Is there a possibility that UNICODE will be used in the future FILEMAN database?? Today only ASCII is used. Answer: At the time of this writing, UNICODE utilization has not been discussed; that is not to say that it may not come up in the future. This work is still fairly early in the design and requirements phases.

4. VA Design Patterns Briefing and VistA Evolution Update: Questions and Answers Question: Has anyone talked with IBM about the similarities between the underlying Vista database structure and IBM’s flagship database VSAM? From my experience with both, they look very similar. If an architecture could be devised that made them work together, a world of software, security, hardware, flexibility and programmers would become available to the VA using the existing underlying data and software. Answer: At the time of this writing a request for information is being developed and will be released to anyone interested for review and comment. All perspective vendors may reply with their suggestions. An extensive analysis comparing VistA's database structures to any proprietary database structures has not yet been conducted. VA favors vendor neutral solutions although VA remains open to proprietary options if they are advantageous and cost-effective. The acquisition process is just starting; VA acknowledges your suggestion, indicating that you feel this option should be considered as part of the acquisition phase, determining the appropriateness of a purchase versus build discussion.

5. VA Design Patterns Briefing and VistA Evolution Update: Questions and Answers Question: What effect will the VistA Evolution work have on the future Innovation projects from VHA? Answer: The VistA Evolution Program will oversee the transformation of VistA so that it adheres to a Service- Oriented Architecture design pattern. This result in a vendor-agnostic technology platform that is highly responsive to changing clinical needs: new functionality can be added as new services, old functionality can be changed by modifying or replacing existing services. Other applications will connect through middle-tier components, such as VistA Exchange, which will themselves appear as services. They, in turn, will reach down to patient-related information, such as that accessible through Enterprise FileMan, VA eHealth Exchange, the outpatient-appointment scheduling system, and DoD. These enhancements will allow Veterans to access their health data quickly and easily from a wide variety of devices.

6. VA Design Patterns Briefing and VistA Evolution Update: Questions and Answers Question: Is it the VA’s intent to adopt or support a common, open standard such as FHIR (Fast Healthcare Interoperability Resources) to interoperate with external partners via web services? Answer: FHIR is not yet part of the DoD/VA Target HSP, nor a Nationally-approved standard. However, the DoD/VA interoperability approach has proactively adopted Consolidated Clinical Document Architecture (CCDA) for external exchanges and HL7’s Fast Healthcare Interoperability Resources (FHIR) standard for real- time, dynamic DoD/VA exchanges. These information model standards will define specific XML and JSON formats for health data. This will allow both parties to bi-directionally translate their local representations to the common format. VA will continue to work with DoD, as well as outside Standards Development Organizations, to incorporate emerging standards within OneVA enterprise architecture, as well as drive the their adoption as nationally recognized health data standards. Please note that eHMP has FHIR APIs that can be used to pull data out of VistA Exchange for interoperability.

7. VA Design Patterns Briefing and VistA Evolution Update: Questions and Answers Question: Who is the Point-of-Contact with work with the eMI Sandbox to test/prototype new applications? Answer: Sandbox development work is being handled through HSPC. For more information on HSPC, please contact Reggie Humphries (Reginald.Humphries@va.gov), 540-969-9410.

8. VA Design Patterns Briefing and VistA Evolution Update: Questions and Answers Question: How do you plan on building security within Open Source VistA? Answer: Legacy VistA is reliant upon VistA logon capabilities to maintain system security. As VistA migrates to a Service Oriented Architecture, responsibility for Authentication and Authorization will migrate to the eMI. In the case of VA, Single Sign On capability will be provided by VA’s Identity and Access Management (IAM) service, while authorizations will be maintained within the eMI itself. In the case of Open Source VistA, this same architecture will be implemented. While VA is using a proprietary product as its eMI, Open Source VistA will have the capability of using proprietary, or open source, messaging infrastructures to provide the same capability. Note that this refers to a desired end-state; the business rules for eMI to enforce authorization on requests have yet to be developed. Until these rules are developed, authorization, enforced by existing access logic, will reside within VistA.

9. VA Design Patterns Briefing and VistA Evolution Update: Questions and Answers Question: How do you see VistA Open Source integration with the new DoD System? No drop-in service? eHMP? Answer: Vista 4 will rely on its open source code base, open architecture, and adherence to open standards (as contained in the DoD/VA Health Standards Profile), when possible, to interface with DoD, as well as other industry partners. eHMP will eventually replace the Computerized Patient Record System (CPRS) as VA’s primary point of care application to show information in a single view, which will allow clinicians to use comprehensive patient data and images more easily. The middle tier components of eHMP will allow for federation of a complete enterprise Virtual Patient Record (eVPR), which contains all available patient data from exchange partners, such as DoD.