1. Joint Interoperability Initiative of the Department of Veterans Affairs & Department of Defense Lemuel Dizon Northwestern University HIT 405 Interoperability, Standards and Integration

2. Vision Department of Defense (DoD) Military Health System (MHS) Armed Forces Health Longitudinal Application AHLTA Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Veterans Health Information System and Technology Architecture VistA AHLTAVistA Share Health Data Interoperability

3. Scenario

4. Scope of the Problem Congressional Mandate – NDAA 2008 Deadline –September 2009 Strengths Limitations Capabilities

5. VistA Architecture Application View Health Data Repository BCMA VistA Imaging VI Viewer CPOE Clinical Notes Medication, Pharmacy, Laboratory, Nursing, Diagnostics, Dietary CPRS

6. VistA Architecture Computerized Patient Record System (CPRS) Computerized Order Entry (CPOE) Bar Code Medication Administration (BCMA) VistA Imaging -image management system -multimedia data -DICOM, PACS -EKG’s, pathology images, gastroenterology(endoscopic) images, laparoscopic images, scanned paperwork

7. VistA Image

8. Architecture AHLTA System View Application Platform Entity EE Interface Consult Tracking, Order Entry, Lexicon, DEERS, Security, MPI/MPL, Immunization AP Interface People, Information Interchange, Communication

9. AHLTA Architecture Application Software Entities -Consult Tracking -Order Entry -Lexicon -Immunizations -Defense Enrollment and Eligibility Reporting System -Security -Master Patient Index/Master Patient Locator

10. AHLTA Architecture Application Program Interface Application Platform Entity External Environment Interface External Environment -People -Information Interchange -Communication

11. AHLTA Note

13. DoD/VA Integration Note

18. Standards MUMPS Massachusetts General Hospital Utility Multi-Programming System -healthcare -hierarchical database -ANSI standards X11.1-1995 -ISO standard 11756-1992 -ISO/IEC 11756-1999 language standard -ISO/IEC 15851-1999 Open MUMPS Interconnect -ISO/IEC 15852-1999 MUMPS Windowing Application Programmers Interface

19. Standards Continuity of Care Record (CCR) Continuity of Care Document (CCD) Bi-directional HL7 messages VistA communicates EMRs Mirth open source

20. Information Models

21. Interoperability Objectives VA and DoD ObjectiveDescription Refine social history dataData that describe hazardous activities and use of tobacco and alcohol Share physical exam dataPhysical exam process when separates from active duty Demonstrate initial gateway operationOperation of secure network gateways for joint health information sharing Expand questionnaires and self assessment tools Viewable to VA from DoD Expand DoD inpatient medical records system Expand to at least one additional site in each military medical department Demonstrate initial document scanningDoD to demonstrate and share with VA

22. Integration Issues Interoperability Architecture Development Programming Language Shared Standard CCR/CCD Legacy Systems of VistA Large Scale Project

23. Analysis System Architecture Not Developed Project Management Structure Not in Placed Project Management Plan Lacking

24. Recommendation Architecture for an electronic interface Select a Lead Entity Project Management Organization (PMO)

25. Conclusion & Implication Expectations: Falls short Valuable Lessons: Success Vs. Failure NHIE