1. DoD and Veterans Affairs: Health Information Interoperability Joint Venture Conference February 2006

2. 1 Topics Path to Interoperability Federal Health Information Exchange (FHIE) Pre- and Post-Deployment Health Assessments Bidirectional Health Information Exchange (BHIE) Clinical Data Repository/Health Data Repository (CHDR) Laboratory Data Sharing Initiative (LDSI) Site Implementation Considerations BHIE/CHDR Interface Other Initiatives Summary

3. 2 BHIE 2-way Local exchange Text data Real-time FHIE 1-way Enterprise exchange Text data CHDR 2-way Enterprise exchange Computable data Real-time BHIE Bidirectional Health Information Exchange FHIE Federal Health Information Exchange CHDR Clinical Data Repository/ Health Data Repository The Path to Interoperability Interoperable Electronic Health Records

4. 3 Federal Health Information Exchange Supports monthly, 1-time transfer of electronic health information from DoD to VA at the point of a Service member’s separation One-way, enterprise exchange of text data

5. 4 Federal Health Information Exchange 3.27 million unique patients 45 million lab results 7.19 million radiology reports 45.2 million pharmacy records 41.8 million standard ambulatory data records Over 2 million separated Service members have presented to the VA ~2,700 messages transmitted daily in Dec 05 on VA patients treated by DoD under local sharing agreements As of 31 January 2006

6. 5 Pre-/Post-Deployment Health Assessments Enables VA health care providers to access pre- and post-deployment health assessments on separated Service members

7. 6 Pre-/Post-Deployment Health Assessments Assessments transferred from DoD to Federal Health Information Exchange data repository Historical data pull of 400,000 assessments completed July 2005 Monthly data transfer started in September 2005 More than 515,000 assessments available on more than 266,000 individuals VA began retrieving the data in December 2005 DoD plans to add post-deployment health reassessments in fiscal year 2006

8. 7 Bidirectional Health Information Exchange Enables real-time sharing of electronic health information between DoD and VA for shared patients Two-way, BHIE sites and all of VA exchange of text data

9. 8 Bidirectional Health Information Exchange Allergy, outpatient pharmacy, demographic, laboratory, and radiology data 3,124 FHIE-BHIE queries/week (Jun–Dec 2005) Data from DoD BHIE sites available to all VA sites Deployment to additional sites in fiscal year 2006

10. 9 BHIE Sites Mike O’Callaghan Federal Hospital Madigan AMC NMC San Diego Eisenhower AMC William Beaumont AMC David Grant Medical Center Landstuhl RMC Brooke AMC Darnall ACH NH Great Lakes NH Camp Lejeune NH Charleston Womack AMC NH Camp Pendleton Tripler AMC BHIE operational National Capital Area BHIE implementation proposed for fiscal year 2006 Elmendorf AFB Bassett ACH

11. 10 BHIE FHIE KEY BHIEBidirectional Health Information Exchange DoDDepartment of Defense FHIEFederal Health Information Exchange VistAVeterans Health Information and Systems Technology Architecture BHIE DoD Legacy System VistA

12. 11 Clinical Data Repository/Health Data Repository Will support interoperability between DoD’s Clinical Data Repository (CDR) & VA’s Health Data Repository (HDR) Two-way, enterprise exchange of computable data

13. 12 Clinical Data Repository/Health Data Repository Bidirectional exchange of demographics, outpatient pharmacy, and allergy data anticipated in fiscal year 2006 –Support drug-drug and drug-allergy interaction checking Bidirectional exchange of laboratory data (chemistry and hematology) next data set

14. 13 CHDR AHLTA CDR DoD CHDR Interfac e VA CHDR Interfac e VA HDR KEY CDRClinical Data Repository CHDRClinical Data Repository/Health Data Repository HDRHealth Data Repository VADepartment of Veterans Affairs

15. 14 Laboratory Data Sharing Initiative Supports bidirectional capability for either DoD or VA to act as a reference lab for order entry and results retrieval (lab chemistries)

16. 15 Laboratory Data Sharing Initiative LDSI metrics from National Defense Authorization Act (NDAA) demonstration sites –El Paso, Texas (Started January 2005) 40 tests mapped – using 25 574 tests in January 2006 –San Antonio, Texas (Started August 2005) 7 tests mapped – using 7 142 tests in January 2006 Adding functionality for anatomic pathology and microbiology –Anticipate testing in June 2006 (El Paso) and July 2006 (San Antonio)

17. 16 LDSI Sites NMC San Diego & San Diego VA Health Care System William Beaumont AMC & El Paso VA Health Care System Brooke AMC, Wilford Hall Medical Center, & South Texas VA Health Care System NH Great Lakes & VA Medical Center, Chicago Tripler AMC & Pacific Islands VA Health Care System LDSI operational LDSI discussions ongoing Bassett ACH & Alaska VA Health Care System Mike O’Callaghan Federal Hospital & Southern Nevada VA Health Care System

18. 17 Site Implementation Considerations Business Case Leadership support MOU/MOA and sharing agreements Facility schedule IT and functional and staff availability Minimal training required None or minimal additional costs for hardware infrastructure

19. 18 AHLTA CDR DoD CHDR Interfac e VA CHDR Interfac e VA HDR FHIE BHIE DoD Legacy System VistA BHIE/CHDR Interface KEY BHIEBidirectional Health Information Exchange CDRClinical Data Repository CHDRClinical Data Repository/Health Data Repository DoDDepartment of Defense FHIEFederal Health Information Exchange HDRHealth Data Repository VADepartment of Veterans Affairs VistAVeterans Health Information and Systems Technology Architecture

20. 19 Other Initiatives Inpatient documentation Image sharing Medical record scanning

21. 20 Summary

22. 21 DoD and VA Are… Sharing large volumes of electronic health information Making progress on interoperable health records Continuing to enhance HIPAA compliant data sharing solutions