1. DoD/VA Information Management/Information Technology Update Lois Kellett Cliff Freeman 2007 Joint Venture Conference March 7, 2007

2. 2 Topics Federal Health Information Exchange (FHIE) Deployment Health Assessments Bidirectional Health Information Exchange (BHIE) Clinical Data Repository/Health Data Repository (CHDR) Laboratory Data Sharing Initiative (LDSI) Joint Inpatient Collaboration

3. 3 Path to Interoperability 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 Interoperable Electronic Health Records

4. 4 Federal Health Information Exchange (FHIE) 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. 5 FHIE Statistics 3.7 million patients 51.8 million lab results 8.6 million radiology reports 52.2 million pharmacy records 52.2 million standard ambulatory data records 1.6 million consultation reports Over 2.2 million separated Service members have presented to the VA As of January 31, 2006

6. 6 Deployment Health Assessments Enables VA healthcare providers to access Pre- and Post-Deployment Health Assessments (PPHDAs) and Post-Deployment Health Reassessments (PDHRAs) on separated Service members and demobilized Reserve and National Guard members –1.5 million forms on 640,000 individuals –PPHDAs and PDHRAs transmitted monthly –PDHRAs transmitted weekly for individuals referred to VA for care or evaluation As of January 31, 2007

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

8. 8 BHIE Statistics As of January 31, 2006 Real-time exchange of readable data –Patients treated in both DoD and VA –Data includes allergies, outpatient pharmacy, demographics, lab results, and radiology reports Operational at… –All VA sites –14 DoD medical centers –17 DoD hospitals –More than 170 DoD outlying clinics Over 9,900 weekly FHIE/BHIE queries (1 st Qtr FY 2007)

9. 9 BHIE Operational Sites BHIE Operational BHIE Implementations Planned During FY2007 NCA Brooke AMC Wilford Hall LRMC Mike O’Callaghan Federal Hospital David Grant MC Bassett ACH Elmendorf AFB Madigan AMC NHC Great Lakes Eisenhower AMC NH Charleston Tripler AMC William Beaumont AMC NMC San Diego NH Camp Pendleton NH Camp Lejeune Womack AMC NH Pensacola Darnall ACH MacDill AFB NH Jacksonville NH Groton NH Corpus Christi Wright-Patterson AFB Martin ACH NH Lemoore NMC Portsmouth Minot AFB BHIE-CIS Operational

10. 10 BHIE – DoD View DOD clinician signs on to SHARE

11. 11 BHIE – DoD View Outpatient Medication List

12. 12 BHIE – DoD View Detail review of Cipro order placed in VA

13. 13 BHIE – VA View VA clinician signs on to VistA CPRS

14. 14 BHIE – VA View VA Clinician views Tibia/Fibula radiology report from DoD entered at Landstuhl

15. 15 BHIE Enhancements Inpatient Document Sharing –Current: Discharge summaries –Future: Operative notes/ inpatient consultations Site-independent data pulled from CDR Allergies, outpatient pharmacy, demographics, lab results, and radiology reports (3 rd Quarter FY 2007) Clinical notes, procedures, problems Vital signs Scanned/imported documents/images

16. 16 BHIE – DoD Inpatient Documentation View

17. 17 Clinical Data Repository/Health Data Repository (CHDR) Supports interoperability between DoD’s Clinical Data Repository (CDR) & VA’s Health Data Repository (HDR) Two-way, Enterprise exchange, Computable data

18. 18 CHDR Status Standardized, computable data –Outpatient Rx, medication allergies –Supports drug-drug and drug-allergy checks using data from both DoD and VA Operational at… –William Beaumont AMC and El Paso VA –Eisenhower AMC and Augusta VA –NH Pensacola and VA Gulf Coast –Madigan AMC and VA Puget Sound –NHC Great Lakes and North Chicago VA –NH San Diego and VA San Diego

19. 19 Laboratory Data Sharing Initiative (LDSI) Supports bidirectional electronic order entry and results retrieval of chemistry laboratory tests with either DoD or VA acting as a reference lab for the other agency

20. 20 LDSI Workflow Diagram

21. 21 LDSI Status Available for use throughout DoD and VA Used daily where one Department serves as a reference lab for the other Currently testing addition of lab anatomic pathology (AP) and microbiology orders and results

22. 22 LDSI Operational Sites LDSI Operational LDSI Implementation Planned in FY2007 Brooke AMC/VA South Texas HCS Mike O’Callaghan Federal Hospital/ VA Southern Nevada HCS Bassett ACH NHC Great Lakes/North Chicago VA MC Tripler AMC/VA Pacific Island HCS William Beaumont AMC/ El Paso VA HCS NMC San Diego NH Pensacola/VA Gulf Coast HCS NH Jacksonville SA North Central Fed Clinic/Wilford Hall MC

23. 23 Joint Inpatient Collaboration AHLTA, the DoD ambulatory electronic health record, is in place worldwide DoD is planning to enhance its inpatient automation capabilities by expanding its electronic health (EHR) record to include inpatient care Vista, the VA outpatient, ambulatory, and inpatient EHR, is deployed across all VA VA is planning to modernize its EHR, including the inpatient component Traditionally, DoD/VA IT sharing has been through systems interfaces Unique opportunity to explore a “born seamless” approach for an inpatient EHR

24. 24 Joint Inpatient Collaboration Most of DoD and VA inpatient healthcare is similar Battlefield Care Domiciliary Care Acute Care Hospitals & Medical Centers VADoD A few specialties e.g., pediatrics A few specialties e.g., domiciliary Most healthcare specialties VADoD Healthcare Specialties Healthcare Venues

25. 25 Joint Inpatient Collaboration Medical records must follow the Service member through venues of care within DoD & between DoD and VA Joint approach to an inpatient electronic health record will better support the continuum of care between DoD and VA Battlefield Care Theater Hospital Community Hospital Medical Center Long-Term & Home Health Care Medical Clinic

26. 26 Discussion and Questions