1. eHMP Training
DRAFT

2. eHMP Value and Benefits
eHMP At A Glance
eHMP is a clinician facing application
Goal is to improve access to health care and provide an exceptional patient experience, every time (Blueprint for Excellence)
Gives clinicians streamlined access to Veterans’ complete patient history from VA, DoD and health partners displayed in a single reliable, customizable, and secure interface that is easy to use
Offers clinical knowledge enrichment and clinical decision support services that provide the right data at the right time from the VA, DoD, and external partners
The eHMP Project is a multi-year effort designed to provide a new web-based clinical application that will eventually replace CPRS. eHMP will incorporate and enhance CPRS functionalities as well as introduce new clinical capabilities.
Components include:
The User Interface (UI)
A clinical data services engine
Other middle tier services such as Clinical Decision Support, Context Persistence, Orders Selection Service, Orders Management Service, Data Annotation Service, Clinical Workflow, Concept Relationship Service, Documentation and Text Search Service, and Business Rules Management System
Can briefly go over this slide during the presentation
*Federated refers to the ability to collect clinical data from disparate sources (VA VistAs, DoD Clinical Data Repository, Virtual Lifetime Electronic Record Data Access Service [VA DAS], Patient Provided data, etc.) and aggregate it in a virtual database where it can be used for clinical care, clinical business intelligence, or other analysis such as Clinical Decision Support
VA Internal Use Only 2

3. eHMP Objectives Provide a single Point of Care tool for providers
Present providers with information rather than data
Improve provider pain points
Support Veteran-centric, team- based, quality driven healthcare
Tailor and track care to Veteran functional goals and preferences
Gather and analyze new data for improvements in quality improvement and efficiency of operations
Provide robust long-running workflow and decision support
Develop reusable components and services
Provide a multipurpose technology platform
Decrease cost and time to market
Improve ability to use COTS/externally developed applets, services, content and products
Develop and improve industry partner relationships

4. Agile Methodology

5. Waterfall vs Agile Methodology4
444 :
Requirements
Design
Implementation
Verification
AGILE
WATERFALL
Documents
Unverified Code
Software

6. eHMP Agile Ceremonies Scope defined in Epics, Themes and User Stories
Progress monitored via Scrums
Work completed in Sprints (2 weeks) and demonstrated and reviewed by customer during Sprint Reviews (every 2nd Wednesday)
Work Planned in 3 Months Increments called PSIs (Potentially Shippable Increments)

7. eHMP Scaled Agile Project (Portfolio) Release (Program) Sprint (Team)
PMAS DOCUMENTS
INVESTMENT THEMES
PWS CLIN 1
PWS CLIN 2
PROJECT BACKLOG
RELEASE BACKLOG
System Team
PSI 1
Potentially Shippable Increment
HARDENING
PSI 2…
FEATURE
EPICS SPAN
RELEASES
FEATURES FIT IN RELEASE
USER STORIES
FIT IN SPRINTS
SCRUM
TEAMS
Uber Product Owner
Chief Architect
Uber Scrum Master
UX and System Archs
CI & CD
SYSTEM BACKLOG
METRICS &
DASHBOARD
Product Management
Release Management
TEAM BACKLOG
SPRINT
BACKLOG WITH USER
STORIES
2-Week Sprints
Quarterly Release
Potential Release (Every quarter)
Product Owner
Scrum Master
Vision & Product
Roadmap
ARCHITECTURAL EPICS
FUNCTIONAL EPICS
Kanban
FUNCTIONAL
PRIORITIZED
ARCHITECTURAL
Governance
eHMP Leadership
Change Control Board (CCB)
UX Core Design Team
Integrated Project Team (IPT)

8. Versions

9. eHMP v1.2, v.1.3, 2.0
eHMP v1.2: Enhanced viewer with condition-based analysis and user-defined workspaces. Provides longitudinal view of full patient record including all VA VistA data, DoD data and available community partner data. Includes text search, patient photo, multiple charts and graphs and significantly enhanced auditability. Read Only Version, targeted for enterprise wide deployment. eHMP v1.3: Initial write back iteration with improved access management and comprehensive audit and reporting capabilities. Incorporates outpatient encounters, progress notes, and introduces placing lab orders using multiple integrated platform services including initial task management, clinical decision support (CDS) and notifications. Targeted for Initial Operating Capability (IOC) site production use. eHMP v2.0: Enhanced write back capabilities, Enterprise Single Sign On (SSOi) Integration including PIV authentication. Introduction of Activity Management that incorporates task management, team management, order management, CDS, forms, alerts/notifications to enable future generation of clinical workflows. Includes additional order types, consults, observations goals and problem lists. Targeted for IOC entry in FY16.

10. eHMP v1.2 Feature Highlights
Feature Description
User-defined screens
Allowed a user to create and save multiple screen configurations containing applets of various views (Trend, Expanded, etc.) to support specific clinical workflows.  Applets are resizable and can be repositioned as needed
Trend views
Displayed a snapshot of aggregated clinical data viewed as a trend available within certain applets
Global Timeline Date Filter
Provided an interactive graphical display showing clinical activity over time, in reverse chronological order.  The GTDF also serves as the date control for presenting information on the screen
Meds Review Sparkline
Enhanced the Medications Review Applet with additional fields and an inline sparkline graph showing order data
Patient Photo
Created the structure to display patient photos from VistA imaging
Receive/Display Community Health (VLER)
Enhanced the Community Health Summaries applet to show C-CDA documents coming from VLER in addition to the C32s that it currently displays
Auditing
Tracked user activities beyond Sensitive record access
Test Search Improvements
Provided a Google-Like search containing results from across the entire integrated patient record within VX
Condition-based
Analysis Workspaces
Created pre-defined condition-based analysis workspaces (ex. Diabetes) that have pre-set filters and applet organization to support focused information for a select set of chronic diseases
Health Summaries
Provided access to CPRS Health Summary Reports for each facility where the patient has a record
On-line Help
Logically constructed, responsive, context-sensitive help screens
User Analytics
Ability to track user transitions between workspaces

11. Viewer Enhancements (Read-only) New Features (Write-Back)
eHMP v1.3
Milestones
New user context workspace view
Demonstrate write-back in Production
Create and sign outpatient lab order
Introduce role-based access controls
Ready-only configuration
Deploy CDS and Activity Management
Establish Production release process
Scalability/Performance enhancements
Production Strategy
Deploy R1.3 to IOC sites to validate read-only configuration and write-back capabilities.
Assign default read-only access to all R1.2 Production users & upgrade to R1.3.
Assign write-back privileges to limited group of focus users for simulated clinical use in test and actual patient records
Viewer Enhancements (Read-only)
Patient selection
Medication Applet
Med Review
Stacked Graphs
Orders Applet
Text search
GUI consistency/508
New Features (Write-Back)
Vital signs - Add, mark as EIE
Allergies – Add, mark as EIE
Basic notes – Create, delete, sign
O/P Lab Orders – Create, cancel, save, sign
Record locking & order checks
Task List Applet
Follow-up order protocol activity
Cache management/expiration
ASM Proprietary Information – Do Not Distribute

12. eHMP v1.3 Feature Highlights
Feature Description
Viewer Enhancements
Implemented enhancements to the view features in v1.2 based on feedback from users, stakeholders, and human factors engineering (HFE) studies
Vital signs
Enter new vital signs data or mark previously entered data as “entered-in-error”
Allergies
Enter new allergy information or mark previously entered data as “entered-in-error”
Basic Progress Notes
Create, modify, save, and sign basic progress notes back to the legacy VistA Text Integration Utilities (TIU) package
Outpatient Lab Orders
Create, save, sign, and discontinue VistA orders for basic, outpatient laboratory tests including associated record locking & order checks
Follow-up order protocols
Allow the user to associate follow-up protocol activities to laboratory orders including integration with the task manager, notification system, and clinical decision support services
Task List Applet
Gives the user a list of assigned tasks for the patient in context or all patients related to the user on the "My Workspace" view
Encounter Management
Allow the user to establish new clinical encounters or select an existing encounter for compatibility with the legacy VistA Patient Care Encounter (PCE) package
Cache Management
Implement strategy for refreshing the VX-Sync cache of expired patient data across multiple sites
Access Management
Access controls based on role based permission sets
Audit and Reporting
Comprehensive audit and reporting capability for both reads and writes to all patient records

13. ASM Proprietary Information – Do Not Distribute
eHMP v2.0
Milestones
Full multi-tasking user experience
Central, non-VistA clinical data repository
Integrated production services – activity/order management, clinical decision support, notifications/alerts, concept relationship management
Enterprise order management/selection
Consult management solution
New Features
Multi-tasking UX
Note objects/Data annotation
Outpatient lab orders
Diagnostic imaging orders
Task creation and management
Team/roles management
Problem List write-back
Immunizations write-back
Activity/Order selection service
Quick orders/activities
Activity Management
Consult orders
Nursing orders
Order sets/menus
Notifications/alerts
Context persistence
Patient-specific observation goals
Production Strategy
Full deployment to all sites
Add users as infrastructure permits
ASM Proprietary Information – Do Not Distribute

14. eHMP v2.0 Feature Highlights
Feature Category
Feature Description
Multi-tasking User Interface
Allow the user to access the entire patient record during all write-back activities
Note Objects/Data Annotation
Create annotations while entering clinical data that can be used to document the activities in progress notes and other
Order O/P Diagnostic Imaging
Create, save, sign, and discontinue VistA orders for basic, outpatient diagnostic imaging including order checks
Task Creation and Management
Create and assign patient related tasks to team-based roles to improve communications and enable care coordination
Team/Roles Management
Interface with the Patient Care Management Module (PCMM) to provide team/role services to the eHMP platform
Problem List write-back
Enable an authorized user to add new or modify existing SNOMED-CT based Problem List entries for a patient
Immunizations write-back (VIMM)
Record new immunizations or mark existing immunizations as “entered-in-error”
Activity/Order Selection Service
Provide centralized definition and management of enterprise orderables and local formularies
Activity Management Service
Implement an Activity Management Service that provides a rapid method for creating, altering, assigning, reviewing, testing and publishing patient oriented care pathways/protocols and support routing of tasks to teams or individuals
Alerts and Notifications
Provides a notification service to include modeling, history, display, and disposition of notifications and alerts related to patient care 
Consults Orders
Allow authorized users to create, view, save, delete, and sign outpatient consult orders
Order sets/menus
Create enterprise order sets and menus to support consult activities
Authentication and Access Enhancements
Integration with enterprise Single Sign On service and enablement of PIV authentication
Ability to provide granular or individual permissions to users in addition to role based permission sets.
Nursing orders
Create and manage free text orders assigned to nursing or other allied healthcare roles
Context persistence
Allow the user to optionally resume the application at the last patient/workspace context
Patient-specific observation goals
Create, modify, and delete patient-specific goal targets for numeric observations (vitals & lab results) that can be graphically displayed or used as inputs to the clinical decision support (CDS) service

15. ASM Proprietary Information – Do Not Distribute
eHMP Beyond 2.0
Milestones
Abstraction of Platform Components
Implementation of Additional Workflows
Advanced Pharmacy Orders
Advanced Concept Relationships
Advanced CDS & Complex Event Processing
Scheduling Integration
Patient Flow Integration
Third Party Applications
Statistical Engine Integration
New Features
Activity Management Enhancements
Human Notification Services
Team Instant Messenger
Workload Capture
Natural Language Processing
Cohort/Panel Management
Automated Classification Methodology
Forms Enhancements
Data Annotation Enhancements
Stateful Data Reconciliation
Information Assembly
Workspace Layout and List
Applet Face and List
Applet Content
Document/Notes Templates
Help Enhancements
Goal Enhancements
Interactive Graphics
Task Manger Enhancements
Care Plan Manger
Negation Tools
Patient Flow Management
Personal Management
Multi-Management
Data Panels Support
Multi Form-Factor Presentation
Production Strategy
Gradually increase user adoption and deploy to all sites
Implement horizontal scaling to accommodate increasing user base
ASM Proprietary Information – Do Not Distribute

16. eHMP as a Platform

17. eHMP as a Platform
Enterprise Health Management Platform (eHMP) is the infrastructure and user interface that will eventually replace Computerized Patient Record System (CPRS) as VA’s primary point of care application
A critical cornerstone project under the VistA Evolution Program
Being designed as an Event Driven Open Platform
A Key enabler in achieving VistA Evolution Program goals
Improve interoperability with DoD and other healthcare partners to provide information VA clinicians can act upon
Enhance VistA to support a patient-centric, goal oriented, team-based health care delivery model
Establish a robust Information Technology (IT) architecture to underpin current usage and future innovation
VA Internal Use Only

18. How eHMP Fits into the Larger Architecture
Source: eHMP 1.3 and Immunization Write Bach Architecture Tiger Team Executive Level Views brief, July 14, 2015 6

19. eHMP Architecture 19 This is the overall eHMP architecture
Next two slides split this diagram (TOP and BOTTOM) for easy viewing
Everything in blue represents VistA Exchange and its components
Everything in grey represents everything external to VistA exchange 19
VA Internal Use Only

20. v2.0 Technology Platform Status
Workspace
UI/UX Framework
User Configurable Workspaces
Alert & Notification Framework
Configuration Based UI Rendering
Common UI Components
Workspace
Applet Repository
Allergies
Medications
Notes
Vitals
Labs
Consults
Composite Services
BPMN/Configuration Based Activity Management
Composable Business Rules & Activity Framework
Business Domain Agnostic Components
OpenSource/COTS Based (JBoss BPM & Drools)
CDS
Engine
Activity
Mgmt.
Business
Rules
Engine
Team
Mgmt.
Orders
Mgmt.
Data Layer
Aggregated Patient Data Across All Vista Instances
Optimized Data Synchronization Process
Normalized & Enriched Data
Highly Performant Data Cache
SolR Data Store for Optimized Text Search
VistA Write-Back Through Exposed RPC
JDS
Normalize
Map
Enrich
CDS
Rules
State
SolR
VA & External Rules Content
COTS / OpenSource Components
VA Custom Component
VA Specific Interfaces
Authoritative Data
RPC
RPC
RPC
DAS
DoD
VistA
VistA
VistA

21. Enterprise Health Management System (eHMP): Beyond v2.0
Workspace
Workspace
UI/UX Framework
Workspace
Third Party Applets (From FTL / Platform Users)
Advanced Team Communications / IM Capability
Voice Input
Applet Repository
Allergies
Medications
Notes
Non-eHMP Applet
Vitals
Labs
Consults
Non-eHMP Applet
Non-eHMP Applet
Bus Rules
Engine
Team
Mgmt.
Existing OpenSource / COTS Components
New Modular Components: COTS / OpenSource
Event Driven Architecture
Services Enabled & Composable Components
CDS
Engine
Population
Health
Composite Services
Semantic
Engine
Complex
Events
Orders
Mgmt.
Activity
Mgmt.
NLP
Engine
Statistics
Engine
VA & External Rules Content
COTS / OpenSource Components
VA Custom Component
VA Specific Interfaces
Data Layer
CDS
Rules
Normalize
Map
Enrich
State
SolR
JDS
Authoritative Data
RPC
RPC
RPC
DAS
DoD
VistA
VistA
VistA

22. eHMP Software Development Kit (SDK)
Provide a framework for adding incremental functionality to eHMP by creating new applets and server resources to access VistA Exchange
In the future, provide an environment for sharing and collaborating on applets and functionality
The SDK that is currently used for all internal eHMP and application development and will serve as SDK for new external developers to create functionality.
It will be made available to internal and external stakeholders by late summer intially through Future Technologies Lab (FTL) (previously known as VHA Innovations VACI Sandbox)

23. SDK Overview SDK RDK ADK VistA Exchange
Both the VX-API and the eHMP-UI is developed using the VistaCore SDK.
ADK

24. SDK Documentation https://ehmp. vistacore
SDK Documentation UI Component Library
If time allows walk through the documentation.

25. Questions?