264 - Welcome to SCIDO and You    The Re-engineered Spinal Cord Package

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Important note regarding questions. Historical Perspective. Spinal Cord Dysfunction Version 2.0 released December 1996It is a menu driven system that has 72 optionsCaptures patient data and interacts with other vista packagesUploads patient data to the National SCD Registry in Austin. The NEW SCIDO.

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264 - Welcome to SCIDO and You The Re-engineered Spinal Cord Package

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1. 264 - Welcome to SCIDO and You – The Re-engineered Spinal Cord Package Kevin Cownie, Clinical 3 team EPS Craig Hunter, TSO Bob Holzmann Clinical 3 team EPS Jean Laubscher, National SCI Services Welcome to SCIDO and You the new Re-engineered Spinal Cord Package. My name is Bob Holzmann with me today is Kevin Cownie, Craig Hunter and Jean Laubscher. Kevin and I are members of the Enterprise Product Support group on the Clinical 3 team. Craig is an IT Specialist with the Health Provider Systems. Many of you know Craig from SCI installations and previously imaging installs across the country. Jean is a Program Specialist with the National SCI Center based at the VA Puget Sound.Welcome to SCIDO and You the new Re-engineered Spinal Cord Package. My name is Bob Holzmann with me today is Kevin Cownie, Craig Hunter and Jean Laubscher. Kevin and I are members of the Enterprise Product Support group on the Clinical 3 team. Craig is an IT Specialist with the Health Provider Systems. Many of you know Craig from SCI installations and previously imaging installs across the country. Jean is a Program Specialist with the National SCI Center based at the VA Puget Sound.

2. Important note regarding questions I have asked Phoebe, my golden retriever, to help me remember to remind everyone of one important note before we start in regard to questions. If you have any questions please use the index cards provided. If there aren't any blank cards in your area please raise you hand and one of the room attendants will make some available. This way after the presentation we can post all of the questions and answers on the web page for everyone to view. I have asked Phoebe, my golden retriever, to help me remember to remind everyone of one important note before we start in regard to questions. If you have any questions please use the index cards provided. If there aren't any blank cards in your area please raise you hand and one of the room attendants will make some available. This way after the presentation we can post all of the questions and answers on the web page for everyone to view.

3. Historical Perspective Spinal Cord Dysfunction Version 2.0 released December 1996 It is a menu driven system that has 72 options Captures patient data and interacts with other vista packages Uploads patient data to the National SCD Registry in Austin Currently we are running version 2.0 of the SPINAL CORD DYSFUNCTION which was originally released back in December of 1996. There have been several changes to this software but this is written in the classic vista format of menu driven options that collects patient information and interacts with other vista packages. Then rolls up the data and sends it to the National SCD Registry.Currently we are running version 2.0 of the SPINAL CORD DYSFUNCTION which was originally released back in December of 1996. There have been several changes to this software but this is written in the classic vista format of menu driven options that collects patient information and interacts with other vista packages. Then rolls up the data and sends it to the National SCD Registry.

4. The NEW SCIDO Red Hat Linux Weblogic Cache Oracle KAAJEE J2EE SDS Delivery Service ETS JAVA SSH PuTTY RAI/MDS Person Service Lookup This slide lists a some of what we will be using in the new Spinal Chord Injury and Disorders Outcome package. Many of these items we will be discussing today to try and provide you an idea of what’s coming. SCI&DO is being developed under the HealtheVet VistA re-hosting initiative. The new package will include the use of Linux operating systems with Weblogic server software. In the future we maybe using PuTTY to SSH to the regional application server. Well what does all this mean. To put it simply SSH stands for Secure Shell and is a network protocol that allows data to be exchanged using a secure channel between two computers. Putty is a terminal emulator application we can run on a windows computer that will act as a client to connect to a LINUX machine. But on the other hand what we are doing is no different in theory than what we do every day using a PC, kea session to telnet and connect to Vista. As you can tell the new SCI&D package will very different than the SCI package we have been using and we hope to explain some of this today. This slide lists a some of what we will be using in the new Spinal Chord Injury and Disorders Outcome package. Many of these items we will be discussing today to try and provide you an idea of what’s coming. SCI&DO is being developed under the HealtheVet VistA re-hosting initiative. The new package will include the use of Linux operating systems with Weblogic server software. In the future we maybe using PuTTY to SSH to the regional application server. Well what does all this mean. To put it simply SSH stands for Secure Shell and is a network protocol that allows data to be exchanged using a secure channel between two computers. Putty is a terminal emulator application we can run on a windows computer that will act as a client to connect to a LINUX machine. But on the other hand what we are doing is no different in theory than what we do every day using a PC, kea session to telnet and connect to Vista. As you can tell the new SCI&D package will very different than the SCI package we have been using and we hope to explain some of this today.

5. Application Architecture Overview The national Corporate Franchise Data Center (CFDC) 23 regional application/database centers The application Architecture can be broken down into three components. Consisting of the national Corporate Franchise Data Center formerly known as Austin Automation Center, 23 regional centers and the local medical center databases. The diagram on the right of this slides provides a breakdown of the interactions of the three components and where the users will fit into the application. The top level shows the clinical users and their local vista systems which interact with the regional level. Administrative users and some clinical users will have access to and the regional databases. Access to the national database will be limited to national administrators of the SCIDO program and researchesThe application Architecture can be broken down into three components. Consisting of the national Corporate Franchise Data Center formerly known as Austin Automation Center, 23 regional centers and the local medical center databases. The diagram on the right of this slides provides a breakdown of the interactions of the three components and where the users will fit into the application. The top level shows the clinical users and their local vista systems which interact with the regional level. Administrative users and some clinical users will have access to and the regional databases. Access to the national database will be limited to national administrators of the SCIDO program and researches

6. National Node Architecture located in Austin will consists of a pair of hardware servers, one containing an Oracle database server. The data is sent from the regional centers to the to the national data base in the form of HL7 messages. The second server is the Weblogic J2EE application server. Weblogic is the software that manages the web pages the SCIDO package utilizes. These servers both utilize the Redhat Linux operating system. The delivery service component is the connection between the national application, regional application and local legacy servers. Kevin will provide additional information on delivery services later.National Node Architecture located in Austin will consists of a pair of hardware servers, one containing an Oracle database server. The data is sent from the regional centers to the to the national data base in the form of HL7 messages. The second server is the Weblogic J2EE application server. Weblogic is the software that manages the web pages the SCIDO package utilizes. These servers both utilize the Redhat Linux operating system. The delivery service component is the connection between the national application, regional application and local legacy servers. Kevin will provide additional information on delivery services later.

7. Regional Node Architecture consists of a pair of hardware servers, one containing a Cache database server, and one containing a Weblogic J2EE application server. These servers both utilize the Redhat Linux operating system. The servers are architected with shared storage so that either server can assume the responsibilities of the other should one fail. In this slide you can see the regional database communicates with the local VistA servers seen on the right and the national oracle server seen on the upper left. This slide also shows how the delivery services and Enterprise Terminology service fit into the picture. Regional Node Architecture consists of a pair of hardware servers, one containing a Cache database server, and one containing a Weblogic J2EE application server. These servers both utilize the Redhat Linux operating system. The servers are architected with shared storage so that either server can assume the responsibilities of the other should one fail. In this slide you can see the regional database communicates with the local VistA servers seen on the right and the national oracle server seen on the upper left. This slide also shows how the delivery services and Enterprise Terminology service fit into the picture.

8. Spinal Cord Injury Centers Field Test Sites: Tampa Dallas Seattle Sites in National Rollout containing SCI Centers: Albuquerque Augusta Boston Bronx Castle Point Cleveland East Orange Hines Houston Long Beach Memphis Miami Milwaukee Palo Alto Richmond (includes Hampton) St. Louis San Antonio San Diego San Juan This project began with three test site. They were Tampa, Dallas and Seattle. After the initial testing deployment moved to each of the remaining sites displayed on the slide, with the exception of those sites in Region 4 that is Boston, Bronx, Castle Point, and East Orange. There system will be located in Brooklyn at the newly established Regional Data Processing Center (RDPC). All of the sites listed are Spinal Cord Injury Centers. This project began with three test site. They were Tampa, Dallas and Seattle. After the initial testing deployment moved to each of the remaining sites displayed on the slide, with the exception of those sites in Region 4 that is Boston, Bronx, Castle Point, and East Orange. There system will be located in Brooklyn at the newly established Regional Data Processing Center (RDPC). All of the sites listed are Spinal Cord Injury Centers.

9. Partial SCI&DO Topology To summarize, the SCI&DO Application is a distributed application which is best described as a hub-and-spoke architecture as seen in the figure on the screen. The centralized application or hub resides at the Corporate Franchised Datacenter (CFD) previously known as the Austin Automation Center (AAC), and there are 23 regional application servers (the spokes). Each Spinal Cord region consists of a number of hospitals who all maintain their own Vista databases. Each regional Spinal Cord application will communicate to each of these hospital databases via VistA RPC calls. The regional SCI&DO application communicates with the national SCI&DO application via HL7 messaging. To summarize, the SCI&DO Application is a distributed application which is best described as a hub-and-spoke architecture as seen in the figure on the screen. The centralized application or hub resides at the Corporate Franchised Datacenter (CFD) previously known as the Austin Automation Center (AAC), and there are 23 regional application servers (the spokes). Each Spinal Cord region consists of a number of hospitals who all maintain their own Vista databases. Each regional Spinal Cord application will communicate to each of these hospital databases via VistA RPC calls. The regional SCI&DO application communicates with the national SCI&DO application via HL7 messaging.

10. Project Goals and Objectives Summary General patient information in one location Improved health care of veterans with SCI by enhancing the ability to store, retrieve, and analyze outcomes data Ready access to frequently used information Patient counting and tracking Easy identification of veterans with SCI Annual evaluation tracking Admission and discharge alerts SCIDO project goal is to improve the health care of veterans by improving the ability to store, retrieve, and analyze outcomes data from the treatment of veterans with spinal cord injuries and disorders. As previously shown there will be one national database and 23 regional databases for treatment of SCI patients.SCIDO project goal is to improve the health care of veterans by improving the ability to store, retrieve, and analyze outcomes data from the treatment of veterans with spinal cord injuries and disorders. As previously shown there will be one national database and 23 regional databases for treatment of SCI patients.

11. Valid Roles for SCI users Role Key Assignment Clinician SPN_CLINICIAN Researcher SPN_RESEARCHER IRM staff SPN_IRM Administrator SPN_ADMIN Regional View SPN_CATCHMENT All users require three secondary options: SPN GENERAL USER RPC DGRR GUI PATIENT LOOKUP XUS KAAJEE WEB LOGON There are 4 roles available to users of the SCIDO package. Users may require one or more of these keys depending on their role. Privileged clinicians will have the ability to create, modify, display, store and sign patient information. There are two views available to privileged clinicians. The recommended one is the institutional view which provides access to patients at their local facility as well as an improved response time. Those holding the SPN_CATCHMENT key have the regional view which may show a more comprehensive view of the patient status and SCI population. However the response time may be slower. Once a researcher has documented they have an approved VA research project and approval by the Institutional Review Board they will be given the SPN_RESEARCHER key which provides limited access to aggregate patient data at the national level only for the query and generation of reports. IRM role is controlled by the SPN_IRM key and allows modifications of the SCIDO application , such as the ability to add or delete medical centers from SCI regions, modify regional attributes, perform a national or regional audit and monitor system activity. Administrators are the individuals who have the advanced SCIDO application management permissions allowing access to the administrator tab in the application. Administrators will also have access to the national database and have the ability to import records from the National Franchise Data Center for patients who relocate to and from an area. There are 4 roles available to users of the SCIDO package. Users may require one or more of these keys depending on their role. Privileged clinicians will have the ability to create, modify, display, store and sign patient information. There are two views available to privileged clinicians. The recommended one is the institutional view which provides access to patients at their local facility as well as an improved response time. Those holding the SPN_CATCHMENT key have the regional view which may show a more comprehensive view of the patient status and SCI population. However the response time may be slower. Once a researcher has documented they have an approved VA research project and approval by the Institutional Review Board they will be given the SPN_RESEARCHER key which provides limited access to aggregate patient data at the national level only for the query and generation of reports. IRM role is controlled by the SPN_IRM key and allows modifications of the SCIDO application , such as the ability to add or delete medical centers from SCI regions, modify regional attributes, perform a national or regional audit and monitor system activity. Administrators are the individuals who have the advanced SCIDO application management permissions allowing access to the administrator tab in the application. Administrators will also have access to the national database and have the ability to import records from the National Franchise Data Center for patients who relocate to and from an area.

12. The support Plan To obtain SCIDO software assistance: Enter a Remedy Ticket or Call the VA Service DESK 888 596-HELP (4357) To obtain hardware assistance Contact the HP Expertise center 800 299-7282 With the release of the new SCIDO package we have made some changes to our support plan. One thing that hasn’t changed is the initial request of assistance is made by entering Remedy help desk ticket directly or placing a call to the VA Service desk at 888 596 HELP that is 888 596 (4357). If this is a hardware issue i.e. failed hard drive the initial call should be made to the HP Expertise center at 800 299-7282 and then advise the software group secondarily.With the release of the new SCIDO package we have made some changes to our support plan. One thing that hasn’t changed is the initial request of assistance is made by entering Remedy help desk ticket directly or placing a call to the VA Service desk at 888 596 HELP that is 888 596 (4357). If this is a hardware issue i.e. failed hard drive the initial call should be made to the HP Expertise center at 800 299-7282 and then advise the software group secondarily.

13. The support plan on Remedy Category – Applications – HealtheVet -VistA (existing) Type – Spinal Cord Injury & Disorder Outcomes (SCIDO) 3.0 (new) Item – Access Issue (new) – Browser Issue (new) – Connectivity Issue (new) – Database Issues (new) – Other (new) – Report Issue (new) For those used to the new re-hosted HealtheVet VistA applications you will see a lot of similarities but for those of us used to the traditional package residing on Vista we will see a lot of change. When a ticket is entered for one of these items you will be contacted by a member of the clinical 3 team.For those used to the new re-hosted HealtheVet VistA applications you will see a lot of similarities but for those of us used to the traditional package residing on Vista we will see a lot of change. When a ticket is entered for one of these items you will be contacted by a member of the clinical 3 team.

14. The support plan on Remedy Category – Applications-HealtheVet -VistA (existing) Type – Spinal Cord Injury & Disorder Outcomes (SCIDO) 3.0 (new) Item – Red Hat Enterprise Linux  (new) – Linux/Cache  (new) – WebLogic Issue  (new) Issues and problems related to Linux, Cache or WebLogic will be handled by Enterprise Infrastructure Engineering (EIE) Health Systems Technical Support Team (HSTS), Infrastructure Team. Again for hardware issues, for example a hard drive failure, they will be handled in a manner similar to how they are handled currently for the VistA system where HP is contacted directly and they resolve the issue with an informative ticket entered into Remedy for the purpose of tracking and monitoring the repair or for additional assistance if needed. Now I’d like to introduce Kevin Cownie.Issues and problems related to Linux, Cache or WebLogic will be handled by Enterprise Infrastructure Engineering (EIE) Health Systems Technical Support Team (HSTS), Infrastructure Team. Again for hardware issues, for example a hard drive failure, they will be handled in a manner similar to how they are handled currently for the VistA system where HP is contacted directly and they resolve the issue with an informative ticket entered into Remedy for the purpose of tracking and monitoring the repair or for additional assistance if needed. Now I’d like to introduce Kevin Cownie.

15. Understanding the redesigned SCIDO Now presenting Kevin Cownie Good afternoon. Bob just gave you a overview of the new SCIDO application. I’m going to go into a little more detail, hopefully giving you a better understanding of the hardware and data flow.Good afternoon. Bob just gave you a overview of the new SCIDO application. I’m going to go into a little more detail, hopefully giving you a better understanding of the hardware and data flow.

16. Platform Architecture Phase 1 Integrated Lights Out (ILO) Red Hat Linux – Enterprise v 4.0 Cache Relational Database – Linux BEA WebLogic – Linux – J2EE After the HP technician completed the hardware install, site visits were scheduled with the implementation team. During these visits Integrated Lights Out (ILO) utility, Linux, Cache and WebLogic were installed. ILO is an embedded server management technology which makes it possible to perform activities on an HP server from a remote location. This is a valuable tool used for troubleshooting and setup of the servers. Linux Enterprise version 4 is installed on both servers for the operating system. Clustering technology will be in place so one server can back up the other. With this install two logical drives are setup on the raid array, U01 and U02 where WebLogic and Cache are installed. Cache version 5.2 is installed on both servers on logical drive U02. Weblogic version 8.1 is installed on logical drive U01. After the HP technician completed the hardware install, site visits were scheduled with the implementation team. During these visits Integrated Lights Out (ILO) utility, Linux, Cache and WebLogic were installed. ILO is an embedded server management technology which makes it possible to perform activities on an HP server from a remote location. This is a valuable tool used for troubleshooting and setup of the servers. Linux Enterprise version 4 is installed on both servers for the operating system. Clustering technology will be in place so one server can back up the other. With this install two logical drives are setup on the raid array, U01 and U02 where WebLogic and Cache are installed. Cache version 5.2 is installed on both servers on logical drive U02. Weblogic version 8.1 is installed on logical drive U01.

17. Here is a picture of the two servers that are deployed at the 23 SCI centers. This picture does not show the two Uninterruptible Power Supplies located at the bottom of the rack. Following the VA standard naming convention the servers are named VHAxxxSCI0 and VHAxxxSCI1 with x representing your three letter site code. Here is a picture of the two servers that are deployed at the 23 SCI centers. This picture does not show the two Uninterruptible Power Supplies located at the bottom of the rack. Following the VA standard naming convention the servers are named VHAxxxSCI0 and VHAxxxSCI1 with x representing your three letter site code.

18. Platform Architecture Phase 2 SCIDO application installed Database seeded These two steps will be performed remotely. The KIDS build included with this application will be installed by the local IRM service. Before the regional Database can be seeded the Corporate Franchise Data Center (CFDC) in Austin will need to run a regional conversion. After the seeding is done there are three queries that compare record counts in the legacy SCD database, the national SCIDO database and the regional SCIDO database. These counts will need to be compared to make sure no patient data was lost during conversion and seeding.These two steps will be performed remotely. The KIDS build included with this application will be installed by the local IRM service. Before the regional Database can be seeded the Corporate Franchise Data Center (CFDC) in Austin will need to run a regional conversion. After the seeding is done there are three queries that compare record counts in the legacy SCD database, the national SCIDO database and the regional SCIDO database. These counts will need to be compared to make sure no patient data was lost during conversion and seeding.

19. This slide shows SCIDO dependencies. They include: Java 2 Enterprise Edition known as (J2EE) Regional Database – Cache v 5.2.3.710.0.5059 Oracle Database - Corporate Franchise Data Center (CFDC), formerly Austin Automation Center Kernel Authentication & Authorization for J2EE (KAAJEE) – v1.0.0.019 Resident Assessment Instrument/Minimum Data Set (RAI/MDS) Patient Lookup (PLU) – v 4.0.4.4 Delivery Services - Vitria Interface Engine (VIE) – phase 4 v 1.8 VistaLink – v 1.5 CCOW Master Patient Index (MPI) Standard Data Services (SDS) – v 10.0 Now lets go through these individually. This slide shows SCIDO dependencies. They include: Java 2 Enterprise Edition known as (J2EE) Regional Database – Cache v 5.2.3.710.0.5059 Oracle Database - Corporate Franchise Data Center (CFDC), formerly Austin Automation Center Kernel Authentication & Authorization for J2EE (KAAJEE) – v1.0.0.019 Resident Assessment Instrument/Minimum Data Set (RAI/MDS) Patient Lookup (PLU) – v 4.0.4.4 Delivery Services - Vitria Interface Engine (VIE) – phase 4 v 1.8 VistaLink – v 1.5 CCOW Master Patient Index (MPI) Standard Data Services (SDS) – v 10.0 Now lets go through these individually.

20. Various External Dependencies Explained Blind Rehab Patient Advocate Tracking System (PATS) Veterans Personal Finance System (VPFS) Spinal Cord Injury and Disorders Outcomes (SCIDO) Kernel Authentication and Authorization for Java 2 Enterprise Edition known as KAAJEE is a framework that provides secure sign on architecture for HealtheVet – VistA web based applications. For example Blind Rehab; Patient Advocate Tracking System (PATS); Veterans Personal Finance System (VPFS) and of course Spinal Cord Injury and Disorders Outcomes (SCIDO). These HealtheVet web based applications are able to authenticate against Kernel on the VistA M server through a internet browser on the client workstation and a middle tier application server such as WebLogic.Kernel Authentication and Authorization for Java 2 Enterprise Edition known as KAAJEE is a framework that provides secure sign on architecture for HealtheVet – VistA web based applications. For example Blind Rehab; Patient Advocate Tracking System (PATS); Veterans Personal Finance System (VPFS) and of course Spinal Cord Injury and Disorders Outcomes (SCIDO). These HealtheVet web based applications are able to authenticate against Kernel on the VistA M server through a internet browser on the client workstation and a middle tier application server such as WebLogic.

21. Various External Dependencies Explained Resident Assessment Instrument/Minimum Data Set (RAI/MDS) provides computerized storage, access, and analysis of the MDS 2.0 long-term care data on patients in nursing homes across VA medical centers. The MDS system is intended to create a standard, nationwide system for connecting VAMCs with nursing home facilities to the Corporate Franchise Data Center (CFDC) for the purpose of electronic interchange of data, reports, and other information. The MDS transmission system provides: Receipt of MDS records from the CFDC by VAMCs. Authentication and validation of MDS records received from VAMC facilities. Feedback to VAMCs indicating acknowledgment of the transmission of the data and specifying the status of record validation. Storage of MDS records in the database repository at Austin. And Will replace PAI and provide RUG III codes to the ARC (Allocation Resource Center). Resident Assessment Instrument/Minimum Data Set (RAI/MDS) provides computerized storage, access, and analysis of the MDS 2.0 long-term care data on patients in nursing homes across VA medical centers. The MDS system is intended to create a standard, nationwide system for connecting VAMCs with nursing home facilities to the Corporate Franchise Data Center (CFDC) for the purpose of electronic interchange of data, reports, and other information. The MDS transmission system provides: Receipt of MDS records from the CFDC by VAMCs. Authentication and validation of MDS records received from VAMC facilities. Feedback to VAMCs indicating acknowledgment of the transmission of the data and specifying the status of record validation. Storage of MDS records in the database repository at Austin. And Will replace PAI and provide RUG III codes to the ARC (Allocation Resource Center).

22. Various External Dependencies Explained Person Services (PS) Person Service Identity Management (PSIM) Person Service Demographics (PSD) Patient Lookup (PLU) v 4.0.4.4 or Person Services (PS) is part of the common business services layer within HealtheVet and acts as the authoritative source of person administrative data. It formulates an abstraction layer between applications and databases and is comprised of sub-services which support the input/retrieval of data and person-specific functionality such as identity management, demographics, lookup and enumeration. PS also broadcasts person data changes to subscribers and synchronizes traits across systems of interest and with VistA during transition from Legacy VistA to HeV VistA. Person Service Identity Management (PSIM) enumerates and maintains person identities of both patients and non patients, synchronizes identities with VistA during transition from Legacy VistA to HeV; maintains a history of ID changes; correlates the VPID to internal and external identity domains; provides duplicate prevention and resolution tools; identifies and initiates identity link and unlink activities; and provides a data quality management user interface. PS Demographics (PSD) provides category-based support including validation, retrieval, insertion, update and deletion of person demographic data values. A composite business service, the Patient Service Construct (PSC), provides support for Legacy-VistA retrieval of patient oriented data including identity, demographics, ADT, eligibility and enrollment. PS Lookup (PSL) provides GUI interface components for web and Java rich client implementations as well as business components to support programmatic selection of patient records. Person Service will be the foundation for Master Patient Index (MPI) re-engineering, demographics for all person categories, person category management, the broadcast of data changes to subscribers and the synchronization of data across systems of interest. The aggregation of redundant person records and their respective categories to a centralized/distributed view results in enhanced data quality and an improved "One VA" face to beneficiaries and the public. Patient Lookup (PLU) v 4.0.4.4 or Person Services (PS) is part of the common business services layer within HealtheVet and acts as the authoritative source of person administrative data. It formulates an abstraction layer between applications and databases and is comprised of sub-services which support the input/retrieval of data and person-specific functionality such as identity management, demographics, lookup and enumeration. PS also broadcasts person data changes to subscribers and synchronizes traits across systems of interest and with VistA during transition from Legacy VistA to HeV VistA. Person Service Identity Management (PSIM) enumerates and maintains person identities of both patients and non patients, synchronizes identities with VistA during transition from Legacy VistA to HeV; maintains a history of ID changes; correlates the VPID to internal and external identity domains; provides duplicate prevention and resolution tools; identifies and initiates identity link and unlink activities; and provides a data quality management user interface. PS Demographics (PSD) provides category-based support including validation, retrieval, insertion, update and deletion of person demographic data values. A composite business service, the Patient Service Construct (PSC), provides support for Legacy-VistA retrieval of patient oriented data including identity, demographics, ADT, eligibility and enrollment. PS Lookup (PSL) provides GUI interface components for web and Java rich client implementations as well as business components to support programmatic selection of patient records. Person Service will be the foundation for Master Patient Index (MPI) re-engineering, demographics for all person categories, person category management, the broadcast of data changes to subscribers and the synchronization of data across systems of interest. The aggregation of redundant person records and their respective categories to a centralized/distributed view results in enhanced data quality and an improved "One VA" face to beneficiaries and the public.

23. Various External Dependencies Explained Delivery Service is the authoritative provider of messaging service for the HealtheVet infrastructure. Delivery Service facilitates and standardizes messaging operations in a distributed environment. VistA Interface Engine (VIE) \ Vitria is the legacy system that brokers messaging traffic between the re-hosted and legacy systems. Phase 4 version 1.8.Delivery Service is the authoritative provider of messaging service for the HealtheVet infrastructure. Delivery Service facilitates and standardizes messaging operations in a distributed environment. VistA Interface Engine (VIE) \ Vitria is the legacy system that brokers messaging traffic between the re-hosted and legacy systems. Phase 4 version 1.8.

24. Various External Dependencies Explained The VistALink 1.5 resource adapter is a transport layer that provides communication between HealtheVet-VistA Java applications and VistA/M servers, in both client-server and n-tier environments. It allows Java applications to execute remote procedure calls (RPCs) on the VistA/M system and retrieve results, simultaneously. VistALink 1.5 is also referred to as “VistALink J2M.” VistALink consists of Java-side adapter libraries and an M-side listener: • The adapter libraries use the J2EE Connector Architecture (J2CA 1.0) specification to integrate Java applications with legacy systems. • The M listener process receives and processes requests from client applications. The VistALink 1.5 resource adapter is a transport layer that provides communication between HealtheVet-VistA Java applications and VistA/M servers, in both client-server and n-tier environments. It allows Java applications to execute remote procedure calls (RPCs) on the VistA/M system and retrieve results, simultaneously. VistALink 1.5 is also referred to as “VistALink J2M.” VistALink consists of Java-side adapter libraries and an M-side listener: • The adapter libraries use the J2EE Connector Architecture (J2CA 1.0) specification to integrate Java applications with legacy systems. • The M listener process receives and processes requests from client applications.

25. Various External Dependencies Explained http://www.hl7.org CCOW – Clinical Context Management is a method to synchronize multiple GUI clinical computer applications to the same patient. Context management is accomplished by a context vault and software that receives a change request from a CCOW enabled application and transmits that request to other active CCOW enabled applications on the user’s workstation. In instances where one application cannot accept the change request without adverse consequences the user is informed and allowed to cancel the change request. Cancelling a change request does not close the application. HL7 CCOW User Context standard is the name of the CCOW HL7 standard. More information about this and other medical record standards can be found at http://www.hl7.org. CCOW – Clinical Context Management is a method to synchronize multiple GUI clinical computer applications to the same patient. Context management is accomplished by a context vault and software that receives a change request from a CCOW enabled application and transmits that request to other active CCOW enabled applications on the user’s workstation. In instances where one application cannot accept the change request without adverse consequences the user is informed and allowed to cancel the change request. Cancelling a change request does not close the application. HL7 CCOW User Context standard is the name of the CCOW HL7 standard. More information about this and other medical record standards can be found at http://www.hl7.org.

26. Various External Dependencies Explained Master Patient Index (MPI) Master Patient Index (MPI) established the framework for the sharing of patient information between sites. The objectives of the MPI are to Create an index that uniquely identifies each active patient treated by the Veterans Administration and to Identify the sites where a patient is receiving care. This is crucial to the sharing of patient information across sites. During the process of initialization to the Master Patient Index, each active patient received: An Integration Control Number (ICN) A Treating Facility List of sites where the patient is also known by this ICN Each site becomes part of the network of sites that share key demographic data for patients through HL7 messaging. Master Patient Index (MPI) Master Patient Index (MPI) established the framework for the sharing of patient information between sites. The objectives of the MPI are to Create an index that uniquely identifies each active patient treated by the Veterans Administration and to Identify the sites where a patient is receiving care. This is crucial to the sharing of patient information across sites. During the process of initialization to the Master Patient Index, each active patient received: An Integration Control Number (ICN) A Treating Facility List of sites where the patient is also known by this ICN Each site becomes part of the network of sites that share key demographic data for patients through HL7 messaging.

27. Various External Dependencies Explained Provide an enterprise-wide view of valid data tables and person information Create standard interface points and processes for both data maintenance and data access Improve data quality and consistency Improved flexibility for applications to receive authoritative data via API components With the migration to the HealtheVet framework, it is necessary to centrally house and manage the current VistA Reference Files in a Oracle format. Standards Data Services (SDS) is what manages these VistA Reference Files. SDS provides an enterprise-wide view of valid data tables and person information, creates standard interface points and processes for both data maintenance and data access, improves data quality and consistency and improves flexibility for applications to receive authoritative data through API components. Standard Data Services (SDS) version 10.0. With the migration to the HealtheVet framework, it is necessary to centrally house and manage the current VistA Reference Files in a Oracle format. Standards Data Services (SDS) is what manages these VistA Reference Files. SDS provides an enterprise-wide view of valid data tables and person information, creates standard interface points and processes for both data maintenance and data access, improves data quality and consistency and improves flexibility for applications to receive authoritative data through API components. Standard Data Services (SDS) version 10.0.

28. SCIDO Architectural Overview This graphical display shows the applications, that were just discussed, that the user hits when logging into and navigating through the various subcomponents and services of the SCIDO application.This graphical display shows the applications, that were just discussed, that the user hits when logging into and navigating through the various subcomponents and services of the SCIDO application.

29. SCIDO Data Flow This slide shows data from the local SCI servers going to Delivery Service/Vitria in real-time but being uploaded to the SCI repository at the Corporate Franchise Data Center (CFDC) in overnight batches. This slide shows data from the local SCI servers going to Delivery Service/Vitria in real-time but being uploaded to the SCI repository at the Corporate Franchise Data Center (CFDC) in overnight batches.

30. High level timeline: Development/SQA testing complete – 2/04/08 Bay Pines IV&V test lab testing waiver approved winter 2007 Field testing complete – spring 08 (tentative) Release to EPS – spring 08 (tentative) National implementation complete – 9/30/08 (tentative) Post Implementation review – 10/31/08 (tentative) Here’s a timeline of the application development process, of course all dates are subject to change. Phase 1 implementation which included the Linux, Cache and WebLogic install was completed in spring of 2008. By VEHU all but national and post implementation tasks should be completed. National implementation would include SCIDO application install and database seeding.Here’s a timeline of the application development process, of course all dates are subject to change. Phase 1 implementation which included the Linux, Cache and WebLogic install was completed in spring of 2008. By VEHU all but national and post implementation tasks should be completed. National implementation would include SCIDO application install and database seeding.

31. Platform Summary Platform Architecture (Phase 1 & 2) SCIDO External Dependencies SCIDO Data Flow To recap I’ve gone over what’s involved in the installation for hardware and software. The external dependencies required by SCIDO and the application data flow. Now I’m going to turn it over to Craig who will discuss key trouble shooting items.To recap I’ve gone over what’s involved in the installation for hardware and software. The external dependencies required by SCIDO and the application data flow. Now I’m going to turn it over to Craig who will discuss key trouble shooting items.

32. Troubleshooting SCIDO Now presenting Craig Hunter

33. Troubleshooting Key Items Linux Clustering provides high availability to SCIDO data Automatic server failover takes place when hardware failure occurs Cluster failover provides automatic restart of Cache and WebLogic applications New login to SCIDO application is required after cluster failover Server and cluster monitoring tools available to IT staff The SCIDO technical architecture provides high availability to the application through the use of clustering software built into the Red Hat Linux operating system. This means that each of the two SCIDO servers monitor the operational status of system resources. If one server goes down, the other one automatically restarts the Cache database and WebLogic application onto the operational server. The failover takes approximately 10 seconds. The only impact to the SCIDO user is a new login to the application is required. A full set of graphical monitoring tools are available to the IT staff at each site to evaluate and troubleshoot cluster status and failover. The next few slides will show the graphical tools for cluster management. The SCIDO technical architecture provides high availability to the application through the use of clustering software built into the Red Hat Linux operating system. This means that each of the two SCIDO servers monitor the operational status of system resources. If one server goes down, the other one automatically restarts the Cache database and WebLogic application onto the operational server. The failover takes approximately 10 seconds. The only impact to the SCIDO user is a new login to the application is required. A full set of graphical monitoring tools are available to the IT staff at each site to evaluate and troubleshoot cluster status and failover. The next few slides will show the graphical tools for cluster management.

34. Red Hat Linux Cluster Administrator The Red Hat Linux cluster administrator is started from the System Settings drop-down box as shown. Root level access is required to execute this application. The Red Hat Linux cluster administrator is started from the System Settings drop-down box as shown. Root level access is required to execute this application.

35. Red Hat Linux Cluster Administrator Two view options are available in the Cluster Administrator GUI. Cluster Configuration provides a view and edit capability for the cluster configuration file. Cluster Management provides real-time monitoring and manual failover of the cluster applications. Two view options are available in the Cluster Administrator GUI. Cluster Configuration provides a view and edit capability for the cluster configuration file. Cluster Management provides real-time monitoring and manual failover of the cluster applications.

36. Red Hat Linux Cluster Administrator The location of the active cluster configuration file is shown. This XML file provides all processing and setup options used by the Red Hat Linux cluster software. The location of the active cluster configuration file is shown. This XML file provides all processing and setup options used by the Red Hat Linux cluster software.

37. Red Hat Linux Cluster Administrator View and edit capability of the cluster configuration file is provided in the Cluster Administrator GUI. After initial cluster setup and testing, this file would normally not be modified in the SCIDO environment. Changes to the cluster configuration file can have drastic effects on system operations. Any changes to the cluster configuration require a restart of the Linux cluster services.View and edit capability of the cluster configuration file is provided in the Cluster Administrator GUI. After initial cluster setup and testing, this file would normally not be modified in the SCIDO environment. Changes to the cluster configuration file can have drastic effects on system operations. Any changes to the cluster configuration require a restart of the Linux cluster services.

38. Red Hat Linux Cluster Administrator Depressing the Cluster Management button switches to the GUI screen for cluster application status and failover options.Depressing the Cluster Management button switches to the GUI screen for cluster application status and failover options.

39. Red Hat Linux Cluster Administrator Operational status is displayed for the two SCIDO cluster applications – Cache database server and WebLogic application server. Possible states are: Started Stopped Failed Starting and Recoverable The current server that is hosting each application is displayed under the Owner column. Operational status is displayed for the two SCIDO cluster applications – Cache database server and WebLogic application server. Possible states are: Started Stopped Failed Starting and Recoverable The current server that is hosting each application is displayed under the Owner column.

40. Red Hat Linux Cluster Administrator Each cluster application can be manually started or stopped using the Services button shown on the screen. To use one of these options, first click the application to highlight it and then depress one of the Service options. Application state should change according to the action requested. Each cluster application can be manually started or stopped using the Services button shown on the screen. To use one of these options, first click the application to highlight it and then depress one of the Service options. Application state should change according to the action requested.

41. Red Hat Linux Cluster Administrator The cluster status for each of the two SCIDO servers is listed. A status of member is required for each server to participate in cluster monitoring and failover. If a server fails to show up in this display with member status, it usually means the server is not running, it is not communicating on the network, or it does not have the cluster services running.The cluster status for each of the two SCIDO servers is listed. A status of member is required for each server to participate in cluster monitoring and failover. If a server fails to show up in this display with member status, it usually means the server is not running, it is not communicating on the network, or it does not have the cluster services running.

42. Red Hat Linux Cluster Administrator Cluster applications such as Cache or WebLogic can be manually transferred between the two SCIDO servers with a simple drag and drop process. To do this, highlight the desired application and depress the left mouse button. Then hold down the left mouse button and drag the application to the desired server on the top of the screen. The application status will change to “Stopped” and then “Restarting” while the designated Red Hat Linux shutdown and startup scripts execute. Once this is completed, the application status should switch to “Started” highlighted in green and the new server will be listed as the owner. Normally, manual transfer of applications is not required, but there are two cases where you should perform these manual transfer steps: First, if one SCIDO server is planned to be shutdown, it is recommended to manually transfer both applications to the operational server. Cache and WebLogic can run on the same server without system degradation. Second, when both servers are brought back online after a failover or shutdown, it is recommended that Cache be moved to server 0 and WebLogic be moved to server 1. Cluster applications such as Cache or WebLogic can be manually transferred between the two SCIDO servers with a simple drag and drop process. To do this, highlight the desired application and depress the left mouse button. Then hold down the left mouse button and drag the application to the desired server on the top of the screen. The application status will change to “Stopped” and then “Restarting” while the designated Red Hat Linux shutdown and startup scripts execute. Once this is completed, the application status should switch to “Started” highlighted in green and the new server will be listed as the owner. Normally, manual transfer of applications is not required, but there are two cases where you should perform these manual transfer steps: First, if one SCIDO server is planned to be shutdown, it is recommended to manually transfer both applications to the operational server. Cache and WebLogic can run on the same server without system degradation. Second, when both servers are brought back online after a failover or shutdown, it is recommended that Cache be moved to server 0 and WebLogic be moved to server 1.

43. Resource Information Four VA web sites are shown that provide links to additional information and support for the SCIDO application. The TSPR link provides access to the SCIDO Project Repository which displays key points of contact along with a comprehensive list of SCIDO project documentation. The VistA University Site contains online training for many medical system applications. The link shown above can access the specific SCIDO training page in VISTAU. The VistA Documentation Library is the comprehensive online documentation repository for all VistA components. And finally, the Service Desk link is VA’s comprehensive portal to Enterprise IT Support including Remedy ticket submission and tracking. This concludes the Red Hat Cluster presentation along with a description of online resource links. Now, I will turn over the presentation to Jean Laubsher for a demonstration of the redesigned SCIDO application tabs. Four VA web sites are shown that provide links to additional information and support for the SCIDO application. The TSPR link provides access to the SCIDO Project Repository which displays key points of contact along with a comprehensive list of SCIDO project documentation. The VistA University Site contains online training for many medical system applications. The link shown above can access the specific SCIDO training page in VISTAU. The VistA Documentation Library is the comprehensive online documentation repository for all VistA components. And finally, the Service Desk link is VA’s comprehensive portal to Enterprise IT Support including Remedy ticket submission and tracking. This concludes the Red Hat Cluster presentation along with a description of online resource links. Now, I will turn over the presentation to Jean Laubsher for a demonstration of the redesigned SCIDO application tabs.

44. Demonstration of the redesigned SCIDO Application Tabs Now presenting Jean Laubscher

45. SCI Primary Care Teams The SCI Primary Care Teams include a Social Worker, nurse and physician appointed by the Chief of Staff. They are trained teams who are knowledgeable about primary and basic specialty care for persons with SCI, and know about the need for referrals to the SCI Centers. SCI Primary Care Teams must be identified within each facility without an SCI Center and consist of a social-worker, nurse and a physician. Appointed by the Chief of Staff based on their professional experience and interest. Providers must have completed the VHI continuing medical education package on SCI or have equivalent training and experience. Nurse and social worker must complete a learning needs assessment as part of their annual competency assessment. The goal is to congregate care of patients with SCI under these trained teams. SCI Primary Care Teams must be identified within each facility without an SCI Center and consist of a social-worker, nurse and a physician. Appointed by the Chief of Staff based on their professional experience and interest. Providers must have completed the VHI continuing medical education package on SCI or have equivalent training and experience. Nurse and social worker must complete a learning needs assessment as part of their annual competency assessment. The goal is to congregate care of patients with SCI under these trained teams.

46. SCI Center 23 SCI Centers Pending construction: Minneapolis, Syracuse, Denver, Jackson Designated by the Under Secretary for Health Independent services under the Chief of Staff. Provide full spectrum of care. Within the SCI Centers there is a full interdisciplinary team including nursing staff, physicians, therapists, social workers, psychologists, dieticians, respiratory therapists, etc., etc. So now we have reviewed the SCI PCTs and the SCI Support Clinics, Next lets look at the 23 SCI Centers that serve the USA and San Juan, Puerto Rico. Designated by the Under Secretary for Health They must be independent services under the Chief of Staff. They provide acute rehabilitation, patient/family education, psychological, social, and vocational care, medical/surgical care, and research and professional training of residents and students in the care of persons with spinal cord injury. Within the SCI Centers there is a full interdisciplinary team including nursing staff, physicians, therapists, social workers, psychologists, dieticians, respiratory therapists, etc., etc. These are teams that represent 24 hour 7 day per week care of the patient. No matter how well trained a three person SCI team or clinic at the non SCI Center, you cannot ensure the same level of expertise as that available within the SCI Center. For this reason, referral guidelines were developed. So now we have reviewed the SCI PCTs and the SCI Support Clinics, Next lets look at the 23 SCI Centers that serve the USA and San Juan, Puerto Rico. Designated by the Under Secretary for Health They must be independent services under the Chief of Staff. They provide acute rehabilitation, patient/family education, psychological, social, and vocational care, medical/surgical care, and research and professional training of residents and students in the care of persons with spinal cord injury. Within the SCI Centers there is a full interdisciplinary team including nursing staff, physicians, therapists, social workers, psychologists, dieticians, respiratory therapists, etc., etc. These are teams that represent 24 hour 7 day per week care of the patient. No matter how well trained a three person SCI team or clinic at the non SCI Center, you cannot ensure the same level of expertise as that available within the SCI Center. For this reason, referral guidelines were developed.

47. The SCI&D project is being developed under the HealtheVet VistA re-hosting initiative and will be run on a Web-based platform with a Graphical User Interface (GUI). The application is accessed from a PC as a Web application through a browser-based interface, The typical log on screen is currently displayed. The new application is an interactive, point-and-click interface which is 508 compliant and also provides for keyboard navigation and entry. After entering the system a patient selection screen appears.The SCI&D project is being developed under the HealtheVet VistA re-hosting initiative and will be run on a Web-based platform with a Graphical User Interface (GUI). The application is accessed from a PC as a Web application through a browser-based interface, The typical log on screen is currently displayed. The new application is an interactive, point-and-click interface which is 508 compliant and also provides for keyboard navigation and entry. After entering the system a patient selection screen appears.

48. New Cover Sheet The application is organized after the World Health Organizations concepts. This is an example of a patient status screen for a patient currently registered in the SCIDO data base. The tabs across the bottom of the screen allow for access to the registration sheet, as well as entry of impairments, medical complications, activities and participation. The application is organized after the World Health Organizations concepts. This is an example of a patient status screen for a patient currently registered in the SCIDO data base. The tabs across the bottom of the screen allow for access to the registration sheet, as well as entry of impairments, medical complications, activities and participation.

49. Registration Tab If a patient selected had not been entered into the SCIDO application prior to selection the user would have been sent to the registration screen we see on this slide. This screen allows for the easy entry of a variety of information. The required information is contained in the center column and noted with an asterisk and includes registration status, SCI network and Date changed. Although we encourage as much additional information as is available. If a patient selected had not been entered into the SCIDO application prior to selection the user would have been sent to the registration screen we see on this slide. This screen allows for the easy entry of a variety of information. The required information is contained in the center column and noted with an asterisk and includes registration status, SCI network and Date changed. Although we encourage as much additional information as is available.

50. Impairments Tab This tab illustrates some of the new display features such as the graphing on both sides of the screen as well as the easy to use data entry section in the central portion of the screen.This tab illustrates some of the new display features such as the graphing on both sides of the screen as well as the easy to use data entry section in the central portion of the screen.

51. This slide represents one of the assessments available, the ASIA – American Spinal Cord Injury Association for standard neurological classification of spinal cord injuries.This slide represents one of the assessments available, the ASIA – American Spinal Cord Injury Association for standard neurological classification of spinal cord injuries.

52. The is the Medical Complications Tab, it holds a number of patient-specific reports available at the click of a button as well as a section to document and assess pressure ulcer and pressure ulcer risk. The is the Medical Complications Tab, it holds a number of patient-specific reports available at the click of a button as well as a section to document and assess pressure ulcer and pressure ulcer risk.

53. This is the Activities tab which contain assessment tools for Functional Independence, Functional Measure , Medical Needs, Expanded Disability Status and Functional Systems Scale.This is the Activities tab which contain assessment tools for Functional Independence, Functional Measure , Medical Needs, Expanded Disability Status and Functional Systems Scale.

54. This is the Participation and Satisfaction with Life Survey Page. It contains the SWLS/Diener and CHART-SF assessments coupled with information on attendant care, employment status and volunteer activity. This is the Participation and Satisfaction with Life Survey Page. It contains the SWLS/Diener and CHART-SF assessments coupled with information on attendant care, employment status and volunteer activity.

55. Reports The reports tab allows for a variety of predefined reports as well as custom built ones. This application is fully intergraded with local vista systems and contains information regarding other diagnoses, prescriptions, surgical procedures, laboratory tests, radiology exams, patient demographics, hospital admissions, and clinical visits. Thus allowing identified providers the full extent of our Vista database.The reports tab allows for a variety of predefined reports as well as custom built ones. This application is fully intergraded with local vista systems and contains information regarding other diagnoses, prescriptions, surgical procedures, laboratory tests, radiology exams, patient demographics, hospital admissions, and clinical visits. Thus allowing identified providers the full extent of our Vista database.

56. This is the filters page associated with Filter Reports on the preceding page. Any filtered report could be filtered by any element on this page creating a custom view of the information.This is the filters page associated with Filter Reports on the preceding page. Any filtered report could be filtered by any element on this page creating a custom view of the information.

57. This is a sample report output. Note that the information from the report can be easily exported to comma-separated value (CSV) file format or into an Excel spreadsheet with the click of a button.This is a sample report output. Note that the information from the report can be easily exported to comma-separated value (CSV) file format or into an Excel spreadsheet with the click of a button.

58. This is the Administrative Page. From this page, an individual holding the SPN-ADMIN key could: assign VistA mail groups associated with SCIDO, import patient information from the National SCIDO database, request an ICN number from MPI or activate/inactivate a patient, an assessment or an episode of care. This is the Administrative Page. From this page, an individual holding the SPN-ADMIN key could: assign VistA mail groups associated with SCIDO, import patient information from the National SCIDO database, request an ICN number from MPI or activate/inactivate a patient, an assessment or an episode of care.

59. This is the IRM page. From this page, a person holding the SPN_IRM key could check the Audit Log, check for patient or assessment locks, update the regional configuration or upload/download information from the National SCIDO database. This is the IRM page. From this page, a person holding the SPN_IRM key could check the Audit Log, check for patient or assessment locks, update the regional configuration or upload/download information from the National SCIDO database.

60. This page is the Audit Log – you must hold the SPN_IRM key to view/use this page. This page is the Audit Log – you must hold the SPN_IRM key to view/use this page.

61. This page reflects locking detail information for a patient and an assessment. Episodes of Care (EOC) locks can also be viewed here. This page reflects locking detail information for a patient and an assessment. Episodes of Care (EOC) locks can also be viewed here.

62. This page represent the options of uploading or downloading information from the National SCIDO database. This page represent the options of uploading or downloading information from the National SCIDO database.

63. SCIDO Help Desk Jean Laubscher – SCIDO Program Specialist (206) 277-1210 [email protected] Erik Wallen - Instructional Systems Specialist (206) 277-4749 [email protected] Contact information for the SCIDO Help Desk.Contact information for the SCIDO Help Desk.

64. Acronyms ETS - Enterprise Terminology Services MPI – Master Patient Index RAI/MDS - Resident Assessment Instrument/Minimum Data Set SCIDO – Spinal Cord Injury and Disorders Outcomes SDS – Standard Data Service PSL – Person Service Lookup VIE – Vitria/VistA Interface Engine

65. Questions?

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