VHA OI Emerging Health Technologies Sampler

1. VHA OI Emerging Health Technologies Sampler Presented to: VA Information Resource Center (VIReC) November 17, 2008 Jim Demetriades Nancy Wilck Emerging Health Technologies

2. Presentation Outline • Emerging Health Technologies Overview • Clinical Wiki Pilot • Point of Care Device Technology Assessments • Collaborative Innovation • Electronic Health Record System Visioning

3. Emerging Health Technologies Overview • Organization: VHA Office of Information start-up chartered in October 2006 • Purpose: to sense and extend VHA’s information technology horizon through the application and introduction of technologies and practices • Approach: to provide evidence of healthcare technology value via high-level studies, proofs of concept, pilots to help inform both strategic and tactical planning • Focus: 3-5 year future window

4. Presentation Outline • Emerging Health Technologies Overview • Clinical Wiki Pilot • Point of Care Device Technology Assessments • Collaborative Innovation • Electronic Health Record System Visioning

5. Clinical Wiki Pilot • Working with Office of Information and Technology (OI&T) to establish a formal clinical wiki pilot inside VA • Intend to assess VHA interest in and viability of this technology • Premise is clinicians and allied health professionals will utilize wiki technology to freely share clinical knowledge with colleagues • Contributes to larger goal of assessing Web 2.0 ‘social networking’

6. Anticipated Wiki Benefits • Will encourage collective creation of knowledge within VHA and ensure its availability to interested persons • Viewed as credible information source and provide immediate relevance to VHA clinicians • Attract wide range of clinical users including nurses, researchers, residents, medical and allied health students

7. Clinical Wiki Pilot (con’t) • Initial wiki environment will use same feature set as found in the open source technology powering Wikipedia.com • Will support both general and specialized communities (portals) and availability of discussion areas, news and event postings • Will require contributor authentication and attribution • Expect pilot to be available early next quarter

8. Presentation Outline • Emerging Health Technologies Overview • Clinical Wiki Pilot • Point of Care Device Technology Assessments • Collaborative Innovation • Electronic Health Record System Visioning

9. Point of Care (POC) Device Assessment Program • Purpose: Examine the use of information technology products for use by VHA clinicians at the point of care • POC device definition: Information technology (IT) products with user interfaces (e.g. hand held, mobile, wireless, laptop, thin/thick client devices) that can access VA’s VistA computer system and / or other information sources • What is excluded: diagnostic and therapeutic biomedical devices

10. POC Device Assessment Approach • Approach: • Define POC device reference model (framework) • For a particular setting (e.g. clinic, ward, long term care) and role (primary care doc, nurse, specialist) identify and prioritize devices of high interest • Engage clinicians in conducting assessments (tablet PCs will be first examined) • Provide opportunity for diverse collaboration with other teams (e.g. security, patient safety, etc.)

11. POC Device Assessment Program (con’t) • Publish a series of on-line ‘Consumer Reports’ like articles. • Program will serve as information resource for sites looking at devices • Focus is on technology and not products • Acquisition recommendations are out of scope. • Timeframe: Contract award to develop methodology and framework expected in Dec. 2008

12. Presentation Outline • Emerging Health Technologies Overview • Clinical Wiki Pilot • Point of Care Device Technology Assessments • Collaborative Innovation • Electronic Health Record System Visioning

13. Collaborative Innovation Definition Collaborative Innovation “Self-organizing groups of highly motivated individuals working together towards a common goal ….” –Peter A. Gloor, Carey Heckman, Fillia Makedon

14. Our Focus: The Intersection Collaborative Innovation happens here

15. Innovation Sandbox Description • The Innovation Sandbox is much more than a software development environment. It is also a virtual space for people to collaborate, innovate, and develop ideas and requirements • The Sandbox is a geographically limitless solution to the historic challenge of locally bound development efforts • The Sandbox is intended for anyone wishing to contribute ideas to VistA development

16. Collaborative Innovation Initial Accomplishments • VHA Informatics and Data Management Committee (IDMC) charge • Early 2007 • Propose a way to preserve innovation, minimizing IT re-organization challenges • Cross organizational workgroup • Chartered May 2007 • Stakeholders from field, OI&T and OI • Innovation Concept of Operations (CONOPS) • Presented and approved for pilot by IDMC Sept 2007 • Industry review and comment: Gartner, Perot Systems, EDS, Microsoft, IBM

17. Collaborative Innovation Goals • Perpetuate local innovation in support of mission needs • Strengthen early idea sharing • Encourage communities of interest • Increase collaboration • Eliminate redundancy • Rapidly deploy innovative software which adheres to national development standards

18. Collaborative Innovation Principles • Access is easy and open to all • The Sandbox is structured to allow ideas and work products to be freely shared • There is a well-defined path for mainstreaming innovative creations into production • Failures are expected and accepted as a cost of being innovative • Sandbox governance promotes process consistency, simplicity, and reuse

19. User Experience • Receive general innovation news • Access resource libraries • Discover or create ‘birds of a feather’ communities • Contribute ideas and collaborate in shaping business requirements • The more technically inclined can initiate software projects • Innovation ideas or requirements may be submitted to the New Service Request (NSR) process • Applications that meet ‘high-bar’ exit criteria for national business value, OI&T programming standards and infrastructure capacity may be fast-tracked within the NSR process

20. Market Survey • Contract awarded to survey market for toolset • final recommendations received in March 2008 and refreshed in August 2008 • The market is clearly emerging and volatile • No single solution meets our wants • Current thinking: bridge two commercial products • one strong in idea and community management • a second to provide a solid development environment

21. Collaborative Innovation Current and Future Plans • In progress now • “Bench” validation of candidate products • Development of functional requirements for Sandbox environment • In the queue • Pilot approach decision • Acquisition/installation • Initial live testing (pilot) • Transition planning

22. Presentation Outline • Emerging Health Technologies Overview • Clinical Wiki Pilot • Point of Care Device Technology Assessments • Collaborative Innovation • Electronic Health Record System Visioning

23. Definition of EHR-S • EHR-S includes all clinically related systems or applications such Computerized Patient Record Systems (CPRS) and radiology, lab, scheduling, and pharmacy packages • Medical devices and national data bases such as Decision Support System (DSS) and the Administrative Data Repository (ADR) are not part of the EHR-S although the need to interface with them will be a key characteristic of it

24. EHR-S Visioning Objective • Want to define ‘shared vision’ for next generation EHR-S • Called ‘shared’ because products of meetings become basis for vision document that will be available for broad community review and contribution • Will seek to make shared vision an authoritative document • Will serve as roadmap for VHA as it defines capabilities and priorities for future development efforts

25. EHR-S Visioning Approach • Facilitating a series of meetings with key EHR-S stakeholders • Final meeting will begin tomorrow with allied health, research, education, and academic affiliations • VHA stakeholders (e.g., Veteran Service Organizations (VSO) and healthcare partners (e.g., DoD and IHS) will be briefed • Vision document will be iterated and available for contributions from larger VHA community • Look for draft vision in January

26. EHR-S Visioning: How You Can Contribute • Participate in development of the shared vision: • Contact the VIReC Help Desk at virec@va.gov for the VA Intranet address • Propose additional guiding principles if needed • Propose capabilities the EHR-S must provide to support your line of business (remembering that it is first and foremost a clinical tool) • Encourage your co-workers and colleagues to contribute to the shared vision

27. Contacts for Additional Information Jim Demetriades Jim.Demetriades@va.gov 518-449-0627 Nancy Wilck Nancy.Wilck@va.gov 703-927-8880

28. Discussion

29. Supplemental Material This material supplements the formal briefing. Feel free to contact us if you have questions on any of it.

30. EHR-S Guiding Principles Participants in the visioning meetings developed the following EHR-S Guiding Principles statement: • In building the EHR-S of the future: • VHA will define its content, functionality and performance requirements. • Clinicians will lead and collaborate with other stakeholders in the continuous evolution of the system. • The EHR-S of the future will support and enable VHA’s missions, with specific focus on patient safety and quality of care, by: • Being patient-centric; • Facilitating knowledge discovery, accommodating innovation and changes in health care practice and information needs; • Providing a framework to identify and promote use of best practices and innovation, in both patient care and informatics; • Reducing undesirable variation through support for consistent approaches to common tasks; • Supporting standardization at the core and diversity at the periphery; • Enhancing communication internal and external to VHA, among clinicians and with patients, across organizations and the continuum of care; and • Promoting the efficiency and effectiveness of clinical staff.

31. EHR-S Capabilities Participants in the visioning meetings determined that the EHR-S must have the following characteristics: • Be flexible, modular, and integrated • Promote data standardization, data quality, information and data reuse; capture the data once and use it many times • Support context-driven views, giving the right information at the right time • Provide access to data for all users, including people with disabilities (e.g., access from numerous places with numerous devices) • Manage the patient's composite record including longitudinal patient views (internal source, format, location, identity) • Be context, role, and event aware • Be instrumented to support user efficiencies • Promote the wellness of the veteran population

32. EHR-S Capabilities (con’t) • Provide both prescriptive and assistive real-time clinical decision support • Be configurable with standard defaults • Enable support care team collaboration (any handoffs—internal/external) • Support data input from multiple sources (devices) and locations • Be easy to navigate and comprehend • Provide multiple information horizons, arranged by cognitively significant context, and provide multiple-level views and abstractions. • Incorporate transportable tools, templates, lists, orders, and pathways • Provide ability to manage workflow • Must ensure complete, computationally correct, dynamic records. • Facilitate a user interface in which provision of care is compatible with care eligibility

33. Profile of Attendees at EHR-S Visioning Sessions To Date • Medical Doctors (24) • Registered Nurses (8) • Clinical Pharmacists (2) • Psychologist (1) • PhD. (2) • Clinical Applications Coordinator (1) • Experts in: • Clinical Decision Support (1) • Cognitive Engineering (1) • Data Quality (3) • Enterprise Portfolio Management (2) • Health Eligibility (1) • Health Information Management (1) • Information Management (2) • National Data Systems (1) • Privacy (1) • Section 508 (1) • Security (2)