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Health Management Platform for Transforming Patient Care

The Health Informatics Initiative (hi2) aims to transform healthcare delivery through health informatics. The Health Management Platform is a key component of this initiative, providing comprehensive, integrated, and coded patient data, supporting team-based and multi-patient care, enabling workflow-driven and role-based activities, and offering knowledge-driven and context-based decision support. The platform also includes Virtual Patient Record (VPR) and various application services for a modern, tiered architecture.

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Health Management Platform for Transforming Patient Care

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  1. Health Management Platform March 28, 2012 Presentation for iEHR Engineering Deep Dive

  2. Why Was the Initiative Created? “Transform Healthcare Delivery through Health Informatics” (Health Informatics Initiative or hi2) was created by Secretary Shinseki in May 2010 with these missions: • Provide foundational IT and Informatics components for VHA’s transition from a medical model to a patient-centered model of care. • Build a sustainable collaborative approach, capacity, and tools to deliver informatics solutions to transform health care delivery to Veterans through three major projects or Workstreams.

  3. Initiative Workstreams • Workstream A: Adopt a Health/IT Collaborative Supporting Rapid Product Development and Delivery Methods. • Workstream B: Build a Health Management Platform to Transform Patient Care. • Workstream C: Create Health Informatics Capacity • Workstream D: Deliver Communication and Drive Change

  4. Health Management Platform • Healthcare Team-facing • Browser-based, healthcare team user-interface modules • Workflow driven, role-based activity systems • Knowledge-driven, context-based decision support • Team-based, multi-patient care environment • Patient-facing • Meaningful patient use, population reach and impact • Engage patients in their care • System/Population-facing • Feedback to clinicians for panel management • Population and epidemiology-like studies • Measure how the “system” is performing – real-time visibility 4

  5. Clinical Context 5

  6. Key Concepts • Four Key Clinical Concepts • Comprehensive, integrated coded data • Team-based, multi-patient care • Workflow-driven, role-based activities • Knowledge-driven, context-based decision support • Within an open source/open architecture environment 6

  7. Comprehensive, Integrated Coded Data • Comprehensive: Data can be accepted from various sources including: VA facilities, DOD, NwHIN, and others - Architecture ready to accept multiple sources • Integrated: System assumes all patient data is available and creates integrated views of data - Virtual Patient Record (VPR), Search Service • Coded: The data is standardized and coded via a terminology system • Demo: Multiple facilities data, data grids/details, Search service 7

  8. Team-based, Multi-patient Care • Single Patient and Multi-patient (Panel) views are supported by the system - Roster/Panel services first phase is available. • Team-based care is designed into the system • Tools to manage and communicate with the clinical care teams is provided. • Demo: CHF Panel, Index Panel, Roster Builder and Service, Integrated multi and single patient views 8

  9. Workflow-driven, Role-based Activities • System understands user’s role. Role determines views, menus, choices and inputs presented to user - Modularity and data driven starting point, roles • System no longer linear, but works the way user wants to work. Documentation created as a by product. Order anywhere. • Supports various work-flows - Modularity • Work-flows are definable and flexible - Worksheets • Demo: Modular framework, worksheet beginnings with ordering service from worksheet, Free form pages 9

  10. Knowledge-driven, Context-based Decision Support • Knowledge-driven systems behind scenes provide links, guidelines for decision support tools - Info Buttons • System understands various contexts including: Role-based, Problem-driven, and Time-based. - CHF • Decision support tools drastically expanded to aid in planning, assessment, and goals of patient care. • System is smart and provides suggestions as clinical care is given. • Demo: Info Button & Search Service, CHF specific pages 10

  11. Rosters Search Provider packages Info But CART VPR Order Entry PHR Med Rec Care Plan Technical Framework Accomplishments Legacy HMP User Application Platform CPRS • Virtual Patient Record VPR • HMP/MDWS application services • Modular, data-driven user interface approach • Resulting in a modern, tiered architecture Presentation Application Services VistA Business Logic Consistent Data Store MDWS Data Services NwHIN Patient Data Data DoD CDW Local National 11

  12. VPR Virtual Patient Record (VPR) • Solves issues: Proprietary, LAN based, inefficient data access • VPR • New VistA routines return a web-friendly, complete patient data XML document • Rebuildable cache - kept fresh • HiTSP informed, non-proprietary data model • Multiple data sources - computable data set • Highly indexed for performance • HMP/MDWS patient data web services (REST/SOAP) Presentation VistA Business Logic Consistent Data Store MDWS Data Services NwHIN Patient Data Data Local DoD CDW Local National 12

  13. Rosters Provider packages Search Info But Order Entry HMP/MDWS Application Services • Web application services • Contribute to/consume from ESB • Expose VistA capabilities • Patient data service • Roster/panel service • Order entry service • Provide new clinical capabilities • Information button “Info Button” service • Patient chart search service Presentation Application Services VistA Business Logic Data 13

  14. CART PHR Med Rec Care Plan Modular Data Driven User Interface Approach CPRS User Application Platform • Flexible, industry best practice • Demonstrate 3 modularity modes • Application level • Page level • Summary module • Shared Context - user, patient, clinical objects • Visible and business logic components registration at runtime • Data driven view with “view specifications” Presentation Business Logic Data 14

  15. Rosters Provider packages Info But Search CART VPR Order Entry PHR Med Rec Care Plan Technical Framework Summary Legacy HMP User Application Platform CPRS • Virtual Patient Record VPR • HMP/MDWS application services • Modular, data-driven user interface approach • Resulting in a modern, tiered architecture Presentation Application Services VistA Business Logic Consistent Data Store MDWS Data Services NwHIN Patient Data Data DoD CDW Local National 15

  16. Rosters Population Analytics Population packages Patient packages Provider packages Info But Search CART VPR etc. Epinome Order Entry VPopR Terminology PHR VPHR ADT Med Rec Care Plan Technical Framework Migration HMP Legacy User Application Platform CPRS • Presentation Layer • Industry best practice web environment • User-adaptable interfaces • Context-based modules • Widget technology • Device agnostic mobile apps Presentation VistA Application Services • Service Layer • HMP/MDWS application services • (e.g. Roster, Search) • Contributes to/consumes from ESB • Open Source model • REST, SOAP interfaces Business Logic Consistent Data Store • Exposed Data Layer • Temporary cache from multiple data sources • Longitudinal, standards encoded • Promotes interoperability & data exchange MDWS Data Services • MDWS read/write data services • Merged HMP/MDWS data services • Richer, consistent data • XML format • NwHIN extracts for VLER NwHIN Data Patient Data CDW PED DoD ??? Local National 16

  17. iEHR and hi2 Health Management Platform (HMP)Common Architectural Areas Presentation (Common GUI) HMP Modules Janus Modules Other Modules Applications and Services VA Unique (6) DoD Unique (16) Common (Joint) Applications & Services (30) Pharmacy PersonalHealth Record Laboratory Blood Mgmt Battlefield Care Pediatrics Nursing Home Long Term Care HMP/MDWS Services (e.g. Roster, Search, OE, OM, Note Writer) HMP/MDWS Services (e.g. Roster, Search, OE, OM, Note Writer) DisabilityEvaluation InpatientOrders Mgmt EmergencyDept Care DocumentMgmt MilitaryReadiness Obstetrics Rehabilitative Care TransientOutreach Dental Care Consult &Referral Mgmt Immunization OperatingRoom Mgmt Enroute Care Veterinary PharmacyMail Order OccupationalHealth (VA) Common Interface Standards Common Services Broker (includes Enterprise Service Bus (ESB) and Infrastructure Services) HMP/MDWS Services (e.g. Patient Data Services) Common Interface Standards Common Data Centers Common Information Interoperability Framework (CIIF) 17

  18. iEHR & hi2 – Current Collaboration (Jan 2012) • CIIF (Common Information Interoperability Framework) • hi2 will inform and support CIIF • iEHR Presentation Layer • Similar development tools/environment and approach • Data Read/Write - MDWS • Merging hi2 read/write services into MDWS • Service Layer - ESB • hi2 will attend iEHR meetings (ESB selection pending) • North Chicago & Tripler • Clinical Decision Support • hi2 coordinating with iEHR

  19. iEHR & hi2 – Moving Forward (Jan 2012) • Create strategy and definition of convergence by June 2012 • Foster technical collaboration • Brief VA and DoD clinical community • Establish a plan with options for: • Idea/Information exchange • Consensus building between VA/DoD • Socializing/Marketing expectations across departments • Engagement opportunities • Execution/Implementation considerations • Training and Sustainment realities

  20. iEHR & hi2 – Moving Forward (Jan 2012) • Acknowledge shared vision and goals • Modern, tiered architecture • Open Source • Developer/end user collaboration • Data/terminology standards • Integration of disparate data sources • Agree to establish an internal/external communication strategy • Bi-weekly conference calls – hi2 & VHA iEHR leads • Coordinate external communication with OIA and VHA

  21. Health Management Platform – FY12 Goals • Continue to build AViVA foundation and infrastructure • Stand-up development teams for Patient and System/Population • Install and test HMP Module 3 in Production at pilot sites • San Diego, Indianapolis, Portland, Loma Linda • Build and expand development partnerships • CART, VINCI, MDWS, iEHR • Publish Collaborative Development Environment • Leverage Health Management Platform and AViVA framework to initiate “democratization of IT” • Communicate & educate stakeholders

  22. Collaborative Development Environment • 1° GOAL - Position the Collaborative Development Environment (CDE) in a cloud with internet access to allow wide open source development participation and stakeholder and user engagement. • Currently setting up CDE in Innovations virtual environment. Getting necessary ports opened up and resolving performance issues. • Other options include an environments like RackSpace or similar. • 2° GOAL – get into a cloud that offers a non-SQL database such as MongoDB (MongoHQ-hosted version) so we can explore as an option and evaluate performance. • Similar to B-Tree structure, and schema design is a function of the data and the use case (unlike more rigid schemas in relational DBs) • Fast, efficient, flexible aggregation, scalable, open source • These types of databases are now being used by many major companies

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