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DoD/VA Health Information Technology Collaboration. Joint Venture Conference O ctober 18, 2011. Session Objectives. Discuss the current DoD/VA health data sharing initiatives

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dod va health information technology collaboration

DoD/VA Health Information Technology Collaboration

Joint Venture Conference

October 18, 2011

session objectives
Session Objectives
  • Discuss the current DoD/VA health data sharing initiatives
  • Discuss factors influencing the need to broaden data sharing initiatives to include private sector and other agency providers
  • Discuss how the Departments are jointly looking to the future…
dod va data sharing stakeholders
DoD/VA Data Sharing Stakeholders
  • Beneficiaries
  • Providers
  • Military and Veterans and Service Organizations
  • Military Services
  • Government Accountability Office
  • Office of Management and Budget
  • Congress
  • Executive Branch
military health system mhs
Military Health System (MHS)
  • Over 9.6 Million Beneficiaries
    • 42% active duty, 58% retirees and dependents
  • Direct Care:
    • Over 700 fixed medical and dental facilities
  • Purchased Care:
    • Over 380,000 civilian providers accept TRICARE
mhs electronic health record ehr footprint sustaining base
AHLTA – Worldwide

Covers Every Time Zone

9.6 Million Beneficiaries

190 Million Outpatient Encounters

140,000 Additional Encounters Daily

77,000 Active Users

110,000 End User Devices

White House Medical Unit

MHS Inpatient Solution

59 Sites (100% of DoD Inpatient Beds)

Deployment completed in April 2011

MHS Electronic Health Record (EHR) Footprint (Sustaining Base)

Supporting transient patient populations and transient health care teams

mhs ehr footprint theater
Operation Enduring Freedom/ Operation Iraqi Freedom

Over 4.5 Million Outpatient and over 63,000 Inpatient Clinical Encounters captured electronically

Over 11.3 Million Orders for Ancillary Services (inpatient and outpatient laboratory, radiology, and pharmacy)

Iraq, Qatar, Kuwait, Afghanistan

EHR capability on board ships

MHS EHR Footprint (Theater)
department of veterans affairs va
Department of Veterans Affairs (VA)

Source: VHA Statistics, VHA Policy and Planning, October 7, 2010

  • Over 8.1 million enrollees
    • Increase of over 105 percent since 1995 (2.5 million enrollees)
  • Over 5.7 million patients
    • Older, sicker and poorer patient populations
  • Over 1,300 Direct care sites
    • 152 medical centers/hospitals
    • 784 clinics (hospital, community-based and independent)
    • 277 counseling centers
    • 134 nursing homes
department of veterans affairs va continued
Department of Veterans Affairs (VA) (continued)
  • Over 86,000 Health Care Providers
    • 15,000 Physicians
    • 38,000 Nurses
    • 33,000 Allied Health Professionals
    • 10,000 fewer employees than 1995
  • Affiliations with 127 Academic Health Systems
    • 25,000 affiliated physicians, 36,000 residents and fellows, and 25,000 medical students
    • 114,000 trainees in all disciplines
    • Nearly half of all US health professionals (65% of US physicians and 50% of US psychologists) have had some training in a VA facility
  • $1.7 Billion in Research (Rehabilitation, Health Services, Clinical, and Basic)
motivations for sharing data
Motivations for Sharing Data
  • Close proximity or co-located facilities
    • Joint venture sites/local sharing agreements
  • Reserve/Guard medical care
    • Care in VA post-demobilization
    • Care in MHS when remobilized
  • Service members post-separation
    • Continuity of care
    • Determination of benefits
point of separation
Lab results

Radiology reports

Outpatient Rx data

Allergy information

Discharge summaries

Consult reports

Point of Separation

327 million messages (DoD to VA) on 5.7 million retired or discharged Service members

  • Admission/discharge/ transfer information
  • Standard ambulatory data record elements
  • Demographic data
  • Pre-/post-deployment health assessments
  • Post-deployment health reassessments*

*Transmitted weekly for individuals referred to VA for care or evaluation

shared patients

Outpatient pharmacy


Inpatient and outpatient lab results

Radiology reports

Ambulatory encounter notes


Problem lists

Shared Patients

Supports care for more than 4.1 million patients to date

DoD providers access VA data through AHLTA

VA providers access DoD data through *VistA CPRS or VistAWeb

Specialists in VBA access DoD data through *CAPRI

  • Inpatient notes (from DoD Essentris sites)
  • Theater clinical data
  • Vital signs
  • Family history, social history, other history
  • Questionnaires

* VistA – Veterans Health Information Systems and Technology Architecture

* CPRS – Computerized Veterans Health System

* CAPRI – Compensation and Pension Record Interchange

computable data
Computable Data
  • Supports interoperability between DoD’s Clinical Data Repository (CDR) and VA’s Health Data Repository (HDR)
  • Standardized, computable outpatient pharmacy and medication allergy data
  • Computable data supports real time drug-drug and drug-allergy checks using data from both DoD and VA
    • For shared patients set as “active dual consumers,” data is seen enterprise-wide
wounded warrior image transfer
Wounded Warrior Image Transfer

Digital radiology images and scanned medical records for severely wounded warriors sent from DoD to VA when the decision is made to transfer the patient (inpatient to inpatient)

Data push at time of referral

  • Walter Reed Army Medical Center
  • National Naval Medical Center
  • Brooke Army Medical Center
  • Tampa Polytrauma Center
  • Palo Alto Polytrauma Center
  • Minneapolis Polytrauma Center
  • Richmond Polytrauma Center

From 2007 to present:

  • Images for more than 440 patients
  • Scanned records for more than 545 patients
image sharing dod capability
Image Sharing – DoD Capability
  • DoD Health Artifact and Image Management Solution (HAIMS)
    • Global awareness of and global access to artifacts and images, including:
      • Scanned documents
      • Digital radiographs (X-rays, CTs, MRIs, mammography, and sonograms)
      • Clinical photographs
      • Video
      • EKGs and echocardiographs
    • Phase 1 Limited User Testing completed in September 2011; report to Services
    • Phase 2 development well underway
image sharing va capability
Image Sharing – VA Capability
  • VA VistA Imaging System
    • Facilitates clinical decisions
    • Provides clinicians with multimedia component of patient record
    • Images are integrated into patient record
    • Records are available on the clinician’s desktop
    • Enables VA image sharing enterprise-wide
      • Clinical images, scanned documents, motion video, electrocardiograms and other non-textual data files
    • VA enhancements will enable view of DoD HAIMS data
what s next
What’s Next?
  • Continue to expand the DoD document scanning and image sharing capability as approved by the Services
  • NeuroCognitive Assessment Tool (NCAT)
  • Traumatic Brain Injury/Behavioral Health (TBI/BH)
  • Medical Evaluation Tool – Information Technology Initiative (MEB-ITI)
a look to the future
A Look to the Future
  • DoD and VA currently share significant and unprecedented amounts of health data
  • More than half of DoD and VA health care comes from private sector providers
  • DoD and VA need access to private sector health documentation to create a true lifetime electronic health care record
a week in the mhs
A Week in the MHS*
  • 23,300 Inpatient Admissions
    • 5,100 direct care
    • 18,200 purchased care
  • 1.8 Million Outpatient Visits
    • 809,000 direct care
    • 1.001 million purchased care
  • 3.5 Million Claims Processed
  • 2.6 Million Prescriptions
    • 924,000 direct care
    • 1.44 million retail pharmacies
    • 228,000 mail order
  • 2,400 Births
    • 1,000 direct care
    • 1,400 purchased care

* From the 2011 MHS Stakeholders Report

average monthly purchased care in va
Average Monthly Purchased Care in VA
  • Annually, VA processes more than 1 million purchased line items for non-VA medical care with the following monthly averages:
    • 234 unique patients for pharmacy
    • 11,051 unique patients for inpatient admissions
    • 72,659 unique patients for outpatient visits
    • 3,885 unique patients for dental visits
    • 213 unique patients for child birth delivery

The New England Journal of MedicineApril 16, 2009

  • “1.5% US Hospitals have a comprehensive electronic records system”
  • “7.6% US Hospitals have a basic electronic records system”
  • “17% US Hospitals have computerized provider-order entry for medications”

“Very low levels of adoption of electronic health records in US Hospitals”


“The very low levels of adoption of electronic health records in U.S. hospitals suggest that policymakers face substantial obstacles to the achievement of health care performance goals that depend on health information technology. A policy strategy focused on financial support, interoperability, and training of technical support staff may be necessary to spur adoption of electronic-records systems in U.S. hospitals.”


american recovery and reinvestment act arra of 2009
American Recovery and Reinvestment Act (ARRA) of 2009
  • In December 2009, HHS Secretary Sebelius announced plans to establish health IT "Beacon Communities"
    • $235 million set aside to fund nationwide Beacon Community Program
    • The program will take communities at the cutting edge of EHR adoption and health information exchange and push them to a new level of health care quality and efficiency
  • Potential Beacon Communities should have local institutions and health information exchange (HIE) networks wanting to partner with MTFs and VAMCs
    • To ensure initiatives are in-line with enterprise initiatives
    • Services work through Service CIOs/CMIOs
future state where are we going

Source: Washington Post, April 9, 2009

Future State – Where Are We Going?

On April 9, 2009, President Obama directed DoD and VA to create a Virtual Lifetime Electronic Record (VLER) that:

“will ultimately contain administrative and medical information from the day an individual enters military service throughout their military career and after they leave the military.”

- President Barack Obama

vler initiative goal
VLER Initiative – Goal
  • To provide seamless access to electronic records for Service members and Veterans through a single portal
    • Success is dependent on the existence of an electronic health record (EHR) capability in each participating organization
    • While VLER builds on that capability, the capability is separately developed and funded
vler initiative transition

CurrentDoD/VA Health Information Exchange

UnderwayNationwide Health Information Network

Historical data from 1989 forward, live data flow as of 2002, bidirectional data flow as of 2004, all DoD and VA medical facilities as of July 2007

Health Bank or PHR Support Organization

State and Local Governments

Community Health Centers

Community #1




Mobilizing Health Information Nationwide



Bidirectional Health Information Exchange




IntegratedDelivery System


Community #2

  • Health data on more than 5.7 million Service members
  • 4.1million correlated patients
  • 89.0 million lab results
  • 14.5 million radiology reports
  • 92.2 million pharmacy records
  • 110 million standard ambulatory data records
  • 4.9 million consultation reports
  • 3.3 million deployment-related health assessments on more than 1.5 million individuals
  • (As of August 31, 2011)

The Internet

Standards, Specifications and Agreements for Secure Connections

VLER Initiative – Transition


CDC – Centers for Disease Control & Prevention

CMS – Centers for Medicare & Medicaid Services

PHR – Personal Health Record

SSA – Social Security Administration

vler capability areas vcas
VLER Capability Areas (VCAs)

*Suspense dates are tentative and subject to change

vler initiative vca1 pilots
VLER Initiative – VCA1 Pilots

Six Month Increments

Puget Sound Pilot

San Diego Pilot

Tidewater Pilot

Spokane Pilot

  • January 31, 2010
  • Health Record Data: Healthcare Information Technology Standards (HITSP) C32 subset:
    • Allergy/Drug Sensitivity
    • Condition
    • Healthcare Provider
    • Information Source
    • Language Spoken
    • Medication
    • Person Information
    • Emergency Contact
  • Partners:
    • San Diego VA Medical Center
    • Naval Medical Center San Diego
    • Kaiser Permanente in San Diego
  • September 15, 2010
  • Health Record Data:
    • HITSP C32 subset (from San Diego)
    • Comment
    • Hematology Lab Result
  • Partners:
    • Naval Medical Center Portsmouth
    • VA Medical Center Hampton
    • Med Virginia
  • March 25, 2011
  • Health Record Data:
    • HITSP C32 subset (from Tidewater)
    • Vital Sign
    • Chemistry Lab Result
  • Partners:
    • 92nd Medical Group, Fairchild AFB
    • Spokane VA Medical Center
    • Inland Northwest Health System
  • September 26, 2011
  • Health Record Data:
    • HITSP C32 subset (from Spokane)
    • Advance Directive *
    • Encounter
    • Immunizations*
    • Insurance Provider
    • Procedures
    • Unstructured Documents:
      • Consults/Referrals
      • Discharge Summaries
      • Results of Diagnostic Studies
      • Procedure Notes
      • History & Physicals
  • Partners:
    • Madigan Army Medical Center
    • VA Puget Sound Health Care System
    • MultiCare Health Org
  • * will display but not send
  • November 16, 2010
  • Additional Partners:
    • McDonald Army Health Center (MCAHC), Fort Eustis
    • 633 Medical Group, Langley AFB
vler initiative vca2
VLER Initiative – VCA2
  • VCA 2 expands health information from the set exchanged in VCA 1 to include the exchange of additional electronic health information for Veterans Benefits Administration and Social Security Administration disability claims adjudication
    • Use Cases complete September 2011
    • Concept of Operations and functional requirements development underway
    • Initial operating capability by December 2012
    • Full operating capability by December 2014
integrated electronic health record iehr conceptual architecture
Integrated Electronic Health Record (iEHR) Conceptual Architecture

Common DoD-VA Requirements: HL7 EHR-S Functional Model with DoD and VA vetted Extensions (SV-4)

Common DoD-VA Integrated Health Business Reference Model (OV-5)

Common DoD-VA “To Be” Process Flow Model (OV-6C)


(Common GUI)

Applications and Services

VA Unique

DoD Unique

Common (Joint) Applications & Services


PersonalHealth Record


Blood Mgmt

Battlefield Care


Nursing Home

Long Term



InpatientOrders Mgmt

EmergencyDept Care







Dental Care

Consult &Referral Mgmt


OperatingRoom Mgmt

Enroute Care


OccupationalHealth (VA)

Common Interface Standards

Common Services Broker(includes Enterprise Service Bus (ESB) and Infrastructure Services)

Common Interface Standards

Common Data Centers

Common Information Interoperability Framework (CIIF)

Common Information Model, Common Terminology Model,

Information Exchange Specifications, Translation Service

Common Data Standards: SNOMED CT and Extensions, LOINC and RxNorm

Common DoD-VA Measures of Effectiveness, Measures of Performance and Key Performance Parameters

DoD Only

VA Only

Joint DoD/VA