NASA Electronic Medical Record Project Collaboration with Indian Health Service

1. NASA Electronic Medical Record ProjectCollaboration between NASA and Indian Health Serviceby G. Wyckliffe Hoffler, MD (Dynamac Corp.) for NASA Office of the Chief Health and Medical Officer Presentation at Open Collaboration: Networking Health Information Technology Ballston, VA 18 April 2006

2. NASA EHRS ProjectSynopsis Origin and Inception Professional, Technical, and Cultural Assessments External Resources and Relationships Design Concepts and Criteria Development of Requirements Initial Trajectory — Commercial Pursuit Midcourse Modification – IHS Collaboration Present Status Projected Course

3. NASA EHRS Project Origin and Inception • NASA Occupational Health Care Responsibilities • About 75,000 employees at 14 geographically dispersed sites • Civil Servants and Contractors • Charged to the NASA Chief Health and Medical Officer • Via contracted multi-disciplined, professional services • Under NASA contract management • Major Services Provided • Employee work-related medical surveillance and certifications • International travel clearances • Civil Servant authorized health maintenance evaluations • Health promotion/wellness • On site first care and emergency provisions for injury/illness • Case management and Work Force health assessments/demographics

4. NASA EHRS Project Origin and Inception (continued) • Health Information Maintained on Paper Records since 1958 • One except is the Longitudinal Study of Astronaut Health developed in the 1990’s at the Johnson Space Center • “Feasibility Study” Initiated April 2002 • Launched appraisal of effort to convert to an EHRS after assessing effectiveness of converting existing paper system • Scope of the Task • Many parallel and serial efforts involving internal and external contacts

5. NASA EHRS ProjectProfessional, Technical, and Cultural Assessments • Baseline Data Visits Made to All Site Clinics (2002-2003) • Assessed the modus operandi at each clinic • Tabulated work loads, personnel, facilities and infrastructure • Publicized project intent for NASA management and major professional contacts • Emphasized “buy-in” by all potential users, recruited champions • Named Agency-wide, multi-disciplined Task Force • Data Assimilation for Estimating and Closing the “Gap” • Reckoned commonalities and differences • Evaluated available in situ equipment and augmentations needed • Estimated preliminary requirements and likely candidate systems

6. NASA EHRS ProjectExternal Resources and Relationships • State-of-the-Art and Available Sources Sought • TEPR, HIMSS • Academic recommendations (AAFP, IOM, ACP) • Consultants • Vendors queried (RFI) • Demonstrations observed • Extant Functional Systems Studied • VHA Outpatient Clinic, Viera, FL • University of Texas Medical Branch, Galveston, TX • Small practitioner clinics • In-house NASA system experiences

7. NASA EHRS ProjectDesign Concepts and Criteria • Determining Principles and Guidelines • Standardize terminology, process, forms, drugs, outputs, etc. • Design unified, interoperable, single Agency system • Serve individual clinical user (real time), management, and epidemiologic (data warehouse) needs • Minimize effort and time for data entry and recall • Automate data capture and reporting when feasible • Incorporate context sensitive reminders/alerts • Furnish health data subsets for other discipline requirements • Assure confidentiality,validity, and preservation of data • Meet regulatory/statutory requirements for IT • Assure continuity of service, user training, and helps

8. NASA EHRS ProjectDevelopment of Requirements • Details, Conditions, and Factors for Integration • Technical and Functional Requirements • Clinic Work Flow Process • Magnitude/volume of data base • Hardware system components: Work stations, server(s), and med test • Architecture and Connectivity: Decide among site-specific servers, central server, or hybridized systems • Access time, back-up system, and allowable “down” time • Security, safety, and confidentiality; user access • User training requirements • Practicable deployment scheme • Resources required for: development, deployment, and O&M

9. NASA EHRS ProjectInitial Trajectory — Commercial Pursuit • Procurement of Commercial System • No system known or evaluated met all NASA requirements • A NASA Occupational Health Module must be developed, adapted, and customized for the NASA OH environment • Translation of design concepts/requirements into Statement of Work (SoW) • Proceeding toward release of RFP (April 2004) • NASA not fully comfortable with reiterated SoW and available options • Certain constraints on some priority candidates

10. NASA EHRS ProjectMidcourse Redirection – IHS Collaboration • Concurrent Influences • e-Gov initiatives and Jan 2004 Presidential declaration Re: EHRS • Advisors both internal and external to NASA suggest and recommend evaluation of the RPMS/EHRS of the Indian Health Service • Establishment of the Office of the National Coordinator of HI Technology (May 2004) • Visit to IHS Hospital in Cherokee, NC (July 2004) • Demonstration of their RPMS (Roll and scroll offshoot of the VISTA system of VHA) and EHRS (GUI in-house/contractor developed) • An in depth review of pros and cons led to recommending this route • Inter-agency Agreement (IAA) signed between NASA and IHS-- April 2005

11. NASA EHRS ProjectPresent Status • Principals of IHS and NASA EHRS interests have formed a Steering Committee meeting regularly for transfer of the RPMS/EHRS from IHS to NASA • The NASA EHRS Agency Task Force meets periodically for input, review, recommendations, communication to respective site clinic personnel • The NASA EHRS Team: • Keeps site clinic personnel updated on all related activities • Has established essential internal and external links to bring the IHS RPMS/EHRS aboard NASA • Works with NASA technical managers and procurement to effect the contractual instrument for developing the OH Module • Aligns channels with NASA Data Center, IntraNet keepers, and Safety, Security, and Information Technology interests

12. NASA EHRS ProjectProjected Course • Continue Collaboration with IHS to transfer RPMS/EHRS to NASA • Develop OH Module via IT Contract • Complete Risk Assessment and Security Plan • Coordinate within NASA Elements for Connectivity, Central Server, Data Base Management, Help Desk, and Overall System Operations and Maintenance • Train Trainers, Establish User Training Program, • Develop Schedule for Alpha- and Beta-testing, and Phased Deployment to NASA Site Clinics • Establish User Group Feedback and Continual Improvement • NASA EHRS (with OH Module) subsequently open to others