VHA Health Information Model (VHIM) Orientation

1. VHA Health Information Model (VHIM) Orientation VHIM Home Page http://vaww.va.gov/vhaea/scripts/vhim.asp

2. Agenda • VHA Business Drivers – The need for HealtheVet • HealtheVet – The need for the VHIM • What is the VHIM? • How does VHIM work? • What does the VHIM do for you? • VHIM Team Organization • VHIM Team Interactions • Take-aways

3. VHA Business Drivers • Shift from Institutional-centric data to Veteran-centric • Establish consistency in the meaning of data within VHA • Meet requirements of authoritative, longitudinal, accessible, Electronic Health Record (EHR) • Achieve interoperability with partners (DoD, CDC, Homeland Security, external providers) • Meet Federal Enterprise Architecture and Federal Health Architecture requirements

4. VHA Business Drivers (concluded) • Align with health information standards • Increase focus on improved health outcomes, increase patient safety, increase quality and reduce wait times • Improve billing support and revenue collection • Provide robust support for analytical computing and clinical decision support • Improve privacy and security of health information

5. Business Climate • Multiple external pressures in the Medical, Business, Legal, Technical, and Financial arenas drive a complete re-engineering of VHA’s healthcare systems • Critical requirement for consistent application of an Enterprise-wide Architecture in order to facilitate interoperability and reuse

6. HealtheVet Characteristics • “System of Systems”; not a collection of modules • Service Oriented Architecture; not Client/Server • Data retrieved by “asking” a service; not just by accessing a shared database • Data is an Enterprise Asset; not “owned” by a Project (e.g. Lab) or by the originating facility

7. HealtheVet Overview (concluded) getLabResult(“… <Patient VPID=123/> <LabObservation testCode=276148/> … ”) Rx Service Lab Service Nursing Service (COTS) CAIP DoD HealtheVet “Backbone” CHDR CDS Person Service VETS / SDS CDS Gateway Kaiser- Perm. “<MicrobiologyObservation> <Organism code=567891/> <AntibioticSensitivityObservation antibiotic=454798 value=“>=32” units=“mcg/ml” interpretation=731974/>” HDR ADR

8. Enter the VHIM VHIM Pharmacy Drug HealtheVet Medication Reactant Allergy Re-engineering Radiology Contrast Agent • The authoritative source for semantics and information structure for VHA. It defines the structure and content of interactions betweenservices and between VHA and external partners. • Portion of architectural strategy to ensure semantic interoperability among HealtheVet components. • Enterprise-wide initiative to guide the re-engineering of VHA’s systems

9. What is the VHIM? • A UML model which carries definitions of crosscutting information within VHA and contains classes, their attributes and their relationships

10. What is the VHIM (concluded) • Computationally Independent Model within MDA • Organized by domains such as Demographics, Pharmacy, etc. • Ensures harmonization with industry standards through active involvement with SDOs (HL7, NCPDP, CHI, DICOM, ASC X12) • Aligned with HL7 Reference Information Model and HL7 3.0 Vocabulary Domain

11. VHIM Versions • VHIM 2.x • Consumers: FHIE, HDR IMS, CHDR, BHIE • Uses OMG COAS structures / datatypes • VHIM 3.x • Consumers: HealtheVet, HDR II, CDS • Uses HL7 3.0 Datatypes; aligned with HL7 3.0 Reference Information Model (RIM)

12. The VHIM and Enterprise Reference Terminology (ERT)

13. The VHIM and Enterprise Reference Terminology (ERT) (concluded) Reference Terminology Information Model • Allergy domain • Reactants | 300 • Pollen | 301 • Bees | 302 • Penicillin | 303 • … • Reactions | 400 • Rash | 401 • Headache | 402 • Diarrhea | 403 • …

14. VHIM – Implementation VHIM Class Diagram XML Schema Definition (XSD) Java <xs:element name="PatientIdentity" type="VaIdentity" substitutionGroup="personIdentity" /> - <xs:complexType name="PatientIdentity"> - <xs:complexContent> - <xs:extension base="PersonIdentity"> - <xs:sequence> - <xs:element name="administrativeGender" type="AdministrativeGenderCode"> - <xs:annotation> <xs:documentation>A value representing the gender (sex) of a person. The for allowable values for this field as specified by the DS DAT for Demographics are: F (Female), M (Male) and UN (unspecified).</xs:documentation> </xs:annotation> ... public interface PatientIdentity extends personSRDTs.PersonIdentity { livingSubject.AdministrativeGenderCode getAdministrativeGender(); void setAdministrativeGender(livingSubject.AdministrativeGenderCode administrativeGender); livingSubject.AdministrativeGenderCode addNewAdministrativeGender(); livingSubject.BirthTime getDateOfBirth(); void setDateOfBirth(livingSubject.BirthTime dateOfBirth); livingSubject.BirthTime addNewDateOfBirth(); ...

15. VHIM Templates • Templates are a subset of the VHIM used to define payloads • Example: From the Pharmacy domain, we may specify InPatientOrder, OutPatientOrder, RefillRequest, etc. • Templates represent that information needed to define a transaction between two systems.

16. VHIM Templates (concluded) • Templates are not limited to a single domain – they may draw from multiple domains (e.g., patient information in the Refill Request) • Expressed as one or more XML Schema Documents (XSDs) • HIA will maintain a “Template Registry” where templates will be documented and available for re-use

17. VHIM Team Organization

18. VHIM Process - Roles Modeling Team Information Requirements Domain Models Project Teams Gathers Interoperability Use Cases Gathers Detailed Requirements Inception Team Implementation Team Interoperability Requirements Provides Orientations Creates Templates

19. VHIM Inception Team • The VHIM Inception Team is the front end of the modeling effort. • Activities include: • Provide VHIM related orientation and education to the project teams • Analyze project needs and assist the project teams in properly documenting use cases and requirements • Maintain a current status of VHIM related touch points to project re-engineering teams

20. VHIM Modeling Team Activities • Create class diagrams to support the project teams information exchange requirements. • Define information structure and relationships. • Work with ERT and DS to ensure proper semantic rigor. • Ensure alignment with relevant external standards. • Represent the project teams requirements to HL7 and other SDOs.

21. VHIM Implementation Team • The VHIM Implementation Team comprisesthe transformation arm of the modeling effort. • Identify detailed information messaging requirements • Create and/or enhance VHIM templates to meet the needs of project teams • Construct and test the templates and placement of the templates into the template registry • Assist implementation projects with creating and testing VHIM-conformant payloads • Assist in the creation of VHIM-based logical and physical data models for HDR • Perform tooling activities that pertain to transformation of the VHIM model into implementable artifacts

22. VHIM Contacts • Project Manager – Geff Garnhart • Inception Lead – Sherri Walter • Modeling Lead – Galen Mulrooney • Implementation Lead – Becky Reed • Quality Manager – Sherri Walter • Requirement Manager – Susan Dahlberg • Change Manager – Susan Dahlberg • Risk Mitigation Manager – Geff Garnhart • Configuration Manager – Becky Reed

23. SDOs/Drivers DS, ETS • HL7 • X12 (HIPAA) • CHI • NCPDP • LOINC… • Terminology • Code Sets • VUID translation Project App Team • Business Reqs • Use Cases • Behavioral Model • PDM/LDM • DDL Team Interactions Unified semantics Re-usable artifacts Standardized calls Template Registry DATs VHIM Team • Stds Alignment • Class Model Architecture/Initiatives • HIA • ASIS • Common Services • / CDS SME Input Templates Model Reviews

24. Project Teams in Scope for VHIM Inception 1.0 Please note: These are the projects that we have had contact with. This is not a complete list and will grow over time

25. VHIM Changes / Enhancements • Requested changes and enhancements to the model are submitted through the VHIM Change Control process • VHIM Change Manager communicates requests to the following groups: • VHIM Stakeholder Council • Receives the requests for changes / enhancements • Harmonizes each request across known consumers to ensure against conflicts • VHIM CCB • Impacts harmonized change requests against scope, cost, schedule • VHIM Domain Leads • Impacts the complexity of the requested change from a domain perspective • VHIM Executive Steering Committee • Comprised of senior leadership in HIA and OI, makes final scoping and scheduling decisions for large impacting change requests

26. Together, we’ll define: • Interoperable service message payload structures - what information needs to be shared / exchanged. • Messaging use cases and/or requirements (external messages), to include attributes and associations. • How these messages fit together.

27. Communication Facilitation VHIM Conformance is a 2-way street Goal: Unified semantic approach • By aligning your application to the VHIM you will: • Assist in establishing the communication standard between HVV systems and services • Better position your application for future expansion and interoperability • Enable re-use of datastore schemas, messaging payload standards and implementable java objects thereby shortening development time • To ensure that the VHIM meets your needs, you should: • Communicate business requirements and use cases • Identify public data - Determine what data you will need to share with (and require from) other applications.

28. Take Aways • The VHIM is the authoritative source for semantics and information structure for VHA • HealtheVet system-to-system communications are dependent on the VHIM • Iterative VHIM publications permit expanding content and frequent delivery while enabling a feedback loop for incorporating enhancement requests • HDR II and CDS are VHIM early adopters • Find out more here: http://vaww.va.gov/vhaea/scripts/vhim.asp • Get involved!