Gary A. Christopherson, Senior Advisor to Under Secretary Robert M. Kolodner, M.D., Acting VHA CIO...
28
Gary A. Christopherson, Senior Advisor to Under Secretary Robert M. Kolodner, M.D., Acting VHA CIO Veterans Health Administration, Department of Veterans Affairs Current VistA Future Healthe Vet-VistA Future Healthe People-VistA ntation to the Information Systems Advisory Committ
Transcript of Gary A. Christopherson, Senior Advisor to Under Secretary Robert M. Kolodner, M.D., Acting VHA CIO...
Gary A. Christopherson, Senior Advisor to Under SecretaryRobert M. Kolodner, M.D., Acting VHA CIO
Veterans Health Administration, Department of Veterans Affairs
Current VistA
Future HealtheVet-VistA
Future HealthePeople-VistA
Presentation to the Information Systems Advisory Committee
“VHA’s integrated health information system, including its framework for using performance measures to improve quality, is considered one of the best in the nation.”
Institute of Medicine (IOM) Report, Leadership by Example: Coordinating Government Roles in Improving Health Care Quality (2002)
• VistA/CPRS was & is a success • Built by “fire” of VHA collaboration• Publicly owned by VA; could be for future as well• Strong interest by public/private in using VistA
• Largest integrated health info system for nation’s largest integrated health system
• Helps serve 4.1 million American veterans annually• Supports:
• $23+ billion nationwide health system• 1,300 care sites, incl. 163 hospitals & 800+
community & facility based clinics• 180,000 health care staff; 85,000 trainees
• Considered best overall health information system
Success in supporting health delivery for millions of veterans
• Mostly developed & owned by VA (publicly owned)• Began as Decentralized Hospital Computer Program
(DHCP; 1980s)• Transformed into VistA (1990s)• Next generation VistA (2002-20__) -- Includes
HealtheVet-VistA on improved platform using modern tools & languages following enterprise architecture
• National software w/ local flexibility/innovation: • Innovation developed locally & enterprise wide• Standard packages distributed enterprise wide, e.g.
latest version of CPRS (January 2002)
Nationally integrated outpatient & inpatient information system
VISTA INFORMATION
SYSTEM
USERSECURITY
MAILMAN
DEVICE MANAGER
MENU MANAGER
RPCBROKER
INTEGRATED DATABASE
PATIENTS
WARDS
DRUGS
PERSONS
INVENTORYPRESCRIPTIONS
IMAGES
LAB RESULTS
VISTA SOFTWARE PACKAGES
SCHED-ULING
INPATIENTPHARMACY
LABORATORY
SURGERY
MEDICINE
SOCIAL WORK
DENTAL
ENGINEERING
INTEGRATED FUNDS CONTROLACCOUNTING &PROCUREMENT
ADMISSIONDISCHARGETRANSFER
DIETETICS
MENTALHEALTH
HEALTHSUMMARY
NURSING
LIBRARY
PATIENTFUNDS
MEDICALRECORDSTRACKING
ACCOUNTSRECEIVABLE
VOLUNTARYSERVICE
REHABMEDICINE
RADIOLOGY
ONCOLOGY
COMPUTERIZEDPATIENT RECORDSYSTEM
(CPRS)
KERNELTASKMANAGER
VA FILEMAN
TEXTINTEGRATION
UTILITIES (TIU) OUTPATIENTPHARMACY
CLINICAL PATIENT RECORD
AUTHORIZATION SUBSCRIPTION
UTILITY (ASU)
BAR CODEMEDICATIONADMINISTRATION
WOMEN’SHEALTH
BLOOD BANK PROBLEM LIST
VistAIMAGING
CONSULTS /RESULTTRACKING
CLINICALREMINDERS
MEDICAL CARECOST RECOVERYSites of Care
•Clinics•Hospitals•Nursing Homes•Domiciliaries•Home/Workplace
• Not lose functionality we have • Strengthen VistA
• Move to person & data focus• Move to standardized, fully sharable health data• Modernize & replace older systems• Ensure documentation on application programs• Move to modern technologies• Increase flexibility to respond to future health needs• Lower cost of maintenance
• Support our future health system
VistA - Why change?
Scope – home, clinic, hospital, nursing home
Size – $23+B (health care)& $1B (IT) annually
Sites of care – over 1,300 nationwide
HealthePeople Strategy
Functionality – highest & growing
Oversight – VA, OMB, Congress, VSO, etc
HealtheVet Strategy
Resources – 180+k staff + contractors
Partners – VA, VHA, Other Fed, Other Public, Private
Data element & standards - many
Veterans served – over 4 million annually
Dimensions of complexity
Person Based
Care Coord
ination
PopulationBased[community, VISN, nation]
Care Coordination
Maximize Veterans Health/Ability & Satisfaction
eHealth
Community care
Nursing home care
Inpatient care
Ambula-tory care
Domicili-ary care
EpisodeBased
Status – Well, Acute
Illness, ChronicIllness,
Custodial
Max Health/Ability
Max Satisfaction
Max Accessibility
Max Affordability
Max Quality
VA Health System –Best Practices & Ideal
H&IT
H&IT
H&IT
H&ITH&IT
H&IT
H&IT
H&IT
BP/Ideal
BP/Ideal
BP/Ideal
BP/Ideal
BP/Ideal
BP/Ideal
BP/Ideal
BP/Ideal
HealtheVet – strategy overview• Moves from facility-centric to person/data-centric
•Uses national, person-focused health data repository for production & management/analysis/research
• Builds on, enhances & utilizes VistA •Moves from legacy VistA to HealtheVet-Vista
• Uses best, appropriate modern technology•Programming, software, hardware, networking
• Moves “core” applications to run “enterprise-wide” • Standardizes core data & communications • Enhances the five major systems
•Regis./eligibility/enrollment, health data, provider, management/ financial, “e” commun./transactions
• Enhances cross-cutting•Security/privacy, architecture, data quality/standards, infrastructure, enterprise system/resources management
VistA Legacy (Maintenance/Enhancement until “Retirement”) [Current – 2005]
VistA Imaging
Fee
Billing
Pharmacy
Laboratory
Health Data Repository
VistA to HealtheVet (incl. HealtheVet –VistA)
Secure systems/infrastructure
Enterprise ArchitectureStrong Project Management
... 2000 2001 2002 2003 2004 2005 2006 2007
High Performance Network/Infrastructure
HealtheVet-VistA(Person/Data-Centric Next Generation VistA) (2005- )
High Performance Workforce
Scheduling
Health Data Repository [Health]
Registration, Enrollment,
Eligibility Database [OneVA/Health]
Financial Database [OneVA/Health]
Health Provider System
(input/output)
Management & Financial System (input/output)
Registration, Enrollment & Eligibility System
(input/output)
HealtheVet (Veterans health info system, including VistA)
Information & Education System (“e”
communications/transactions)
OneVA [VBA, NCA, Staff Offices]N
on-V
A H
ealt
h &
Inf
orm
atio
n E
nvir
onm
ent
Health Data System (input/output)
Veteran Input & Output
My HealtheVet
[virtual health record]
Support resources for person Decision/learning support for provider
Security Archi t ectu
re Data Q
ua li ty Infrastru
cture
Management & Financial System
Health Provider (including clinical Interface) & Data System
Registration, Enrollment & Eligibility System
Database/Standards
“e” communications/ transactions
Billin
g System
Provid
er Paym
ent
System
Ph
armacy S
ystem
Lab
oratory System
Rad
iology System
En
rollmen
t System
Sch
edu
ling S
ystem
Blood
System
Outside health organizations
VA organizations
Database/Standards
Database/Standards
S
S S
S S
S
S S
SS
IE IE
IE
EHR
My HealtheVet[web site, virtual health
record, trusted information, self-reported information,
link to other health providers]
NextGeneration HealtheVet-VistA - High Performance Info System Components/Links/Standards
Other health organi-zations
My HealtheVet / My HealthePeople
S
My HealtheVet / HealthePeople[Personal Health Record System]
“health in a box” on PC and/or web site via community, health, non-health, government
S
Electronic Health Record System (e.g. VistA)
Database/Standards
S
Primary healthprovider
Software & Hardware
Person
Health Record•Access to health records•Sharing health records•Self-entered health recordServices•Checking/filling prescriptions•Checking/confirming/making appointments•Checking/paying co-payments•Participating in support groups•Health decision support•Health self-assessment•Messaging with health provider•Diagnostic/therapeutic tools•Reminders•“Checking in”•Safety services/tools•Links to other health sitesInformation•Trusted information
Electronic Health Record System
Database/Standards
Software & Hardware
S
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Standards• Data• Communications
---------------------
Health Info Systems• Electronic Health
Records Systems (EHRs)
• Personal Health Record Systems (PHRs)
• Info Exchange
ImprovedHealth
Paperless (IOM)
Improved health & “paperless”
Adoption by health organizations &
persons of affordable, high
quality & standards-based EHRs, PHRs
& Health Info Exchange
Toward standards & high performance info systems• VA push EHRs, PHRs, Health Information Exchange & Standards in Federal and nationwide
• EHRs – VA •Current -- VistA electronic health record system•Next generation -- HealtheVet-VistA•Public version -- HealthePeople-VistA
• PHRs – VA•My HealtheVet
• Health Information Exchange (IE) – VA•Federal Health Information Exchange with DoD•Electronic Health Records Interoperability (HealthePeople (Federal) with DoD
• Standards – VA•Adoption of VA-wide standards•Adoption of standards between VA and DoD and VA and IHS•Consolidated Health Informatics
Toward standards & high performance info systems• EHRs –
•Provide financial incentives•Strongly encourage private sector vendors to make available affordable, high quality, standards-based EHRs
•Strongly encourage provider-based efforts like AAFP •Continue to improve HealthePeople-VistA & make available
• PHRs – •Strongly encourage public/private sector to work together to develop & make available PHRs for persons
• Health Information Exchange (IE) – •Strongly encourage public & private sector to work together to develop & make available national “exchange” solution
• Standards – •Consolidated Health Informatics as federal leadership•Strongly encourage public/private development/adoption of national standards
Person
HealthePeople Virtual Health System - EHRs, PHRs, Health Info Exchange (IE) & Standards (S)
Personal Health Record Systems (PHR)
PersonNon health org
Elec-tronic Systems
Other health org
EHRs & Other Health Info Systems
Population/ Community
Healthprovider
ElectronicHealth Record Systems (EHR)
IESIES
IE
S
IE
S
Management & Financial System
Health Provider (including clinical Interface) & Data System
Registration, Enrollment & Eligibility System
Database/Standards
“e” communications/ transactions
Billin
g System
Provid
er Paym
ent
System
Ph
armacy S
ystem
Lab
oratory System
Rad
iology System
En
rollmen
t System
Sch
edu
ling S
ystem
Blood
System
Outside health organizationsw/ EHRs
PHR (e.g., My HealthePeople)[web site, virtual health record, trusted information, self reported information, link to other health providers]
HealthePeople - EHRs, PHRs, Health Info Exchange & Standards
Database/Standards
Database/Standards
S
S S
S S
S
S S
SS
IE IE
IE
EHR
Personal Health Record Systems (PHR)
Personal Health Record Systems (PHR) (e.g. My HealthePeople)
Health Record•Access to health records•Share health records•Self-entered health recordServices•Check/fill prescriptions•Check/confirm/make appointments•Check/pay co-payments•Participate in support groups•Health decision support•Health self-assessment•Message with health provider•Diagnostic/therapeutic tools•Reminders•“Check in”•Safety services/tools•Links to other health sitesInformation•Trusted information
Health
p
roviders
Electronic Health Record Systems (EHR)
Person
(provid
ersp
onsored
)
EHRs & Other Health Info Systems
Person
(hom
e)
Personal Health Record Systems (PHR)
Person
(external
service)
Elec-tronic Systems
P
P
P PPP
IE IE
IEIE
IES
[HL7]
A&APerson
ID
Search
Inter-face
P – PersonIE – Internet-based exchange, including components belowEHR – High function & interoperablePerson Health ID – a) Voluntary or b) Provider Assigned (Bilateral) A&A – Authorization & authentication controlled by personInterface – Capability for exchange (send & receive/useSearch – Search tool for finding records held by persons/organizations
A&A
HealthePeople Virtual Health System - Health Info Exchange (IE)
Prim
ary health
p
rovider
Electronic Health Record Systems (EHR)
Oth
er health
org
Personal Health Record Systems (PHR)
Bilateral
P – PersonIE – Internet-based exchange, including components belowEHR – High function & interoperablePerson Health ID – a) Voluntary or b) Provider Assigned (Bilateral) A&A – Authorization & authentication controlled by personInterface – Capability for exchange (send & receive/useSearch – Search tool for finding records held by persons/organizations
Health
p
roviders
Electronic Health Record Systems (EHR)
Oth
er health
org EHRs &
Other Health Info Systems
Multilateral
Person
Personal Health Record Systems (PHR)
Non
-health
org
Elec-tronic Systems
EHRs & Other Health Info Systems
Person
IES
[HL7]
A&APerson
ID
Search
Inter-face
P
P
P
P PPP
P
P
IE
IE
IE IE
IEIE
IE
Health Information Standards Development/Adoption• NCVHS –
•Strongly encourages development/adoption of standards in public & private sectors
• Standards Development Organizations – •Many efforts underway to develop standards
• Federal Agencies – •VA, DoD & IHS agree individually to standardize•VA/DoD & VA/IHS agree to standardize across agencies
• Consolidated Health Informatics – •Joint effort led by HHS, VA & DoD•1st five standards adopted•Working on total of 24 domains, incl. 6 active workgroups
National standards & high performance systems
2001 2010
Improved Health Via
National Health
Information Standards
Info Exchange/ Sharing
High Performance
Health Info Systems
Personal Health Record
Systems
Convergence
VA, DoD, IHS individual/joint adoption
National -- Public/Private•Individual (e.g. Kaiser Permanente)•Joint (Connect. Health, eHealth, NCVHS, SDOs, …)
HealthePeople(Fed)
HealthePeople
Consolidated Health Informatics (CHI)
Convergen
ce
DoD CHCS II
IHS (to HealthePeople-VistA)
Public/Private (CMS, VA, AHRQ, NHII, AAFP, health providers, payers, regulators, private sector vendors, persons/consumers)
HealthePeople(Fed)
HealthePeople
VA HealtheVet/HealthePeople-VistA
Hea
lth
In
form
atio
n
Sys
tem
s
Sta
nd
ard
s
Back-up Slides
Terms
• HealtheVet – VHA effort to modernize & enhance its current information system, incl. enhanced CPRS, health data repository, scheduling, billing, fee, VistA imaging, pharmacy, laboratory, “My HealtheVet”. HealtheVet-VistA is the name for the next generation of VistA.
• HealthePeople – joint efforts with other federal, public & private sector organizations with respect to national standards, high performance systems & sharing information (when appropriate/authorized). HealthePeople-VistA is the name for VistA when it used outside VA.
• HealthePeople (Federal) – joint efforts by VA, DoD & HHS/IHS with respect to data standardization, joint build/procurement, sharing software & potential software convergence.
