Health IT Sharing Opportunities: 4th Annual Analysis

Date Submitted:

February 1, 2005

Prepared By:

Health IT Sharing Program

Health Informatics Strategy Office

VHA Office of Information

Table of Contents Page

Executive Summary 1

1.0 Introduction 10

2.0 Background 11

3.0 General Approach / Methodology 14

4.0 Analysis & Findings of Health IT Sharing Opportunities 18

5.0 Conclusions & Recommendations 26

Appendices 29

Executive Summary

“HealthePeople” Overview

“HealthePeople” is the Veterans Health Administration (VHA) and Department of Veterans Affairs’ (VA) long-range collaborative strategy to increase the availability and use of high performance, interoperable health information systems in order to substantially improve the health care of people in the U.S. and other nations. One of the HealthePeople goals is to pursue collaborative partnerships with public and private sector organizations that result in open health information systems with common architectures and standardized data and communications elements. HealthePeople has the potential of bringing together a wide range of health care provider organizations, commercial companies, consumer groups, and government agencies in a collaborative and constructive partnership to better serve all citizens, especially our veterans. Specific objectives of HealthePeople include:

  • Developing and adopting common solutions and standards for architecture, data, communications, security, technology and systems.
  • Seeking appropriate opportunities for sharing existing health information systems and technologies.
  • Seeking appropriate opportunities for joint procurements, development, or operation of health information systems.
  • Seeking appropriate opportunities for improved health information exchange.
  • Working with partners toward convergence on high performance health information systems.

By adopting common data, terminology, and communications standards, data from multiple agencies can be gathered and analyzed more readily for population studies.

Health Information Technology Sharing (HITS) Program Overview

The Health Information Technology Sharing (HITS) Program within the VHA Office of Information (OI) has been specifically focused on providing support for the HealthePeople long-range strategy of pursuing mutually beneficial collaborative partnerships with organizations in the public and private sector. The goals of the HITS program are to work with other VHA and CIO offices to:

  • Proactively identify, document, and explore new opportunities for interagency collaboration and cooperation in the area of health information systems.
  • Better leverage and utilize collective resources of collaborating organizations to acquire or develop health information systems.
  • Help foster increased awareness, acceptance and support for information systems sharing within the health care community.

Health Information Sharing Initiatives

The "Health IT Sharing: 4th Annual Analysis" report was developed by the HITS staff and includes a list of current health information sharing accomplishments and activities and recommendations for potential new health information sharing opportunities and initiatives for FY 2005 and 2006. The findings and recommendations are based on a detailed analysis of the extensive data which have been collected and entered into the HITS database, including data on existing and planned health information systems and sharing activities across the public and private sectors.

Summary of Selected Accomplishments &CurrentActivities

  • Federal Health Architecture (FHA) and theConsolidated Health Informatics (CHI) Initiatives—The FHA and CHI are multi-year, interagency initiatives at achieving systems convergence and agreement on architecture and standards for health information systems across Federal government agencies (e.g. HHS, DoD/Military Health, VHA, IHS).
  • Federal Health IT Standards—VHA, DoD/Military Health, and other Federal agencies participating in the Consolidated Health Informatics (CHI) eGov initiative have successfully adopted over twelve standards to support interoperability, e.g. HL7, LOINC, NCPDP, DICOM, X12, etc.
  • Federal Credentialing System & VetPro—This effort initially started as a collaborative partnership between HRSA and VA with other Federal Agencies on standardized, electronic credentialing system and databank that meets JCAHO standards. See
  • Interagency Memorandum Of Understanding (MOU) & VHA—VHA has put in place a number of MOUs with Federal agencies such as the FDA, NLM, and NCI to support collaboration on a National Drug File, sharing drug information, developing terminology standards for medication information, and other purposes.
  • Interagency Committees/Work Groups—VHA OI staff currently participate on key federal health care information committees such as, the Quality Interagency Coordination Task Force (QuIC), National Committee on Vital and Health Statistics (NCVHS), and the National Health Information Infrastructure (NHII) Work Groups.
  • National & International Health Information Standards—Continued involvement by VHA and the IT Architects in national and international non-government organizations (NGO) working on the development and adoption of healthcare information and communications standards (e.g. HL7, LOINC, X12). This work also relates to the VA/DoD EHR and the CHI eGov initiatives.
  • National SNOMED License—VA, DoD, and HHS collaborated on an agreement with the College of American Pathologists (CAP) to license the College's standardized medical vocabulary system (i.e. SNOMED) and make it freely available throughout the U.S.
  • Functional Model and Standards for Electronic Health Record (EHR) Systems—VHA initiated an effort to develop functional model and standards for EHRs. The collaboration included VHA, CMS, AHRQ, NHII, The Robert Wood Johnson Foundation, HIMSS, Institute of Medicine and HL7.

oFederal eGov Initiatives—OI staff have been participating in a number of Federal eGov health IT initiatives, e.g. CHI, FHA, eVitals, eGrants, eDisaster.

  • President’s Task Force to Improve Health Care for Our Nation’s Veterans—The President’s Task Force was established to identify specific, practical reforms in the delivery of health care to beneficiaries of VA and DoD. The VA/DoD Health IT Sharing Program provided IT subject matter expertise to the President’s Task Force. The Task Force issued a final report containing strategies for use in addressing the major barriers to collaboration between the two Departments and the need to exchange patient information.
  • VA/DoD Electronic Health Record (EHR) System—The goal of the joint EHR Plan is to support the joint HealthePeople (Federal) strategy. This is a large umbrella initiative involving VA/DoD collaboration on an Electronic Health Record (EHR) System involving a Clinical/Health Data Repository (C/HDR), and other components such as pharmacy, laboratory, scheduling, and imaging.
  • Clinical Data Repository/Health Data Repository (C/HDR)—This project seeks to ensure the interoperability of the DoD Clinical Data Repository with the VA Health Data Repository. The Departments have formed an active working group to lead this effort and have made significant progress toward building a prototype. The prototype is planned to support the bi-directional exchange and use of pharmacy data in VA and DoD systems.
  • VA/DoD Joint Venture Sites—Existing—VA/DoD Joint Venture health care sites are operating at seven locations: Albuquerque, NM; El Paso, TX; Las Vegas, NV; Anchorage, AK; Miami, FL; Honolulu, HI; Fairfield (Martinez), CA.
  • VA/DoD Planned Demonstration Sites–The FY 2003 National Defense Authorization Act, Section 722 requires selection of at least three VA/DoD demonstration sites for the conduct of specific collaborative IT solutions focusing on: a) Budget & Financial Management b) Coordinated personnel staffing and assignment, and c) Medical Information & Technology solutions. The sites have been selected and work has begun.
  • Federal Health Information Exchange (FHIE)—FHIE provides historical data on separated and retired military personnel from the DoD’s Composite Health Care System (CHCS) to the FHIE Data Repository for viewing by VA clinicians in CPRS. FHIE was successfully deployed across all VA medical centers beginning in June 2002. Enhancements to the system continue to be made. A new, related initiative known as the Bi-Directional Health Information Exchange (BHIE) was also recently approved.
  • VA/DoD Laboratory Data Sharing & Interoperability (LDSI) Project—The LDSI Project was a multi-year, joint VA and DoD initiative to develop a national solution to allow the Department’s healthcare facilities to send lab test orders and receive lab test results to and from any site, as needed. Work is now underway to enhance the LDSI software with bi-directional exchange capabilities that will permit DoD to submit labs to VA for performing tests and returning results.
  • VA/DoD Consolidated Mail Outpatient Pharmacy (CMOP) Project—The Departments collaborated on an application that supports VA’s refilling of outpatient prescription medications from DoD’s Military Treatment Facilities at the option of the beneficiary. Beta testing conducted at three sites was successful and is now complete.
  • VA Access to Deployment Related Medical Records Online (DRMROL) and Other Data— The VA/DoD Health IT Sharing Program is presently working with the Army Surgeon General staff to identify a process and mechanism to transfer DRMROL data from DoD to VA VistA systems. These data would be used by VA clinicians for treatment of returning active duty personnel and veterans of recent deployments. DRMROL data consist of pre- and post-deployment health surveys that are self-reported by active duty personnel.
  • VA/DoD Credentialing—The Departments developed a prototype to support data sharing between the VA VetPro system and the DoD Centralized Credentials and Quality Assurance System (CCQAS). The Credentialing initiative is responsive to House Appropriations Committee Report 107-298, which directed DoD to study the merits of integrating its credentialing system with the VA system. The Departments tested the joint solution at selected Joint Venture sites.
  • VA/DoD eHealth Portals—The Departments are collaborating on the development and enhancement of their e-portal systems, TRICARE Online and My HealtheVet. Both Departments acquired the health and wellness content for the applications from the same vendor thus providing uniform patient health information to the beneficiaries of both Departments.
  • TRAC2ES - This successful joint VA/DoD development effort was aimed at integrating all assets (medical and transportation) required to facilitate the decision process of evacuating military casualties from a combat theater to a source of definitive medical care within the Continental United States (CONUS). It is through this system that designated VA hospitals report available medical capability under the VA/DoD Contingency Plan, as mandated under P.L. 97-174.
  • VistA & D.C. Government—OI staff provided limited technical assistance to the D.C. government over the past year as they successfully implemented the VistA system in three of their major outpatient clinics. Sixteen more sites are planning to use VistA.
  • VistA & American Samoa—Working with the Honolulu VAMC,OI staff provided limited technical assistance to the American Samoan government over the past few years as they successfully implemented the VistA system in the LBJ Tropical Medical Center.
  • VistA & National Hansen's Disease Centers—The National Hansen's Disease Programs (NHDP), based in Baton Rouge, Louisiana, is primarily responsible for inpatient and outpatient care and treatment of Hansen's disease (leprosy). In addition to the clinical programs in Baton Rouge, the NHDP also coordinates outpatient care for Hansen's disease patients throughout the U.S. at BPHC grant funded clinics as well as private physician offices. They brought up the Vista system in 1989 and updated their infrastructure in 2000. They have a patient database size of 16,082 patients.
  • VistA & State Government Health Departments—OI staff have received numerous calls from state government representatives expressing an interest in possibly acquiring and using the VistA/CPRS system. Briefings and demonstrations have been arranged as needed. Examples include:
  • West Virginia, Texas, Hawaii, Pennsylvania, Michigan, and several other states that have expressed an interest in acquiring and implementing VistA and CPRS.
  • VistA & Washington State—Washington State has implemented and been successful in their use of VistA at three facilities over the past decade, (i.e. Western State Hospital, Tacoma, Child Study & Treatment Center, Tacoma. and Eastern State Hospital, Spokane).
  • VistA & State Veterans Homes—OI staff is working with representatives from the State Veterans Homes, the Geriatrics Program, the VISNs, VAMCs, and the Office of CyberSecurity on this initiative.
  • VistA Implementations—Oklahoma is moving forward with plans to acquire and implement VistA/CPRS in their seven healthcare facilities. VistA has already been implemented in three sites. Other states are also interested in VistA.
  • CPRS Read Only—Over 120 State Veterans Homes have expressed interest in obtaining CPRS Read Only access to patient data in VistA for a limited number of their clinical staff. Over 65 sites have now been given CPRS Read Only access to date with many more sites in the works.
  • VistA & Indian Health Service (IHS)—VA and IHS have a long history of working jointly on health information technology. VA and IHS recently signed a new inter-agency MOU in support of health information sharing efforts (e.g. CPRS, VistA Imaging). The agencies will work on developing and adopting common health information standards and technical solutions. In addition, the agencies will continue to identify new opportunities for joint development and/or procurement of health information systems.
  • VistA & AAMC/Affiliated Medical Schools—VHA has academic affiliations with 107 medical schools andover 1,200 other educational institutions. Working with the Office of Academic Affiliations and the American Academy of Medical Colleges (AAMC), the VHA OI has select several pilot sites to test collaborative health information solutions in FY 2005.
  • VistA & Veterans Service Organizations (VSO)—VHA has made VistA and CPRS Read Only available to authorized patient representatives in Veterans Service Organizations (VSO) over the past year, e.g. VFW, DAV, PVA.
  • VistA & Public Health and Biosurveillance—The Department of Health & Human Services (HHS) has numerous public health systems and databases that capture data on specific diseases, deaths, incidents, and other events which could be populated electronically by VistA. Initial efforts were started in FY 2004 involving the transmission of de-identified patient data from the VA data warehouse at the Austin Automation Center (AAC) to the HHS Center for Disease Control (CDC). Links to other Federal and State public health databases may be put into place over the coming years.
  • VistA & Local Governments—OI staff regularly provide information on VistA and arrange for demonstrations of the system to city and county governments across the country, e.g. L.A., Detroit, Cleveland, Chicago.
  • VistA & International Healthcare Communities—A number of countries have either implemented VistA or have expressed an interest in possibly acquiring and implementing the system. These include: Finland, Egypt, Germany, Mexico and others. Representatives from many other countries have contacted VHA and have been briefed and/or given demonstrations of the VistA system, e.g. Jordan, Malaysia, India, Japan.
  • VistA & Mexico—The Instituto Mexicano del Seguro Social (IMSS) is moving forward with testing and implementing the VA VistA system. They have successfully implemented a Spanish version of VistA in one hospital and are in the process will implement it in 2 more by the end of 2004. They plan on implementing VistA in 50 hospitals in 2005, and a total of 260 hospitals over the next 3-4 years.
  • VistA Sharing & the Open Source Healthcare Communities—VA has been approached by numerous organizations in the wider health care community about making VistA/CPRS available to them for their own use. The Open Source healthcare software movement also continues to grow. Under the Freedom of Information Act (FOIA), VA has released copies of VistA software to these organizations upon request. The agency should continue to carefully monitor how VistA is used by these other organizations in the health care and Open Source communities.
  • VistA Office EHR & HHS/CMS -The Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), and the Veterans Health Administration (VHA) collaborating on an initiative to transfer VistA, the VHA’s Electronic Healthcare Record (EHR) system, to the private physician office setting. Targeted for release July 2005, the VistA-Office EHR system will be available to individual practices and the EHR industry.
  • VistA & the Vendor Community -The VistA Software Alliance (VSA) was formed to allow a collaboration between government and private businesses to facilitate the implementation of VistA within healthcare organizations outside of the VA. The VSA provides a neutral buffer organization so that the government can encourage a broad base of industry investment, without favor to any specific company. A growing number of major software vendors have joined the VSA, e.g. HP, EDS, PerotSystems, InterSystems, etc.

oBi-Directional Web Connections—In an attempt to create a more comprehensive and tightly coupled online community of information sharing for veterans on the Internet, HITS staff have worked with the following organizations to put in place hyperlinks between them and the VA.

  • Department of Defense (DoD)—Army, Navy, Air Force, Marines, Coast Guard, and National Guard
  • Federal Agencies’ Veterans Programs—Office of Personnel Management (OPM), Housing and Urban Development (HUD), Department of Labor (DOL), Department of Agriculture (USDA), FirstGov, and GovBenefits
  • State Agencies—State Health Departments and State Veterans Affairs Offices
  • Veterans Service Organizations—e.g.American Legion, Veterans of Foreign Wars (VFW), and Disabled American Veterans (DAV)
  • Community Health Information Exchange (HIE) Networks—Over the next decade, numerous community health information exchange networks will be put in place to allow public and private healthcare organizations and providers to securely view patient data from different provider organizations. Based on lessons learned and actual cost/benefits, a national strategy for implementing community health information exchange solutions will be put in place by FY 2005. Implementation activities could extend well into the next decade.
  • HIE Pilots —VHA is planning to participate in a pilot test involving the exchange of patient data between the VA Outpatient Clinic and a number of other partnering public and private sector healthcare organizations in Santa Barbara County, CA. Other patient data exchange systems in local communities around the country are continuing to be examined as VHA seeks to craft a national strategy and solution, e.g. New England Health Exchange Network (NEHEN), Grand Junction HIE. The VISNs and their VA Medical Centers should probably have primary responsibility for pursuing and implementing this component of the HealthePeople program.
  • My HealtheVet & Personal Health Records (PHR) for Veterans—Veterans and those members of their family directly involved in their care need to be provided ready, yet secure access to their medical records, health education materials, and preventive health information at a minimum. VA has taken a number of steps to make this a reality. For example, VA recently implemented a new system called My HealtheVet, an online web site personalized to meet the specific needs of veterans at ( The capabilities of My HealtheVet will be greatly expanded over the coming years. In addition, a number of home health telemedicine pilot projects are underway that hold great promise for the future. The My HealtheVet strategy is being further developed to greatly expand the program side and help VHA move to a more veteran-centric approach to improving veterans’ health.
  • National 211 Project—Local VA Medical Centers are collaborating with efforts at the state and local community levels across the U.S. on their implementation health and human services Information and Referral (I&R) telephone call centers accessed by dialing “211”.
  • Knowledge Exchange & the Healthcare Community -VHA Office of Information (OI) staff have met with senior representatives from numerous major healthcare provider organizations (e.g. Kaiser Permanente, CHRISTUS, Adventist Health) to share knowledge and lessons learned related to implementing health IT systems.

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