OSEHRA Immunization Work Group Meeting Minutes
MEETING DETAILS
DATE: / Thursday, February 18, 2016MS LYNC: / 650-479-3207 & Online Meeting
MEETING LEAD: / Nancy Anthracite
TIME: / 4:00 PM EST
ACCESS CODE(S): / 660 146 910
FACILITATOR: / Nancy Anthracite
SCRIBE: / Jacquie Marian
INVITEES: / See below.
ATTENDEES & ROLES
ATTENDED / LAST NAME / FIRST NAME / ROLEX / Anthracite / Nancy / President, CMO & Director, WorldVistA
X / Arzt / Noam / HLN Consulting
Avery / Keith / VIMM PMO MUMPS Developer
Avila / Rick / VA Senior Advisor to CIO
Chertcoff / Daryl / HLN Consulting
Davis / Shelita / VIMM PMO Technical Writer
Erickson / Lisa / VA eMI project team member
X / Gong / Ruth / VA CPRSv32 Functional Analyst
Goyal / Pawan / Medsphere
Groom / Amy / IHS OIT
Habiel / Sam / Director of Technology, VistA Expertise Network
Hebert / Linda / VA Immunization SME
Henderson / Mike / OSEHRA Director Open Source Product Management
Johnson / Brett / Chief Integrator, One Million Solutions in Health
Keener / Michael
Kemp / Dennis / VIMM PMO Project Manager
Kim / Jane / VA National Center for Health Promotion and Disease Prevention (NCP)
X / Li / Peter / OSEHRA CISSP Director, Engineering
Lilly / George / VistA Expertise Network & CIO, WorldVistA
Loucks / Melanie / VA OIA Program Analyst
Love / Tom / Cimarron Informatics
X / Magoon / Keith / VA VIMM Project Manager
X / Mantle / Maria / DSS
X / Marian / Jacquie / VIMM PMO Business Analyst
Martin / Heidi / VA Business Office Clinical Informatics
Maulden / Sarah / VA Terminology
McKeon / John / DSS
Montali / Michael / VA Developer Competency Manager
Morgan / Brian / VIMM PMO SME
Opie / Morgan / Maryland Immunization IT
Peterson / Dennis / VA VLER Health Project Manager
X / Puleo / Anthony / VA CPRS
Ramsey / John / Patagonia Health
Redington / Patrick / VA M Developer
Remillard / Mike / IHS Software Developer
Rhodes / Chris / Director, Open Source VHA
Richards / Susan / IHS Office of Information
Ruslavage / Michelle / IHS OIT
Schlehuber / Cameron / Community volunteer, Former DBA for VistA
X / Silverman / Rob / VA Immunization SME
Steele / Kathy / VIMM PMO Technical Writer
Suralik / Mike / HLN
X / Taylor / Jack / CMIO BITS
Vaidya / Kamalini
Volpp / Bryan / VA Informatics SME
X – Present. O – Excused absence. Blank – no report.
MEETING TOPICS
PRESENTER: Keith Magoon / Rob Silverman
TOPIC: Update on VA Immunization Project
DISCUSSION:
· Keith stated Eric’s direction has been to get the 2 OSEHRA servers mirrored to what ICE development server is inside the VA network. Eric reported today that all the software has been loaded the mirrors the internal VA ICE server, but there does not seem to be a VistA instance attached to that server. Eric is ready to run JMeter simulations on it and provide reports.
o Peter Li stated there is a VistA instance setup with the December 2015 FOIA release. Peter indicated he could provide the instructions to Eric and Keith Avery on how to access the VistA instance and install VIMM patches.
o Keith stated either Keith Avery or Mary Thomas, who are the MUMPS developers for VIMM, can assist in getting the VistA instance up to date with PX patches.
· Keith stated Anthony has been very proactive in making sure that ICE is going to be functional upon initial integration. There have been discussions about deployment strategy due to the constraints the VA has designated about where the 2 ICE servers will be located and about how to make them work for initial deployment into the VA network. Deployment strategy is to have a server in Pennsylvania, which will be the production server of ICE, and another in Texas, which will be used for reports. Determined the success criteria to be that no provider will wait more than 5 seconds for the output of ICE to display in CPRS or eHMP.
o Nancy stated one possibility is to not to query the server every single time a provider brings up the veteran’s medical record and it has been mentioned previously to do the query on a scheduled basis such as their birthday or every 6 months. Anthony stated there have been discussions about a cached strategy and also some future recommendations for ICE. Anthony believes he will need to do some caching, but there are still some details that will need to be worked out such as how long to cache, the size of the database needed, whether to monitor PCE for any updates needed to the cache, etc..
o Keith stated he already submitted his documentation to Service, Delivery & Engineering (SD&E) already to state we need at least 1 instance of ICE in each Regional Data Center, but the answer that was provided was to do network analysis first and then SD&E will evaluate in order to make the decision to increase the allocation of ICE onto Regional Data Centers.
o Jack Taylor asked if it is a difficulty with the regions to be able appropriately direct to a standardized site-base so that ICE can transmit or is it just resistance to the incompleteness of the infrastructure at the present moment.
§ Keith stated it is funding because the Regional Data Centers have the space and you have to pay for the space and the maintenance on the servers. Keith stated 2 years ago each VA Medical Center had their own instance of VistA that was located on site and the last couple of years they have been moving all of those VistA instances to Regional Data Centers.
o Noam stated there may be some additional optimization that might be able to happen on the ICE server itself and until you have an implementation contract in place, it may be prudent to not make any decisions or assumptions about the performance. It may be possible to achieve other efficiencies than the out of the box installation.
o Noam asked if the plan is still to deploy ICE onto the eHMP OpenCDS environment.
§ Keith stated it is still the responsibility of eHMP to host ICE on its servers and to make the connections for inputs and outputs of ICE. The eHMP project has moved its deployment to the right and eHMP v1.3 is only going to 6 sites for their IOC and then shutting down. The enterprise wide deployment of eHMP is to be with v2.0, which does not have a schedule at this time.
§ Keith stated CPRS v32 is going to Beta in July 2016 and eHMP will go out for National Release in November 2016.
§ Keith stated he will have to ensure ICE, which is going to be hosted by eHMP, can support an enterprise distribution of CPRS v32 in November 2016.
§ No determination at this time whether code changes are needed to work in the VA network since it is not deployed to the VA network.
· Keith stated the Implementation Assistance for ICE RFP had 7 responses. Currently, the technical evaluations of the responses are being done and will be submitted to the TAC. One has been submitted and the lawyers are reviewing at this time.
o Keith stated the Period of Performance (PoP) contract will probably not be signed before March.
· Keith stated there was a conversation with Texas and they do not enter any data into their Immunization Registry system unless they have a signed or on-record paper copy of an opt-in. They receive thousands of inputs a day from commercial pharmacies like Walgreens and such, but if there is not a signed opt-in they delete the file. If the VA went with Texas, we establish the interface with Texas to send them veteran data, but we also communicate with the VA Medical Centers in Texas to have them ask their veterans to sign the form to allow their data to be shared.
o If we institute a new process or a new work flow in the Texas facilities, we can increase the amount of veteran data that actually being retained instead of being deleted by the Texas Immunization Registry.
o Keith stated in the next 3 months we will be inputting into VistA any service member’s Department of Defense (DoD) record that leaves the service and enters the VA medical system.
§ Nancy asked if that would include Japanese encephalitis, Anthrax, and others or will it be filtered.
§ Rob stated if it is provided by DoD, then VistA is capable of receiving it.
o Noam asked if the signed opt-in form had to be on record with the provider of the immunization.
§ Keith stated it would have to be on file at the registry itself and an identification number would be assigned. If they sign it as a minor and do not resign by the time they are 25 years old, then they are considered not to be opted in.
o Noam asked if Texas prescribe the exact form that is used and whether they would accept an electronic representation of that consent (HL7 message).
§ Keith stated his understanding is the forms are available on their website and would need to be signed and sent to the IIR.
§ Nancy stated there is a different form for first responders and family members.
o Keith stated when that form is sent to Texas it can be kept at the provider, but Texas receives that form and assigns that individual a unique identifier. So for every other immunization that is sent for that person from that date Texas notes the unique identifier, recognizes they have the form, and retains the data.
o Nancy asked if the plan is to use iMedConsent to do that or how would you store it if you had to keep it locally.
§ Rob stated that is getting out of scope of what is VIMM and now what is the responsibility of the Veterans Integrated Service Network (VISN) for the Texas VA(s) to represent the form in its exact image for consent and to have a process of providing it to Texas.
o Keith stated the business logic that we are developing looks for the preferred facility of the veteran. The Master Patient Index and the Enrollment system keep the preferred facility of the veteran as well as 8 alternate facilities. The logic being developed is the system will look to MPI for the preferred facility and if it matches the Station ID for a state we have an interface with, then it will be sent to the preferred facility. Georgia does not accept adult immunizations in their registry only minors.
§ Keith provided an example: a veteran who’s preferred facility is Michigan, but goes to Florida in the fall and while there receives a flu shot then it would be recorded as a flu shot in their preferred facility of Michigan.
§ Rob stated there is a difference of opinion. Rob stated a veteran’s home in Michigan and spending the winter in Florida and while in Florida they receive a flu shot. It is recorded in the VistA system at the Florida VAMC and Rob thought it would be reported to the Florida Immunization Information Registry.
§ Keith stated right now the business logic being written by Data Access Service (DAS) is to send the immunization information to the state where the preferred facility is located.
§ Rob asked who he needs to intervene with to change the business logic being done by DAS because the data should be shared with the registry associated with the VA facility where the treatment was done.
§ Keith stated that would be during our conversations with DAS on the business logic they are writing that pulls from the preferred facility for an encounter. Rob stated he will make sure to attend one of those meetings to correct the business logic and change it from the registry of the preferred facility to the registry of the treating facility or to update it to be sent to both registries for the preferred facility and treating facility.
o Keith reminded everyone that VistA does not share data on a real time basis.
§ Example, treatment received at another VA Medical Center and the encounter was printed out and handed to the veteran with instructions to provide it to their preferred facility so it can be recorded.
PRESENTER: All
TOPIC: Open Forum
DISCUSSION:
______
ACTION ITEMS
ASSIGNED TO / ASSIGN DATE / DUE DATE / ACTION ITEM / DISPOSITION / STATUSPage 1 of 7