february 7, 2006 greg w. donham bhie/fhie interagency project director federal health information...
TRANSCRIPT
February 7, 2006
Greg W. Donham
BHIE/FHIE Interagency Project Director
Federal Health Information Exchange
(FHIE) &
Bidirectional Health Information Exchange
(BHIE)
January 8, 2006Indian Health Service Brief
Interagency Presentation Agenda
• Program Overview
• Technical Overview
• Back-up Slides
January 8, 2006Indian Health Service Brief
Interagency Project Background
•Break-through information technology effort between the Departments of Veterans Affairs and Defense
– Award winning interagency product in 2005 and 2006– Based up design and analysis work that the Indian Health
Service provided from 1998-2000•Approved OMB Exhibit 300 project, proceeding through FY2012
– Part of President’s Management Agenda, Initiative #14– Among highest scoring VA Exhibits examined by OMB
•Affordability achieved through re-use of existing processes and joint, interagency infrastructure
– DoD pays 50% of annual operating costs– IHS start-up costs would be manageable
•Embraces high performance project management and continuous improvement
January 8, 2006Indian Health Service Brief
FHIE/BHIE contributes to Interoperability
•Operate a joint system for perpetual one-way transfer and two-way exchange of electronic health information between DoD and VA
• Provide on-demand electronic DoD health information to assist in the compensation process
• Demonstrate compliance with HIPAA regulations by creating an interagency environment for storing very sensitive information
• Use a patient-focused information technology familiar to authorized VA and DoD (and IHS?) users
January 8, 2006Indian Health Service Brief
Federal Health Information Exchange (FHIE)
• Federal Health Information Exchange (FHIE) provides clinically relevant DoD health information about separated and retired members of the Uniformed Services
• FHIE Interagency Capabilities: • Provides historical views, from 1987 forward, of DoD laboratory
results, radiology reports, outpatient pharmacy, PDTS, allergy information, patient demographics, consult reports, DoD’s Standard Ambulatory Data Records, and discharge summaries
• Updated monthly, averaging 9,000 additional patients• Receives daily clinical data about VA beneficiaries (DoD’s
PATCAT – K61), shortly after they receive care at DoD MTFs• Initial Operating Capability (IOC) with CHCS and VistA
achieved Memorial Day, 2002• First VHA system to be Re-certified and Re-accredited
December 2005– NIST independently scored was 100 !
• Quick performance---average response time <30 seconds with over 5,300 weekly queries
January 8, 2006Indian Health Service Brief
3.3 million unique patientswith clinical data**
Correlated Patients2.4 million unique patients registered
in the VA with DoD clinical data
DMDC Data4.1 million records*
*Due to the incremental deployment of CHCS in the early 1990s, many of those who separated during that period had no entries within CHCS, therefore this number will not match the data extraction number from DMDC.
FHIE Repository Statistics: Access by IHS ?
Separated Service Members(As of February 3, 2006)
January 8, 2006Indian Health Service Brief
Bidirectional Health Information Exchange (BHIE)
• Supports effective, quality care at Joint Venture, medical sharing locations and, if approved, any Interagency entity
• Provides both Veteran’s Health Administration (VHA) and authorized physicians access to clinical data for a patient, regardless of the location of the data
• Bidirectional Health Information Exchange (BHIE) allows physicians of Federal Departments to view in real time laboratory results, radiology text results, outpatient medication profiles and allergy information
– Plus, displays any historical information from FHIE
CHCS/VistA bidirectional, real-time enhancements
January 8, 2006Indian Health Service Brief
Clinical Displays: VA and DoD
January 8, 2006Indian Health Service Brief
CPRS Interface – DoD Cytology Report
January 8, 2006Indian Health Service Brief
BHIE Functionality: Current and Future
• Incremental Clinical Functionality delivered within budget and on time in October 2004:
Patient Identity Management and Correlation Bidirectional transmittal and display of Outpatient Pharmacy and Allergy data
Incremental Clinical Functionality delivered within budget and on time in May 2005:
Bidirectional transmittal and display of Surgical Pathology reports, Cytology, Microbiology data, Chemistry and Hematology results, Laboratory Order information, and Radiology text reports
Incremental Clinical Functionality delivered within budget in January 2006:
Prototype of displaying non-CHCS Discharge Summaries from Madigan’s Essentris system
Work underway for an enterprise solution, based upon experience building the prototype
Incremental Clinical Functionality to be delivered in 2006 Interface with DoD’s Armed Forces Health Longitudinal Technology
Application (AHLTA) --- compliments CHDR work Additional DoD Inpatient documentation (e.g. Progress Notes, Operative
Notes, etc.), pending project review
January 8, 2006Indian Health Service Brief
BHIE Sites: Current and Future with IHS ?
BHIE operational
BHIE implementations planned during FY2006
NCA
Brooke AMC
LRMC
Mike O’Callaghan Federal Hospital
David Grant FMC
Bassett ACH
Elmendorf AFB
Madigan AMC
NH Great Lakes
Eisenhower AMCNH Charleston
7 DoD host sites = 7 DoD Medical Centers, 5 DoD Hospitals & 50 DoD Clinics
(Access to over 880,000 correlated patients)
Tripler AMC
William Beaumont AMC
NMC San DiegoNH Camp Pendleton
NH Camp Lejeune
Womak AMC
NH Pensacola
Darnall ACH
January 8, 2006Indian Health Service Brief
Further use of the Interagency framework
• VA-DoD Pre- and Post Deployment Health Assessments (PPDHA) – Milestone achieved: Two new progress notes are available for
displaying (a) Pre- and (b) Post-Deployment Health Assessment (PPDHA) data in CPRS from DoD’s Defense Medical Surveillance System (DMSS)
PPDHA information delivered on schedule and within budget via CPRS Remote Data View (RDV) on December 7, 2005
From service members deployed for IOF/OEF --- over 475,000 currently available (DoD Forms 2795 and 2796)
Monthly updates provided to VA from DMSS Re-used BHIE architecture --- proving its extensibility Analysis underway for delivery of DoD Form 2900 (Post Deployment Health Reassessment) in the same manner, pending availability of funding
January 8, 2006Indian Health Service Brief
TECHNICAL OVERVIEW
January 8, 2006Indian Health Service Brief
FHIE/BHIE Framework
• Jointly owned and operated by VA and DoD --- non-proprietary, standards-based and open-systems compliant
– Principles that DoD, IHS, and VA agreed to in 1998
• Built-on notion of logical domains
• Domains collaborate with other domains
• Extensible architecture
– Used by the Office of Information’s HSD&D to build the HDR-IMS
– Interfaced with CAPRI to share same DoD data with VBA
– CHDR will use BHIE’s secure network infrastructure for operations
– Demonstrating interoperability with EPIC, IBM and ALLScripts @ HIMSS 2006
– Explore with the Indian Health Service ?
• VHIM compliant with Reference Information Models (RIM)
• Standards employed
January 8, 2006Indian Health Service Brief
BHIE/FHIE Services & Standard Interfaces
IIOP/CORBA HTTPS IIOP/
CORBA HTTP
PIDSAdapter
SOAP/XML
COASAdapter
HL7 V3(Future)
PIDSAdapter
HL7 V2.2Adapter
SQLAdapter
WSBeans
IIOP CHCSftp ODBC SOAP/
XML
Patient Identity Management Information Location/Collection Security and Privacy Terminology Data Normalization (RIM)
FHIE/BHIEFramework Services
Connectors
Adapters
MPI
Client Access
EI/DS HL7 FHIE
Repository
Electronic Health
Record Work Station
January 8, 2006Indian Health Service Brief
Vitria IE
High-Level FHIE/BHIE Architectural Components
DoD FHIE/BHIE Framework VA
Legacy EHR Legacy EHR
Legacy EHR
Sharing Facility
MHS Data Repository
FHIE Framework
FHIERepository
Patient Identity Service Information Locator Security Optimization Adapter/Connector
VistAVA Host
(Station 200) VistALocalVAMC
CPRS
VA MPI
DoD Web Server
DoD GUI
HL7 Messages
WS/XML
CACHE’
WS/XML
HL7/ADT HL7/ADT
Query Access
VistALINK RDV
PIDS/Correlation
January 8, 2006Indian Health Service Brief
FHIE Repository
FHIE FrameworkPatient data delivered to Physician
Authorized Inquiry
Requests for Records
RecordsReturned
VA Facility or DoD Facility
DoD Military Treatment Facilities
with BHIE
All VA Facilities
Index of where patients have records Temporary aggregate
clinical record
BHIE Data Flow and Access
January 8, 2006Indian Health Service Brief
Security Architecture
EI/DS Consolidator
CHCSSystem s
CHCSSystem s
VA W AN
AAC LAN
FHIE Host / Fram ew ork Subnet
YCPRS Users(Health CareProviders)
FHIE Host Site(Austin Automation
Center)
NIPRNet
(Internet)
Framew ork
Rem oteAccess
(Internet)
Pow erChannelhost
Key
Pow erChannel tunnelRem ote Access VPN
Internet Gatew ay VPN
VA FHIE Hosts
Rem oteSysAdm in
W orkstation(w / VPN client)
AAC Contivity VPN(planned)
VA GatewayFirewall/VPN(Checkpoint)
DOD GatewayFirewall/VPN(Checkpoint)
FHIEFirewall/VPN(Cisco PIX)
HL7 Interface Engine(Pow erChannel host)
VistA CPRS Servers
VA M PI Servers
FHIE QueryEngine
FHIE DataRepository
WAN Management Responsibilities
• Gateway Firewall operation • Gateway-to-Gateway VPN• VISN Routing and Security• RAS Server Operation
• User Identification• User Authentication• Privacy Disclosure Controls• Privacy Act / HIPAA Training• System Access Control
VistA and CPRS Responsibilities
• Off Site Data Storage• Intrusion Detection• Vulnerability Scanning• VPN (Remote Administration)
AAC Host Site Responsibilities
Operations and Maintenance Contractor Responsibilities
• Cisco PIX Firewall Configuration• Network Configuration and
Operation• Secure Host Configuration• Data Backup and Recovery
Framework Responsibilities
• Data Access Control• Local I & A (SysAdmins)• Event Logging & Auditing
• Privacy Disclosure Records• PowerChannel Decryption,
decompression• RAS Client Operation
DOD Responsibilities
• Data Filtering• Record Release Approval• DOD Firewall Operation• Gateway-to-Gateway VPN operation• PowerChannel Encryption and Compression
January 8, 2006Indian Health Service Brief
Standards Support
•Framework services are available to external clients through standard interfaces
• HL7 (2.x)• CORBAMed (COAS, PIDS)• WebServices SOAP XML• NCPDP• Java JMS
•Service also supports non-standard data interchanges (custom adapters)
January 8, 2006Indian Health Service Brief
Local Domain
Analogous to Local Healthcare Information Infrastructure
Master Patient Index
Cache
Medical RecordsSystem
RadiologySystem
RegistrationSystem
LaboratorySystem
Information Locator Index
Query Access Interface
ExternalProvider Client
Clinical DataRepositories
Information Collector
DoD Data Adapters
FHIE/BHIE Framework
January 8, 2006Indian Health Service Brief
Current Domain Infrastructure
DoD SQL MPI
DoD Data Adapters
DoD Data Repositories
CHCSSystem 1
CHCSSystem 2
CHCSSystem 3
PDTSSystem
SADRSystem
DoD Person SubsystemSQL Person Graph Collection
X Cache Subsystem:
Cache Graph Collection
VA Person Subsystem:Pids Person Graph
Collection
VA Cache
VA Framework COAS Adapter:
Query Access Impl
VA Cache Subsystem: Cache
Graph Collection
X Person Subsystem:Sql Person
Graph Collection
X SQLMPI
VA Non-Captive PIDS Adapter
:CPRS
System A:VISTA System
:VISTA Primary Host
Austin VA PIDSServer: VA_MPI
DoD Cache Subsystem:Cache Graph Collection
VA 0 Local Domain Cross Domain DoD 0 Local Domain
DoD B/DSMessage Consolidator
January 8, 2006Indian Health Service Brief
BACKUP SLIDES
January 8, 2006Indian Health Service Brief
Path to Interoperability
BHIEBidirectional Health
Information Exchange
FHIEFederal Health
Information Exchange
CHDRClinical Data Repository/
Health Data Repository
• One-way • Enterprise exchange• Historical access• Text data
• Bidirectional • Enterprise exchange• Real-time access • Text data
•Bidirectional •Enterprise exchange•Real-time access•Computable data
Path to Interoperability
January 8, 2006Indian Health Service Brief
High-Level FHIE Architectural Components
Legacy EHR Legacy EHR
Legacy EHR
MHS Data Repository
FHIE Framework
FHIERepository
VistAVA Host
(Station 200) VistALocalVAMC
CPRS
VA MPI
DoD FHIE Framework VA
HL7 Messages
Query Access RDV
PIDS/Correlation
Patient Identity Service Information Locator Security Optimization Adapter/Connector
January 8, 2006Indian Health Service Brief
MDR
VistALocal
VAMC
VistALocal
VAMC
VistALocal
VAMC
CPRS
VA MPI
RE-Use-Correlation-Information Locator-Security-Optimization-Adapter/ConnectorData Securely Pulled
From EIDS via PowerChannel
VistAVA Host
(station 200) E
FHIE Framework
Reuse
High-Level FHIE/BHIE Architectural Components
CHCSMTFCHCS
MTF
HL7PDTSSADRK61
FHIERepository
QueryAccess/VistaLink
RDV
DoD GUI/Share
CHCSSharing Facility
DOD Web Server Vitria
IE
Web services/SOAPQuery/Response
real time HL7/ADT
HL7 ADTWebServices MEDsand AllergiesRAD, LAB
Cache’
WS/XML
HL7/ADT
HL7PDTSSADRK61
HL7/ADT
HL7PDTSSADRK61
WS/XML
WS/XML
HL7/ADT PIDS
104 DoD MTFs
174 VA MTFs
January 8, 2006Indian Health Service Brief
Sample of a transmitted HL7 Message from DoD to the FHIE Framework
Example of DoD HL7 Message: