February 7, 2006 Greg W. Donham BHIE/FHIE Interagency Project Director Federal Health Information Exchange (FHIE) & Bidirectional Health Information Exchange

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


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


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


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


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)


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


Clinical Displays: VA and DoD


CPRS Interface – DoD Cytology Report


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


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


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


TECHNICAL OVERVIEW


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


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


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


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


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


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)


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


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


BACKUP SLIDES


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


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


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


Sample of a transmitted HL7 Message from DoD to the FHIE Framework

Example of DoD HL7 Message:

Documents

February 7, 2006 Greg W. Donham BHIE/FHIE Interagency Project Director Federal Health Information Exchange (FHIE) & Bidirectional Health Information Exchange