IT News from James A. Lovell Federal Health Care Center69.59.162.218/HIMSS2012/Venetian Sands Expo Center/2.23.12_Thu... ·

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  • IT News from James A. Lovell Federal Health Care Center

    DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

  • Conflict of Interest Disclosure

    Frank A. Maldonado, MD, FCCP

    LCDR Donna M. Poulin, MSC, USN

    Have no real or apparent

    conflicts of interest to report.

    2012 HIMSS

  • Placeholder for 5 min video FHCC

  • Learning Objectives Identify challenges of integration between

    Naval Health Clinic Great Lakes and North Chicago VA Medical Center and how they are being overcome

    Discuss current interoperability capability solutions developed at Lovell FHCC

    Describe how lessons learned from developed tools inform vision for future operations

    Explain future enhancements in the delivery of healthcare as identified by users

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  • Review: First Integrated Year

    816,639 total outpatient visits

    4,489 inpatient admissions

    Approximately 90,000medical records integrated

    186,007 total dental visits

    1,870,170 total pharmacy prescriptions


  • Review: First Integrated Year

    Deployed 84 Lovell FHCC Sailors throughout the world to support various Department of Defense missions

    Twenty one deployed in support of Operation Continuing Promise 2011

    USS Red Rover processed more than 38,000 U.S. Navy Recruits.

    Delivered more than 178,000 immunizations


  • Highlights: First Integrated Year Named The Joint Commissions Top Performer

    Top 13% of 3,099 hospitals in the nation

    Awarded Meritorious Unit Commendation by Navy Medicine East

    Opened both a state-of-the-art, inpatient medical surgical ward and the nations first VA/DoD Caregiver Support Center

    Activated a new 209,000-square-foot Ambulatory Care Center

    Linking electronic medical records that allow portability between the two systems 8

  • Existing VA-DoD Health Information Exchange

    VistaWeb (CPRS)

    Remote Data View (CPRS)

    DoD/VA/Theater Viewer (AHLTA)

    DoD: Health Information Exchange Portal (HIP)

  • Bidirectional Health Information Exchange (BHIE)

    DoD: AHLTA

    DoD/VA/Theater History

    VA: CPRS

    Remote Data View or VistaWeb

  • CPRS BHIERemote Data View




  • Challenges Prior to integration

    Requirement to use two EHRs in one medical center

    BHIE/CHDR functionality not reliable for FHCC tempo

    Different security requirements for each agency

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    Initial Desired IM/IT Solutions

    Evaluate Scheduling

    Clinic Appointment

    MSSO W/ Context Mgmt

    (Single Desk Top) - Sentillion and


    Single Registration

    Business Intelligence

    Order PortabilityAHLTAVistA

  • IM/IT: Current Status Single Patient Registration: Operational

    Medical Single Sign On with Context Management: Operational

    Orders Portability

    Radiology: Deployed June 14, 2011

    Laboratory: Risk Analysis completed

    Phase 1 deployment January 2012

    Consults : Under Development

    Pharmacy/Allergies: Interim plan in place

    Final capability part of iEHR14

  • Joint Patient Registration Operational since October 2010

    Allows for joint registration of all patients treatedveterans, recruits, active duty, dependents, non-veterans, humanitarian, etc.

    Correlates patient records in four systems: CHCS, DEERS, VistA and MVI

    Completes mini-registration with full registration completed in VistA and/or CHCS

    Demographic changes update in all four systems

  • Joint Patient RegistrationLESSONS LEARNED

    Identity Management is key to effective interoperability

    Must ensure that all patients are registered and correlated across VA and DoD databases

    Time consuming: requires both manual and batch processing

  • Single Sign-on with Context Management

    Allows for access to multiple applications with single entry of access code or password.

    Maintains same patient across all active applications.

    Two products operational at the FHCC:

    Sentillion (Microsoft) on VA terminal

    CareFx (Vangent) on DoD terminals

  • Sentillion (Microsoft)

    AHLTA, CHCS, CPRS, VistA, VistA Imaging, ImedConsent, iEHR

    Pros: VistA Web, VA applications are locally install, access to non-context CPRS sessions, patient log

    Cons: Requires second PIN entry when accessing DoD network; no roaming

  • CareFx (Vangent)

    AHLTA, CHCS, VistA, CPRS, VistA Imaging,HIP

    Pros: Roaming capability, single PIN for access to both VA and DoD network.

    Cons: no access to VistA Web, applications reside in Citrix environment

  • Orders Portability Definition:

    Any test can be ordered using either VA or DoD EHR

    Order available for processing in both EHR

    Results populate both EHRs as computable data

    Eliminates gaps in the patients VA and DoD EHR

    Orders Portability Types:





  • Orders PortabilityRadiology

    Deployed 14 Jun 11 Allows for entering of order, processing, resulting and

    populating both electronic records with results. Initial issues:

    provider mapping test mapping patient registration local factors

    Manual/human backup safety plan Provider Alert functionality for transmission errors PACS integrator allowing for sharing of images

  • Orders PortabilityLaboratory

    Phase 1 Deployed January 2012

    Issues: test mapping

    local factors

    Roll out in clinics with patients who will not be affected by error messages

    Manual/human backup safety plan

    Provider Alert functionality for transmission of OP errors

  • Orders PortabilityConsults

    Requirements phase

    Deployment 12 months afterwards

    Reason for more immediate need: minimize progress note gaps in medical record

    Front end issues: ordering and viewing consult notes

    Back end issues: triaging, status and tracking

  • Orders PortabilityPharmacy

    SMEs deemed OP Pharm too complex for FHCC

    Incorporated into integrated EHR (iEHR) project


    duplicate Rx numbers


    Need for computable allergy and medications data

    View-only data not sufficient need computable allergy and med data to be truly effective

  • iEHR Presentation Layer

    Developed at Honolulu VA/Tripler AMC

    Known as JANUS

    Joint presentation of VA and DoD clinical data in a single interface

    Customizable by provider to adjust for workflow

    Deployed at FHCC on December 1, 2011

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  • iEHR Presentation LayerFuture Enhancements

    Present state is read only. Need to become interactive

    Include scanned documents and pictures from AHLTA

  • Questions?