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
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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
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Highlights: First Integrated Year• Named The Joint Commission’s “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 nation’s 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
VISTA
WEB
AHLTA BHIE
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
CareFX
Single Registration
Business Intelligence
Order PortabilityAHLTA<>VistA
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 treated—veterans, 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 patient’s VA and DoD EHR
• Orders Portability Types:
– Radiology
– Laboratory
– Consults
– Pharmacy
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
• Issues:
– duplicate Rx numbers
– PDTS
– 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
• Placeholder iEHR slide #2
• Placeholder iEHR slide #3
iEHR Presentation LayerFuture Enhancements
• Present state is read only. Need to become interactive
• Include scanned documents and pictures from AHLTA
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