June 30, 2011
Agenda/Topics of Discussion Project Goals/Objectives Desired Outcomes Technical Overview Current Status & iehr Identity Management Lessons Learned Summary Comments & Questions 2
Project Goals/Objectives Description: The JALFHCC is a unique DoD/VA endeavor under a single line of authority to manage VA and DoD medical and dental care provided to DoD/VA beneficiaries while meeting the unique missions of both Departments Stand up of the integrated JALFHCC command October 1, 2010 Implementation of the integrated JALFHCC capabilities: Patient Registration and Medical Single Sign On with Context Management December 13, 2010 Orders Portability Laboratory and Radiology solutions were decoupled. Orders Portability for Radiology was implemented on 6/15/11. The restart of the phased implementation of Orders Portability for Laboratory will resume 30 45 days after the technical solutions have been delivered. Goal: The IM/IT goal of the JALFHCC Demonstration Project is to implement systems or capabilities that safely integrate VA and DoD Electronic Health Record (EHR) systems, in a combined VA/DoD facility, with multiple care locations Objective: The initial business requirements in support of healthcare delivery and operational readiness are: Single Patient Registration Medical Single Sign on with Patient Context Management, Orders Portability for Laboratory, Pharmacy, Radiology, and Consults 3
Desired Outcomes Single Patient Registration Registers and updates a patient with single user interface Registers, verifies eligibility, and updates a patient through in native DoD and VA systems Common service, built once, used on both DoD and VA systems Medical Single Sign On with Patient Context Management (MSSO/CM) User logs in once and has access to the DoD and VA systems Select the patient once and active clinical applications display patient s data with assurance that this is the correct patient Orders Portability: Laboratory, Pharmacy, Radiology and Consults Place an order and the order automatically goes to filling/execution location regardless of which system is used Updates the orders status regardless of system, completing the order Results visible in both systems regardless of where the order originated Orders Portability (OP) of Pharmacy/Allergies and Consults: Based on the March 17th SECDEF and SECVA decision, JALFHCC and Integrated Electronic Health Record (iehr) will develop a strategic joint solution regarding Pharmacy/Allergies and Consults OP for VA and DoD 4
North Chicago FHCC: Technical Overview Three Distinct Networks Department of Defense (DoD), Department of Veterans Affairs (VA) and Navy Network Enclaves User Access to Clinical Applications DoD and VA users can access Common Registration System, AHLTA/CHCS and VistA/CPRS respectively Clinical Single Sign On/Context Management (SSO/CM) Commercial off the shelf (COTS) products Citrix/CareFx (DoD); Sentillion (VA) DoD/VA programs of records virtualized using Citrix Integrated Solutions Web Portal Single Patient Registration Orders Portability between AHLTA/CHCS and CPRS/VistA DoD and VA Enterprise Service Buses (ESB) integration 5
Reason for Design and Technical Approach Loosely coupling systems is a best engineering practice to integrate disparate applications across three separate networks Allows applications to subscribe to existing enterprise services across network boundaries Allows DoD and VA to develop capabilities independently of one another to support their other enterprise needs Tightly integrated applications or data sharing framework for DoD and VA Could impact timeliness of improvements needed for information sharing to support DoD Force Health Protection, Medical Command & Control and Readiness systems Could impact legacy ports and protocols that are being leveraged by each department s ESB Could have 2 nd and 3 rd order effects on DoD and VA specific applications/systems if changes are made to tightly integrated solutions Could potentially impact wounded, ill and injured programs that support war fighters as they move across the continuum of care Approach allows network or information assurance changes on either side without impacting current capabilities or significantly slowing integration, testing and delivery of new capabilities to the end user
JAL FHCC Development & iehr Current Status: MSO and Single Patient Registration in Production ESB and SOA infrastructure in Production Radiology Orders Portability in Production Laboratory Orders incrementally deployed starting June; addressing SME technical issues prior to resuming implementation iehr Pharmacy Service in Requirements stage Joint Pharmacy application and Allergy Service Architecture used at JAL FHCC can support iehr Will need to replace products with iehr agreed to solutions SOA is plug and play using HITSP standards Terminology and Translation mapping must be created for new Services 7
JAL FHCC & iehr JAL FHCC ESB Orchestration Broker Audit, Security JAL FHCC SOA Registration Radiology Laboratory iehr Pharmacy (2012) 8
JAL FHCC & iehr Orders Service(LAB) Send/Receive service Result/update service Common Services Terminology Identity Management Cross Reference Exception Management 9
Identity Management Initial Key Capabilities Provide across reference enterprise identifier capability which translates a patient's DoD EDIPN to a VA ICN and vice versa iehr Capabilities DMDC developing a service for Point of Service Eligibility to be leveraged for Pharmacy and future joint efforts This service will return the following based on a patient inquiry Patient information Contact information DOD and VA eligibility Subscriber Person identity information (same if sponsor is patient) including DOD Beneficiary ID DoD and VA health care eligibility 10
Proposed Solution for iehr Way Ahead A Inquire eligibility B C View Eligibility info Update contact info A B C Joint Identity, Contact & Eligibility Service (JICES) A C VA eligibility query using national ICN / returns VA eligibility/contact data Update contact info Patient Identity Joint Registry DOD Eligibilit y DEERS DRAFT 11
Lessons Learned Mapping and terminology service challenges Team effort to successfully implement and integrate applications Managed functional support areas jointly (i.e., CM, RM, IA, and etc.) Offsite quarterly meetings to flush out differences; weekly management meetings Business requirements must align with technical design to meet customer expectations Adequate testing environments and staff to meet scheduled and shortnotice testing requirements Three distinct networks and security issues Account for individual department review and approval timelines in IMS Contract alignment between departments Restriction on legacy modifications 12
Summary Comments & Questions Single Patient Registration and Medical Single Sign with Context Management implemented on December 13, 2010 Pharmacy Phase I implemented on December 13, 2010 Radiology Orders Portability went live on June 15, 2010. The implementation is progressing as scheduled. Laboratory Orders Portability is currently in a strategic pause while the technical teams and users address outstanding software defects, complete user account and laboratory test mapping, and fix patient registration issues. Once these issues are addressed a technical solution will be delivered. The Site has requested an additional 30 45 days from software delivery to implement new orders portability business processes. May 31 June 3, 2011, DoD/VA personnel met in Tampa, Florida to initiate a revised plan for future Pharmacy, in line with the iehr effort Departments will maintain delivered capabilities, and require not yet delivered capabilities to be joint, in coordination with the iehr effort 13