Transcript Document

January 27, 2004
Moving
to a
“Virtual
Health System”
Presentation to World Health Care Congress
Gary A. Christopherson
Senior Advisor to the Under Secretary
Veterans Health Administration, Department of Veterans Affairs
Improved health & “paperless”
Standards
• Data
• Communications
---------------------
Health Info Systems
• Electronic Health
Records Systems
(EHRs)
• Personal Health
Record Systems
(PHRs)
• Info Exchange
Adoption by
health
organizations &
persons of
affordable, high
quality &
standards-based
EHRs, PHRs &
Health Info
Exchange
Improved
Health
Paperless
(IOM)
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Virtual Health System - EHRs, PHRs,
EHR/PHR Info Exchange (IE) & Standards (S)
Health
Electronic Health
provider Record Systems (EHR)
Population/
Community
IE
Non health org
Electronic
Systems
S
S IE
Person
Person
S IE
IE
S
Other
EHRs & Other
health org Health Info Systems
Personal
Health
Record
Systems
(PHR)
Toward a “Virtual Health System”
•EHRs –
•Provide financial incentives
•Strongly encourage private sector vendors to make available
affordable, high quality, standards-based EHRs
•Strongly encourage provider-based efforts like AAFP
•Continue to improve HealthePeople-VistA & make available
•PHRs –
•Strongly encourage public/private sector to work together to
develop & make available PHRs for persons
•EHR/PHR Info Exchange (IE) –
•Strongly encourage public & private sector to work together to
develop & make available national “exchange” solution
•Standards –
•Consolidated Health Informatics as federal leadership
•Strongly encourage public/private development/adoption of
national standards
“Virtual Health System” – VA Role
•VA push EHRs, PHRs, EHR/PHR Info Exchange &
Standards in Federal and nationwide
•EHRs – VA
•Current -- VistA electronic health record system
•Next generation -- HealtheVet-VistA
•Public version -- HealthePeople-VistA
•PHRs – VA
•My HealtheVet
•EHR/PHR Info Exchange (IE) – VA
•Federal Health Information Exchange with DoD
•Electronic Health Records Interoperability (HealthePeople
(Federal) with DoD
•Standards – VA
•Adoption of VA-wide standards
•Adoption of standards between VA and DoD and VA and IHS
•Consolidated Health Informatics
Electronic
Health
Record Systems (EHR)
Electronic Health Record Systems (EHR)
(w/ PHRs, EHR/PHR Info Exchange & Standards)
Outside health
organizations
w/ EHRs
IE
S
IE
Registration, Enrollment
& Eligibility System
Database/
Standards
[web site, virtual health
record, trusted information,
self reported information,
link to other health
providers]
S
Management &
Financial System
Health Provider (including clinical
Interface) & Data
System
S
Database/
Standards
S
Provider Payment
System
S
Database/
Standards
S
Billing System
Blood System
Scheduling System
Radiology System
Pharmacy System
S
(e.g., My HealthePeople)
IE
S
Laboratory System
Enrollment System
EHR
S
“e” communications/
transactions
S
PHR
“VHA’s integrated
health information system,
including its framework for using performance
measures to improve quality, is considered one of
the best in the nation.”
Institute of Medicine (IOM) Report, Leadership by Example:
Coordinating Government Roles in Improving Health Care Quality
(2002)
HealtheVet – strategy overview
• Moves from facility-centric to person/data-centric
•Uses national, person-focused health data repository for
production & management/analysis/research
• Builds on, enhances & utilizes VistA
•Moves from legacy VistA to HealtheVet-Vista
• Uses best, appropriate modern technology
•Programming, software, hardware, networking
• Moves “core” applications to run “enterprise-wide”
• Standardizes core data & communications
• Enhances the five major systems
•Regis./eligibility/enrollment, health data, provider, management/
financial, “e” commun./transactions
• Enhances cross-cutting
•Security/privacy, architecture, data quality/standards,
infrastructure, enterprise system/resources management
NextGeneration HealtheVet-VistA - High Performance
Info System Components/Links/Standards
Outside health
organizations
IE
S
VA
organizations
IE
Registration, Enrollment
& Eligibility System
Database/
Standards
S
Management &
Financial System
Health Provider (including clinical
Interface) & Data
System
S
Database/
Standards
S
Provider Payment
System
S
Database/
Standards
S
Billing System
Blood System
Scheduling System
Radiology System
Pharmacy System
S
[web site, virtual health
record, trusted information,
self-reported information,
link to other health
providers]
IE
S
Laboratory System
Enrollment System
EHR
S
“e” communications/
transactions
S
My HealtheVet
Personal
Health
Record Systems (PHR)
Personal Health Record Systems (PHR)
Person
(community)
Health
providers
Electronic
Health
Record
Systems
(EHR)
P
Personal
Health
Record
Systems
(PHR)
IE
IE
P
P
IE
IE
P
Person
(external
service)
Person
(provider
sponsored)
EHRs &
Other
Health
Info
Systems
P
P
Electronic
Systems
Personal Health Record Systems
(PHR) (e.g. My HealthePeople)
“health in a box” on PC and/or web site via
community, health, non-health, government
Health Record
•Access to health records
•Share health records
•Self-entered health record
Services
•Health programs
•Check/fill prescriptions
•Check/confirm/make appointments
•Check/pay co-payments
•Participate in support groups
•Health decision support
•Health self-assessment
•Message with health provider
•Diagnostic/therapeutic tools
•Reminders
•“Check in”
•Safety services/tools
•Links to other health sites
Information
•Trusted information
My HealtheVet/HealthePeople PHR
Primary Electronic Health
health
Record System
provider (e.g. VistA)
S
S
Person
S
Other
Electronic Health
health
Record System
provider
Person
My HealtheVet/HealthePeople Personal Health
Record System (PHR)
Health Record
• Access to health records
• Share health records
• Self-entered health record
Services (Interactive)
• Check/fill prescriptions
• Check/confirm/make appointments
• Check/pay co-payments
• Participate in support groups / group services
• Health decision support
• Health self-assessment
“health in a
• Message with health provider
box” on PC
• Diagnostic/therapeutic tools
and/or web
• Reminders
site via
• “Check in”
community,
• Safety services/tools
health, non• Link to other health sites
health,
Information
government
• Trusted information
EHR/PHR
Health
Information Exchange
EHR/PHR Info Exchange (IE) - Multilateral
Electronic
Health
Record
Systems
(EHR)
IE
P
IE
Person
Health
providers
Health
providers
Electronic
Health
Record
Systems
(EHR)
IE
Personal
Health
Record
Systems
(PHR)
P
P
P
IE
IE
Non-health
org
Other
health org
EHRs &
Other
Health
Info
Systems
P
P
P
P – Person
IE – Internet-based exchange, including components below
EHR – High function & interoperable
Person Health ID – a) Voluntary (Multilateral) or b) Provider Assigned (Bilateral)
AAA – Authorization & authentication & accountability, controlled by person
Interface – Capability for exchange (send & receive/use)
Search – Tool for finding/requesting records held by persons/organizations
S – Standards, e.g. HL7
AAA
Search
S
IE
Person
ID
Interface
Electronic
Systems
Computerized Health Records
(FY 2005+)
DoD
CHCS II
Software
HealthePeople (Federal)
Joint, Shared Software
DoD CHCS II
Clinical Data Repository
HealthePeople (Fed.) Data
Standards (standardized
across MHS/VHA)
VA
HealtheVet-VistA
Software
VA/DoD
Exchange
VA HealtheVet-VistA
Health Data Repository
Federal Data, Communications, Security
Standards
HealthePeople (Fed.) Data
Standards (standardized
across VHA/MHS)
Standards – Jointly use data, communications, architecture, security, technical, software standards; federal
standards& potential national standards across public/private sector
Software – VA/DoD/Joint high performance software
Databases – Separate; enterprise-wide w/i each agency
Hardware – Separate; mix of enterprise & local w/i each agency
Exchange – Two-way VA/DoD
Health
Information Standards
Health Information Standards
Development/Adoption
• NCVHS –
•Strongly encourages development/adoption of standards in public
& private sectors
• Standards Development Organizations –
•Many efforts underway to develop standards
• Federal Agencies –
•VA, DoD & IHS agree individually to standardize
•VA/DoD & VA/IHS agree to standardize across agencies
• Consolidated Health Informatics –
•Joint effort led by HHS, VA & DoD
•1st five standards adopted; six more essentially adopted
•Working on total of 24 domains, incl. 6 active workgroups
Health Information Standards
• Initial Five Standards Adopted by CHI
•Messaging (DICOM)
•Messaging (IEEE 1073)
•Messaging (NCPDP SCRIPT)
•Messaging (HL7)
•Lab Result Names (LOINC)
• HIPAA Standard Adopted
•Applicable X12 EDI Standards
• Additional Six Standards Nearing Final CHI Adoption
•Anatomy (SNOMED, HL7, NCI)
•Demographics (HL7)
•Immunizations (HL7)
•Medications (FDA, RxNorm, LOINC, HL7, NDF-RT)
•Laboratory Test Order Names (LOINC)
•Units (HL7)
National standards & high performance systems
VA, DoD, IHS individual/joint adoption
Health Information
Standards
Systems
Consolidated Health Informatics (CHI)
HealthePeople(Fed)
National -- Public/Private
•Individual (e.g. Kaiser Permanente)
•Joint (Connect. Health, eHealth, HIMSS, NCVHS,
SDOs, …)
HealthePeople
DoD CHCS II
VA HealtheVetHealthePeople-VistA
Info
Exchange
/ Sharing
High
Performance
Health Info
Systems
IHS (upgraded RPMS)
HealthePeople(Fed)
Public/Private (NHII, CMS, VA, health providers/
payers/regulators, private sector vendors)
HealthePeople
2001
National
Health
Information
Standards
Personal
Health
Record
Systems
2010
“Electrifying”
th
1/7
of US Economy
Back-up slides
Success in supporting health delivery
for millions of veterans
• VistA/CPRS was & is a success
• Built by “fire” of VHA collaboration
• Publicly owned by VA; could be for future as well
• Strong interest by public/private in using VistA
• Largest integrated health info system for nation’s
largest integrated health system
• Helps serve 4.1 million American veterans annually
• Supports:
• $26+ billion nationwide health system
• 1,300 care sites, incl. 163 hospitals & 800+
community & facility based clinics
• 180,000 health care staff; 85,000 trainees
• Considered best overall health information system
Drivers for health
• Maximize health/abilities
• Maximize satisfaction
• Maximize quality
• Maximize accessibility/portability
• Maximize affordability
• Maximize patient safety (defects/errors to zero)
• Minimize time between disability/illness &
maximized function/health (time to zero)
• Minimize inconvenience (inconvenience to zero)
• Maximize security & privacy
Maximize Health/Ability & Satisfaction
Population
Based
[community,
region, nation]
Person
Based
Episode
Based
BP/
H&IT
Ideal
Care Coordination
BP/
H&IT
Ideal
BP/
H&IT
Ideal
BP/
H&IT
Ideal
AmbulaInpatient
tory care care
Community
care
Status –
BP/
H&IT
Ideal
BP/
H&IT
Ideal
eHealth
Health Systems –
Best Practices & Ideal
Well, Acute
Illness, Chronic
Illness,
Custodial
Max Accessibility
Max Affordability
Max Quality
BP/
H&IT
Ideal
Nursing
home
BP/
care
Ideal
H&IT
Domiciliary care
Max Health/Ability
Max Satisfaction