VistA Evolution and

Enterprise Health Management Platform

Region Update by

Marcia Pickard

October 8, 2014

Definitions: Program and Products

• VistA Evolution is the joint Office of Information and

Technology (OIT)-Veteran Health Administration (VHA)

program to refresh VistA.

• VistA 4 is the featured product

Technical approach is to keep parts of current VistA and gradually

add more modern and flexible components to allow more rapid,

higher quality, less expensive addition of new functionality.

2

VistA Evolution

VistA 4(Clinical Systems)

VLERInteroperability

Population Management &

Analytics

Top level coordinates among product lines

This product line is pre-decisional

Program

Product Lines

*

VistA 4 Product Roadmap

3

Colleague EHR(Gartner Gen 4)

Care CoordinationInteroperability and Improved

Care ManagementCore Care Management and Office of

National Coordinator (ONC) CertificationInitial Care Management

Capabilities

2014 2015 2016 2017 2018

Gen 4: Advanced systems that provide substantial functionality for nurses, physicians and pharmacists; have more decision support and workflow capabilities along with tools that permit providers to more easily bring Evidence Based Medicine to the point of care.

Before VistA Evolution – The Health Informatics Initiative (hi2)

“Transform Healthcare Delivery through Health Informatics” (Health Informatics Initiative or hi2) was created by Secretary Shinseki in May 2010 with these missions:

• Provide foundational Information Technology (IT) and Informatics

components for Veterans Health Administration (VHA)’s transition from a

medical model to a patient-centered model of care.

• Build a sustainable collaborative approach, capacity, and tools to deliver

informatics solutions to transform health care delivery to Veterans

through three major projects or Workstreams.

• Build a platform and functionality to support collaboration with VistA

Evolution and Computerized Patient Record System (CPRS) – Health

Management Platform (HMP)

Health Management Platform (HMP)

• Hi2 committed to providing HMP capabilities to two sites by Sept. 2014 (IOC carryover from iEHR milestone)

• Commitment was met by production implementation of HMP at San Diego, Hampton and San Antonio, including these capabilities: Google-like Search across patient records Improved Medication Review InfoButton links to external medical references News Feed Tasks CPRS classic views

• HMP currently complements but does not replace any part of CPRS.

• Large contract award to ASMR/Agilex in September

2013 – referred to as UX (User Experience)

• HMP code has been provided to ASMR/Agilex to serve

as the foundation for the enterprise product (eHMP).

VPR is being reused, but the UI is a new start.

• Hi2 team has transitioned from initiative status, merging

with Dr. Nichol’s office – Health Solutions Management –

effective October 1, 2014, and will continue to contribute

code to eHMP

Enterprise Health Management Platform (eHMP)

6

eHMP and eVPR

• The combination of the HMP, JLV and User Experience

teams’ efforts will become Enterprise Health

Management Platform (eHMP)

• Will become the eventual CPRS replacement

• eHMP will be a Product that consists of multiple

components: eHMP GUI, Enterprise Virtual Patient

Record (eVPR), and Vista Exchange

• VistA will continue to be an authoritative data store

where it is so today

7

Enterprise Health Management Platform (eHMP)

8

eHMP User Experience

• Vista Exchange• Clinical Decision Support• Context Persistence• Orders Selection Service• Orders Management

Service• Data Annotation Service• Clinical Workflow• Concept Relationship

Service• Documentation and Text

Search Service• Business Rules

Management System

JLV ViewCPRS Features

HMP IOC FeaturesONC Certification Features

eHMP ServicesMiddle tier Components

• eHMP will provide end user clinical encounter and care coordination transaction capabilities, data visualization, and decision support integration between Provider, Patient, and System facing components and devices. Different capability configurations will be available based on user roles. eHMP will:

become the eventual CPRS replacement

maintain the joint VA/DoD JLV functionality

provide new clinical functionality

be used for ONC 2014 edition certification

eHMP – User Experience

9

VistA Exchange and eVPR

• eVPR includes information model binding, terminology normalization, knowledge enrichment, and search indexing for all available longitudinal patient record data aggregated from VA, DoD, and exchange partner sources.

• VistA Exchange is the VistA 4 clinical application data services engine, providing an enterprise Virtual Patient Record service (eVPR) optimized for the enterprise Health Management Platform (eHMP) and other point of care applications and workflows

Abstracted Architectural Roadmap

11

2014 2015 2016 2017 2018

Replace some VistA applications

Enhance VistA database and some VistA applications

Critical fixes

Cut IT funding

Vist

A Ba

seeH

MP

VLER Enhance interoperability (get data from external providers)

Standardize clinical terms

Better user experienceAdd data abstraction layer

External applications

Native standardized data

Scalable architectureAdvanced decision support

Pop

Hea

lth

eHMP FY 14-16 PSI Functional Roadmap (Proposed)

PSI-6 Nov 18 – Feb 23 ‘15

• Tasks• CPOE • Drug-Drug/Drug-Allergy

Interaction• Drug-formulary Checks• eSignatures

• Documentation • Immunizations• Smoking Status

• Info Presentation• Persist user references• User-defined views/filers• CPRS Graphing• Patient

Inquiry/Insurance/MHV• T.O.C.

• Receive, Display, and Incorporate TOC

• Create/Transmit TOC• CDS

• Open CDS

PSI-7 Feb 24 – May 18 ‘15

• Tasks• ePrescribing

•Documentation• Clinical reconciliation -

Med reconciliation•Info Presentation

• VistA Web Health Summaries/Report

• VistA Imaging• CPRS Graphing• Reports CPRS

•T.O.C.• Clinical Summary (AVS)

•CDS• ONC CDS

PSI-8 May 19 – Aug 24 ‘15• Tasks

• Orders/Tasks• Documentation

• Amendments• Note objects• Free text notes & old note

objects•Info Presentation

• Image Viewer• Printing• CPRS Graphing• Reports CPRS

• T.O.C.• Data Portability• Clinical Summary (AVS)

• CDS• Patient Specific Education• Open CDS other• Authoring• Concept Relationship• Other CDS• Workflow Management• Care Plan Basic

eHMP FY 14-16 PSI Functional Roadmap (Proposed)

PSI-9 Aug 25 – Nov 17 ‘15

• Tasks• Order sets • Quick orders• Order Menu• Formulary Restricted• ePrescribing

• Documentation• Progress Notes

Modernization• Documentation Kit

[Legacy/New]o Family Historyo Smoking statuso Functional Status

• Annotation*• Encounters• Templates, fields, objects

• Info Presentation• VBA User• Printing• Reports CPRS• Concept-driven displays

PSI-9 Continued

• CDS• Clinical Reminders

Replacement – KBS help?• Other CDS• Concept relationship

authoring• Workflow (CDS support)• Care Plan

PSI-10 Nov 17 – Feb 22 ‘16

• Tasks• Order authoring• Order sets• In patient meds for

Outpatient• Documentation

• Progress Notes Modernization

• Dialogs [Legacy/New•Info Presentation

• Printing• CDS

• Clinical Reminder Translation - Contract?

• Other CDS• Workflow (CDS support)• Care Plan

eHMP FY 14-16 PSI Functional Roadmap (Proposed)

PSI-6 Nov 18 – Feb 23 ‘15

• VPR Sync• Sync Overhaul• Cache update on write-back• Support CDS to update RPCs

• User Identity & Access Services• ABAC• User Repository• User Provisioning• ONC Audit

• Performance• VistA Routine Dep• Split Resource Server

(clusters)• Monitoring

• System Monitoring• External Integration

• jMeadows• NwHIN• DoD Adapter• VPR APIs VX Patient record• VSA Spike

PSI-7 Feb 24 – May 18 ‘15

• User Identity & Access Services• SSO/PIV

Authentication• Performance

• SOLR• PEP• Authentication

Validation in parallel• Monitoring

• Production Level Monitoring (similar to JLV)

• External Integration• jMeadows• VSA

• DR/Failover• 2 sites

PSI-8 May 19 – Aug 24 ‘15

• Performance• Concept Searches• Reverse Proxy

Change• External Integration

• VSA

PSI-9 Aug 25 – Nov 17 ‘15

• DR/Failover• Multi site

Modularity and SDK in eHMP• Development modularity and services will exist at

multiple levels – user interface, middle tier, data levels• Software Development Kit (SDK) will be made

available to the community.• The SDK is comprised of:

• Application Development Kit (ADK) to drive development of the client-side web application. Build using JavaScript, backbone.js, marionette, bootstrap. Resulting application is SPA, static HTML served from web server (no J2EE server)

• Resource Development Kit (RDK) to drive the development of service side resources (web services) to support the web application. Build using JavaScript, express.js. Deploy to node.js; relies on npm for package management.

eHMP Application Development Kit (ADK)

• ADK provides mechanisms for applet developers to• Discover the current patient• Fetch patient data from vista exchange, can use canonical model (based on

VPR) or provide custom "view" model• Bind data to backbone views, provide templating• Choose preselected display paradigms (tableview, etc) and UI controls. UI style

set by application• Create three different "size" views to support responsive / adaptive design

• ADK provides mechanisms for screen designers to• Create a screen, choose from predefined layouts and assign applets to regions

• ADK provides for application designers • Runtime UI shell for application. Displays current patient, current user. Provides

navigation• Mechanism to choose the screens that are part of the application

• ADK also provides • CI pipeline/devops for pulling applets/screen configurations from artifact

repository, compiling, packing, testing, and publishing to artifact repository. This produces a CM-ed version of the web application (which includes specific version of applets)

eHMP Resource Development Kit (RDK)

• Resource = a single web service (e.g., save allergies)• Resource Family = collection of resources• Resource Server = deployable unit, including a family and configuration• RDK for resource developers

• Configuration of the resource family• For each resource, specifies relative mount path and method using

standard express signature function(request, response, next)• Specifies resource characteristics (sensitive, audit information)

• Request provides resource information about the request: url, path parameters, query parameters, header, current user, access to RDK utility methods, access to current resource server, configuration information, logger

• Response provides resource ability to send response: status code, json or text body, media information

• Resources with handles to common external systems, including JDS, VistA(s), solr search engine

eHMP Resource Development Kit (RDK)• RDK for deployment engineers when creating a resource server

• Group resources into a logical deployment unit called a resource server. • Specify how many processes using cluster/fork• Deployment engineer chooses which resource family should be registered

using: (show code)• Resource Server deployed behind a reverse proxy (apache httpd) for load

balancing• Ability to enable: authentication, authorization/PEP, audit• Specify logging rules, configuration, resource caching rules• Routes calls to resources based on URL and media type (content-negotiation)• Provides health check (binary and discrete information) based on each resource

registered. Deployment engineer can specify additional health check rules.• RDK also provides

• Centralized dependency management • Automatic creation of resource directory• CI pipeline/devops for pulling applets/screen configurations from artifact

repository, compiling, packing, testing, and publishing to artifact repository. This produces a CM-ed version of the web application (which includes specific version of applets)

‘Local’ VistA

Remote VistA

RPCCALLS

(WRITE)

VA

PartnersDoD

CDR

RPC

Brok

er

AHLTACHCSEssentris

BHIE SHARE

DoD VLER ADAPTER

Logical View of Patient Encounter – VistA 4 (Simplified)

PDTS

VA Partner

VA Partner

VA Partner

DoD Partner

DoD Partner

DoD Partner

VistA Shadow

SFC(Ret) Smith’s Care Team

DHMSM

AccessManagement

VINCI

Terminology ServiceRemote

VistA

MHV

CDS SupportServices

READ

SRE

ADS

Consent Management

Future Services(ie., Orders)

CDW

VistA Exchange

READS – (VDEF, RPC and FMQL)

DRAFT

FHIR

ESB connections(with VSA services)

MDR

HSDW

eHMPintegrates

HMP/Mobile/JLV

Team – Patient - System

DMIX / DHMSM HIE

Future Services(Knowledge Base)

Identity Management

VLER DAS