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Agenda/Topics of Discussion
2
• Project Goals/Objectives
• Desired Outcomes
• Technical Overview
• Current Status & iEHR
• Identity Management
• Lessons Learned
• Summary Comments & Questions
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 Consults3
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
5
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 2nd
and 3rd
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 a cross 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
11DRAFT
A Inquire eligibility
VA eligibility query using national ICN / returns VA eligibility/contact data
Joint Identity, Contact & Eligibility Service
(JICES) Update contact info
Patient Identity
Joint Registry
DOD Eligibilit
y
B
DEERS
Proposed Solution for iEHR Way Ahead
View Eligibility info
Update contact info A
C B
C
C
A
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 short‐
notice 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