Download This “Health IT Sharing Activities: 4th Annual Analysis

Health IT Sharing Opportunities: 4th Annual Analysis
Date Submitted:
February 1, 2005
Prepared By:
Health IT Sharing Program
Health Informatics Strategy Office
VHA Office of Information
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
Table of Contents
Page
Executive Summary
1
1.0 Introduction
10
2.0 Background
11
3.0 General Approach / Methodology
14
4.0 Analysis & Findings of Health IT Sharing Opportunities
18
5.0 Conclusions & Recommendations
26
Appendices
29
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
Executive Summary
“HealthePeople” Overview
“HealthePeople” is the Veterans Health Administration (VHA) and Department of Veterans
Affairs’ (VA) long-range collaborative strategy to increase the availability and use of high
performance, interoperable health information systems in order to substantially improve the
health care of people in the U.S. and other nations. One of the HealthePeople goals is to pursue
collaborative partnerships with public and private sector organizations that result in open health
information systems with common architectures and standardized data and communications
elements. HealthePeople has the potential of bringing together a wide range of health care
provider organizations, commercial companies, consumer groups, and government agencies in
a collaborative and constructive partnership to better serve all citizens, especially our veterans.
Specific objectives of HealthePeople include:





Developing and adopting common solutions and standards for architecture, data,
communications, security, technology and systems.
Seeking appropriate opportunities for sharing existing health information systems and
technologies.
Seeking appropriate opportunities for joint procurements, development, or operation
of health information systems.
Seeking appropriate opportunities for improved health information exchange.
Working with partners toward convergence on high performance health information
systems.
By adopting common data, terminology, and communications standards, data from multiple
agencies can be gathered and analyzed more readily for population studies.
Health Information Technology Sharing (HITS) Program Overview
The Health Information Technology Sharing (HITS) Program within the VHA Office of
Information (OI) has been specifically focused on providing support for the HealthePeople
long-range strategy of pursuing mutually beneficial collaborative partnerships with
organizations in the public and private sector. The goals of the HITS program are to work with
other VHA and CIO offices to:



Proactively identify, document, and explore new opportunities for interagency
collaboration and cooperation in the area of health information systems.
Better leverage and utilize collective resources of collaborating organizations to
acquire or develop health information systems.
Help foster increased awareness, acceptance and support for information systems
sharing within the health care community.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
Health Information Sharing Initiatives
The "Health IT Sharing: 4th Annual Analysis" report was developed by the HITS staff and
includes a list of current health information sharing accomplishments and activities and
recommendations for potential new health information sharing opportunities and initiatives for
FY 2005 and 2006. The findings and recommendations are based on a detailed analysis of the
extensive data which have been collected and entered into the HITS database, including data on
existing and planned health information systems and sharing activities across the public and
private sectors.
Summary of Selected Accomplishments & Current Activities
o Federal Health Architecture (FHA) and the Consolidated Health Informatics (CHI)
Initiatives—The FHA and CHI are multi-year, interagency initiatives at achieving systems
convergence and agreement on architecture and standards for health information systems
across Federal government agencies (e.g. HHS, DoD/Military Health, VHA, IHS).
o Federal Health IT Standards—VHA, DoD/Military Health, and other Federal agencies
participating in the Consolidated Health Informatics (CHI) eGov initiative have
successfully adopted over twelve standards to support interoperability, e.g. HL7, LOINC,
NCPDP, DICOM, X12, etc.
o Federal Credentialing System & VetPro—This effort initially started as a collaborative
partnership between HRSA and VA with other Federal Agencies on standardized,
electronic credentialing system and databank that meets JCAHO standards. See
http://bhpr.hrsa.gov/dqa/fcp.htm
o Interagency Memorandum Of Understanding (MOU) & VHA—VHA has put in place a
number of MOUs with Federal agencies such as the FDA, NLM, and NCI to support
collaboration on a National Drug File, sharing drug information, developing terminology
standards for medication information, and other purposes.
o Interagency Committees/Work Groups—VHA OI staff currently participate on key federal
health care information committees such as, the Quality Interagency Coordination Task
Force (QuIC), National Committee on Vital and Health Statistics (NCVHS), and the
National Health Information Infrastructure (NHII) Work Groups.
o National & International Health Information Standards—Continued involvement by
VHA and the IT Architects in national and international non-government organizations
(NGO) working on the development and adoption of healthcare information and
communications standards (e.g. HL7, LOINC, X12). This work also relates to the VA/DoD
EHR and the CHI eGov initiatives.
o National SNOMED License—VA, DoD, and HHS collaborated on an agreement with the
College of American Pathologists (CAP) to license the College's standardized medical
vocabulary system (i.e. SNOMED) and make it freely available throughout the U.S.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
o Functional Model and Standards for Electronic Health Record (EHR) Systems—VHA
initiated an effort to develop functional model and standards for EHRs. The collaboration
included VHA, CMS, AHRQ, NHII, The Robert Wood Johnson Foundation, HIMSS,
Institute of Medicine and HL7.
o Federal eGov Initiatives—OI staff have been participating in a number of Federal eGov
health IT initiatives, e.g. CHI, FHA, eVitals, eGrants, eDisaster.
o
President’s Task Force to Improve Health Care for Our Nation’s Veterans—The
President’s Task Force was established to identify specific, practical reforms in the delivery
of health care to beneficiaries of VA and DoD. The VA/DoD Health IT Sharing Program
provided IT subject matter expertise to the President’s Task Force. The Task Force issued a
final report containing strategies for use in addressing the major barriers to collaboration
between the two Departments and the need to exchange patient information.
o VA/DoD Electronic Health Record (EHR) System—The goal of the joint EHR Plan is to
support the joint HealthePeople (Federal) strategy. This is a large umbrella initiative
involving VA/DoD collaboration on an Electronic Health Record (EHR) System involving
a Clinical/Health Data Repository (C/HDR), and other components such as pharmacy,
laboratory, scheduling, and imaging.
o Clinical Data Repository/Health Data Repository (C/HDR)—This project seeks to ensure
the interoperability of the DoD Clinical Data Repository with the VA Health Data
Repository. The Departments have formed an active working group to lead this effort and
have made significant progress toward building a prototype. The prototype is planned to
support the bi-directional exchange and use of pharmacy data in VA and DoD systems.
o VA/DoD Joint Venture Sites—Existing—VA/DoD Joint Venture health care sites are
operating at seven locations: Albuquerque, NM; El Paso, TX; Las Vegas, NV; Anchorage,
AK; Miami, FL; Honolulu, HI; Fairfield (Martinez), CA.
o VA/DoD Planned Demonstration Sites–The FY 2003 National Defense Authorization Act,
Section 722 requires selection of at least three VA/DoD demonstration sites for the conduct
of specific collaborative IT solutions focusing on: a) Budget & Financial Management b)
Coordinated personnel staffing and assignment, and c) Medical Information & Technology
solutions. The sites have been selected and work has begun.
o Federal Health Information Exchange (FHIE)—FHIE provides historical data on
separated and retired military personnel from the DoD’s Composite Health Care System
(CHCS) to the FHIE Data Repository for viewing by VA clinicians in CPRS. FHIE was
successfully deployed across all VA medical centers beginning in June 2002.
Enhancements to the system continue to be made. A new, related initiative known as the
Bi-Directional Health Information Exchange (BHIE) was also recently approved.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
o VA/DoD Laboratory Data Sharing & Interoperability (LDSI) Project—The LDSI Project
was a multi-year, joint VA and DoD initiative to develop a national solution to allow the
Department’s healthcare facilities to send lab test orders and receive lab test results to and
from any site, as needed. Work is now underway to enhance the LDSI software with bidirectional exchange capabilities that will permit DoD to submit labs to VA for performing
tests and returning results.
o VA/DoD Consolidated Mail Outpatient Pharmacy (CMOP) Project—The Departments
collaborated on an application that supports VA’s refilling of outpatient prescription
medications from DoD’s Military Treatment Facilities at the option of the beneficiary. Beta
testing conducted at three sites was successful and is now complete.
o VA Access to Deployment Related Medical Records Online (DRMROL) and Other
Data— The VA/DoD Health IT Sharing Program is presently working with the Army
Surgeon General staff to identify a process and mechanism to transfer DRMROL data from
DoD to VA VistA systems. These data would be used by VA clinicians for treatment of
returning active duty personnel and veterans of recent deployments. DRMROL data consist
of pre- and post-deployment health surveys that are self-reported by active duty personnel.
o VA/DoD Credentialing—The Departments developed a prototype to support data sharing
between the VA VetPro system and the DoD Centralized Credentials and Quality
Assurance System (CCQAS). The Credentialing initiative is responsive to House
Appropriations Committee Report 107-298, which directed DoD to study the merits of
integrating its credentialing system with the VA system. The Departments tested the joint
solution at selected Joint Venture sites.
o VA/DoD eHealth Portals—The Departments are collaborating on the development and
enhancement of their e-portal systems, TRICARE Online and My HealtheVet. Both
Departments acquired the health and wellness content for the applications from the same
vendor thus providing uniform patient health information to the beneficiaries of both
Departments.
o TRAC2ES - This successful joint VA/DoD development effort was aimed at integrating all
assets (medical and transportation) required to facilitate the decision process of evacuating
military casualties from a combat theater to a source of definitive medical care within the
Continental United States (CONUS). It is through this system that designated VA hospitals
report available medical capability under the VA/DoD Contingency Plan, as mandated
under P.L. 97-174.
o VistA & D.C. Government—OI staff provided limited technical assistance to the D.C.
government over the past year as they successfully implemented the VistA system in three
of their major outpatient clinics. Sixteen more sites are planning to use VistA.
o VistA & American Samoa—Working with the Honolulu VAMC, OI staff provided limited
technical assistance to the American Samoan government over the past few years as they
successfully implemented the VistA system in the LBJ Tropical Medical Center.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
o VistA & National Hansen's Disease Centers—The National Hansen's Disease Programs
(NHDP), based in Baton Rouge, Louisiana, is primarily responsible for inpatient and
outpatient care and treatment of Hansen's disease (leprosy). In addition to the clinical
programs in Baton Rouge, the NHDP also coordinates outpatient care for Hansen's disease
patients throughout the U.S. at BPHC grant funded clinics as well as private physician
offices. They brought up the Vista system in 1989 and updated their infrastructure in 2000.
They have a patient database size of 16,082 patients.
o VistA & State Government Health Departments—OI staff have received numerous calls
from state government representatives expressing an interest in possibly acquiring and
using the VistA/CPRS system. Briefings and demonstrations have been arranged as needed.
Examples include:
o West Virginia, Texas, Hawaii, Pennsylvania, Michigan, and several other states that
have expressed an interest in acquiring and implementing VistA and CPRS.
o VistA & Washington State—Washington State has implemented and been successful in
their use of VistA at three facilities over the past decade, (i.e. Western State Hospital,
Tacoma, Child Study & Treatment Center, Tacoma. and Eastern State Hospital, Spokane).
o VistA & State Veterans Homes—OI staff is working with representatives from the State
Veterans Homes, the Geriatrics Program, the VISNs, VAMCs, and the Office of
CyberSecurity on this initiative.
o VistA Implementations—Oklahoma is moving forward with plans to acquire and
implement VistA/CPRS in their seven healthcare facilities. VistA has already been
implemented in three sites. Other states are also interested in VistA.
o CPRS Read Only—Over 120 State Veterans Homes have expressed interest in
obtaining CPRS Read Only access to patient data in VistA for a limited number of
their clinical staff. Over 65 sites have now been given CPRS Read Only access to
date with many more sites in the works.
o VistA & Indian Health Service (IHS)—VA and IHS have a long history of working
jointly on health information technology. VA and IHS recently signed a new inter-agency
MOU in support of health information sharing efforts (e.g. CPRS, VistA Imaging). The
agencies will work on developing and adopting common health information standards and
technical solutions. In addition, the agencies will continue to identify new opportunities for
joint development and/or procurement of health information systems.
o VistA & AAMC/Affiliated Medical Schools—VHA has academic affiliations with 107
medical schools and over 1,200 other educational institutions. Working with the Office of
Academic Affiliations and the American Academy of Medical Colleges (AAMC), the VHA
OI has select several pilot sites to test collaborative health information solutions in FY
2005.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
o VistA & Veterans Service Organizations (VSO)—VHA has made VistA and CPRS Read
Only available to authorized patient representatives in Veterans Service Organizations
(VSO) over the past year, e.g. VFW, DAV, PVA.
o VistA & Public Health and Biosurveillance—The Department of Health & Human
Services (HHS) has numerous public health systems and databases that capture data on
specific diseases, deaths, incidents, and other events which could be populated
electronically by VistA. Initial efforts were started in FY 2004 involving the transmission
of de-identified patient data from the VA data warehouse at the Austin Automation Center
(AAC) to the HHS Center for Disease Control (CDC). Links to other Federal and State
public health databases may be put into place over the coming years.
o VistA & Local Governments—OI staff regularly provide information on VistA and
arrange for demonstrations of the system to city and county governments across the
country, e.g. L.A., Detroit, Cleveland, Chicago.
o VistA & International Healthcare Communities—A number of countries have either
implemented VistA or have expressed an interest in possibly acquiring and implementing
the system. These include: Finland, Egypt, Germany, Mexico and others. Representatives
from many other countries have contacted VHA and have been briefed and/or given
demonstrations of the VistA system, e.g. Jordan, Malaysia, India, Japan.
o VistA & Mexico—The Instituto Mexicano del Seguro Social (IMSS) is moving forward
with testing and implementing the VA VistA system. They have successfully implemented
a Spanish version of VistA in one hospital and are in the process will implement it in 2
more by the end of 2004. They plan on implementing VistA in 50 hospitals in 2005, and a
total of 260 hospitals over the next 3-4 years.
o VistA Sharing & the Open Source Healthcare Communities—VA has been approached
by numerous organizations in the wider health care community about making VistA/CPRS
available to them for their own use. The Open Source healthcare software movement also
continues to grow. Under the Freedom of Information Act (FOIA), VA has released copies
of VistA software to these organizations upon request. The agency should continue to
carefully monitor how VistA is used by these other organizations in the health care and
Open Source communities.
o VistA Office EHR & HHS/CMS - The Department of Health and Human Services (HHS),
the Centers for Medicare & Medicaid Services (CMS), and the Veterans Health
Administration (VHA) collaborating on an initiative to transfer VistA, the VHA’s
Electronic Healthcare Record (EHR) system, to the private physician office setting.
Targeted for release July 2005, the VistA-Office EHR system will be available to individual
practices and the EHR industry.
o VistA & the Vendor Community - The VistA Software Alliance (VSA) was formed to
allow a collaboration between government and private businesses to facilitate the
implementation of VistA within healthcare organizations outside of the VA. The VSA
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
provides a neutral buffer organization so that the government can encourage a broad base of
industry investment, without favor to any specific company. A growing number of major
software vendors have joined the VSA, e.g. HP, EDS, PerotSystems, InterSystems, etc.
o Bi-Directional Web Connections—In an attempt to create a more comprehensive and
tightly coupled online community of information sharing for veterans on the Internet, HITS
staff have worked with the following organizations to put in place hyperlinks between them
and the VA.
o Department of Defense (DoD)—Army, Navy, Air Force, Marines, Coast Guard, and
National Guard
o Federal Agencies’ Veterans Programs—Office of Personnel Management (OPM),
Housing and Urban Development (HUD), Department of Labor (DOL), Department
of Agriculture (USDA), FirstGov, and GovBenefits
o State Agencies—State Health Departments and State Veterans Affairs Offices
o Veterans Service Organizations—e.g. American Legion, Veterans of Foreign Wars
(VFW), and Disabled American Veterans (DAV)
o Community Health Information Exchange (HIE) Networks—Over the next decade,
numerous community health information exchange networks will be put in place to allow
public and private healthcare organizations and providers to securely view patient data from
different provider organizations. Based on lessons learned and actual cost/benefits, a
national strategy for implementing community health information exchange solutions will
be put in place by FY 2005. Implementation activities could extend well into the next
decade.
o
HIE Pilots —VHA is planning to participate in a pilot test involving the exchange of
patient data between the VA Outpatient Clinic and a number of other partnering public and
private sector healthcare organizations in Santa Barbara County, CA. Other patient data
exchange systems in local communities around the country are continuing to be examined
as VHA seeks to craft a national strategy and solution, e.g. New England Health Exchange
Network (NEHEN), Grand Junction HIE. The VISNs and their VA Medical Centers should
probably have primary responsibility for pursuing and implementing this component of the
HealthePeople program.
o My HealtheVet & Personal Health Records (PHR) for Veterans—Veterans and those
members of their family directly involved in their care need to be provided ready, yet
secure access to their medical records, health education materials, and preventive health
information at a minimum. VA has taken a number of steps to make this a reality. For
example, VA recently implemented a new system called My HealtheVet, an online web site
personalized to meet the specific needs of veterans at (www.myhealth.va.gov). The
capabilities of My HealtheVet will be greatly expanded over the coming years. In addition,
a number of home health telemedicine pilot projects are underway that hold great promise
for the future. The My HealtheVet strategy is being further developed to greatly expand the
program side and help VHA move to a more veteran-centric approach to improving
veterans’ health.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
o National 211 Project—Local VA Medical Centers are collaborating with efforts at the state
and local community levels across the U.S. on their implementation health and human
services Information and Referral (I&R) telephone call centers accessed by dialing “211”.
o Knowledge Exchange & the Healthcare Community - VHA Office of Information (OI)
staff have met with senior representatives from numerous major healthcare provider
organizations (e.g. Kaiser Permanente, CHRISTUS, Adventist Health) to share knowledge
and lessons learned related to implementing health IT systems.
__________________________________________________________________________________________
Recommendations for Potential New Sharing Opportunities and Initiatives
The following sharing opportunities have been identified for further follow-up in the coming
year. These were previously identified in the "3rd Annual Analysis of Health IT Sharing
Opportunities" but no specific pilot projects were pursued. Preliminary studies completed
over the past year have now identified potential pilot projects that could be pursued.

Genomic Information Systems—The Human Genome project is the publicly financed
international research effort whose goal is to decipher the human genome code and to
provide these data freely and rapidly to the public. Genomic Information Systems will
ultimately allow clinicians to more rapidly diagnose existing genetic diseases; predetermine genetic risk for developing; design novel therapeutic agents for the treatment and
prevention of disease, rather than the treatment of the underlying symptoms; and prescribe
medical intervention based on a person’s genetic information, reducing the chance of an
allergic, or otherwise detrimental, drug reaction. Based on a preliminary study completed
by the HITS staff into Genomic Information Systems, it is recommended that VHA should
consider collaborating with HHS and the NIH Human Genome Project because there will
be a need to integrate a Genomic Information System and a BioRepository within VistA
and CPRS in the coming years. A number of opportunities exist to collaborate with other
Federal agencies on Genomic Information Systems application software, architecture, and
standards.

Internet2/Next Generation Internet (NGI) - Internet2 is a consortium being led by 205
universities working in partnership with industry and government to develop and deploy
advanced network applications and technologies, accelerating the creation of tomorrow's
Internet. The Next Generation Internet (NGI) initiative is a multi-agency Federal research
and development program that is developing advanced networking technologies,
developing applications that require advanced networking, and demonstrating these
capabilities on test beds that are 100 to 1,000 times faster end-to-end than today's Internet.
The Federal agencies that have participated in NGI include DARPA, NSF, DOE, NASA,
NIH, NLM and NIST. Key Internet2/NGI projects include initiatives in the following
fields of healthcare - radiology, orthopedic surgery, telehealth, medical education, and
medical imaging. Based on a preliminary study completed by the HITS staff, it was
determined that opportunities exist for VHA to collaborate with other Federal agencies on
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
Internet2/NGI and should be pursued in the areas or standards, architecture, and
applications.

State Health Departments across the country also operate hundreds of healthcare facilities
supported by a variety of health IT systems. They maintain public health files/databases and
disease registries, provide access to online patient education and medical reference
materials, are starting to put in place online Living Wills and/or Advanced Directives, are
building biosurveillance systems with information exchange capabilities, etc. Based on a
preliminary study recently completed by the HITS staff, it was determined that a number of
new, mutually beneficial opportunities for collaboration between VHA, its local healthcare
facilities, and state health departments exist. The VISNs and their VA Medical Centers
should have primary responsibility for pursuing and implementing this component of the
HealthePeople program.

Open Source Community - Based on a preliminary study completed by the HITS staff , it
is recommended that VHA collaborate further with the larger VistA and Open Source
communities, e.g. VSA, WorldVistA, OSHCA, Mexico, etc. A pilot project ought to be
initiated to help VHA design and put in place an effective process for better importing and
exporting software modules and technologies with the open source community.
There is only one truly new potential sharing opportunity that has been identified in this "4th
Annual Analysis of Health IT Sharing Opportunities".

National Commercial Health Information Systems - A number of 'free' or relatively low
cost health information systems or services have emerged from the private sector that VHA
ought to consider taking advantage of such as My HealthDirective, Vital/CHEK, NCPDP,
MedicAlert, and LifeFone/Personal Response. These private sector solutions provide
services that meet selected needs of both VHA and its patients. Using these existing
services may be more cost beneficial than VHA developing its own solution. Many
additional solutions will no doubt emerge over the coming years in the private sector that
VHA may be able to integrate into HealthePeople-VistA. VHA needs to explore further
how to best partner with these private sector 'For Profit' and 'Non-Profit' organizations.
One final recommendation regarding the Health IT Sharing Program is also presented in this
report for consideration by the CHIO 
HealthePeople Program Office— Over the past few years HealthePeople has evolved from
initial concept into an approved high level strategy that now encompasses distinct
programmatic areas with specific projects. These projects are actively moving forward with
varying degrees of limited support and resources. It is recommended that the HITS
program should be terminated and its resources be merged under the HealthePeople
program office by the end of FY 2005. The CHIO has appointed a HealthePeople program
manager who is charged with managing and coordinating all HealthePeople initiatives and
related activities.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
1.0
Introduction
“HealthePeople” is the Veterans Health Administration (VHA) long-range collaborative
strategy to increase the availability and use of (a) high performance health systems and, (b)
high performance, interoperable health information systems in order to substantially improve
the health care of people in the U.S., especially military veterans. One of the HealthePeople
goals is to pursue collaborative partnerships with public and private sector organizations that
result in open health information systems with common architectures and standardized data and
communications elements. HealthePeople has the potential of bringing together a wide range of
health care provider organizations, commercial companies, consumer groups, and Federal and
State government agencies in a collaborative and constructive partnership to better serve all our
citizens. Specific objectives of HealthePeople include:





Developing and adopting common solutions and standards for architecture, data,
communications, security, technology and systems.
Seeking appropriate opportunities for joint procurements, development, or operation
of health information systems.
Seeking appropriate opportunities for sharing existing health information systems and
technologies.
Seeking appropriate opportunities for improved health information exchange.
Working with partners toward convergence on high performance health information
systems.
By adopting common data, terminology, and communications standards, data from multiple
agencies can be gathered and analyzed more readily for population studies and other public
health purposes.
On September 25, 2001, the VHA CIO approved the formation of the Health IT Sharing
(HITS) Program within the Health Informatics Strategy office of the VHA Office of
Information (OI). The HITS program has been focused on providing support for the
HealthePeople long-range strategy of identifying and pursuing mutually beneficial health
information systems sharing initiatives with organizations in both the public and private sector.
The goals of the HITS program are to work with other VHA and other OI offices to:



Proactively identify, document, and explore new opportunities for interagency
collaboration and cooperation in the area of health information systems.
Better leverage and utilize collective resources of collaborating organizations to
acquire or develop health information systems.
Help foster increased awareness, acceptance and support for information systems
sharing within the health care community.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
Over this past year, the HITS program has been concentrating on health information sharing
opportunities and activities associated with the following five key components of
HealthePeople:
o
o
o
o
o
Electronic Health Records (EHR)
Personal Health Records (PHR)
Health Information Exchange (HIE)
Public Health Information Systems
Health Information Standards
Within each of these areas, health IT sharing opportunities and activities with other
organizations have been grouped as follows:
o Interagency Health IT Sharing
 Federal government
 VA/DoD Health IT Sharing
 State government
 Local government
 Tribal government
o Non-Government Health IT Sharing
 For Profit Organizations
 Non-Profit Organizations
o International Health IT Sharing
In all of these HealthePeople and Health IT Sharing (HITS) program areas, the HITS staff
seek to:
o
o
o
o
o
Identify new, high priority health information systems sharing opportunities for senior
management's consideration.
Maintain an up-to-date database containing information on health information systems,
collaborative projects, and potential health information sharing partners
Provide needed support during the startup phase for new sharing initiatives.
Serve as the primary liaison office within OI to many of these external organizations.
Track the status of ongoing health information systems sharing initiatives.
Identified in the HITS database are over 400 existing health IT systems and 200 sharing
projects involving the public and private sector. The HITS staff also have access to the
Dorenfest database that has information on IT systems in over 5,000 private sector healthcare
organizations, including many of their future plans. This 4th annual report on health
information sharing opportunities highlights current findings and presents preliminary
recommendations for new initiatives based on a continuing analysis of the information gathered
to date.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
2.0
Background
Changing health care practices, evolving patient expectations, outdated infrastructure and rising
health care costs in the face of severe budget cuts reinforce the need for federal agencies and
other healthcare organizations to partner and maximize use of pooled resources, including those
devoted to the development and acquisition of information systems.
As interest in health information sharing increased over the past few years, the Health
Enterprise Strategy office within the VHA Office of Information (OI) discerned the need to
establish the Health IT Sharing (HITS program to help build relationships with other
organizations in the public and private sector which have an interest in pursuing mutually
beneficial IT sharing initiatives. On September 25, 2001, the VHA CIO approved the formation
of the HITS Program within the Health Enterprise Strategy office of the VHA Office of
Information.
In the "VA Information Technology Strategic Plan for FY2002—FY2006", Goal #2 calls for
the creation of high-leverage partnerships with IT leadership groups in the public and private
sectors. Goal #3 calls for VA to work on crosscutting Department-wide initiatives for the
benefit of the veteran. The HITS Program will work to further support cooperation between the
various Departments of the federal government and other health care organizations, promote
the transfer of technology between the Departments, and support the establishment of joint
health care IT strategic initiatives in both public and private sectors that have long-term success
capabilities and that will have a positive impact on healthcare delivery to veterans.
Activities and Accomplishments of the Health IT Systems (HITS) Program
During its first year of operations, the HITS program focused on the following startup activities and
initial collaboration opportunities:




Organizing and staffing the HITS Program, preparing program plans, budget,
operating procedures, and completing the many other startup activities.
Collecting information on both existing health information systems/applications and
plans to acquire or develop new systems from VA, DoD, and other Federal agencies.
Collecting information on major health information sharing initiatives in the public
and private sector, information previously not readily available.
Identifying initial set of key health information sharing opportunities to pursue in FY
2002:
—
—
—
—
—
—
—
Veterans Benefits Reference System (VBRS) Project
Compensation and Pension Evaluation Redesign (CAPER) Project
VA/DoD Electronic Health Record (EHR) Initiative
VistA use by the D.C. government and its healthcare facilities
Indianapolis/Santa Barbara Care Data Exchange Networks
VistA and the Open Source Community
VistA and the International Healthcare Community
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
—



Consolidated Health Informatics (CHI) eGov Initiative
Developing the Health IT Sharing Handbook, documenting the sharing process and
incorporating lessons learned to date.
Identifying and establishing contact with key personnel in other public and private
sector healthcare information organizations.
Establishing Health IT Sharing Internet and Intranet Web sites and populating it with
relevant documents and links to useful sharing resources.
During its second year of operations, the HITS program continued to evolve and became ever
more focused on its role in support of the HealthePeople long-range strategy. The staff
continued to gather information on healthcare information systems activities of the DoD and
other federal government agencies. It also gathered information on health information systems
and collaboration projects within state governments and other healthcare organizations in the
public and private sector. This data continues to be fed into the HITS database and is constantly
reviewed and analyzed by the staff with an eye towards mutually beneficial health information
sharing opportunities with other organizations. Some of the major activities of the program and
new areas the HITS staff focused on in its second year included:










Working with the State Veterans Homes and their interest in the VistA system.
Following up on the potential sharing of clinical information from VistA with the
Department of Health & Human Services (HHS) and their Public Health
systems/databases.
Helping to coordinate OI management activities and support for the implementation of
VistA by the D.C. Department of Health (DOH) and the LBJ Medical Center in
Samoa.
Ongoing liaison with the DoD and MHS on new opportunities for VA/DoD health
information sharing opportunities.
Implementing a secure Virtual Private Network (VPN) between VA and DoD for use by
the FHIE, LDSI, VA/DoD CMOP, and other joint systems.
Providing support to the Presidential Task Force to Improve Health Care Delivery for
Veterans.
Following up on the various community patient data exchange initiatives around the
country (e.g. Indianapolis, Santa Barbara, and New England).
Obtaining a licensed copy of the Dorenfest database containing data on over 35,000
health care facilities in the private sector in order to better analyze their use of health IT
systems and future plans.
Liaison with the Open Source Health care Software Community and their interest in the
VistA system.
Liaison with the international health care community and their interest in the VistA
system.
During its third year of operations, the Health IT Systems (HITS) program continued to
further evolve and continued to support the HealthePeople long-range strategy and the various
national projects that have now emerged as a result of this strategy. The staff continued to
gather information on healthcare information systems activities of the Department of Defense
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
(DoD) and other federal government agencies. Staff also focused on gathering additional
information on health information systems and collaboration projects involving state and local
governments and healthcare organizations in the private sector. This data continues to be fed
into the HITS database and is constantly reviewed and analyzed by the staff with an eye
towards new and mutually beneficial health information sharing opportunities. Some
noteworthy accomplishments during this third year include:









Receiving senior management approval and issuing guidance to the field to provide the
State Veterans Homes across the country with VistA/CPRS Read Only access.
Helping to coordinate the initial steps to now transmit selected clinical information from
VistA to the Department of Health & Human Services (HHS) and their public health
systems and bio-terrorism tracking databases.
The successful implementation of VistA in the hospitals and clinics of American Samoa
and the D.C. Department of Health (DOH) .
Ongoing liaison and collaboration with DoD and MHS on the EHR initiative.
Implementation of a secure Virtual Private Network (VPN) between VA and DoD for
use by the FHIE, LDSI, VA/DoD CMOP, and other joint systems.
Providing staff support to the Presidential Task Force to Improve Health Care Delivery
for Veterans in producing their final report.
VA and other participating partners of the Consolidated Health Informatics (CHI) eGov
initiative have jointly adopted health information standards in 5 of 24 clinical domain
areas and expect to adopt additional standards in the very near future.
Helping to facilitate the involvement of the Los Angeles VA Health Care System (HCS)
in the Santa Barbara community data exchange (CDE) pilot project.
Serving as liaison with the International healthcare community and arranging
demonstrations of VistA for the governments of the United Kingdom, Mexico, Jordan,
and Japan.
In its fourth year of operations, the Health IT Systems (HITS) program continued to further
evolve and position itself to better support the HealthePeople long-range strategy and the
various national projects that have now emerged as a result of this strategy.




Internally, the HITS Program successfully spun off the VA/DoD Health IT Sharing
Program into a separate and fully staffed program office; the OneVA Health IT Sharing
efforts were terminated since it falls outside the scope of the HealthePeople program;
and the HITS web site, procedural handbook, and database/files were all updated.
A Program Manager (PM) was officially appointed by the VHA Chief Health
Information Officer (CHIO) to oversee all HealthePeople projects and activities.
A Program Manager was appointed by the CHIO to oversee all VHA collaborative
projects and activities related to the Indian Health Service (IHS).
Hits staff continue to serve as the primary liaison to State Veterans Homes and local
VA Medical Centers across the country that are in the process of obtaining VistA/CPRS
Read Only access. Over 70 homes should have access by the end of 2004.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005











3.0
HITS staff served as the primary liaison to the Oklahoma Department of Veterans
Affairs as they successfully implemented VistA in the first three of its seven state
veterans homes. All seven sites should be operational by the end of 2005.
HITS staff continue to serve as the primary liaison to a number of state health
departments that are planning on implementing VistA, e.g. West Virginia, Hawaii.
A Health Information Exchange (HIE) program charter and high level plan were
developed to guide VHA as it begins to pursue specific pilot projects, e.g. Santa
Barbara, Grand Junction.
Following up on previous recommendations, a Public Health & Biosurveillance
Information Council (PHIBC) was established and a pilot project completed involving
the exchange of biosurveillance information between VHA and the CDC.
Following up on last years recommendations, meetings were held between VHA and
the AAMC, a working group established, and several pilot projects with affiliated
medical schools were identified and which will begin in FY 2005.
Following up on last years recommendations, preliminary studies into Genomic
Information Systems and Internet2/Next Generation Internet were completed and sent to
the CHIO, IT Architects, and the HealthePeople program manager for review.
Serving as liaison with the International healthcare community and arranging
demonstrations of VistA for the governments of the Mexico, Jordan, Malaysia and other
countries. Mexico successfully implemented VistA in the first of 268 hospitals.
Increasing numbers of local governments (city & county) have contacted VHA about
possibly acquiring and using VistA, e.g. Los Angeles, Chicago, Detroit. The HITS staff
have provided information and arranged demonstrations for them upon request.
The Open Source community (see - WorldVistA, OSHCA, Hardhats) continued to
embrace the VistA system, releasing an Open Source version of VistA in 2004.
A segment of the vendor community is coalescing around VistA and has established the
VistA Software Alliance (VSA). It includes several major corporations such as HewlettPackard (HP), Perot Systems, InterSystems, MedSphere, Oleen, DSS, and others.
The private sector healthcare provider community has become much more aware of
VistA in light of the VistA Office EHR collaborative initiative being supported jointly
by HHS, CMS, and VHA. HITS staff have provided information and arranged
demonstration for many provider organizations across the country, e.g. CHRISTUS,
Presbyterian Health, etc.
General Approach/Methodology
As outlined above, the basic approach calls for the HITS program staff to initiate contact with
key IT offices within government and non-government organizations. The HITS staff
documents the key contacts with these organizations and then attempts to collect information
on their portfolio of existing and planned health information systems and enters it into the
HITS database. The next step calls for the analysis of the information collected and the
creation of an annual report with findings and recommendations to the VHA Chief Health
Information Officer (CHIO).
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
This “Health IT Sharing Activities: 4th Annual Analysis” focused on potential health
information systems sharing opportunities that would support the long range HealtheVet and
HealthePeople strategies and plans. The analysis looked at the five major VHA systems areas
and program/business information needs:





Registration & Enrollment/Eligibility
Health Data Systems
Provider Systems
Management & Financial Systems
Information & Education Systems
The analysis also took into consideration the five crosscutting information issues:





Security/Privacy
Data Quality
IT Architecture
Infrastructure
Leadership/Management
In addition, the information sharing opportunities identified in this report focus on the
HealthePeople and its priorities:





Health Information Standards
Electronic Health Records (EHR)
Personal Health Records (PHR)
Health Information Exchange (HIE)
Public Health Systems
Based on the analysis, the HITS staff identifies a number of new health information systems
sharing opportunities and generates preliminary recommendations for the CHIO and other
senior managers to review. Based on their guidance, a final prioritized list of new health
information systems sharing opportunities to pursue in the coming year(s) is produced.
The next phase of the health IT sharing process involves establishing further contact and
facilitating the initial steps to further explore the targeted sharing opportunities.
To better illustrate the outcome of the process, the following matrix provides a high level view
of the current health information sharing activities from both a HealthePeople and HITS
Program area perspective.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
HealthePeople & Health Informatics Strategy – Program Matrix
VA/DoD
Standards
–VA/DoD
Architecture
EHR Systems
–EHR
–C/HDR
PHR Systems
Information Exchange
–eHealth (MHV &
TriCare Online)
–BHIE / FHIE
–LDSI
-TRACES
Joint Development &
Operations
–Joint Venture &
Demo Sites
–VA/DoD CMOP
Program Matrix Glossary
ASTM
ANSI HISB
CHI
CPRI
DICOM
FHIE
HL7
IHS
IEEE
ISO
KP
LDSI
NCVHS
NHII
OMG
PKI
QuIC
WHO
VSO
Interagency–
Federal, State, Tribal
–FHA & CHI Initiatives
–NCVHS & NHII
–HHS/NLM & Terminology
i.e. SNOMED, LOINC
– QuIC
–VistA Office EHR
–IHS & VistA
–D.C. Govt. & VistA
–State Govts. & VistA, e.g. WV,
WA, TX, OK
–L.A. County & VistA
Non-Government
–HL7, ASTM, OMG,
DICOM, ANSI HISB
–NHII & Standards (Data and
Terminology)
–KP & EHR/PHR Standards
–MedStar & VistA
–CPRI
–Open Source Community
- NHII & NCVHS
– eHealth Initiative
–HealthePeople(Federal)
–VistA & BioSurveillance
–VistA & Public Health (CDC)
–State Veterans Homes &
CPRS Read Only
–BiDirectional Web Links
(VA and State Depts. Of Health
& Veterans Affairs)
–State Veterans Homes &
VistA (e.g. Iowa)
–USA Services
–eVitals System
–eDisaster Portal
–Santa Barbara, Grand Junction,
Mountain Home TN, ...
–Medical Schools & VistA/CPRS
Read Only
–VSOs & CPRS Read Only
–211 Project
–BiDirectional Web Links
(VA & Medical Schools)
- VistA Software Alliance
International
–IEEE
–ISO TC 215
–Samoa & VistA
–Egypt & VistA
–Germany & VistA
–Finland & VistA
–Mexico & VistA
–Jordan & VistA
–WHO & VistA
------------------------
----------------------
American Society for Testing and Materials
American National Standards Institute/Health Informatics Standards Board
Consolidated Health Informatics–Federal eGov Initiative
Computerized Patient Record Institute
Digital Imaging and Communications in Medicine
Federal Health Information Exchange Project
Health Level Seven
Indian Health Services
Institute of Electrical and Electronics Engineers
International Standards Organization
Kaiser Permanente
Laboratory Data Sharing & Interoperability Project
National Center for Vital Health Statistics
National Health Information Infrastructure
Object Management Group
Public Key Infrastructure
Quality Interagency Coordinating Task Force
World Health Organization
Veterans Service Officers
4.0
Findings of the Health IT Sharing Analysis
4.1
OneVA Health IT Sharing
It is was determined that the HITS program no longer focus on OneVA sharing activities since
these efforts fall outside the scope of the HealthePeople program.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
4.2
VA/DoD Health IT Sharing
The VA/DoD Health IT Sharing Program was successfully spun off from the HITS Program
this past year and has now become a separate program office of its own. The new VA/DoD
Health IT Sharing (HITS) program will be conducting its own analysis of health information
sharing opportunities between VA and DoD and submit its recommendations regarding new
health information sharing opportunities directly to the CHIO.
The VA/DoD Health IT Sharing Program staff have worked collaboratively with the DoD
Military Health System (MHS) for over a decade to identify and foster health information
management and information technology projects and programs that benefit beneficiaries of
both Departments by improving patient health care and safety. This close relationship has
resulted in many highly successful projects such as the Federal Health Information Exchange
(FHIE), the VA/DoD Consolidated Mail Order Pharmacy (CMOP), and the Laboratory Data
Sharing & Interoperability (LDSI) projects, to name just a few. Since April 2002, the VA/DoD
Joint Electronic Health Records (EHR) Plan known as HealthePeople (Federal) has provided
the overarching structure and guidance for all current and future VA and DoD health
information technology sharing. This includes the new Bi-Directional Health Information
Exchange (BHIE) and Clinical/Health Data Repository (C/HDR) projects.
(Visit http://vaww1.va.gov/vadodhealthitsharing/ )
4.3
Interagency Health IT Sharing (Federal, State, Local & Tribal Governments)
4.3.1 Federal Government
Analysis of IT Portfolio
During the first quarter of FY 2004, the HITS staff concentrated on collecting additional
information on both the existing health IT systems or applications of Federal agencies and their
plans to acquire or develop new health IT systems. This information was then added to the
existing Health IT Sharing (HITS) database. Identified in the HITS database to date are over
300 existing systems or applications and over 50 planned health IT systems development or
acquisition projects. In addition, we have been able to identify over 100 inter-agency
collaborative Health IT initiatives already underway. The complete listing is contained in the
HITS database.
The HITS Database currently contains information on more than 400 Federal agencies’
information system and IT sharing initiatives. All of these systems or IT sharing projects tend
to fall into one of the following major categories:




Electronic Health Records (EHR) Systems
Personal Health Records (PHR) & Tele-health
Provider Health Information Systems
Web-based Information & Education Systems
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005




Health Information Exchange (HIE) Systems
IT Architecture & Standards
IT Privacy & Security
IT Infrastructure
The HITS Program staff has reviewed the data on the existing and planned health information
systems in the Federal government, compared it with the existing VA health IT systems and
plans, and compiled a list of systems/projects where new health IT sharing opportunities for
VA may exist. A list of recent accomplishments and preliminary recommendations on new
health information sharing opportunities follows.
Federal Government Health IT Sharing Accomplishments & Current Activities
o Federal Health Architecture (FHA) and the Consolidated Health Informatics (CHI)
Initiatives—The FHA and CHI are multi-year, interagency initiatives at achieving systems
convergence and agreement on standards for EHR systems across Federal government
agencies (e.g. HHS, DoD/Military Health, VHA, HIS).
o Federal Health IT Standards—VHA, DoD/Military Health, and other Federal agencies
participating in the Consolidated Health Informatics (CHI) eGov initiative have
successfully adopted over twelve standards to support interoperability, e.g. HL7, LOINC,
NCPDP, DICOM, X12, etc.
o Federal Credentialing System & VetPro—This is a collaborative partnership between
HRSA and VA with other Federal Agencies on standardized, electronic credentialing
system and databank that meets JCAHO standards. See http://bhpr.hrsa.gov/dqa/fcp.htm
o Interagency Memorandum Of Understanding (MOU) & VHA—VHA has put in place a
number of MOUs with Federal agencies such as the FDA, NLM, and NCI to support
collaboration on a National Drug File, sharing drug information, developing terminology
standards for medication information, and other purposes.
o Interagency Committees/Work Groups—VHA OI staff currently participate on key federal
health care information committees such as, the Quality Interagency Coordination Task
Force (QuIC), National Committee on Vital and Health Statistics (NCVHS), and the
National Health Information Infrastructure (NHII) Work Groups.

National Bio-surveillance Data System—An initial pilot solution has been developed and
put in place to extract and feed data from VistA to the Center for Disease Control (CDC)
within (HHS). VHA collaborated with CDC to transmit de-identified patient data from the
VA Austin Automation Center (AAC). VA is now planning on transmitting additional
segments of data extracted from VistA to other Federal public health and disease
surveillance systems maintained by HHS.

eDisaster Portal eGov Initiative—OI staff have helped ensure that VA, and EMSHG in
particular, are linked to the DisasterHelp.Gov portal that was established to provide federal,
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
state, and local emergency managers on-line access to disaster management related
information, planning and response tools. (https://disasterhelp.gov/portal/jhtml/index.jhtml)

National SNOMED License—VA, DoD, and HHS have successfully collaborated on an
agreement with the College of American Pathologists (CAP) to license the College's
standardized medical vocabulary system (i.e. SNOMED) and make it available without
charge throughout the United States.

USA Services eGov Initiative—VHA OI staff have been participating, along with VA CIO
staff, in the initial planning of this Federal eGov initiative, to develop and deploy a Federal
government contact system for citizens. The system will provide citizens with timely,
consistent responses about government information and services. USA Services will enable
citizens to interface with the government through multiple communications channels (e.g.,
Internet, phone, fax) in a privacy-protected environment.
It is expected that VHA will continue to collaborate extensively on the following Federal
government health information sharing initiatives:






Federal Health IT Architecture (FHA) eGov Initiative
Consolidated Health Informatics (CHI) eGov Initiative
VistA Office EHR Project
Federal Health Information Exchange (FHIE) & Bi-Directional Health Information
Exchange (BHIE)
HHS Public Health & Disease Surveillance Systems
Other Federal eGov Initiatives, (e.g. USA Services, Disaster Assistance ePortal,
eVitals, and eGrants.)
It is also expected that VHA will continue to participate on key federal health care information
committees such as:




Quality Interagency Coordinating Task Force (QuIC)
National Committee on Vital and Health Statistics (NCVHS)
National Health Information Infrastructure (NHII)
ONCHIT Working Groups
New Federal Health IT Sharing Opportunities and Initiatives
The following sharing opportunities have been identified for further follow-up in the coming
year. These were previously identified in the "3rd Annual Analysis of Health IT Sharing
Opportunities" but no specific pilot projects were pursued. Preliminary studies completed
over this past year have now identified potential pilot projects that could be pursued.
o Genomic Information Systems—The Human Genome project is the publicly financed
international research effort whose goal is to decipher the human genome code and to
provide these data freely and rapidly to the public. Genomic Information Systems will
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
ultimately allow clinicians to more rapidly diagnose existing genetic diseases; predetermine genetic risk for developing; design novel therapeutic agents for the treatment and
prevention of disease, rather than the treatment of the underlying symptoms; and prescribe
medical intervention based on a person’s genetic information, reducing the chance of an
allergic, or otherwise detrimental, drug reaction. Based on a preliminary study completed
by the HITS staff into Genomic Information Systems, it is recommended that VHA should
consider collaborating with HHS and the NIH Human Genome Project because there will
be a need to integrate a Genomic Information System and a BioRepository within VistA
and CPRS in the coming years. A number of opportunities exist to collaborate with other
Federal agencies on Genomic Information Systems application software, architecture, and
standards.
o Internet2/Next Generation Internet (NGI)—Internet2 is a consortium being led by 205
universities working in partnership with industry and government to develop and deploy
advanced network applications and technologies, accelerating the creation of tomorrow's
Internet. The Next Generation Internet (NGI) initiative is a multi-agency Federal research
and development program that is developing advanced networking technologies,
developing applications that require advanced networking, and demonstrating these
capabilities on test beds that are 100 to 1,000 times faster end-to-end than today's Internet.
The Federal agencies that have participated in NGI include DARPA, NSF, DOE, NASA,
NIH, NLM and NIST. Key Internet2/NGI projects include initiatives in the following
fields of healthcare - radiology, orthopedic surgery, telehealth, medical education, and
medical imaging. Based on a preliminary study completed by the HITS staff, it was
determined that opportunities exist for VHA to collaborate with other Federal agencies on
Internet2/NGI and should be pursued in the areas or standards, architecture, and
applications.
4.3.2 State & Local Governments
Analysis of IT Portfolio
This past year, the HITS Program staff began collecting data on State Health Departments,
State Veterans Homes, and their health information systems. The data was then fed into the
HITS database. The staff reviewed the data on the existing and planned health information
systems in the State government, compared it with the existing VA health IT systems and
plans, and compiled a list of systems/projects where new health IT sharing opportunities for
VA may exist. A list of recent accomplishments and preliminary recommendations on State &
Local government health information sharing opportunities to consider pursuing in FY 2005 are
as follows:
State Government Health IT Sharing Accomplishments & Current Activities
o
D.C. Department of Health & VistA—The D.C. Department of Health collaborated with
VA on the successful implementation of the VistA/CPRS software by three of their clinics.
VA supported their implementation efforts by providing updated copies of the VistA and
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
CPRS software along with limited technical assistance and customer support needed to
ensure success. They plan on implementing VistA in 16 more sites if funding allows.
o American Samoa—The LBJ Medical Center in American Samoa collaborated with the
Honolulu VAMC and the VHA Office of Information (OI) on the successful
implementation of the VistA/CPRS software in their healthcare facilities. VA provided
limited technical assistance and customer support, as needed, to help ensure successful
implementation of VistA/CPRS by American Samoa and the contractors they employed.
o Bi-directional Web Links—Web links have been established between VA and State
Health Departments, State Veterans Homes, and State Veterans Affairs Offices Web sites.
o
State Veterans Homes & CPRS Read Only - VA has issued guidance to the VA Medical
Centers on how to provide secure CPRS Read Only access to key staff at all of the State
Veterans Homes across the country over the coming year(s). Over 65 State Veterans
Homes now have CPRS Read Only access.
o State Veterans Homes & VistA - Oklahoma State Department of Veterans Affairs is in the
process of acquiring and implementing the VA VistA system within their seven State
Veterans Homes. Three sites are already using VistA. All seven should be using VistA by
the end of 2005. Other states are also beginning to actively explore doing this, e.g.
Maryland, California, Louisiana.
o
State Health Departments & VistA - Washington State’s Mental Health facilities continue
to use the VistA system and other state health departments are actively following suit, e.g.
West Virginia, Hawaii.
o Local Governments & VistA - HITS Program staff have recently begun working with a
number of local county and city governments that have expressed an interest in possibly
using VistA, e.g. L.A., Chicago, Cleveland, Detroit.
o State Medical Schools - HITS Program staff are also starting to study the feasibility of
providing VistA to state-run medical schools that are affiliated with VA medical centers. A
number of them have expressed a desire to acquire or use the VistA/CPRS system. Others
simply want CPRS Read Only capability so they can better care for veterans that they are
treating There are currently 107 affiliated medical schools of which 58 are part of their
respective state university system.
New State Government Health IT Sharing Opportunities and Initiatives

State Health Departments across the country also operate hundreds, if not thousands, of
healthcare facilities supported by a variety of health IT systems. They maintain public
health files/databases and disease registries, provide access to online patient education and
medical reference materials, are starting to put in place online Living Wills and/or
Advanced Directives, are building biosurveillance systems with information exchange
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
capabilities, etc. Based on a preliminary study recently completed by the HITS staff, it was
determined that a number of new, mutually beneficial opportunities for collaboration
between VHA, its local healthcare facilities, and state health departments exist and ought to
be pursued. The VISNs and their VA Medical Centers should have primary responsibility
for pursuing and implementing this component of the HealthePeople program.
4.3.3 Indian Health Service & Tribal Governments (Native Americans)
VA has a long history of collaborating with the Indian Health Service (IHS) on healthcare
information systems. In the 1980’s VA shared its VistA health information system with the
Indian Health Service that modified and enhance the system to fit their needs. Today, this
system is known as the IHS Resource and Patient Management System (RPMS) and is an
integrated solution for the management of clinical and administrative information used in tribal
healthcare facilities of various sizes and orientations across the country. Many software
enhancements made by IHS were subsequently incorporated into VistA. For example their
Health Summary software module was tailored to meet VA needs and laid a foundation for the
VA Computerized Patient Record System (CPRS). There are several sharing opportunities that
have been identified between VA and IHS in the near term (2005) including:




Tailoring CPRS for use by the Indian Health Service (IHS).
Making VistA Imaging available to IHS for incorporation into RPMS.
Incorporating components of the RPMS Billing module into VistA.
Providing a web site and server to improve collaboration and communication.
The VHA Chief Health Information Officer (CHIO) recently appointed a Program Manager to
head up VA/IHS health IT sharing activities. A detailed plan is currently being prepared to
help guide joint investment and development efforts.
4.4
Health Community IT Sharing (Non-Government Organizations)
Analysis of IT Portfolio
As VHA modernizes and enhances its current systems, sharing information and collaborating
on systems development initiatives with other healthcare organizations and the Open Source
software community could save VA considerable time and money while improving healthcare
provided to veterans and many others. In addition to these measurable cost savings and
efficiencies, it should be noted that collaborating with external partners is one of the keys to
achieving VHA’s, "Six for 2006" goal of building healthy communities.
The HITS Program staff continue to explore potential health community and/or nongovernmental sharing. This section briefly describes accomplishments to date, current sharing
initiatives already underway, and identifies several new sharing opportunities to potentially
pursue. It is clear that there is growing interest in the larger medical community to share systems
and data for the benefit of patients. Non-Government Organizations (NGO) that VA could
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
further partner with include Veterans Service Organizations, Affiliated Medical Schools, certain
non-profit healthcare organizations, and even some for-profit healthcare organizations.
Non-Government Organization Health IT Sharing Accomplishments & Current Activities

IT Architecture - VHA staff continue to actively participate in Standards Development
Organization (SDO) efforts (e.g. HL7, DICOM, OMG).

NHII & ONCHIT - VHA provided subject matter experts to the National Health
Information Infrastructure (NHII) program in support of efforts to develop a national
consensus for guidance in eight key areas: 1) research & population health 2) homeland
security 3) consumer health 4) financial incentives 5) safety & quality 6) standards &
vocabulary7) architecture and, 8) privacy & confidentiality.

CPRS Read-Only & VSOs - CPRS Read Only software was released to all VA medical
centers to grant authorized Veterans Service Organizations (VSO) access to the selected
patient records of veterans for whom they hold power of attorney so that they can help
prepare claims for these veterans.

AAMC & Affiliated Medical Schools - The American Association of Medical Colleges
(AAMC) and a number of affiliated medical schools have expressed a desire to collaborate
with VHA on health information systems initiatives. VA currently has affiliation
agreements with 107 medical schools across the country. Ongoing discussions have
resulted in an agreement to collaborate on a number of pilot projects in FY 2005 which may
include: providing CPRS Read Only access to clinicians at affiliated medical schools;
developing secure health information exchange solutions; collaboration on Electronic
Health Records (EHR) and Personal Health Records (PHR); possible cross system access to
the VetPro Credentialing System; and providing access to Online Reference Materials and
Continuing Medical Education (CME).

VistA Office EHR & HHS/CMS - The Department of Health and Human Services (HHS),
the Centers for Medicare & Medicaid Services (CMS), and the Veterans Health
Administration (VHA) collaborating on an initiative to transfer VistA, the VHA’s
Electronic Healthcare Record (EHR) system, to the private physician office setting.
Targeted for release July 2005, the VistA-Office EHR system will be available to individual
practices and the EHR industry.

VistA & the Vendor Community - The VistA Software Alliance (VSA) was formed to
allow a collaboration between government and private businesses to facilitate the
implementation of VistA within healthcare organizations outside of the VA. The VSA
provides a neutral buffer organization so that the government can encourage a broad base of
industry investment, without favor to any specific company. A growing number of major
software vendors have joined the VSA, e.g. HP, EDS, PerotSystems, InterSystems, etc.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005

Open Source Healthcare Software Community (e.g. WorldVistA, HardHats, OSHCA) The Open Source healthcare software community has long looked at VistA/CPRS with
great interest. Several groups have formed to promote the use of open source software in
the medical world. These include WorldVistA, the Open Source Health Care Alliance
(OSHCA), the HardHats.Org, and others. The VHA OI continues to closely monitor their
efforts and is developing a strategy on how best to interact with this community.
New Health Community IT Sharing Opportunities and Initiatives
The following sharing opportunities were previously identified in the "3rd Annual Analysis of
Health IT Sharing Opportunities" but no specific pilot projects were pursued. Preliminary
studies completed over this past year have now identified specific potential pilot projects that
could be pursued.

Community Health Information Exchange (HIE)—It is estimated that forty percent of
veterans enrolled in VA Health Care receive some part of their care outside of the system.
Having information from other encounters allows the current provider to more safely treat
the veteran. It can also eliminate duplicate or redundant tests. VA should begin to pilot test
and document the benefits of participating in a community based health information
exchange solutions.
It should be noted that such health information exchanges (HIE) would involve exploring
state and local privacy laws and negotiating exemptions for VA Medical Centers. The
ability to participate in governance will require innovative thinking, as will identify
payment vehicles. Privacy considerations must be resolved before any pilot begins. The
VISNs and their VA Medical Centers should probably have primary responsibility for
pursuing and implementing this component of the national HealthePeople program.
o
Santa Barbara County Care Data Exchange—is an operational patient record exchange
involving 70 percent of all providers in Santa Barbara County, California, hospitals,
independent practices, and local labs. The Greater Los Angeles VA Health Care System
has three clinics in Santa Barbara County, and is planning on participating in this patient
data exchange system over the coming year. There is much to be learned by VA from this
pilot effort. Participation in other pilots should be considered in order to better determine
the optimum approach for VA to pursue nationwide.
o
Community Health Improvement Partnership (CHIP)— The Mountain Home VAMC
in Tennessee is one of the key partners in this effort. They are investigating an electronic
Health Information Exchange that would adopt the design and many principles of the Santa
Barbara project.
o
Other communities in Massachusetts, Wisconsin, Michigan, Colorado, and other states are
also actively exploring possible HIE solutions .
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
o National Commercial Health Information Systems - A number of 'free' or relatively low
cost health information systems or services have emerged from the private sector that VHA
ought to consider taking advantage of such as My HealthDirective, Vital/CHEK, NCPDP,
MedicAlert, and LifeFone/Personal Response. These private sector solutions provide
services that meet selected needs of both VHA and its patients. Using these existing
services may be more cost beneficial than developing a VHA owned solution. Many
additional solutions will no doubt emerge over the coming years in the private sector that
VHA may be able to integrate into HealthePeople-VistA.
4.5 International Health IT Sharing Community
VA VistA software has been translated into Finnish, German, Arabic, French, and Spanish as it
has been acquired and implemented in various countries around the world. The VistA system
has also been embraced by the Open Source healthcare software community which has helped
spread the software to healthcare communities in third world nations bordering on the Pacific
and Indians Ocean and into Africa (e.g. Samoa, Egypt, Nigeria).
During this past year, the VA has been contacted by a number of countries interested in
possibly acquiring and using the VistA system. Demonstrations of the system and copies of the
software, documentation, and other associated material were given to representatives from
countries such as Mexico, Jordan, Malaysia, Saipan, Panama, and many others.
o VistA & Mexico—The Instituto Mexicano del Seguro Social (IMSS) is moving forward
with testing and implementing the VA VistA system. They have successfully implemented
a Spanish version of VistA in one hospital and are in the process will implement it in 2
more by the end of 2004. They plan on implementing VistA in 50 hospitals in 2005, and a
total of 260 hospitals over the next 3-4 years.
5.0
Conclusions and Recommendations
The Health IT Sharing (HITS) Program staff has completed this "Health IT Sharing
Opportunities: 4th Annual Analysis" and offers the following conclusions and
recommendations for senior management's consideration.
Current Health IT Sharing Activities
Over the past few years HealthePeople has evolved from initial concept into an approved high
level strategy that now encompasses distinct programmatic areas with many specific projects that
are now well underway. These include but are not limited to: the VA/DoD Electronic Health
Record (EHR) Plan, the FHA and CHI eGov initiatives, VistA/CPRS & State Veterans Homes,
collaboration with the AAMC/Affiliated Medical Schools, community health information
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
exchange (HIE) pilot projects, and the public health & biosurveillance data exchange efforts with
federal and state agencies. Some of these HealthePeople initiatives are actively moving forward
with varying degrees of limited support and resources and will take many years to complete.
HITS Recommendations for Potential NEW Sharing Opportunities and Initiatives
There are already many ongoing HealthePeople related initiatives underway that will take many
years to complete. These include but are not limited to: the VA/DoD Electronic Health Record
(EHR) Plan, the FHA and CHI eGov initiatives, VistA/CPRS & State Veterans Homes,
collaboration with the AAMC/Affiliated Medical Schools, community health information
exchange (HIE) pilot projects, and the public health & biosurveillance data exchange efforts with
federal and state agencies.
The following sharing opportunities have been identified for further follow-up in the coming
year. These were previously identified in the "3rd Annual Analysis of Health IT Sharing
Opportunities" but no specific pilot projects were pursued. Preliminary studies completed
over the past year have now identified potential pilot projects that could be pursued.

Genomic Information Systems—The Human Genome project is the publicly financed
international research effort whose goal is to decipher the human genome code and to
provide these data freely and rapidly to the public. Genomic Information Systems will
ultimately allow clinicians to more rapidly diagnose existing genetic diseases; predetermine genetic risk for developing; design novel therapeutic agents for the treatment and
prevention of disease, rather than the treatment of the underlying symptoms; and prescribe
medical intervention based on a person’s genetic information, reducing the chance of an
allergic, or otherwise detrimental, drug reaction. Based on a preliminary study completed
by the HITS staff into Genomic Information Systems, it is recommended that VHA should
consider collaborating with HHS and the NIH Human Genome Project because there will
be a need to integrate a Genomic Information System and a BioRepository within VistA
and CPRS in the coming years. A number of opportunities exist to collaborate with other
Federal agencies on Genomic Information Systems application software, architecture, and
standards.

Internet2/Next Generation Internet (NGI) - Internet2 is a consortium being led by 205
universities working in partnership with industry and government to develop and deploy
advanced network applications and technologies, accelerating the creation of tomorrow's
Internet. The Next Generation Internet (NGI) initiative is a multi-agency Federal research
and development program that is developing advanced networking technologies,
developing applications that require advanced networking, and demonstrating these
capabilities on test beds that are 100 to 1,000 times faster end-to-end than today's Internet.
The Federal agencies that have participated in NGI include DARPA, NSF, DOE, NASA,
NIH, NLM and NIST. Key Internet2/NGI projects include initiatives in the following
fields of healthcare - radiology, orthopedic surgery, telehealth, medical education, and
medical imaging. Based on a preliminary study completed by the HITS staff, it was
determined that opportunities exist for VHA to collaborate with other Federal agencies on
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
Internet2/NGI and should be pursued in the areas or standards, architecture, and
applications.

State Health Departments across the country also operate hundreds of healthcare facilities
supported by a variety of health IT systems. They maintain public health files/databases and
disease registries, provide access to online patient education and medical reference
materials, are starting to put in place online Living Wills and/or Advanced Directives, are
building biosurveillance systems with information exchange capabilities, etc. There are
many other new, mutually beneficial opportunities for collaboration between VHA
healthcare facilities and state governments exist. The VISNs and their VA Medical Centers
should have primary responsibility for pursuing and implementing this component of the
HealthePeople program.

Open Source Community - The HITS staff recommends VHA more fully collaborate with
the larger VistA and Open Source communities, e.g. VSA, WorldVistA, OSHCA, Mexico,
etc. VHA ought to put in place a process for better importing and exporting software
modules and technologies with these communities.
There is only one new potential sharing opportunity that has been identified in this "4th
Annual Analysis of Health IT Sharing Opportunities".

National Commercial Health Information Systems - A number of 'free' or relatively low
cost health information systems or services have emerged from the private sector that VHA
ought to consider taking advantage of such as My HealthDirective, Vital/CHEK, NCPDP,
MedicAlert, and LifeFone/Personal Response. These private sector solutions provide
services that meet selected needs of both VHA and its patients. Using these existing
services may be more cost beneficial than developing a VHA owned solution. Many
additional solutions will no doubt emerge over the coming years in the private sector that
VHA may be able to integrate into HealthePeople-VistA. VHA needs to explore further
how to best partner with these private sector 'For Profit' and 'Non-Profit' organizations.
One final recommendation regarding the Health IT Sharing Program is also presented in this
report for consideration by the CHIO 
HealthePeople Program Office— Over the past few years HealthePeople has evolved from
initial concept into an approved high level strategy that now encompasses distinct
programmatic areas with specific projects. These projects are actively moving forward with
varying degrees of limited support and resources. It is recommended that the HITS
program should be terminated and its resources be merged under the HealthePeople
program office by the end of FY 2005. The CHIO has appointed a HealthePeople program
manager who is charged with managing and coordinating all HealthePeople initiatives and
related activities.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
Appendix
"A Brief History of Health Information Technology (IT) in the VA"
1955—2004
[Based on extracts from “A History of Information Technology in the VA
1955—2000” and other sources]
Prepared By:
Peter J. Groen
Office of Information (OI)
Veterans Health Administration
Department of Veterans Affairs
December 2004
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
Table of Contents
Part I: The Fifties
Part II:
The Sixties
Part III:
The Seventies
Part IV:
The Eighties
Part V:
The Nineties
Part VI:
The 21ST Century
[While the focus of this history is on health care information systems, I have
also included selected information on other VA non-healthcare information
technology events and systems. This helps to better relate health information
systems activities to the many other major events occurring simultaneously
across the VA which directly or indirectly impact the healthcare program.]
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
PART I: The "Fifties"
The 1950's saw the first tentative forays by the VA into the world of automated data
processing (ADP) and telecommunications technologies. The VA began exploring the
possibilities of moving functions off electronic accounting machines (EAM) and onto the
first generation of computer systems. Punch card systems were introduced along with these
early mainframe computer systems. In the telecommunications arena, use of telephones
and telegraph systems greatly expanded. Other new automation technologies introduced into
the VA during the late 1950's were the use of pneumatic tube systems and microphotography
of documents. The focus on health care systems was minimal.
PART II:
The "Sixties"
During the 1960's, the VA fully committed itself to applying automated data processing
(ADP) and telecommunications technologies to improve major business processes. This
commitment was made very clear with the official establishment of the Department of Data
Management (DDM) on February 1, 1963, and the publication of the first VA long range
ADP plan in 1965. Second generation large scale and medium size computer systems were
acquired and housed in several major data processing centers. Some notable software
applications that were developed and implemented during the 1960's included the:









Insurance System
Education System
Loan Guaranty System
Compensation & Pension (C&P)
Personnel and Accounting Integrated Data (PAID) Pay System
VA Automated Management Information System (AMIS)
VA Logistics System (LOG)
Patient Treatment File (PTF)
Automated Hospital Information System (AHIS)
Electronic accounting machines (EAM) were phased out of existence and punch card data
entry systems were supplemented by the appearance of the first handful of video display units
or CRTs.
In the telecommunications arena, in addition to high-speed teletype systems, the first
generation of data transmission systems between data processing centers became
operational. Other communications technologies developed and introduced into the VA
included facsimile systems, closed circuit TV (CCTV), the federal government (FTS) long
distance telephone service, hospital paging systems, nurse call systems, intercoms, two-way
radios, radio entertainment systems and television systems for patients.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
The use of small-scale computer systems to perform clinical laboratory tests, keep inventory
of drugs, and to capture and transmit electrocardiograms were pilot tested during the late
1960's. Other automated technologies introduced into the VA during this time frame
included microfilm storage systems, remote control dictating systems, automated pneumatic
tube systems, and use of conveyor belt systems.
PART III: The "Seventies"
During the 1970's, the automated data processing (ADP) environment in the VA consisted
primarily of third generation large and medium-scale computer systems housed in a small
number of major data processing centers around the country. These systems were all
connected by the Inter-VA Data Processing Center Telecommunications Network. The VA
added a number of major software applications to its existing inventory of major business
systems such as the:












Veteran Benefits 'Target System'
Beneficiary Identification and Records Locator System (BIRLS)
Centralized Accounts Receivable System (CARS)
Centralized Accounting System for Construction Appropriations (CASCA)
Centralized Accounting for Local Management (CALM) System
Veterans Assistance Discharge System (VADS)
Engineering Management Information System (EMIS)
Honeywell Clinical Laboratories
Automated Prescription Processing, Labeling, Editing & Storage (APPLES) System
Fee Basis System
Out-Patient Treatment (OPT) File
General Counsel Administrative Tracking System
These applications employed new ADP technologies such as data base management systems
(DBMS), distributed data processing systems, and video display terminals or CRTs.
In the telecommunications arena, the VA installed data transmission networks to handle
increasing data traffic between VA data processing centers, VA Regional Offices, and a
number of VA Medical Centers. The VA also began installing telephone exchange (PBX)
systems in VA Medical Centers and Regional Offices. Toll free telephone services to assist
veterans were started. Other areas of innovation included initial investments in satellite
communications, use of network connections to non-VA systems such as the NLM MedLine
information system, and acquisition of word processing systems.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
PART IV: The "Eighties"
During the 1980's, the automated data processing (ADP) environment in the VA moved from
third generation large-scale computer systems housed in a small number of national data
processing centers to wide spread use of mini-computer systems located at each VA Medical
Center, Regional Office, and other major program or field offices. All of these distributed
VA computer systems were linked together by a wide area network (WAN). The VA added a
number of major software applications to its existing inventory of major business systems
such as the:








Decentralized Hospital Computer Program (DHCP) Systems
Supply Processing & Distributing (SPD) System
Financial Management System (FMS)
Integrated Fund Control and Procurement (IFCAP) System
VA Correspondence Tracking System
Automated Monument Application System (AMAS)
Prisoner of War (POW) Tracking System
Agent Orange Registry
In the telecommunications arena, the VA implemented a nationwide packet switching data
transmission network, known as VADATS, to link all of the VA computer systems across the
country by a single wide area network (WAN). This allowed the VA to move forward with
the implementation of a nationwide email system, the Patient Data Exchange (PDX) system
between VA Medical Centers, and the exchange of veterans' information between Veterans
Benefits (VBA) and Veterans Health (VHA) systems using the AMIE and HINQ software
tools. Other areas of innovation included initial investment in emerging technologies such
as Personal Computers (PC), Office Automation Systems (OAS), Computer Assisted
Instruction (CAI) software, IT solutions for the disabled, and the installation of fiber optic
cabling plants to enable the installation of high speed local area networks (LAN).
*** Medical Systems—During FY 1983, the Department of Medicine and Surgery (DM&S) took on a greater role
in the development and maintenance of its own specialized ADP systems and applications. [i.e. The official start
of the Decentralized Hospital Computer Program (DHCP) - http://www.hardhats.org/dhcptovista.html ]
PART V:
The "Nineties"
During the 1990's, the VA information technology (IT) environment transitioned into an all
encompassing client/server architecture that includes both CRTs and PC workstations
connected to distributed computer servers and mainframe systems housing large databases,
interconnected via robust local area and wide area networks (LAN/WAN). The VA added a
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
number of major software applications to its existing inventory of major business systems
such as the:










Computerized Patient Record System (CPRS)
Clinical Imaging Systems
VA Online Bulletin Board System
VA Internet/Intranet Systems (www.va.gov)
Spinal Cord Dysfunction Registry
Decision Support System (DSS)
Medical Care Cost Recovery (MCCR) System
Burial Operations Support System (Boss)
Veteran Appeals Control and Locator System (VACOLS)
Interactive Voice Response (IVR) Systems
In the telecommunications arena, the VA upgraded its national wide area network (WAN),
known as IDCU, from a packet switched to a frame relay network. A national VHA
Telecommunications Infrastructure Project (TIP) to upgrade cabling plants, put in place
fiber optic backbones at all facilities, and acquire the latest, high speed LAN technologies
was successfully completed. This allowed the VA to move forward with the implementation
of VA Internet/Intranet web sites, the Computerized Patient Record System (CPRS) with
clinical imaging, and the widespread replacement of 'dumb' terminals with PC workstations.
The VA also completed a national project to acquire and install bedside phones for patients
in all VA medical centers. Also, the VA National Teleconferencing System (VANTS)
significantly expanded its audio and video conferencing capabilities and services. Other
areas of innovation included initial investment in emerging technologies such as
eCommerce, interactive web applications for veterans, wireless technologies, mobile
workstations, distance learning, kiosks, and smart cards.
PART VI: The "21st Century"
During the first decade of the 21st Century, the VA information technology (IT) environment
began to shift its focus to bringing information technology (IT) directly to bear on the
veterans and other external customers and stakeholders. A number of emerging and
converging technologies have begun to be employed to put the VA online for the veterans via
voice, data, and video communications, 7 days a week, 24 hours a day. In addition, there
have been a growing number of health information and technology collaborative projects
that have been initiated between the VA and government (federal, state, local, tribal) and
non-government (for profit and not-for-profit) organizations. Collectively, these efforts
make up the VHA long range strategy known as HealthePeople. VHA also has continued to
pursue another long range strategy known as HealtheVet which is focused on continuously
enhancing the VistA system and its overall infrastructure.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005
The VA has already completed a number of major projects and added many new IT systems
to its portfolio such as the:













Master Patient Index (MPI)
VistA Imaging System
VetPro Credentialing System
Federal Health Information Exchange (FHIE)
Personal Health Records, i.e. My HealtheVet
Bar Code Medication Administration (BCMA) System
Compensation And Pension Records Interchange (CAPRI)
PT Phone Home Project, i.e. Bedside Phones for Patients
VistA & CPRS Read Only for State Veterans Homes
Federal eGov Collaboration Projects, e.g. FHA, CHI, VistA Office EHR
Biosurveillance & Public Health Information Exchange
OneVA Enterprise Architecture
OneVA Privacy & Security
In the telecommunications arena, the VA plans to continuously to upgrade its national wide
area network (WAN) to meet the growing needs of the agency. This effort is known as the
OneVA Telecommunications Modernization Project. Other areas of innovation included
initial investment in emerging technologies such as wireless technologies, mobile
workstations and apps, distance learning, and health information exchange solutions.
*** A more complete list of VistA software applications with detailed descriptions can be found in the VistA
Monograph available via the web at http://www.va.gov/vista_monograph/ or in hard copy.
Health IT Sharing Opportunities: 4th Annual Analysis -
2/1/2005