The Institute of Federal Health Care Interactive Roundtable Emerging Infectious Diseases InTheater:

1
The Institute of Federal Health CareInteractive
RoundtableEmerging Infectious Diseases
In-Theater Risks and Mitigation June 5, 2009

• Gary A. Roselle, MD
• National Director for Infectious Diseases
• Veterans Health Administration

2
Can Current Surveillance Efforts and Their
Results Be Better Coordinated?

• What are the systems that currently exist to
  share data?
• Are there ways to integrate the data?
• Are there programs looking at coordinated
  surveillance efforts between VA and DoD?

3
What are the Systems that Currently Exit to Share
Data?

• VA/DoD Health Information
• Sharing Technology
• One way viewable - FHIE
• Bidirectional viewable - BHIE
• Bidirectional computable CHDR - HDR
• Sharing to support the severely wounded
  warriors (SWW)
• Remote view of DoD and VA images

4
The Path to Interoperability
Interoperable Electronic Health Records
One-way DoD to VA
Bidirectional sharing of text data
Bidirectional sharing of computable data
FHIEFederal Health Information
Exchange BHIEBidirectional Health Information
Exchange CHDR/HDRClinical Health Data
Repository/Health Data Repository
5
VA/DoD Electronic Information Sharing
6
Data Available through FHIE

• Admission/Discharge/Transfer information
• Allergy information
• Consult reports
• Demographic data
• Discharge summaries
• Lab results
• Outpatient Prescription data

• Pre-/Post-Deployment Health Assessments
• Post-Deployment Health Reassessments
• Radiology reports
• Standard Ambulatory Data Record elements

Historical data available unidirectionally from
DoD to VHA
7
Data Available through BHIE

• Allergies
• Ambulatory encounter
• Demographics
• Family history, social history, other history
• Inpatient and Outpatient lab results
• Inpatient notes (from DoD Essentris sites)

• Outpatient Pharmacy
• Problem lists
• Procedures
• Questionnaires
• Radiology Reports
• Theater clinical data
• Vital Signs

Text data available bidirectionally between DoD
and VHA
Includes Orders, Chemistry Hematology,
Cytology, Microbiology, Surgical Pathology
8
Data available through CHDR/HDR

• Allergies
• Outpatient pharmacy

Computable data available bidirectionally
between DoD and VHA
9
Clinical Health Data Repository (CHDR)
10
VA/DoD Sharing Seriously Wounded Warriors (SWW)

• VA and DoD share data to support the seriously
  wounded warriors
• DoD key military facilities send radiology images
• Scanned paper records in PDF files to VA
  polytrauma centers
• Visible at all VA Centers with Remote Image View.

11
Electronic Health Record (EHR) for VHA (VistA)

• Remote Views
• Remote data button and remote health
  summaries with RDV.
• VistaWeb patient specific data
• Remote ECG view map MUSE
• Remote image view X-ray, scanned images, and
  PDF files.
• Direct sign on to remote site with separate
  access and verify code

12
VistA Cumulative Images Captured
2003-2008
VistA Imaging Facts FY 08 Q2
762 Million Images
13
Are There Ways to Integrate the Data?

• VistA/HDR Vital Sign History

14
VistA/HDR Vital Sign History
Vital Signs 1,249,005,693
15
Hypertension Study 15 Cities
Anchorage, AL
Portland, OR
Fargo, ND
Minneapolis, MN
Boston, MS
Philadelphia, PA
New York, NY
Chicago, IL
Baltimore, MD
Washington, DC
Los Angeles, CA
Houston, TX
Miami, FL
Honolulu, HI
San Juan, PR
16
Controlling Hypertensives with Seasonal Variation
15 Cities 522,264 patients
17
Seasonal Variation
Hypertensives and Normotensives
18
VA DoD Sharing Summary
By Race
0.80
0.75
0.70
0.65
Percent Hypertensives Returned to Normal
0.60
0.55
0.50
0.45
Jan-00
Jun-00
Dec-00
Jun-01
Dec-01
Jun-02
Dec-02
Jun-03
Dec-03
Jun-04
Dec-04
Jun-05
Dec-05
Jun-06
Dec-06
Jun-07
Dec-07
19
Are There Programs Looking at Coordinated
Surveillance Efforts between VHA and DoD?

• Improvement in interoperability makes coordinated
  efforts more likely
• Advent of sharing computable data improves
  likelihood of being able to coordinate like
  efforts

20

• Much of the information contained herein is
  available from a presentation of interoperability
  between VHA and DoD systems for healthcare
  presented at VHA eHealth University (VeHU), July
  2008 and available on the Internet at
• http//www.vehu.va.gov/vehu/WBTPages/WBT08.cfm?Cla
  ssNum277