Health IT in Veteran's Affairs Open Government Plan

The VA's Open Government Plan has some very interesting information regarding health IT. Veterans Affairs Secretary Eric Shinseki has designated Peter Levin, VA’s Chief Technology Officer, as the senior official in charge of the open government initiatives. The plan said the VA intends to report progress on 25 open government initiatives on its online VA Information Technology Dashboard, with deadlines for the next reports ranging from May to October. I have highlighted some of the plan below:

Virtual Lifetime Electronic Record (VLER)

When a Servicemember retires today, the current process requires transporting paper-based administrative and medical records from the Department of Defense to the Department of Veterans Affairs. That is why, in April 2009, President Obama announced with Secretary Robert Gates of the Department of Defense and Secretary Eric Shinseki of the Department of Veterans Affairs a joint effort to provide a Virtual Lifetime Electronic Record (VLER) for Servicemembers and Veterans. VLER will enable Veterans to have a seamless transition from active duty to Veteran with a single file, easily transferred from one agency to another. This major collaboration effort between DoD and VA will also reach out to other partners, including Department of Health and Human Services and private health care organizations.

The basic premise of VLER is to facilitate electronic access to administrative and medical information under proper security and privacy controls from the day young men and women enter military service, throughout their military careers, and for the rest of their lives.

Built on existing point-to-point electronic health record infrastructure, VLER has become a standards-based, open architecture framework that will ultimately enable seamless interoperability with other federal agencies and, crucially, private sector partners. It is the difference between tin cans on a string and wireless handsets that allow you to speak to anybody with a telephone.

The advantages of connecting to the dial tone of web-based communications are astonishing. VA has one of the best platforms in the world and it indisputably improves quality, convenience and continuity of care. VLER will make them better. Benefits administration depends on timely access to military assignment records, administrative records, and service-related medical records. VLER will make that better too. VLER will provide automated information access to Veterans, their families and care-givers, and their service providers. It will relieve them of the burden of keeping track of their paper records, because documentation will all be in one complete, secure and virtual place.

Under the Secretary’s leadership, the ground-up transformation of VA has already begun. His clear vision of the use of information technologies will make a tremendous difference in openness and agency performance. Our dedicated employees are going to get better tools that will enable us to provide better service, faster and more effectively. And, our Veterans are going to get the delivery of their health care and benefits they have deserve, with less stress and red tape.

Virtual Installation of VistA Architecture (AViVA)

A Virtual Installation of VistA Architecture (AViVA) is a recent innovation that we are using to support collaboration. AViVA creates a universal user interface for the electronic health record and includes prototyping of data connectors in order to securely link the AViVA platform to patient data from any source. The AViVA project incorporates HealtheVet as an update of the VistA legacy database system.

VA’s current electronic hospital management system uses a graphical user interface known as the Clinical Patient Record System (CPRS). CPRS data is stored in the legacy data system known as VistA. CPRS requires installation on each machine that operates the program rendering the program difficult to scale and expensive to maintain and update. AViVA’s implementation improves this model in two ways. First, AViVA creates a modular, web-enabled electronic health record system that can be easily and remotely maintained. Second, Medical Data Web Services (MDWS), which can be accessed by the Department of Defense, will allow the creation of applications for any data source to be plugged into the system.

AViVA is a very exciting program for the collaboration portion of our Open Government Plan and because we are committed to creating systems that allow health care providers to collaborate to provide the best care for Veterans. AViVA’s web based presentation layer will allow our doctors and nurses around the country to search patient records as simply and succinctly as you can search for pizza on Google Maps and as securely as the best retail financial service businesses. Additionally, AViVA creates collaboration between VA and DoD, our partner in caring for our nation’s heroes. Finally AViVA creates an open source platform that allows software to be shared with entities outside of VA, creating opportunities for further innovation and development beyond the agency.

Blue Button

In January 2010 we were invited, in conjunction with the Centers for Medicaid and Medicare Services (CMS) to attend the Markle Consumer Engagement Workgroup, which focused on incentivizing the market to provide consumers with electronic access to their health data and technology solutions to better use this data. The workgroup concluded that VA, HHS, and CMS, as major federal health data holders, will participate in follow up discussions on the breakthrough idea of a download or ―blue‖ button. The blue button will be accessible in online health data portals directly enabling individuals to download their electronic health data. At the direction of Health and Human Services and VA CTOs, planning for a virtual meeting is underway for May 2010 to showcase the public availability of a synthetic sample data set designed to foster innovation, and enable industry stakeholders to provide feedback for future development. These efforts are intended to further support e-personal health care using open government principles.

In a great example of crowd sourcing, last August the VA sponsored a contest for collecting ideas to improve claims processing. More than 7,000 employees submitted 3,000 ideas. The in February 45,000 employees submitted 6,500 ideas to improve health IT systems, casting 500,000 votes for the best ideas.

The Washington Post reports on the strategy to reach out to vets using social media. They are using Twitter, a Facebook Fan page (which has over 20,000 fans) and blogs to engage veterans, who are increasingly found online. Much of this work is overseen by Brandon Friedman, who served in Iraq and Afghanistan, and arrived at VA eight months ago with a mandate: to reach veterans using new media. "Veterans want to be engaged," he said. "They want a two-way conversation with us, to tell us what we can improve on."

The VA and HHS so far win the prize for best open government plans.