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VA Design Patterns Briefing
and VistA Evolution Update
November 17, 2014
Dr. Aaron Drew
Senior Enterprise Solutions Architect
Office of Information and Technology (OI&T)
U.S. Department of Veterans Affairs (VA)
VA Design Patterns Briefing and VistA Evolution Update Overview
• Two topics
– VA Design Patterns
– VistA Evolution Update
• In the interest of time, please direct all questions to:
– design-patterns@osehra.org
• Answers will be provided to participants following this meeting
Open Source Memo and Survey
Open source Memo (signed by Mr. Stephen Warren on 4 Nov 2014)
• Establishes requirements for VA to thoroughly evaluate Open Source Software
(OSS) solutions when acquiring software and to consider the use of OSS
development practices within VA.
A white paper on impact of VA design patterns on open source community was also
requested – the core of this paper was a survey of the open source community.
Methodology:
• 8 multiple choice questions with a comments box and 2 short answer questions
• Sent to approximately 2,600 members of the OSEHRA mail group; 18 surveys
received
Based on the survey results:
• The open source community understands why the VA is using design patterns,
however, there are questions about the implementation of these design patterns.
The community understands why VA is using design patterns...
But there is some skepticism as to their value...
Enabling and Empowering Open Source Innovation
• Potential Solution 1: Sandbox environment
– Establish an open source sandbox that will provide implementations of SOA
services for testing.
• Potential Solution 2: Crowd-source capabilities
– Couple open-source innovation with VA’s deep institutional VistA knowledge
base by promoting collaborative development.
• Potential Solution 3: Engagement between VA/Open Source Community
– Continue to engage with the open source community through white papers,
town halls, and regular briefings.
VA Design Patterns Briefing and VistA Evolution Update Overview
• Please direct all questions to: design-patterns@osehra.org
VistA Evolution Program Clinical
Overview
Dr. Walter Paul Nichol
Deputy Chief Informatics Officer
Veterans Health Administration (VHA)
VA Blueprint for Excellence
PERFORMANCE  INNOVATION  SERVICE  ACCOUNTABILITY
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Anticipate and meet the unique health care needs of enrolled Veterans
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Deliver high quality, Veteran-centered care rivaling the private sector
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Leverage IT, analytics, and delivery models to optimize health
Develop a Veterans First culture, and inspire employees to highest performance
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9/8/2014
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Foster continuous learning, responsible risk taking, and personal accountability
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Advance personalized, proactive, patient-driven care
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Lead the nation in research and treatment of service related conditions
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Become a model Integrated Health Services Network
Operate with integrity, transparency and accountability
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9/8/2014
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Modernize health records (HR), procurement, payment, IT and infrastructure to be agile and efficient
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VistA Evolution Delivers and Maintains a VistA-based product that Facilitates Highquality Healthcare, Benefits and Services to our Service Members and Veterans.
PERFORMANCE  INNOVATION  SERVICE  ACCOUNTABILITY
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VistA Evolution improves the lives of Veterans
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VistA Evolution satisfies Interoperability, EHR
Certification, and Care Coordination
requirements
VistA provides VA with a solid EHR foundation. VistA 4 is about improving
our foundation so we can build a modular HIT product to more rapidly and
specifically meet the needs of patients and those providing services to
them
Our FY15 priority is to develop and achieve ONC 2014 EHR Certification for the
enterprise Electronic Health Management Platform (eHMP)
ONC 2014
EHR Certification
Number One
Priority for
VistA Evolution in FY15
Strategic Alignment
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 Prioritize VistA Evolution and Interoperability work, aligned with a compelling
Strategy to benefit Veterans
Why ONC Certification is a Top Priority
Direct value to Veterans (a few examples)
• Improves interoperability of key health information with non-VA providers 1 2 3 4 6
• Allows Veterans to fill VA-ordered prescriptions at retail pharmacies 1 2 6 8
• Automated scorecards to monitor and improve performance on clinical care, such as
screening for smoking and colorectal cancer 1 2 3 4 5 6 7 9
• Improved capability to reconcile medication list data from multiple sources 1 2 6 8
• New capability to reconcile problem list and medication allergy list data from multiple
sources 1 2 6 8
• Improved clinical decision support including usage of HL7 InfoButton
technology 1 2 3 4 5 6 7 9
• More secure online access to MyHealtheVet 1 2 3 4 5 6 8 9
Direct value to part-time VA doctors in the CMS incentive program
• Providers must have at least 50% of their total encounters occurring at facilities with a certified
EHR in order to be eligible for CMS incentives
• Providers attesting to MU will need to be less than 50% at VA until we have a certified EHR
Allows VA to maintain credibility as a leader in Health IT
• All Major EHR products in the commercial market are ONC Certified today
• Catalyst to create a solid foundation for an open standard/open architecture EHR platform
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VistA Evolution Triple Aim:
Team-Based, Veteran-Centric, Quality-Driven
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Veteran-Centric
Team-Based
Quality -Driven
VistA Evolution Program
• User experience that makes it easier and more pleasurable to get work done.
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Faster response
Shorter time to acquire needed information
Enhanced clinical decision support
Improved speed of documentation.
• Studies show EHRs increase work by 75 to 90 minutes a day.
• Coordinated care:
– Patient-centric, team-based, and quality driven healthcare
– Veteran-driven goals drive the plan
– Task-based communication (including orders) improves speed and clarity of
communication while automatically tracking into care plan (may save 30 minutes a
day)
• Lays foundation for many new workflows to support specialty care areas such as
women's health and mental health, as well as population health, etc.
VistA Evolution Program
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Enhanced DoD Interoperability: Architectural work underway to improve performance and reduce
maintenance for components supporting DoD interoperability.
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Advanced Indexing and Enablement of Clinical Data Enrichment: VistA Exchange leverages the eVPR
cache to create a universal index for search. This allows for the addition of external clinical enrichment
features (e.g., natural language processing, tagging, and annotations).
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Web-Based Computerized Patient Record System (CPRS): A web-based alternative to CPRS is being
developed. First release of the this new User Interface (UI) will be December 2014. This UI is leveraging
designs, functionality, and capabilities of the hi2 Health Management Platform (HMP) UI.
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Decoupling of Ancillaries from Core Clinical Functionality Through Open Standards: An open, standardsbased services for Orders Management and Order Selection will be created. This will allow orders to be
managed as enterprise activities, and will decouple the generation of the clinical record from ancillary
fulfillment, thus facilitating the selection and integration for Commercial-Off-the-Shelf (COTS) ancillary
products such as Laboratory and Pharmacy (the ancillary product acquisitions are outside of the scope of
eHMP project).
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Other Evolutionary Generation 3 EHR Capabilities: This would include services for Clinical Workflow and
Activity Management, Decision Support, and Concept Relationship.
VistA Evolution Program Update
VistA Evolution Program
• The VistA Evolution Program will enhance VistA’s core architecture to
achieve interoperability with DoD.
• Further work will augment VistA’s clinical capabilities to support a
patient-centric, team-based healthcare delivery model. The
Program’s end product, VistA 4, will deliver cross-agency
interoperability, a robust health IT architecture to enable future
innovation, and cutting-edge clinical capabilities, allowing VistA to
serve as a cornerstone for the delivery of care and benefits to
Veterans, Service members, and their dependents.
VistA Evolution Program
Feature Set 1
(Delivered September 30, 2014)
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Interoperability (through JLV)
VistA Standardization, Phase 1
Vista Immunization Enhancements (VIMM, 1.0)
Laboratory
Graphical User Interface (GUI) Tools
VistA 4 Application Programming Interface (API),
Initial Release
Feature Set 2
(To Be Delivered By September 30, 2015)
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Feature Set 3
(To Be Delivered By December 31, 2016)
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Interoperable EHR
Broad eHMP Deployment
Enhancements to Pharmacy (In-bound ePrescribing)
VistA Standardization, Phase 3
VistA Service Assembler
VistA Immunization Enhancements (VIMM, 2.0)
ONC 2014 EHR Certification
VistA Scheduling Enhancements
VistA API Exposure, 2.0
iMed Consent Web Migration
Enhancements to Pharmacy (MOCHA, PECS, PPSN, PPS-L, SUMPM)
VistA Standardization, Phase 2
Feature Set 4
(To Be Delivered By September 30, 2018)
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Medical Appoint Scheduling System (MASS) –
broad deployment
Enterprise-wide eHMP Deployment
Veteran’s Authorization and Preferences (VAP)
Women’s Health
Enhancements to Ancillary Systems (Radiology,
Laboratory)
FileMan Modernization
VistA Evolution Program Update: Select Projects
JLV/eHMP/VistA Exchange
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Mr. Keith Michael, eHMP Lead Architect/Product Manager
Ms. Betsy Green , eHMP Project Manager
FileMan Standardization and Modernization
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Mr. Russell Holt, FileMan Portfolio Manager
Enterprise Messaging Infrastructure (eMI)
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Dr. Patrick Pearcy, Director, Veteran Facing Applications and
Service Integration
VistA Evolution Program Update: JLV/eHMP/VistA Exchange
Mr. Keith Michael, eHMP Lead Architect/Product Manager
Ms. Betsy Green , eHMP Project Manager
Joint Legacy Viewer (JLV)
• JLV is the newest health record viewer available to users in both
DoD and VA to meet increasing needs for seamless interoperability
of standards-based health data supporting high quality care for our
nations’ Veterans and Service members. JLV is the only application
providing an integrated, chronological view of electronic health
record information from all VA and DoD facilities at which a patient
has received care, in a user-configurable display.
• JLV is a waypoint on the path to the state-of-the-art, interoperable,
standards based VistA 4 enterprise Health Management Platform
(eHMP)
Enterprise Health Management Platform (eHMP) Overview
The eHMP project is a multi-year effort to evolve a modern, service oriented enterprise
health application platform. It will provide ‘native federation’ of a complete enterprise Virtual
Patient Record (eVPR), including information model binding, terminology normalization,
knowledge enrichment, and search indexing for all available longitudinal patient record data
aggregated from VA, DoD, and exchange partner sources.
eHMP is the name of the overarching system encompassing both the front end application and middle
tier components called eHMP Services
– eHMP Services is the name for the middle tier components that include
• VistA Exchange (Virtualization of Patient
Record)
• Clinical Decision Support
• Context Persistence
• Orders Selection Service
• Orders Management Service
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Data Annotation Service
Clinical Workflow
Concept Relationship Service
Documentation and Text Search Service
Business Rules Management System
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Enterprise Health Management Platform (eHMP) Overview
• Will eventually replace the Computerized Patient Record System (CPRS) as VA’s primary
point of care application.
• Will show information in a single view, which will allow clinicians to use comprehensive
patient data and images more easily, instead of a siloed approach which can sometimes
hinder the exchange of information. This foundational delivery will also integrate several
functionalities into the DoD/VA interoperability infrastructure to support the VistA
Evolution Program’s interoperability commitment. These additions will give clinicians
simplified access to Veterans’ complete patient history from both DoD and VA shown in a
single reliable and secure interface.
• Consists of a middle tier that enables enhanced clinical information exchange through
various components that find, standardize, and interpret many sets of information, to
include demographics, lab and immunization results, visit management,
problem/medication list, and more.
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Software Development Kit (SDK) Technical Details
Components
– Application Development Kit (ADK): Client-side
• JavaScript : Language
• Backbone.js : Library to develop SPA
• Marionette : Framework for backbone.js applications
• Bootstrap : Libraries for front-end development
– Resource Development Kit (RDK): Server-side
• JavaScript : Language
• Express.js: Web Application Framework
– Single Page Application (SPA)
– HTML/JavaScript/CSS returned as “static assets” from web server
– Logic performed in client instead of server
– Fluid and more responsive
• No reloading and re-rending
– JSON creates separation between presentation and application logic
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Application Development Kit (ADK)
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Applet
– Single unit of visual functionality
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Screen
– Defined collection of applets
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Layout
– Abstract arrangement of applets
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Application
– Collection of screens
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Majority of web developers working within eHMP UI will spend their time developing
applets.
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Resource Development Kit (RDK)
• Resource
– Single web service
– (e.g. method @get)
• Resource Family
– Collection of resources
– (e.g. class)
• Resource Server
– Deployable unit, includes a set of resource families and specific configuration
– (e.g. war file)
• The approach to resource servers follow “microservice”
– Allows for discrete instances to be independently deployed, optimized, and load
balanced
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Cover Sheet Mock-Up
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VistA Evolution Program Update: FileMan Modernization &
Standardization
Mr. Russell Holt, FileMan Portfolio Manager
VistA FileMan Modernization & Standardization
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Key features
– Standardization of VistA applications and their corresponding database, including federating
application data to create an enterprise-wide view of patient data.
– Population and cohort queries for applications that are fully converted to use FileMan
Enterprise.
– Powerful interfacing and integration capability of any VistA application to data source,
application, or external system.
– Standardized, enterprise Application Programmable Interfaces (APIs) to VistA applications. These
allow interfacing of external applications to all VistA systems through one enterprise API.
– Interface Modern Internet Database capabilities, including secure web services, web interfaces,
and web data management capabilities.
– Standardize unified method of access for all VistA data through FileMan programmatic
interfaces.
– Ensure FileMan data storage and access supports universal time zones (UTC) (FileMan will be
able to store by implementing UTC offset)
– Enterprise-wide secure FileMan access expand/enhance single character use
VistA FileMan Architecture
FileMan “As-Is” Architecture
WebLogic
VistALink
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FileMan “To-Be” Architecture
Enterprise VistA
Data
base
(1)
API’s
Enterprise
Apps
FileMan
Data
base
(126)
VistA Evolution Program Update: Enterprise Messaging
Infrastructure (eMI)
Dr. Patrick Pearcy
Director, Veteran Facing Applications and Service Integration
Enterprise Messaging Infrastructure (eMI)
• eMI is the sustainment phase of the Service-Oriented Architecture
(SOA) Suite project.
– Provides the ‘transport’ for the messages between both DoD/VA
and supports the associated information management systems in a
standards-based, secure and reliable manner.
– Simplifies the integration of new capabilities, web services, and
other technologies.
• eMI will continue to facilitate the delivery and use of reusable services
in support of VA and other health partners, as dictated by the National
Defense Authorization Act (NDAA).
• eMI has been in place since August 2014.
Enterprise Messaging Infrastructure (eMI) Architecture
VistA Evolution Update
• Please direct all questions to: design-patterns@osehra.org