Keynote: Innovation at Veterans Affairs: Using IT to Transform Care Delivery


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Keynote: Innovation at Veterans Affairs: Using IT to Transform Care Delivery
- Peter L. Levin, Senior Advisor to the Secretary, and Chief Technology Officer, U.S. Department of Veterans Affairs

Fujitsu Labs of America Technology Symposium 2011
Healthcare Technology Convergence: Smart Consumers Meet Care Delivery of the Future
June 01, 2011
Computer History Museum
Mountain View, CA

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  • VLER will proactively provide health, benefits and other administrative information to benefits providers thereby removing the burden from the Veteran or Service member. VLER will: Support the exchange of health information to ensure healthcare providers have information from Department of Defense, the VA and private healthcare providers to deliver high quality healthcare during a clinical encounter.   Provide information to process VA and Social Security Administration disability claims more efficiently by having all required information available to process compensation, pension and other benefits to eligible Veterans. Ensure the information exchange to support existing capabilities to administer other benefits and services including education, housing and insurance. Provide Service members and Veterans access to their own information and empower Veterans to authorize access to their information.
  • Keynote: Innovation at Veterans Affairs: Using IT to Transform Care Delivery

    1. 1. A presentation to Fujitsu Labs of America Technology Symposium<br />Innovation at Veterans Affairs: Using IT to Transform Care Delivery<br />Peter L. Levin<br />Senior Advisor to the Secretary & Chief Technology Officer<br />U.S. Department of Veterans Affairs <br />June 2011<br />
    2. 2. Overview of Veterans Affairs<br />and the case for better health records<br />VA and DoD interagency collaboration<br />connected but not interoperable<br />Innovation at VA<br />suicide prevention and faster claims processing<br />EHR modernization (and early outcomes)<br />Blue Button and a common user interface<br />Open source request for information<br />VAi2<br />1<br />
    3. 3. Veteran Affairs demographic overview<br />23 million veterans<br />Just over 8% are women<br />6 million receive health care from VA<br />1400 points of care, including 152 hospitals<br />3 million receive VA disability compensation<br />800,000 receive education benefits<br />$56 b for medical care; $71 b for entitlements (2010)<br />Over 300,000 employees <br />2<br />
    4. 4. A slice of the healthcare cost equation <br />3<br />
    5. 5. EHR adoption<br />5<br />
    6. 6. Here’s the core of the problem<br />13,000 diagnoses <br />6,000 drugs<br />4,000 medical procedures<br />100,000 deaths per year from medical errors<br />1.5 million adverse reactions or Rx errors<br />I went through eight years of training to become a surgeon, and yet I still see mistakes every week. So . . .we worked with Boeing to learn [how to make] a two-minute checklist for operating rooms. And when we implemented it in eight hospitals, ranging from rural Tanzania to Seattle and London, the average reduction in deaths was 46%. <br /> - Atul Gawande<br />7<br />
    7. 7. Challenge: how can we get technology to…<br />8<br />$2,500,000,000,000<br />… lower this…<br />…so that we can save these?<br />… and increase this…<br />EHRs helped in only 1 of 7 quality indicators nationally<br />
    8. 8. VA and DoDinteragency collaboration<br />9<br />
    9. 9. VA and DoD current state overview<br />10<br />
    10. 10. National DoD-VA electronic data exchange summary<br />13<br />
    11. 11. A better solution to save lives and dollars?<br />Current status<br />Serves 15 m patients<br />$10 b in net sunk costs<br />Connected<br />Difficult to <br />Scale<br />Extend<br />Maintain<br />14<br />Near-future plans<br />Serve 15 m patients<br />Lower operating costs<br />Truly interoperable<br />Easy to <br />Scale<br />Extend<br />Maintain<br />
    12. 12. The case for a joint common approach<br />85% of clinical functions are the same<br />90% of the data is the same<br />AHLTA must be replaced urgently<br />VistA is on a path to modernization<br />16<br />
    13. 13. 19<br />Use Model<br />Schematic<br />Suicide Prevention<br />Outcome Metrics<br />
    14. 14. Internet chat service launched 18 months ago<br />20<br />Steps Visitors take to enter into Chat Service<br />Click on button to Veterans Chat or Homeless Veterans Chat at the bottom right<br />Enter the Veterans Tab on the National Suicide Prevention Lifeline web page <br />Read disclaimer and agree to terms of use. Click on the button to continue <br />Enter user name, a nickname or a handle is recommended to maintain anonymity<br />Start interaction with the Chat Counselor<br />Chat Process <br />Clinical Aspects <br />Chat Counselor's Shift Procedure Flow<br />Source: Lewis, Thompson, and Kemp, VeHU 2010<br />
    15. 15. Detailed flow schematic<br />21<br />
    16. 16. Veterans Crisis Chat andHomeless Prevention Veterans Chat <br />
    17. 17. 23<br />Use Model<br />Schematic<br />Fast Track<br />Outcome Metrics<br />
    18. 18. Fast Track schematic<br />24<br />
    19. 19. Fast Track outcomes<br />120 day implementation<br />VAi2 connection<br />2000+ Vets used automated claims process since Oct 2010<br />120 days or less to complete process compared to 165+ ADC<br />25<br />
    20. 20. EHR Modernization and early outcomes<br />26<br />
    21. 21. VLER<br />Blue Button<br />EHR Modernization<br />DoD Collaboration<br />VistA Open Source RFI<br />27<br />
    22. 22. Decreasing cost & increasing quality of care <br />Decreasing Backlog<br />Access &Control<br />Non-Clinical Case<br />Management<br />Apps<br />Benefits <br />Apps<br />VA<br />Clinical <br />Apps<br />DoD<br />Clinical<br />Apps<br />Future<br />- Veterans Courts<br /><ul><li>Homeless…</li></ul>iEHR<br />Proliferation of other apps<br />Standards & <br />Services<br />Apps<br />V<br />Commercial, Open-Standards Based Interoperability Information Exchange<br />Data<br />DoD<br />HR Data<br />Benefits<br />Data<br />VA<br />Health<br />Data<br />DoD<br />Health<br />Data<br />Private Provider<br />Health<br />Data<br />TBD<br />HUD DOJ, VSO, SSA<br /><ul><li>etc.</li></ul>iEHR<br />VLER Concept<br />
    23. 23. Blue Button: the easiest use model ever<br />BEFORE<br />AFTER<br />29<br />
    24. 24. Blue Button outcomes<br />245k+ unique registered Veterans since Sept ‘10<br />Now includes VistA extracts (link to EHR)<br />50 private-sector consortium partners<br />Close collaboration with DoD & HHS<br />30<br />
    25. 25. Joint DoD and VA commonplatform architecture<br />31<br />
    26. 26. Hands on DoD/VA collaboration using MITRE Collaborative Story Development Kit (CSDK)<br />Joint GUIGUI Development Process was a collaborative effort<br />32<br />2-3 hour sessions. Two joint teams. Each developed both screens.<br />Clinician<br />Home Page<br />Collaboration<br />Outtakes<br />Patient<br />Summary Page<br />Collaboration<br />Outtakes<br />Collaboration session results developed into design concepts by the Parsons Institute for Information Mapping (PIIM)<br />
    27. 27. Storyboard of a joint presentation layer<br />33<br />Default View by Role<br />with widget/tab selection by clinician<br />27<br />
    28. 28. VA is thinking carefully about open source<br />34<br />
    29. 29. Features & Capabilities<br />VistA<br />Private Sector Health Care<br />Today<br />???<br />Why open source for VistA?<br />35<br />
    30. 30. What are the benefits of open source?<br />Clear and accepted industry engagement model<br />Enables innovation far outside of VA investments<br />Broad input on re-building<br />Mitigates risk of massive investment<br />Independent governance model <br />Reassuring to partners and stakeholders<br />Transparent Evolution<br />Constant input from partners outside VA<br />Improved security<br />Many independent reviewers of source code base<br />36<br />
    31. 31. Stimulating long-term innovation<br />VA would put current-state<br />VistA into Open Source<br />Current VistA<br />Open Source VistA<br />VA would license future-state<br />VistA from Open Source<br />Certified Open Source<br /><ul><li>independent governance
    32. 32. clear industry-engagement model
    33. 33. standards-based, open architecture</li></ul>Decongests innovation through transparent process<br />Clinicians fundamentally happy<br /><ul><li>supports nation’s largest hospital system
    34. 34. stable, reliable, and usable
    35. 35. highly responsive (6 seconds average pull)</li></ul>But … innovation in VistA has ground to a halt<br />VA has thought carefully with its commercial partners and stakeholders about this mechanism and is fast approaching the “go forward” decision point<br />38<br />
    36. 36. The basic idea of a custodial agent<br />39<br />
    37. 37. Use model for open source<br />40<br />
    38. 38. Facilitating community innovation<br />41<br />Custodial Agent<br />Value-<br />Added<br />Vendor<br />Stakeholders & Users<br />
    39. 39. Use Case #1: adopt an opensource module<br />all open source<br />CA’s CSB/ESB<br /><ul><li>copy of current version
    40. 40. perpetual license
    41. 41. certification of interoperability
    42. 42. certification of function
    43. 43. documentation</li></ul>Our CSB/ESB<br />35<br />
    44. 44. Use Case #2: adopt commercial code<br />all open source<br />commercial vendor<br />CA’s CSB/ESB<br />COTS<br /><ul><li>direct relationship to vendor
    45. 45. pre-certified to plug into the codebase
    46. 46. no implied certification of function</li></ul>$<br />COTS<br />Our CSB/ESB<br />36<br />
    47. 47. Use Case #3: contribute GOTS code<br />all open source<br />CA’s CSB/ESB<br />open source<br /><ul><li>capabilities we already have
    48. 48. capabilities we create later
    49. 49. may want to only certify for interoperability
    50. 50. may want to contribute to the codebase</li></ul>GOTS<br />Our CSB/ESB<br />37<br />
    51. 51. VAi2 program<br />Up to $100M in new awards<br /><ul><li>sterilization of medical equipment
    52. 52. telemedicine for audiology services</li></ul>- new uses for Blue Button<br />- new prosthetic socket designs to improve fit and comfort of prosthetics<br /><ul><li>self-management technologies for vocational rehabilitation</li></ul>13<br />Second Industry Innovation Competition<br /><br />