1. 21st Century Healthcare
Role of VA National Data Center
Program in Shaping the Future of
the Medical Internet
2. The Five Information System Ages
of Patient Care
Age Period Information System
Hospital Care 1950’s – 1960’s paper
Ambulatory Care 1970’s Paper
Primary Care 1980’s Paper and
Computer
Managed Care 1990’s Computer
Home Care 21st century Computer, personal
health devices
3. VA Information System Age
VA is in the 4th stage (Managed Care)
Extensive use of electronic medical record
Extensive use of physician order entry
VA working on transition to 5th stage (Home
Care)
Emerging networks for telemedicine
Emerging networks for home telehealth
Infrastructure changes will be required
National data centers will play central role in transition
Systems Engineering and Information Protection
need to be considered
4. Ages of Integration
Stage Name # Elements Description
0 None 1 Stand alone systems
(Lab)
1 Interfaced 10 Linked w/ interface
(Lab, X-ray…)
X-
2 Integrated 100 System framework (one
center)
3 Large-Scale 1000
Large- Regional network
(hospital with clinics)
4 Very Large 10,000 Multiple health networks
Scale (VA, DOD…)
5 Global 100,000+ “Medical Internet”
5. VA Age of Integration
VA in Stage 3 (large scale)
Regional networks (VISN and Region)
VA in transition to Stage 4 (very large scale)
Connectivity with DOD
VA participation in Stage 5 (medical intranet)
Will require data exchange with Regional Health Information
organizations in private sector
VA will be leader in transition with all Federal Medicine
organizations (Public Health Service, Indian Health Service,
CDC, FDA, etc)
National Data Centers will play central role in integration
and transition to Stage 5
Systems Engineering and Information Protection need to
be considered
6. RDP To-Be Vision
To-
ONE-VA RDP END-STATE Becoming the “Gold Standard”
VISN Location
• Establish four national data
REGION 1 REGION 2 RDC Location processing centers serving the
VA business needs
REGION 4
23 1
• Build In COOP/ Disaster
Recovery
20 12
11 2
19
21 10 4 • Build Standardization in IT
15
3
Business Structure, Process
Guam
5 and Technology
9 6
21 22
18
16 • Build Tiered Network/Security
7
Management Framework
Philippines
21 REGION 3
17
• Become “Gold Standard” not
only in IT Security, but also in
Alaska
20 Hawaii 8
Achieving Efficiencies
21
Puerto Rico
8
• Framework for interoperability
in national health information
networks
7. Present: Today’s VA
VHA Vision Statement
To be a patient centered integrated health
care organization for veterans providing
excellence in health care, research, and
education; an organization where people
choose to work; an active community
partner and a back-up for national
emergencies
8. VA Strategic Plan
IT is Required tool
Cutting edge technology and information
systems
Information sharing between VHA and VBA,
DoD, other federal agencies, and other
providers
Integration of systems to improve information
sharing and business processes
Implementation of IT security measures
Timely access to data for decision making
9. Interoperability1
Level 1: non-electronic data
non-
Mail, telephone
Level 2: machine transportable data
Fax, scanned documents, PDF formats
Level 3: machine organized data
Structured messages but non-standardized data
non-
Level 4: machine interpretable data
Structured messages with standardized data
1. Walker et al, The Value of Health Care Information Exchange and
Interoperability. Health Affairs. Web Exclusive, Jan 19, 2005
10. DoD/VA Interagency Initiatives
Level II Level III Level IV
Bidirectional CHDR Interface
FHIE Health Information
Exchange (BHIE)
•One-way •Bi-directional
•Bi-directional
•Not real-time access •Real-time access •Enterprise exchange
•Text data •Text data •Real-time access
•Computable data
Path to Interoperability
11. Veterans Health Information Exchange
Formative Stage = business
= technical
How we see the future
National Health Info Network
RHIO RHIO
VA VA
12. Interoperability End State
VA information will be bi-directional and
bi-
real time with Private sector Regional
Health Information Organizations
Infrastructure of NDCP will promote safe
and secure data sharing with RHIOs
Facilitating information exchange from
NDCP will be easier than facilitating from
128 separate databases.
