The Georgia Institute of Technology has successfully demonstrated a proof-of-concept for the Department of Veterans Affairs’ new Digital Health Platform (DHP), designed to integrate veteran data from VA, military and commercial electronic health records.
The VA’s DHP is a cloud-based platform meant to create a 21st century model for the delivery of veteran healthcare services based on a modern, integrated system that incorporates best-in-class technologies and standards. The goal of the DHP proof-of-concept, managed by Georgia Tech, was to demonstrate both mature and emerging interoperability technologies from both the public and private sectors.
The public-private demonstration, which includes the VA’s Office of Information and Technology and HHS’s Office of the National Coordinator for Health Information Technology, included the capability to obtain patient data from disparate military and commercial EHRs, as well as to accept information from a broad range of ancillary services and consumer medical devices.
“Almost five years ago, we created a lab specifically to address the barriers to interoperability,” says Steve Rushing, senior strategic adviser in Georgia Tech’s Health Extension Services, who describes the lab as an “agnostic and safe” collaboration space for health IT vendors and technology developers.
According to Rushing, the principal design goal for the public-private DHP collaboration was to “liberate the data from deep inside a system and securely move it to the cloud and manage its movement through well-designed application programming interfaces (APIs),” thereby integrating data from military and commercial information systems.
“We are doing for healthcare what has already been done for other industries that have used interoperability standards as the foundation for APIs to exchange information among different systems,” adds Rushing.
As part of the proof of concept, 21 system APIs were created to control how specific types of data flow into and out of the DHP, which included data exchanges with a Cerner EHR (representing the Department of Defense and a community hospital), Epic EHR (Duke University Medical Center) as an academic medical provider, DocSnap personal health record (connecting to a Navy medicine pilot project), as well as personal health monitoring devices via Apple HealthKit and Validic.
Among other vendors, the Georgia Tech team included technology partners Salesforce (customer relationship management software) and MuleSoft (API gateway). By leveraging HL7’s emerging Fast Healthcare Interoperability Resources (FHIR) standard, the team built an API gateway around the VA’s legacy EHR system—the Veterans Health Information Systems and Technology Architecture (VistA)—and Georgia Tech’s testing and teaching EHR system called GTonFHIR. The VistA system was accessible via open-source interoperable API gateway connections.
“VistA is 40 years old and was designed for a very specific purpose,” says Rushing, who notes that the DHP proof-of-concept’s scope of work included a critical goal—treating the VA’s legacy system as just another EHR.
Rushing says the intent was for DHP to not only be agnostic regarding commercial EHRs, but agnostic toward VistA as well. “We let VistA do the things that it does very well—being the VA’s core system of record—and with APIs connected it to technologies that do the things that it doesn’t do.”
He observes that DHP’s API-based architecture is not tied to any proprietary systems and that the successful proof-of-concept ensures future developments such as connecting to a robust portfolio of interoperable web services, apps, devices or EHRs that leverage FHIR and other open APIs.
“By using an architecture that is API-driven, we addressed the interoperability requirement, kept what works and added new Veteran Health Administration-created and private industry innovations where needed,” concludes Rushing. “What we set out to do was to give the VA and VHA a way that could extend the life of VistA. While they are making the decision about the future of VistA, they don’t have to lose out on all the breakthroughs that are happening in mobile apps, analytics, wearables, sensors, and monitoring.”
In addition, healthcare analytics vendor Apervita was selected for the proof-of-concept to demonstrate the real-time analytics component of the DHP architecture, which makes recommendations about care, such as enrollment in specialized services for veterans suffering from traumatic brain injury by analyzing the EHRs of service members transitioning from active duty to veteran status.
The DHP proof-of-concept was demonstrated for VA and Veteran Health Administration leadership this past September and October. Currently, the Georgia Tech team is completing the documentation in support of the project as part of its deliverables under its contract with the VA.
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