The Department of Veterans Affairs has developed a blueprint for a cloud-based technology platform that will integrate veteran data from VA, military and commercial electronic health records, as well as apps, devices and wearables, so that the information is available to providers in real time.
While the VA is still finalizing plans for how it implements the Digital Health Platform (DHP), the agency has a strategy in place that is seen as the future path for providing next-generation healthcare to millions of the nation's veterans.
According to LaVerne Council, the VA’s CIO and assistant secretary for information and technology, DHP is meant to provide a comprehensive dashboard covering a veteran’s complete medical record, enabling a holistic approach to healthcare that supports patient-centric care and stresses customer relationship management.
“It moves beyond just the normal looking at an electronic health record and provides so much more than the EHR’s static point of view,” says Council, who oversees the VA’s $4 billion IT budget and more than 8,000 IT employees. “In order to provide great healthcare, we have to have analytics. We have to understand our responsiveness. We need to understand the environment. And, we need to be able to engage veterans in a way that is seamless, easy for them, and at the same time ensures that we are addressing their needs.”
The whole concept around the Digital Health Platform is that “you never see the system, the system just knows you,” she adds.
The VA’s Office of Information and Technology (OI&T) gave a sneak peek of DHP in July when it released its Midyear Transformation Review. However, the VA has now launched a new website laying out additional details about the platform’s envisioned capabilities and benefits.
“DHP leverages a network of application programming interfaces (APIs) to integrate military and commercial health data, while unifying VA’s data stores, connecting patient to provider in real-time, and predicting the most successful care to provide a better experience to the veteran,” according to a VA fact sheet posted on the DHP website.
Council notes that the Digital Health Platform uses open-source standards such as HL7’s Fast Healthcare Interoperability Resources (FHIR) application programming interface to integrate the more than 130 instances or versions of the VA’s legacy EHR system—the Veterans Health Information Systems and Technology Architecture (VistA)—as well as military and commercial EHRs.
“A veteran’s data and full health record is currently housed in many different, complex systems, each holding discrete records,” states the website. “Our DHP liberates this data, connecting to each health record and enabling a wrap-around platform that continuously gathers this discrete data, analyzes each clinical interaction, and prescribes precision, proven care.”
Council contends that the Digital Health Platform will better support veterans throughout the healthcare continuum by creating a new paradigm for the delivery of services with a modern, integrated health system that incorporates best-in-class technologies and standards to give it the look, feel, and capabilities users have come to expect in the private sector but will now receive from the VA.
She adds that system-wide cloud integration will be one of DHP’s defining features and that cloud computing is the “critical linchpin” for its capabilities, which just a few years ago would not have been possible because of concerns about the maturity of cloud technology and security.
Further, now that consumers are able to track their health through mobile apps, smartwatches and other wearable technology, Council says that DHP will also capture this valuable information and combine it with other medical records to better treat veterans—especially the rapidly growing number of women veterans—to improve their healthcare outcomes.
“Imagine if every piece of health data a veteran recorded—the number of steps she took, the flu shot she received at her local pharmacy, her vital signs at her annual physical, and her treatment at a community provider—were available to the veteran and her provider in one place, with a personalized plan for treatment. DHP realizes this vision,” states the VA’s website.
The VA’s current EHR modernization efforts focus on delivering the tools for clinicians to provide more comprehensive, patient-centered care. While Council says the VA is committed to VistA 4, the next iteration of its decades-old legacy EHR system, she believes that it alone does not have all of the capabilities required to meet the needs of veteran healthcare in the first half of the 21st century.
VistA 4, which will include improvements in efficiency and interoperability in fiscal year 2018, is meant to make the system more capable and agile. However, OI&T’s Midyear Transformation Review makes the point that the VA’s “aggressive timeline for upgrading VistA cannot match the accelerating trends of both technology and veterans’ needs.” As a result, the document concludes that it is the Digital Health Platform that ultimately “will support the next-generation VA—and veteran—into the future.”
In July, Council testified before a Senate subcommittee that the VA was looking beyond what VistA 4 will deliver in FY 2018 and was evaluating options for the creation of a Digital Health Platform to “ensure that we have the best strategic approach to modernizing our EHR for the next 25 years.”
She told lawmakers that DHP will be a “system of systems” that is not dependent on any particular EHR, giving the VA the flexibility to integrate new or existing resources into the system without sacrificing data interoperability.
Fast forward five months, Council maintains that VA’s VistA is a clinical EHR that “works,” although she is quick to add that it is a 40 year-old system and isn’t “moving us forward” as aggressively as the agency needs. Still, Council says: “We are looking at leveraging our current EHR capability.”
Nonetheless, the VA recently issued a request for information seeking industry feedback on how it might transition from VistA to a commercial EHR. However, the agency emphasized that it was an “RFI only” for planning purposes and should not be considered a formal solicitation for vendor bids or proposals.
Whether or not the VA’s path forward is to continue with VistA or shift to a commercial EHR remains an open question. What is certain is that with the transition from the Obama administration to the incoming Trump administration, Council’s days at the VA are coming to a close.
In the meantime, she said her team will continue to brief members of Congress and update them on how the agency plans to implement the Digital Health Platform.
“As the President moves on, so will I,” concludes Council, who has been in her position since July 2015. “My objective was to leave the organization with a firm approach and how best to do it.” Working with the VA’s Under Secretary for Health David Shulkin, MD, she believes they have accomplished that goal for the VA, the country’s largest integrated healthcare system.
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