Content Variance Analysis Project
In 2019, the VA aimed to resolve data inconsistencies for EHRM requirements with VistA, Cerner Millennium, and HealtheIntent. To achieve this, the team first analyzed non-standard data domains in legacy systems for Cerner import consistency.
We examined VistA legacy data files to support clinical terminology sustainment and long-term data integrity. Specifically, we analyzed the contents of VistA legacy data files for terminology sustainment. Following this analysis, we identified and standardized inconsistencies, including duplicate spellings of the same word. We updated data fields that had changed purpose over time to reflect current usage and standards. (TO26)
In parallel, we supported the HL7 Patient Care Workgroup, which continues work on several ongoing projects:
Adverse Events: The PC Workgroup collaborates with BRR to mature the Adverse Event resource. Current efforts focus on addressing FHIR trackers and building the model incrementally. This work continues despite lacking a commonly accepted domain description.
Care Plan Domain Analysis Model: This initiative updates the original model published in 2016. Challenges include domain size, complexity, and different conceptions of the care plan. These include its use as a tool for coordination, documentation, and automation.
Gravity Project: This is a joint initiative involving UCSF, RWJF, and others.
It aims to support social determinants of health through use case documentation and FHIR guidance. The project identifies key data elements and supports their implementation in health records.
Clinical Status Harmonization: The workgroup proposed harmonizing clinical status across C-CDA and FHIR. This work focuses on resolving divergence with the International Patient Summary (IPS).
WHITE PAPERS
We also produced white papers on "A Risk-Based Methodology for the Independent Validation and Verification of Healthcare Knowledge." Sharing clinical knowledge and person-specific information is an imperative for government agencies such as Veterans Health Administration (VHA) and Military Health Systems (MHS). Clinical Decision Support (CDS), is a process for enhancing health-related decisions and actions with pertinent clinical knowledge has been an important capability within health information technology systems. If we are to realize the bold evolution of interoperable CDS predicted for the next twenty-five years, there needs to be new tools continuously managed clinical knowledge, with critical attention paid to ensuring that informatics methods assess the quality of knowledge in decision making.
Today
Organizations like NASA and the US Department of Defense (DOD) make heavy use of Independent Verification and Validation (IV&V) techniques to improve the quality of systems and reduce the risks associated with the deployment of those systems. As the US Department of Veterans Administration (VA) moves to the outsourcing of their Electronic Health Record modernization (EHRM), IV&V will become increasingly valuable to VA as part of their project activities. As a result, there is a critical need for cost effective IV&V. The domain area of health informatics plays a vital role in validating and verifying the quality of the cognitive, information processing, and communication tasks provided for medical practice, education, and research, including the information science and the technology to support these tasks.
Health Informatics provides the perspective for medical education, research, and interoperability, and Enterprise Architecture (EA) provides the business, technology, and governance perspectives to help guide implementation, planning, and modernization. An Independent Verification & Validation (IV&V) delivers the objective evidence that assesses how modernization will improve veteran care through information, but also addresses business and organizational issues.
For example, laboratory systems can benefit greatly from data aggregation. This enables sharing of lab results with internal and external partners.
