FEDERAL HEALTHCARE IT PROJECTS
We offer a range of terminology services:
- Terminology Authoring
- VHA's MED-RT Releases
- Updates to VistA reference terminologies for Allergies, Documents and Medications
- Add new terms to VistA
- Terminology matching to align terms to international standards
- Analysis of CHDR data between DoD and VA
We perform clinical data quality analysis and improvement services for the Veterans Health Information Exchange. The team examines incoming and outgoing data in the Joint DoD / VHA Health Information Exchange (JHIE). Next, they determine if data is being sent and interpreted accurately between the VHA and Oracle Health (Cerner Millennium), DoD, and community provider partners. Then we analyze data exchange problems and perform a root cause analysis. The team engages with external and internal data exchange partners to help rectify them.
We represent the VHA at international Standards Development Organizations (SDOs) such as HL7 and SNOMED International. Our presence at the HL7 work groups influences the development of data exchange standards. We report back to the client on work group activities and current ballot issues. Stemming from this these efforts, we contribute to international healthcare message standards for many workgroups. These include Patient Care, Structured Documents, Vocabulary, and FHIR.
Also, for the VHA API Developer Portal (VADP), for AMPL GUI standardization of APIs in HL7 FHIR to support interoperability.
Initially, at the very onset of the pandemic, J P Systems supported the definition of COVID-19 workflows. The VHA clinicians needed to rapidly standardize care processes across the VA enterprise with varying degrees of requirements for complexity. The VA’s Clinical Informatics and Data Management Office, CIDMO, in collaboration with the Emergency Management Coordination Cell (EMCC) and VHA health practitioners, have developed ten baseline COVID-19 clinical workflows. Consequently, these workflows established a baseline for COVID-19 patient care from patient outreach through discharge and follow-up. The clinical workflows include:
- High-Level End-to-End Patient Process
- Virtual Care Pre-Arrival
- In-Person Pre-Arrival
- Emergency Department
- Inpatient
- Intensive Care Unit (ICU)
- Outpatient
- Community Care
- Long Term Care
- Virtual Care Follow-Up
The clinical workflows identify requirements for health data standards and informatics tools including Clinical Decision Support tools and any gaps in current tools.
JPSYS also updated their Electronic Health Record (EHR) system’s terminologies to include diagnosis codes for this new disease.
We supported the Office of Communications and the VA Deputy of Social Media with COVID-19 videos, infographics, posts, and briefings. These social media campaigns kept both Veterans and clinicians informed on urgent and evolving public health concerns. We provided emergency communication support to the VA COVID-19 Rapid Response Communications Team during the height of the pandemic.
Our team helped produce over 250 videos for 362,000 VHA employees, promoting national campaigns such as mask-wearing. We also prepared responses to over 100 congressional inquiries and coordinated many executive appearances, including a TEDx Veterans Affairs speech. Products from our team appear daily on VA websites, with partner agencies, and in public communications across the organization. We drafted the forward for the COVID-19 Response Report, which the VHA EIC accepted without any requested changes.
Dr. Richard Stone highlighted our work in Save Every Life You Can, describing the videos’ powerful impact on leadership discussions. He wrote, "Videos would be quickly seen by more than 40,000 employees… and discussed in morning leadership stand-up meetings."
Supporting the accurate design, creation and firing of alerts, Clinical Decision Support (CDS) is a broad area of concern.
Across our projects, we provide Clinical Decision Support (CDS) so that VA’s EHR systems can provide clinicians with CDS functions and drug-drug interaction alerts. Many of these alerts are now made possible via CHDR, which shares prescription drug information with receiving pharmacy systems so that pharmacists and clinicians can more safely treat patients. Through our terminology mapping work, we have matched allergy reactants, allergy reactions, and medications to current data standards so that patient data can be made more readily available between EHR systems. By doing so, we have enabled cross-departmental CDS between DoD and VA.
We work to provide high quality standardized data for more reliable data for CDS systems. We also analyzed White Paper submissions and provided terminology and clinical feedback for CDS including Gastroenterology, Hepatitis C, Cardiology Cardiac Catheterization, Mental Health Homelessness, and Tobacco Assessment and Cessation.
In 2019, the Department of Veterans Affairs (VA) was questioning certain data variations in relation to EHR Modernization requirements from legacy VistA to Oracle Health (Cerner Millennium) and HealtheIntent. This project examined non-standard domains in legacy systems and other data sources to check for consistency of structure, content and format in preparation for the import of the data into Oracle Health. (TO26)
Here is the updated document from Jay as well: For the Lighthouse—VHA API Developer Platform (VADP)—we supported API developers in standardizing data access using HL7 FHIR. VADP, called Lighthouse, extracts data from a variety of data sources and delivers it via two APIs: the Patient Health API for patient consumption and the Clinical Health API for clinical use. We engaged in terminology mapping to align CDW extracts with HL7 FHIR standards. To support interoperability, we guided developers toward consensus on converting legacy VA healthcare data into HL7 FHIR format. J P Systems analyzed Clinical Data Warehouse (CDW), Virtual Patient Record (VPR), and other datasets, applying our HL7 FHIR knowledge to support this transformation. As a result, we provided detailed mappings and guidance to align VA data with relevant FHIR data elements.
Furthermore, both Lighthouse and VA.gov represent key components of the VA’s digital modernization strategy. In addition to data element and terminology maps, the team has crafted a set of design specifications that support repeatable processes for specifying critical infrastructure and metadata to support seamless data transfer. Drawing from private-sector and agency experience, including CMS’s Blue Button 2.0, we fostered a top-tier developer experience.
Currently, JP Systems personnel lead the FHIR Community of Practice and support the VA FHIR API developers and the Platform and Patient Health API documentation. Explore more here: VA Lighthouse API Program
https://news.va.gov/58726/lighthouse-veteran-centered-api-program-va/
Terminology Standards Support IDIQ
J P Systems secured 41 task orders under our first $100M single award IDIQ from the Veterans Administration. These task orders directly support CIDMO’s Knowledge Based Systems (KBS) group and the VHIE program office. Our team guides VA software teams in implementing Health Informatics practices and terminology standards. We also establish a common framework that enables functional and semantic interoperability of reusable health information. Our work covers nursing informatics, Clinical Decision Support, and Patient Safety systems. The following project summaries outline the major work streams we lead.
Study ON VHA DATA MANAGEMENT AND DATA GOVERNANCE
JPSys analyzed the VHA data acquisition process from Cerner (now Oracle Health). We made recommendations on the use of existing tools (CDW, VistA, Rockys) to improve the transfer of data. Additionally, the team wrote a substantial white paper on Data Management and Data Governance. The paper explained how the principles and framework of data governance are essential to developing a data management approach.
Furthermore, we analyzed the architecture of the legacy VA data governance framework and gave guidance and recommendations. This presented a more scalable solution for an enterprise asset that is accurate, usable and functional. Practical use cases and examples of applying the framework in a real-world setting were researched and provided. Also, we made recommendations specifically applicable to VA. We analyzed the landscape and interviewing top-level VA Subject Matter Experts to gain firsthand knowledge of current issues. The JPSys experts weighed the input received and delivered a solution on how to achieve operational access to the data.
FEDERAL HEALTHCARE IT PROJECTS
We offer a range of terminology services:
- Terminology Authoring
- VHA's MED-RT Releases
- Updates to VistA reference terminologies for Allergies, Documents and Medications
- Add new terms to VistA
- Terminology matching to align terms to international standards
- Analysis of CHDR data between DoD and VA
We perform clinical data quality analysis and improvement services for the Veterans Health Information Exchange. The team examines incoming and outgoing data in the Joint DoD / VHA Health Information Exchange (JHIE). Next, they determine if data is being sent and interpreted accurately between the VHA and Oracle Health (Cerner Millennium), DoD, and community provider partners. Then we analyze data exchange problems and perform a root cause analysis. The team engages with external and internal data exchange partners to help rectify them.
We represent the VHA at international Standards Development Organizations (SDOs) and Standards Related Organizations (SROs) such as HL7 and SNOMED Int'l, to influence development of data exchange standards and report on work group activities. We support many workgroups including Patient Care, Structured Documents, Vocabulary, CIMI and FHIR (TM).
Also for the VHA API Developer Portal (VADP), for AMPL GUI standardization of APIs in HL7 FHIR to support interoperability.
At the very onset of the pandemic, J P Systems supported the definition of COVID-19 workflows for the VHA clinicians as a rapid response effort to standardize care processes across the VA enterprise and its facilities with varying degrees of requirements for complexity. VA’s Clinical Informatics and Data Management Office, CIDMO, in collaboration with the Emergency Management Coordination Cell (EMCC) and Veterans Health Administration (VHA) health practitioners, have developed ten baseline COVID-19 clinical workflows. These workflows established a baseline for COVID-19 patient care from patient outreach through discharge and follow-up. The clinical workflows include: a high-level End-to-End Patient Process, Virtual Care Pre-Arrival, In-Person Pre-Arrival, Emergency Department, Inpatient, Intensive Care Unit (ICU), Outpatient, Community Care, Long Term Care, and Virtual Care Follow-Up. The clinical workflows identify requirements for health data standards and informatics tools including Clinical Decision Support tools and any gaps in current tools.
JPSYS also updated their Electronic Health Record (EHR) system’s terminologies to include diagnosis codes for this new disease.
We supported the Office of Communications and the VA Deputy of Social Media with COVID-19 videos, infographics, posts, and briefings. These social media campaigns kept both Veterans and clinicians informed on urgent and evolving public health concerns. We provided emergency communication support to the VA COVID-19 Rapid Response Communications Team during the height of the pandemic.
Our team helped produce over 250 videos for 362,000 VHA employees, promoting national campaigns such as mask-wearing. We also prepared responses to over 100 congressional inquiries and coordinated many executive appearances, including a TEDx Veterans Affairs speech. Products from our team appear daily on VA websites, with partner agencies, and in public communications across the organization. We drafted the forward for the COVID-19 Response Report, which the VHA EIC accepted without any requested changes.
Dr. Richard Stone highlighted our work in Save Every Life You Can, describing the videos’ powerful impact on leadership discussions. He wrote, "Videos would be quickly seen by more than 40,000 employees… and discussed in morning leadership stand-up meetings."
Supporting the accurate design, creation and firing of alerts, Clinical Decision Support (CDS) is a broad area of concern.
Across our projects, we provide Clinical Decision Support (CDS) so that VA’s EHR systems can provide clinicians with CDS functions and drug-drug interaction alerts. Many of these alerts are now made possible via CHDR, which shares prescription drug information with receiving pharmacy systems so that pharmacists and clinicians can more safely treat patients. Through our terminology mapping work, we have matched allergy reactants, allergy reactions, and medications to current data standards so that patient data can be made more readily available between EHR systems. By doing so, we have enabled cross-departmental CDS between DoD and VA.
We work to provide high quality standardized data for more reliable data for CDS systems. We also analyzed White Paper submissions and provided terminology and clinical feedback for CDS including Gastroenterology, Hepatitis C, Cardiology Cardiac Catheterization, Mental Health Homelessness, and Tobacco Assessment and Cessation.
In 2019, the Department of Veterans Affairs (VA) was questioning certain data variations in relation to EHR Modernization requirements from legacy VistA to Oracle Health (Cerner Millennium) and HealtheIntent. This project examined non-standard domains in legacy systems and other data sources to check for consistency of structure, content and format in preparation for the import of the data into Oracle Health. (TO26)
For the VHA API Developer Platform -(VADP) for AMPL GUI, we supported API developers in the standardization of data accessed by APIs through HL7 FHIR. VADP, formerly known as Lighthouse, is a project that extracts data from the VA Clinical Data Warehouse (CDW) and provides that data to application developers via APIs. Through terminology engagement, CDW data extracts can be matched to FHIR standards. J P Systems analyzed CDW and other data files and applied knowledge and expertise of HL7 FHIR standards. We provided matchings and guidance, describing how to align CDW data to relevant FHIR data elements.