The Current Process for VA Pharmacy Information

Systems Improvements and Enhancements

Lynn SandersVA Pharmacy Informatics Conference

April 2010

Idea Process to submit an idea RAEM and Class 3 Program Office Role

◦ Request for business owner support Approval, prioritization, funding Project Development Project Oversight and Governance The Next Big Thing

Today’s Discussion

Ideas Usually come from a medical center as a result of a Need

Needs come from an issue, such as a patient safety incident or a legislative review.

Once a need is identified – some one needs an idea.

It Starts with the Idea and Need

Ideas are developed in a number of ways At the medical center by a person or group that

designs something locally. In many cases this may simply be a tool used

locally such as a template or file man report In some cases the design is shared and its

believed that other medical centers might benefit.

Ideas may also come from outside VA, other hospitals and vendors

Ideas

There are a few ways that a idea for system improvements to be developed◦ New Service Requests◦ Class III Conversions◦ Innovations Program◦ Local Development

From Idea to Development

The Process to Have an Idea or Need

Developed

PBM Program Office Role

Request for Approval, Prioritization

Pharmacy Re-engineering New Service Requests Class III Development Innovations Local Development Incorporating Commercial Systems

Improving Pharmacy Systems

ESM AND THE RAEM PROCESS

The Enterprise Systems Management (ESM) Office is part of the Veterans Health Administration (VHA) Office of Health Information (OHI) within the Department of Veterans Affairs (VA).  The ESM Office serves as a VHA advocate and facilitator in the advancement of Information Technology (IT) and innovative health information strategies that improve the services provided to our nation’s Veterans.

The Office also serves as a liaison among clinical, business, and IT communities to ensure technology enhancements and strategy requirements are:

Identified Communicated Understood Prioritized Translated into IT investments that meet clinical, business, and

Veterans’ needs

Enterprise Systems Management Office (ESM)

Requirements Analysis & Engineering Management (RAEM) is part of the ESM organization of the VHA Office of Health Information (OHI)

Our primary goals are:• Gathers, documents, analyzes, and evaluates clinical and business requirements.• Analyzes and evaluates projects and programs designed to meet VHA clinical and

business requirements, including analysis of costs, benefits, return on investment, cost effectiveness and suitability for meeting the stated requirements.

• Interprets and assesses the impact of new or proposed Congressional legislation or Administration proposals on VHA user requirements.

• Provides business intelligence to support executive decision making during all stages of project and program planning, policy formulation, and decision making.

• Translates user requirements into functional requirements through coordination with technical resources, documents system Concepts of Operations, and defines requirements for VHA enterprise architecture and compliance.

• Facilitates collaboration among various teams to address process improvement.

VHA utilizes a rigorous, seven-phase process to evaluate NSRs:

Request Initiation Assessment of Request Analysis of Requirements Technical Assessment of Request Prioritization of Requests Approval of Concept Funding and Activation of Project.

New Service Requests

Initiation

New Service Request (NSR) Processing

ProjectActivation

Assessment

Analysis

Prioritization

Approval

Funding & Activation

Revised 6-23-09

Supported

ESM Office Screening and HISEB Review

Supported

Health Data Systems HISEB

Management & Financial Systems

HISEBRegistration , Enrollment &

Eligibility HISEB

Health Provider Systems HISEB

Key CustomerESM Office Decision Boards

(HISEB, IDMC)

Program

OED

Not SupportedIs there

management support?

End Request

Processing

FundingAvailable?

Approved but funding

unavailable

No

Yes

Informatics & Data Management Committee (IDMC)

National Leadership Board (NLB)

Under Secretary for Health (USH)

Not SupportedSupport ?

Filter 4

Not SupportedRanked

Assist Customer in Soliciting

Support

NSR Submitted

Customer Identification of IT Need

High Level Assessment

End Request

Processing

End Request

ProcessingMust Do

Technical Assessment

Joint Interoperability Ventures HISEB

Requirements Artifacts

Common Services HISEB

Requirements Gathering & Documentation

Signed Business Requirements

Software Solutions Assessment

Quad (with Technical Analysis)

Urgent / MandatedWork*

Customer Initiates Request● Customer identifies Information Technology (IT) need.● Customer submits New Service Request (NSR) to Enterprise Systems

Management (ESM) Office.● URL: http://vista.med.va.gov/pas/ITServiceRequest .htmESM Requirements Analysis and Engineering Management (RAEM) ● RAEM works with customer to secure endorsement from Program Office or

Veterans Integrated Service Network (VISN) and identifies business owner .● ESM may override the need for VISN or Program Office endorsement .

ESM/RAEM Team ● Communicates with Business Owner and Stakeholders .● Provides guidance to customer on completion of Customer Business

Justification (relates value to VHA’s strategic goals ).● Defines high-level business needs .● Assesses existing or current development initiatives .● Consults with the Office of Enterprise Development (OED), as appropriate .● VHA Office of Health Information (OHI) Health Data Informatics (HDI)

Patient Safety evaluates request for patient safety risks .● RAEM presents findings to ESM .● ESM presents findings to Health Information Systems Executive Boards

(HISEB).*Note: Requests immediately move into the Analysis Phase if Patient Safety , the ESM Office, or HISEB support a fast track or mandated status . All three groups are still required to review the NSR .

ESM Team ● Routine Analysis involves :

- Interaction with business owner , stakeholders and OI touch points to document a comprehensive set of high level business requirements .

- Solicitation of business owner sign -off of business requirements .- Collaboration with OED for security and infrastructure elements .- Identification of applicable ‘standing’ requirements such as identity management , 508 compliance , privacy, and security.

● Requests of high urgency or risk are handled through a fast -track process.

ESM/RAEM Team● Business Requirements Packet (Business Requirements Document , Draft

Quad Chart with business sections completed ) is shared with OED for technical assessment .

OED Team● Completes Quad Chart with technical analysis recommendations , which

includes estimated cost and duration of the project . It could also include a proposal for inclusion into an active project (change control ).

● Submits their findings to the ESM /OED Review Team for concurrence .ESM Team● Obtains concurrence from Business Owner .

ESM Team● Facilitates development of requirements artifacts .● Finalized artifact documents (business owner approved Business

Requirements Document , Customer Business Justification *, technical proposal from OED , and Quad Chart ) are shared with HISEBs .

● Work is evaluated against strategic goals and value to the organization .● HISEBs create two categories of work :

- Mission Critical Work.- Ranked List of Mission Requirements – A ranked list is developed

reflecting business priorities .

Decision Boards ● HISEB listings are presented to the IDMC .● IDMC may consult additional stakeholders such as the Health Services

Committee.● IDMC recommends funding prioritization to NLB .● NLB makes recommendations to USH .● USH makes final decisions for Veterans Health Administration (VHA)

priorities.

OED● Approved project is submitted to OED .● Project is created in the Technical Services Project Repository (TSPR).● Project is scheduled for activation in accordance with approved project

schedule .

Created By CR, PL, KF, & JM, Edited by DB/LBH /JH/JM v. 3.7

New Service Requests

Determine Program Office Level of Support for National Deployment

Class III Process TriggerNSR Flagged as Class III

After ESM/RAEM NSR Screening Call

Prod

uct

Sele

ctio

n

Workgroup Functional Review

Obtain Sign-Off for the Class III Summary Form

Ranking of Solutions by the Workgroup

Program Office Decision on Solution

Complete Class III Product Summary Form & Initiate

Function Point Count Activity

Initiate SSF, TAF and SRR

Output: Class III Product Summary Form and Customer Business Justification Tool supporting the product,Executive Decision Memo for NLB signature, Product PowerPoint to be used for IDMC presentation.

Multiple Solutions

Yes

No

Elicit Business Needs and Software Capabilities

Concurrent

Analysis

Input: Completed Class III Screening Call Record and Customer Business Justification supporting the product

Enter NSR Process at HISEB Prioritization

Class III Prioritized List, separate from NSR Prioritized List?

Requirements Analysis Subprocess 6.0 for Class III

Review Needed?

Yes

No

No Sign-Off – Rework Documentation

Sign-Off Obtained

EDM Preparation and HSC Review

After HISEB Filtering

If Class III NSR is PSI Mandate or Suggested Mandate

If Class III NSR is not mandated

Enterprise Systems Management Class III to Class I New Service Request Process (Analysis Phase)Version .11

Prioritization By VHAHSIEB, Patient Safety

Health Information Systems Executive Boards (HISEBs)

Five Health Information Systems Executive Boards (HISEBs) have been formed under the authority and guidance of the Informatics and Data Management Committee (IDMC). Each HISEB provides senior VHA management, leadership, and oversight to facilitate and advance the functionality and operation of an IT portfolio in the Office of Health Information.Responsibilities include:

· Ensuring that the portfolio meets current and future needs of VHA customers.

· Ensuring effective resource utilization. · Ensuring that the portfolios are managed in compliance with VA and VHA

plans, policies, standards, infrastructure and architecture. · Establishing project specific sub-groups. · Overseeing the performance, planning and execution of systems within

each portfolio to ensure successful development and operation throughout the system's lifecycle.

Health Provider SystemsHISEB Review Process

NSR # NAME ANALYST STATUS DATE

STATUS HISEB REVIEW

DATE

20080916 Appropriate Use of Hold Jevec 11/17/2008 PSI Mandate

20081114Canned Report for Outpatient Prescription Activity Jevec 1/13/2009

Suggested Mandate

20081115Report to Identify Patients Prescriptions for Recall Notices Jevec 1/13/2009

Suggested Mandate

20081123 Auxiliary Drug Information Enhancements Jevec 1/13/2009Suggested Mandate

20081124 Prescription Label Jevec 1/13/2009Suggested Mandate

20070707 Cardiology Domain – Cath Lab Integration Sklar 2/3/2009 Bypass Filter

20081118 Printing of Non VA Meds as Prescriptions Jevec 2/3/2009 Bypass Filter

20080409Comprehensive Risk Management Program Jevec 1/29/2009

Suggested Mandate

20081126 Customized Drug Information Jevec 2/17/2009 PSI Mandate

20081206

Change CPRS reports to include station address in header Lester 2/19/2009 Bypass Filter

Health Provider Systems Portfolio

Health Provider Systems (HPS) provides IT tools that support clinical care activities, both for direct care givers as well as ancillary service departments. Health Provider Systems are information systems that help healthcare providers care for Veterans by supplying information to main systems, such as VistA.

The HPS portfolio focuses on:• Electronic Healthcare Record (CPRS) • Clinical flow sheets • Laboratory, Pharmacy, Radiology, and Surgery departmental systems • Clinical Image Management services • The Enterprise Systems Managers (ESMs), in conjunction with the Health

Provider Systems Health Information Systems Executive Board (HISEB), will manage and oversee the HPS portfolio.

Health Provider Systems – Active Projects

BCE – Positive Patient IdentificationBlood Bank - VBECS v1.0 UpdatesBlood Bank Application MaintenanceBlood Bank SystemAnticoagulation Management ProgramMandatory Field in Consult Request Software “soonest appropriate date for this service to be provided”CLIO v1CPRS - Display Polytrauma MarkersCPRS GUI Development Version 28EDIS v1VistaWeb v11Radiology HL7 Interface UpdateRadiology Safety & Reporting Enhancements (previously known as Radiology Maintenance & Enhancements- Radiology)RAI/MDS MaintenanceBCMA - Inpatient Medications Requests for SFG IRA - Phase 3 and Phase 4FY 10 Annual Surgery UpdatesFY10 Pharmacy NDF Maint and Data UpdatesDocument and Ancillary ImagingFilmless Radiology (VHA will determine Leg. mandate)VistA Imaging CoreVistA Imaging StorageLaboratory System Reengeering Project (LSRP)FDA Medication Guides Updates - Just approved to activate, project in startupWard Drug Dispensing Equipment (WDDE) InterfacePharmacy Legacy QTR EnhancementsPharmacy Re-Engineering (PRE) .5National Teleradiology ProgramVA/DoD ImagingPaused – Blind Rehabilitation v5.1 (need to replace a contract lost in December)Paused – Spinal Cord Injury v3.0 (need to replace a contract lost in December)Paused - Mental Health Enhancements phase I (this defect repair effort requires two OI&T resources)

Teratogenic Drugs Supratherapeutic Dosages Allergy Checks using COTS CCHIT Transfer In/Out/NVA Order Checking Improvements Complex Order Edit

New Service Requests PBM is asked to Prioritize

Patient Safety Reviews of NSRsItem # Name Product Patient Safety Impact

39 Pharmacy Reengineering (PRE) 0.5

Pharmacy Reengineering

Necessary to reduce Adverse Drug Events (ADEs)

40 Pharmacy Reengineering (PRE) 1.0 (Critical Safety Features)

51 Bar Code Expansion Bar Code Expansion (BCE) Prevents “wrong patient events” due to

mislabeled laboratory specimens and biopsy samples...

62 Lab Reengineering Lab Reengineering Will reduce delays in diagnosis, support

bar-coded samples, and foster better sharing of diagnostic reports.

134 Intensive Care Unit (ICU) -Critical Care Information Systems (CCIS)

Other Health Provider Systems Eliminates “data silos” of critical patient

information within Intensive Care Units. 193 Tissue/Implant Registry Registries

Allows providers to quickly identify the specific implants for a patient and provide necessary clinical actions.. .

341NSR

20071102

Identity Management Identity Management

Ensures compliance to Identity Management data standards for enterprise access to patient data.

381 Oncology National Solution Oncology National Solution Standardizes and allows comprehensive

order entry of complicated chemotherapy protocols. .

Funding By VA ITSubsequent to Prioritization and Cost

Assessment

Sustainment Core Critical Patient Safety Transitional – T 13 Initiative Mission Critical Other Mission Critical Discretionary Mission Critical

What Drives Funding?

Funding PrioritizationDisplay

Line Number

Project/ Proposal Category T13

Initiative

VHA Initiative / Op Plan

Name

Offi ce/Business Sponsor

ESM

1 Austin Enrollment Support Sustainment Maintenance

CBO/Phillip Matkovsky, Tony

Guagliardo & Lynne Harbin

REE

2 HEC IT Enrollment Support Sustainment Maintenance

CBO/Phillip Matkovsky, Tony

Guagliardo & Lynne Harbin

REE

3 Home Telehealth Development

Sustainment Maintenance

PCS / Adam Darkins

HDS-DS

4 Health Data Repository (HDR) - Sustainment

Sustainment Maintenance

PCS/ Stanlie Daniels &

ROB/Gail Graham

HDS-DS

5 Blood Bank System Sustainment Maintenance

Blood Bank/William

Triest

HPS-JS

Occupational Health/Victoria

Davey

7 My HealtheVet - Sustainment

Sustainment Maintenance

PCS/Nichol, Paul & Dr. Agarwal,

OHI, CHIO/ Hancock, Theresa

HPS-SF

Sustainment

6 Occupational Health Record-Keeping System (OHRS) - Sustainment

Sustainment Maintenance

HPS-JS

Display Line

Number Project/ Proposal Category

T13 Initiative

VHA Initiative / Op Plan

Name

Offi ce/Business Sponsor

ESM

8 Positive Patient Identification (PPI) - also known as Bar Code Expansion (BCE)

Critical Patient Safety

BCRO/Chris Tucker

HPS-JS

9 Lab Data Sharing & Interoperability (LDSI) - Anatomic Pathology / Microbiology

Critical Patient Safety

Dependencies

PCS/William Triest

HDS-DE

10 Person Service Critical Patient Safety

Dependencies

OHI/ Gail Graham, &

Elizabeth Franchi

REE

11 Wireless Upgrade Critical Patient Safety

Dependencies

CS

12 Laboratory System Reengineering Project (LSRP)

Critical Patient Safety

PCS Diagnostic Services,

P&LMS/William Triest

HPS-JS

13 Pharmacy Reengineering (PRE) 0.5

Critical Patient Safety

PCS PBM/Michael Valentino

HPS-JS

14 Pharmacy Reengineering (PRE) 1.0

Critical Patient Safety

PCS PBM/Michael Valentino

HPS-JS

C33 FLITE VBMS Crit Pat Safety

VA INITIATIVES/PROGRAMS 2010

VA Initiatives / Programs (IT Priority Categories from Highest to Lowest)

IT $M (Non-Pay)

IT $M cumulative (Non-Pay)

Funding Cut Line

Sustainment of Existing Systems $1,368.1 $1,368.1 CH-33, FLITE, VLER, VBMS, Other High Priority $337.6 $1,705.7 Critical Patient Safety: Lab, Bar Code Expansion, Pharmacy, Others $197.3 $1,903.0

Core $438.5 $2,341.5 VA T-13 Initiatives $365.1 $2,706.7 $2.7B

Administration-Level T-13 / Op Plans $87.7 $2,794.3 Other VHA Mission Critical (OI&T Development Modernization & Enhancement) $280.0 $3,074.3

Discretionary Mission Work (VHA) $0.0 $3,074.3

Project DevelopmentExample of PRE as a Project

Pharmacy Re-engineering

FunctionalityProject Plan Before PMAS

Pharmacy Reengineering Project – Business CasePharmacy Reengineering Project – Business Case

Release Number

Business Capabilities Business Outcomes & Metrics

0.5 Improved Decision Support • Enhanced drug-drug check to provide more clinical information• Enhanced duplicate therapy check to utilize FDB Enhanced Therapeutic Classification which allows for multiple classes per drug• New maximum single dosage check• New Daily Dosage Range check• Ability to customize decision support data as required to meet VA needs • APIs to support order check enhancements• Integration of order checking services provided by a commercial drug database into support Legacy VistA order processing functions• Pre-Release patch for file mapping, setup and review to implement new dosage checks• Quick identification of discontinue/hold action type (e.g. discontinued due to edit)

1.0 Pharmacy Enterprise Product System (PEPS)(Replaces current National Drug File and Pharmacy Data Management modules)

• Display of lab/vital information for pharmacy staff to aid in professional review of medication orders.• NDF mismatched items would be eliminated•Implementation of dispensing limits (qty/days supply)• Enhanced Do Not Mail functionality.• Identification of Product Type and Storage Requirements • Identification of High Risk Drugs for Follow up• Increased frequency and streamlined distribution of drug database updates • Improved Drug and supporting pharmacy file maintenance tools• Manage pharmacy users/user roles functions (role based access and rules)• Improved parameter management

Business Value

Program Summary:The Pharmacy Reengineering (PRE) project will replace all pharmacy applications with a system that better meets the current and expected business

needs for the VA. This product will deliver enhanced order checking functionality utilizing HealtheVet (HeV) compatible architecture to the field with our first iteration addressing known patient safety issues. Other enhancements will include Dispense and Administration, Activate, Inventory, Clinical Monitoring,

and functions with final migration to the HeV environment.

Current Pharmacy functionality is not patient centric and does not include adequate decision support capabilities required for a modern healthcare system. Approximately 124 requests for system improvement have been referred to Pharmacy Reengineering and are deemed not feasible to be implemented in Legacy.

The Pharmacy Reengineering project will provide the ability to respond to the ever-changing patient safety issues, medication treatment cost reduction and containment, beneficiary service requests, and will provide the clinician with an improved work flow and process utilizing a scalable HDR/HealtheVet platform and

realization of One VA.

Justification:

Version Number: 1.0

PM Name: Mike Mims VHA Biz Rep:

VHA Biz Owner:Lynn SandersJeff Ramirez

Business Value Continued

Release Number

Business Capabilities Business Outcomes & Metrics

1.0 (cont.) Pharmacy Enterprise Product System (PEPS)

(Replaces current National Drug File and Pharmacy Data Management modules)

• Enhanced Reporting capabilities • Identification of Drugs Requiring Witness for Administration • Check for Lifetime Cumulative Dose• Check for IV compatibility

2.0 Inventory (Replaces current Controlled Substances, Drug Accountability, Automatic Replenishment/Ward Stock and Pharmacy Data Management (partial) applications

• Enhancements to PEPS Module to support new inventory module (and to finish up what was not done in the initial version)• Replacement of Legacy VistA PBM Inventory and drug data extractions• Ordering Capabilities (includes prime vendor interface)• Inventory accountability• Receiving/Shipping • Return/Recall Management• Reporting and Forecasting Usage• CS Discrepancy Tracking/Documentation• CS Wasting

Business Value Continued

Release Number

Business Capabilities Business Outcomes & Metrics

3.0 Order Entry, Activate, and Clinical Monitoring(Replaces Legacy VistA order entry/finishing modules in Outpatient Pharmacy, Inpatient Medications (UD & IV)Dispensing(Replaces Legacy VistA dispensing functions in Outpatient Pharmacy, Inpatient Medications and Pharmacy Benefits Management (partial) )Administration and Final Migration to HeV(Remaining legacy pharmacy modules retired)

• Enhancements to PEPS Modules to support order entry, activate order and clinical monitoring activities)• Enhancements to Inventory Module if needed• Enhanced Patient Counseling Functionality• Enhanced Intervention Module• Integrated Patient Medication Profile• Single/Guided order entry dialog for medications/supplies• Enhanced Order Actions (e.g. Hold, renew, etc) processing• Enhanced order entry of specialty orders (TPN, Oncology, PCA, complex orders, etc)• Enhanced order pending lists and processing• Medication Order Reconciliation upon Patient Movements• Improved transfer of orders• Creating/Review of Clinical Monitors Replacement of  Legacy VistA PBM dispensing data extraction Support for Barcode/RFID technology System Order Tracking Dispense Exception Tracking Electronic Fill Lists Real Time order tracking with CMOP Enhanced communication between CMOP and remote facilities Tracking of Lot numbers, NDCs and expiration dates with fill records Create/Manage preparation lists Enhanced Missing Dose Requests Enhanced Virtual Due List Display stability data for premixed sterile products Witnessing of Controlled Substances and High Risk Medications Improved medication administration documentation

PMAS is the rigorous management approach VA instituted to address IT development project performance shortcomings.  PMAS delivers smaller, more frequent releases of new functionality to customers, ensuring that customers, project staff, and vendors working on a project are aligned, accountable, and have access to all necessary resources to successfully complete the project’s goals and objectives. PMAS mandates that specific project resources and documentation be in place before development begins and mandates that approval processes be used during the system development life cycle. It also ensures that development projects are outcome-based by institutionalizing the use of standard, end-to-end repeatable processes.

What is the Project Management Accountability System (PMAS) and what role does it play in the IT projects that are being stopped or continued?

Support delivery (IOC) of PRE components in manageable increments not to exceed 6 months. 

Increments must provide functionality to business owners

Accelerate delivery of increments to field testing Reduce duration of lab testing processes Increase reliance on internal SQA and test

accounts at field sites for feature testing Beat schedule for FOC delivery outlined in

approved June 2009 schedule

Pharmacy Reengineering Plan/Progress PMAS Re-planning Objectives

Pharmacy Re-engineering Plan

After PMAS

PMAS Integrated Project Teams

PRE PMAS Integrated Program Team Agenda03/22/2010 (Monday)

10:00am EST (9 Central, 8 MTN, 7 Pacific)Call number (audio) 1-800-767-1750Access Code: 14063# 

Facilitator: Mike Mims Note Taker: Gina Scorca

Live Meeting Link: https://www.livemeeting.com/cc/vaoi/join?id=DM22SM&role=attend&pw=d%2B.s3ZFPRE Website link: http://vaww.itfo.portal.va.gov/svcs/itfopmo/pre05/default.aspxInvitees/Attendees * in attendance  T=Travel/Training  N=Not in attendance  L=Leave  E=Excused R=Sent a representative

Name Service Name Service

* Mike Mims Program Manager * Ed Heitman NTE&O* LuAnne Barron PBM * Robert Russo OGC* Michelle Ott EIE Project Manager * Elisa McReynolds Field Operations

N Marilyn Hodge Director, OED TS N Sarah Emerson Contract Representative

N John Lunden ETS * Laura Rowland Project Planner (OED TS)

* Michaele Mahoney National Support * Tom Grohowski OED TS* Lyn Teague National Support * Dan Soraoka* Jim Weaver Implementation Manager * Jeanne Brych Project Manager

N Angela Chow Implementation Manager N Cathy Harris ITALO

* Richard Muse Project Planner * Gina VeceN Karen Lebo ITALO * Jennifer Freese Development Manager* Cliff Sorenson NTE&O * Kristina Lew TAC Contract SpecialistN Sanders PBM * Arti Iyer SQA TestingN Craig Hunter Implementation Manager * Jim Pollard PRE Project Management* David Honeycutt Program Manager * Gina Scorca Technical Writer* William Whitaker Project Manager N Steve Nagy* David Lyles * Kendra Miller

3737

Pharmacy Reengineering Update (M. Mims)

PMAS/ Project DeliverableIncrement

#Planned Start Planned IOC

PRE Foundational Enhancements 1 10/09 12/09

Pharmacy Enterprise Customization System (PECS)

2 10/09 3/5

Order Checks Phase 1 (Non-Dosing) 3 10/09 6/10

Order Checks Phase 2 (Dosing) 4 10/09 6/10

Pharmacy Enterprise Customization System Enhancements

5 12/09 08/10

Enhanced Order Checks 6 07/10 12/10

COMPLETE

COMPLETE

3838

Pharmacy Reengineering Update (M. Mims)Status YELLOW Current PRE Status.

◦ IOC for PECS (Increment 2) completed 3/5/10 as scheduled.◦ National Hardware Solicitation bids received 3/12/2010. Reviews start 3/15/2010.◦ Setup of Beta sites for Increments 3 and 4 completed as scheduled by 3/15/10.◦ UAT for Increment 4 is planned for the week of 4/12/2010.

Issues◦ Existing SQA testing and Project Planner contracts supporting PRE expire on

3/31/10. If coverage in these areas is not maintained, PRE schedule may be impacted. Indications are that these contracts will not be renewed.

Pharmacy Legacy Quarterly Enhancements CPRS Inpatient Medication Orders BCMA BCRO Lab Re-engineering e-Pharmacy Claims

Other Major Projects

• SM enables Veterans and their healthcare teams to exchange non-urgent health-related information, attend to administrative needs, and in some cases communicate in lieu of an office visit or telephone call. SM is a patient-professional communication tool that enables: 1) patient-clinician communication management; 2) healthcare team management; 3) message management; and 4) patient services/clinical operations management. This e-health service, provided through MHV, is the authorized means for VA staff and patients to communicate electronically with one another.

•  • Expansion of virtual medicine for Veterans is a critical component

of the Veteran Centered Medical Home model transformation. SM through MHV is considered an essential element of the Veteran Centered Medical model enhancing virtual medicine activities and providing patients with access to the care they need in a manner they desire.

My HealtheVet Secure Messaging

BCRO Share Point SiteAccess and Management of Information

Innovations

GREENFIELD INNOVATIONS

Department of Veterans Affairs 1

Remote Cardiology Consultations Using Handheld Devices

Facility: DVA Medical Center

Initial Idea Submitted by: Edward Employee

Innovation Initiative

Local Development – Beating The System

Local Medical Center DevelopmentAlerts, Progress Notes, Reminders, Templates, Consults

Main Ordering Screen

Project Oversight and Governance

PBM, Patient Safety, ESM

Purpose The Business Relationship Meetings between

Under Secretary of Health and VA Chief Information Officer provide a forum for weekly status reports on various projects and activities.  The primary meeting activities are as follows:

•     The review and discussion of status of agenda items as determined by VHA

•     Discussion of various joint activities and projects between VHA and OI&T

•     Focus on development and operational issues

The Business Relationship MeetingVHA & VA IT

Approval of Project PhasesIssue Brief and Concurrence◦ ESM, VA IT, PBM, Patient SafetyAdvisories to Leadership and Medical CentersCompliance MonitoringReport of Contact for ProblemsWorkgroup Participation and Subject Matter

Experts with VA IT Project Leaders and Developers

Knowledge ExpertsTraining and EducationCommunications

PBM Clinical Informatics Role in the Development and Deployment of a Project

Issue:  Date of Report:  Point of Contact:  Desired Release Date:  Emergency Release:  Application Name(s):  Software Product

Description:  Patch Release Dependencies  STATEMENT OF ISSUE:  SUMMARY OF FACTS /

BACKGROUND: Impacts to Healthcare: Impacts to Business Flow: Solutions: CURRENT ACTIONS:  

SUMMARY OF TESTING:  Testing Process:  Peripheral devices affected:  Outstanding Issues:  Exceptions to Testing: Communications:  Proposed IOC Test Sites  IMPLEMENTATION ISSUES: Recommend Approval/ Do Not

Recommend Approval ECOMMENDATION: BASIS OF RECOMMENDATION AND

EFFECTS ON EXISTING PROGRAMS AND/OR FACILITIES:

 CONCURRENCES: VHA OHI IT Patient Safety: Recommend Approval/ Do Not

Recommend Approval/ No review required

Business Owners/Stakeholders Signature:

VHA Software Patch Issue Brief

PBM Tracks NSR Impacts on PRE

EntMgr RequestID PRE Version

Delayed Due to PRE

Request Name

NSR Phase

Request Date

Age in Days

BRD Signed Date (CYTD)

HPS-S 20100309

Signature Receipt for Prescriptions using iMedConsent

Assessment 3/15/2010

30

HPS-F 20100118

View alert for expiring Generic (text) orders

Assessment 1/25/2010

79

HPS-S 20100115PRE V2.0

BCMA-Comment I con on VDL

Assessment 1/22/2010

82

HPS-S 20100109PRE V2.0

View alert for abnormal microbiology (mi subscripted lab test) results

Assessment 1/14/2010

90

Compliance with NDF Patch Updates

SITES NOT INSTALLED BY COMPLIANCE DATE OF 4/13/2010

EL PASO, TX

HINES, IL 15-Apr-10

MANILA OC, PI

ORLANDO, FL 14-Apr-10

The Big PicturePrioritization and Funding for FY 2011

The first part of this plan lays the foundation to transform VHA’s culture to be more patient centered. Beginning in FY 2010, this effort will require a continuous investment over a number of years. Ultimately, it will require every employee, from the physician to the housekeeper, to redefine his or her role within this new context. The Universal Services Task Force laid a foundation for VHA’s new models of care. Their April 2009 report laid out twelve principles that will begin to define this new culture.   1. Honor the veteran’s expectations of safe, high quality, accessible care. 2. Enhance the quality of human interactions and therapeutic alliances. 3. Solicit and respect the veteran’s values, preferences, and needs. 4. Systematize the coordination, continuity, and integration of care. 5. Empower veterans through information and education. 6. Incorporate the nutritional, cultural and nurturing aspects of food. 7. Provide for physical comfort and pain management. 8. Ensure emotional and spiritual support. 9. Encourage involvement of family and friends. 10. Ensure that architectural layout and design are conducive to health and healing. 11. Introduce creative arts into the healing environment. 12. Support and sustain an engaged work force as key to providing veteran centered care.

T 13 Initiatives New Models of Care (12 Principles)

Specific VA goals for VLER are to: · Integrate VA with certified (NHIN-compliant and

authorized) community resources to enhance services to Veterans by aggregating data from VA, DOD, and the private sector

· Establish a consistent universal view of a client’s electronic record

· Become a recognized platform and leader in the nations transformation to higher quality, continuous care services supported by electronic records

· Enable a proactive, convenient, comprehensive, and secure method of access to other VA services and benefits

T -13Virtual Lifetime Electronic Record Project

OHI Organization

1

Health Care Information ManagementGail Graham

Deputy Chief Officer

Business OperationsBill Burrow (Acting)Deputy Chief Officer

Health SystemsChuck Hume (Acting)Deputy Chief Officer

Chief OfficerCraig B. Luigart

Administrative Services Budget & Finance Committee Liaison Office Communications Contracting Human Resources Service Coordination

Enterprise Systems Management (ESM) Chuck Hume – Director

Business Architecture Requirements Analysis &

Engineering Management Program Integration VHA IT Portfolio Management

VA/DoD Health Information Sharing (HIS)Cliff Freeman – Director

Administrative & Operations Support Bidirectional Health Information

Exchange Program Support Clinical/Health Data Repository

Program Office Liaison Health Information Network VAMC Interoperability Liaison

Education and Training IT Patient Safety Program Office

Data Quality Health Care Security Requirements Health Information Management Information Access & Privacy National Data Systems

Section 508 Compliance VACO Library VA Library Network VHA Forms, Pubs, & Records Mgmt

Chief Health Informatics Office (CHIO) Linda Fischetti – Director

Bar Code Resource Office Emerging Health Technology Office Health & Medical Informatics Office Standards & Interoperability Office Veterans and Consumers Health

Informatics Office

Marcia Insley – HDI Deputy Director

Health Data and Informatics (HDI)Vacant – Director

PBM Clinical Informatics Business Model