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Health IT Strategic Framework

Attachment 2

Appendix A - Definitions (Health Resources and Services Administration)

  1. Medically Underserved Areas (MUA) may be a whole county or a group of contiguous counties, a group of county or civil divisions or a group of urban census tracts in which residents have a shortage of personal health services.

  2. Health Professional Shortage Areas (HPSAs) may have shortages of primary medical care, dental or mental health providers and may be urban or rural areas, population groups or medical or other public facilities.

  3. Medically Underserved Populations (MUPs) may include groups of persons who face economic, cultural or linguistic barriers to health care.


Appendix B - Target VA/DoD Standards Profile

Standards Relevant to Information Sharing

Category/Sub-category

Service Area

Standards

Information Standards

Message Format

 

 

 

Clinical Information Electronic Data Interchange (EDI)

HL7 v2.4 (XML encoding preferred)

 

Medical EDI

ANSI ASC X12N 270, 271, 276, 277, 278, 820, 834, 835, 837
FIPS Pub 161-2
NCPDP Telecommunication Standard Implementation Guide v5.1
HL7 v2.4 (XML encoding preferred)

 

Medical Still-Imagery EDI

DICOM v3.0
JPEG 2000

Data Representation Standards

Clinical Data Representation

 

 

 

Drug Codes

NDC

 

Lab and Clinical Observation Codes

LOINC

 

Mental Disorder Codes

DSM-IV

 

Multiaxial Medical Nomenclature

SNOMED, SNOMED-RT

 

Outpatient Procedure

CPT-4

 

Patient Diagnosis

ICD-9-CM

 

Dental Codes

CDT-4

 

Ancillary Services Reporting and Claims Processing

HCPCS

 

Revenue Codes and Workload Weights

RBRVS

Information Modeling and Metadata

 

 

 

Object and Data Modeling

FIPS Pub 184 (IDEF1X)
OMG UML v1.4
OMG XMI

Security Standards

 

Authentication

FIPS Pub 83, 112
IETF RFC 1510, 2138, 2289, 2402, 2633
ISO/IEC 7816 Parts 1-10
Open Group C311

 

Accountability

ISO/IEC 10164-8

 

Data Integrity and Non-repudiation

FIPS Pub 180-1, 186-2
IETF RFC 2246, 2402, 2406, 2633
IEEE 802.10
ITU-T X.509 (2000)/ISO/IEC 9594-8:2001
IETF RFC 2459

 

Confidentiality

FIPS Pub 46-3, 74 , 140-2 , 185, 186-2
IETF RFC 2420, 2559, 2633
ITU-T X.509 (2000)/ISO/IEC 9594-8:2001
IETF RFC 2459

 

Certification

ISO/IEC 15408
FIPS Pub 140-2

 

Security Management

ISO/IEC 10164-8

Technical Standards

Communications

 

 

 

Collaborative Communications

ITU-T.120, T.122, T.124, T.125

 

Directory Services

IETF RFC 1034, 1035 (DNS)
IETF RFC 1777 (LDAP)
ITU-T X.500

 

Internet Transport Services

IETF RFC 791, 793, 919, 922, 950, 959, 1112 (TCP/IP)
IETF RFC 2131 (DHCP)
IETF RFC 792 (ICMP)

 

File Transfer

IETF RFC 959, 2228 (FTP)

 

Electronic Mail

IETF RFC 821, 1869, 1870 (SMTP)

 

Video Teleconferencing

ITU-T H.221, H.230, H.242, H.243, H.244, H.261, H.263, H.320,
H.323, G.711, G.722, G.728, T.120, T.122, T.124, T.125

 

Wireless

IEEE 802.11a, 802.11b

 

Ethernet Standards

ISO/IEC 8802-3 (10-Base-T, Ethernet)
IEEE 802.3u (100-Base-T, Fast Ethernet)
IEEE 802.3ab (1000-Base-T, Gigabit Ethernet)

 

Object Management Services

OMG CORBA v2.3.1
W3C SOAP

 

Web File Sharing

IETF RFC 2616 (HTTP)
ANSI/ISO/IEC 9636 series (CGI)

Information Processing

 

 

 

Document Distribution Format

MS Word (.doc)
Portable Document Format (.PDF)
Rich Text Format (.rtf)

 

Data Management Services

ISO/IEC 9075-3

 

Graphics Data Interchange

GIF
JPEG File Interchange Format v1.02

 

Video Compression

ISO/IEC 11172-, 2, 3 (MPEG1)
ISO/IEC 13818 series (MPEG2)

 

Document Interchange

W3C HTML, XML

 

Graphics Services

ISO/IEC 8632-1, 3, 4 (CGM)


Appendix C - VA Collaborative Standards and Terminology Efforts

  1. VA & NLM Memorandum Of Understanding (MOU) - This MOU was put in place to establish a mechanism to support shared terminology-related services between the National Library of Medicine (NLM), National Institutes of Health (NIH) and VA.

  2. VA & NCI MOU - This MOU was put in place to support shared drug information and terminology-related services between the National Cancer Institute (NCI) and VA.

  3. VA & FDA MOU - National Drug File - This MOU was put in place to establish a formal collaboration between the Food and Drug Administration (FDA) and VA for the purpose of developing and implementing terminology standards for medication information.


Appendix D - VA/DOD Telehealth Technologies

Teleradiology: Ongoing local initiatives include:

  • Eisenhower Army Medical Center (Fort Gordon, GA) and the Augusta VA Medical Center.

  • Blanchfield Army Community Hospital (Fort Campbell, KY) and VA in Kentucky.

  • Moncrief Army Community Hospital (Ft. Jackson, SC) and the Columbia VAMC.

  • The "I-25 Corridor Working Group" has begun connecting together the US Air Force Academy Hospital, clinics at Air Force Bases (Buckley, Schriever, Peterson, Malmstrom, and FE Warren), Evan Army Hospital (Fort Carson, CO) with VA clinics in La Junta and Pueblo CO, and VA Medical Centers in Denver CO and Cheyenne WY. This connection will enable the exchange of digital radiographs and MRIs. Denver VA Medical Center and US Air Force Academy have already starting exchanging images.

  • Sacramento VAMC sends Emergency Room after-hours and weekend x-ray and CT images to Travis AFB's David Grant Medical Center over a point-to-point T1 line using dynamic compression technology. Radiology residents at DGMC make preliminary review and fax results back to VA. Final interpretations and dictations are performed by VA radiologists. This helps maintain workload requirements for Travis radiology residency program and improves quality of life for understaffed VAMC radiologists who have limited on-call responsibilities.

Telepsychiatry: Weed Army Community Hospital (Ft. Irwin, CA) is working with the Los Angeles VA Regional Office to establish a VA/DoD sharing agreement to perform Compensation and Pension examinations, utilizing telemedicine for psychiatric examinations on persons separating/retiring at Fort Irwin who require such evaluation.

Hawaii Integrated Federal Health Care Partnership: The Pacific Telehealth and Technology Hui was established in 1999 as a joint partnership of the VA Medical and Regional Office Center in Honolulu and Tripler Army Medical Center to manage joint Telehealth projects involving research, development, prototype, evaluation and technology transfer. Some of these efforts include two projects developed under a joint initiative with the Joslin Diabetes Center, one of the world's leading research centers for diabetes.

  • The first project, the Joslin Vision Network (JVN), provides a platform for assessing the severity of diabetic retinopathy using a highly sophisticated digital camera to capture and transmit an image of the retina to a reading station for remote evaluation.

  • The second, the joint Hui-Joslin initiative, called the Holopono program, demonstrates the use of Internet technology to manage follow-up care for patients with diabetes.

Alaska Federal Health Care Access Network: This initiative of the Alaska Federal Health Care Partnership is comprised of DoD, VA, Indian Health Service (IHS), the US Coast Guard and other state and Federal agencies. Its goal is to use new telecommunications and telemedicine technology to extend and improve access to health care service and information for over 200,000 Federal beneficiaries, especially Indian Health beneficiaries in remote areas. The project has linked 235 Federal and state health care sites into a statewide telemedicine system. Using state-of-the-art technology and equipment, member organizations have begun to send medical images, health information, and voice data to regional hospitals for remote diagnosis and consulting.

Case Management (Diabetes): The Joslin Vision Network (JVN) is a telemedicine application focused on increasing access of diabetic patients into appropriate eye care and represents a collaborative effort between DoD, VA, and Joslin Diabetes Center in Boston. The original proof-of-concept JVN system has evolved into a second-generation system using non-proprietary Microsoft hardware and software, which leverages the established Patient Archiving and Communications System infrastructure and implements the Comprehensive Diabetes Management Program proposed in the Chronic Care Model developed by Edward Wagner, M.D. Its six components are: (1) Coordination with community resources; (2) Strategic commitment of the organization; (3) Support of patient self-management; (4) Redesign of delivery system; (5) Clinical decision support; and (6) Clinical information systems. The JVN eye care system:

  • Is currently deployed in 32 active remote imaging sites, with six established and certified reading centers distributed across ten different states, from Hawaii to New England;

  • Represents participating sites associated with the DoD, Veterans Health Affairs and the Indian Health Service;

  • Has allowed access to over 12,000 patients into the JVN eye care system since September 2001;

  • JVN CDMP application is currently live at the Joslin Diabetes Center and Walter Reed Army Medical Center; and

  • Provides significant opportunity, when leveraged with deployed teleconsultation systems, to realize substantial cost savings for treating chronic disease.

e-Learning: The Adult Nurse Practitioner Post Master's Program is a collaborative effort between VA and the Graduate School of School of Nursing, Uniformed Services University for the Health Sciences (USUHS), which provides a Nurse Practitioner Distance Learning educational curriculum for VA and DoD nurses. It demonstrated that students and teachers, separated by geographic distance, can participate fully in an effective and meaningful educational process using electronic technology for communication. To date 70 individuals have graduated; the last class in May 2004. This Fall USUHS will enable distance learning in support of the doctoral Nursing Science program for DoD and VA nurses. USUHS is also in the process of building a distance learning component to their Master's in Public Health program that could be utilized by DoD and VA providers.


Appendix E - Examples of VA Public Domain Technology Tranfers

  1. District of Columbia Government - Implementation of VistA in all DC Department of Health clinics over time. There are presently three locations that are fully implemented.

  2. Indian Health Service - Implementation of VistA Imaging and CPRS in Indian Health Service. This work also includes the convergence of two systems including: Women's Health; Mental Health; Patient Billing; and CPRS & Health Summaries.

  3. American Samoa - Implementation of VistA in Samoa LBJ Tropical Medicine Hospital.

  4. State Government Health Departments - Ongoing exploration and/or implementation of VistA/CPRS in state government health departments such as Washington, West Virginia, Los Angeles County, North Carolina, Rhode Island, and Texas.

  5. Association of American Medical Colleges (AAMC)/Affiliated Medical Schools - On-going agreement with the AAMC and affiliated medical schools to form a working group and select initial pilot sites to explore use of VistA systems.


Appendix F - Examples of VA Data Eechange Initiatives

  1. VHA & HHS Data Exchange - Currently pilot testing the capability to extract VistA data maintained at the national Austin Automation Center to be fed into various public health databases and/or biosurveillance systems maintained by HHS, Centers for Disease Control (CDC), and State Health Departments, e.g. Bioterrorism/ National Electronic Disease Surveillance System.

  2. Santa Barbara Care Data Exchange Pilot - Preparing to pilot test the exchange of patient data between the VA Outpatient Clinic and a number of other partnering public and private sector health care organizations in Santa Barbara County, in collaboration with the California HealthCare Foundation and CareScience.

  3. Community Patient Data Exchange Networks - Exploring and collaborating with other patient data exchange systems in local communities around the country including:

    • Mesa County (California) Care Data Exchange;

    • Patient Safety Institute - Delaware & Puget Sound pilot tests; and

    • Indianapolis (Regenstrief) Patient Data Exchange.

  4. VA and Center for Disease Control (CDC) - The Department of Homeland Security designated CDC as the lead agency in March of 2004. VA has worked with CDC to identify a dataset electronically available within its clinical information systems to support syndromic analysis. To date, VA is the only multiple site health care organization (government or private sector) to successfully transfer data to the CDCs Bio-Sense database on a continual basis. VA provided a two-year historical data load for CDC to analyze and develop threshold algorithms, and since August 2003, has provided nightly uploads of previous daily activity from each medical center (170 hospitals and 1300+ clinics).


Last revised: July 29, 2004

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