ATTACHMENT I - VHA HISP - 2021_20210928.pdf

Veterans Health Administration

Health Information Strategic Plan

Fiscal Year 2022 – 2026

October 2021

Veterans Health Administration Health Information Strategic Plan i

TABLE OF CONTENTS

1 INTRODUCTION

1.1 Purpose

1.2 Veteran Benefits From VHA’s Health Information Technology

2 VHA STRATEGIC DRIVERS FOR THE FUTURE OF VHA HEALTHCARE

3 VHA HIT GOALS AND OBJECTIVES

3.1 HIT Goal 1

3.2 HIT Goal 2

3.3 HIT Goal 3

3.4 HIT Goal 4

4 SUMMARY

4.1 Future Vision from the Veteran Perspective

4.2 Future Vision from the Provider Perspective

APPENDIX A – VHA STRATEGIC DRIVER DESCRIPTIONS

APPENDIX B – ACRONYM GLOSSARY

ii

List of Figures

Figure 1 – VHA HISP Impact on Strategic Planning Figure 2 – VHA Strategic Drivers Influence the VHA HIT Strategy Figure 3 – Direct Relationship Between VHA and HIT Goals Figure 4 – Where VA Telehealth Occurs Figure 5 – Three HRO Pillars of Change

List of Tables

Table 1 – List of VHA Strategic Drivers https://dvagov.sharepoint.com/sites/VHAITSDadmin/ITSSC%20HP/Shared%20Documents/Health%20Information%20Strategic%20Plan%20(HISP)/FY22-26%20VHA%20HISP/VHA%20HISP%20-%202021.docx#_Toc83721188

1 INTRODUCTION

1.1 PURPOSE

The Veterans Health Administration (VHA) Health Information Strategic Plan (HISP) defines the strategic direction for health information technology (HIT) within VHA and informs information technology (IT) strategic planning and investment decisions to best meet VHA and Veteran needs. HIT enables VHA to capture and share clinical data and implement advanced clinical processes to realize improved clinical outcomes. The VHA HISP also informs the approach followed by the VHA Governance Board (GB) IT Committee (ITC) as it aligns and prioritizes VHA IT investments with VHA business strategies and leads development of business requirements for IT solutions. This enables VHA’s clinical and business leaders to articulate and meet strategic and tactical objectives. In turn, the VHA Office of Health Informatics (OHI) works with leaders, subject matter experts, and the IT governance community to define the interconnectivity and characteristics of the various IT programs that are required to achieve strategic objectives. VHA OHI also identifies interdependent business requirements to help ensure interoperable IT capabilities in support of workflows that transcend individual work units.

Although written as a separate document, the VHA HISP is best understood when taken in context with the overarching Department of Veterans Affairs (VA) Strategic Plan, Operations Plans for VHA Program Offices and Veterans Integrated Service Networks (VISNs), VHA Long Range Planning Framework, and VHA Modernization: Continuing the Journey 2021. It is designed to inform other strategic documents, such as the VA IT Strategic Plan and VA Enterprise Roadmap developed by the Office of Information and Technology (OIT), the Federal Health IT Strategic Plan and the VA/Department of Defense (DoD) Joint Strategic Plan. The VHA HISP also supports the Planning, Programming, Budgeting and Execution (PPBE) and VHA IT Governance processes. Figure 1 depicts the relationship between the VHA HISP and other strategic planning elements. Additional information on the VHA IT Governance process and mappings of the VHA HISP to other strategic plans are available in the VHA HISP Supplemental Information document.

The VHA HISP provides a characterization of the envisioned future state of the VHA HIT environment including near-term focus areas and long-term goals, derived from the overarching VA goals and objectives.

There are numerous strategic drivers that evolve over time and impact VHA’s HIT strategy and investments. The VHA HISP describes those drivers along with the four long-term HIT goals, and related objectives, that comprise the VHA HIT strategy.

Although VHA IT has matured in many areas, there are areas for improvement that will require a significant investment in both dollars and commitment to meet the future vision. The VHA HISP describes the future IT environment, including current IT initiatives and respective planning elements, to help VHA effectively align scarce resources with needs and support movement toward achieving the HIT goals.

VHA HISP oversight is the responsibility of the VHA GB ITC Health IT Strategy Sub-Committee (ITSSC).

Health ITSSC membership represents a cross section of VHA field operations, program offices, and OIT.

Figure 1 – VHA HISP Impact on Strategic Planning https://www.va.gov/oei/docs/VA2018-2024strategicPlan.PDF http://vhaindwebsim.v11.med.va.gov/hub2/eh/index.html http://vhaindwebsim.v11.med.va.gov/hub2/eh/index.html https://vaww.va.gov/VHACSO/docs/FY2020-2024_VHA_Long-Range_Planning_Framework_71420.pdf https://dvagov.sharepoint.com/sites/VACOVACOMPM/VHA%20Mod%20Documents/17.0%20VHA%20Plan%20for%20Modernization%20and%20Mod%201.0%20Campaign%20Plans/17.3%20VHA%20Continuing%20the%20Journey%20(2019)/Final%20Versions/VHA_Modernization_CTJ2021_11x17_Digital.pdf https://dvagov.sharepoint.com/sites/VACOVACOMPM/VHA%20Mod%20Documents/17.0%20VHA%20Plan%20for%20Modernization%20and%20Mod%201.0%20Campaign%20Plans/17.3%20VHA%20Continuing%20the%20Journey%20(2019)/Final%20Versions/VHA_Modernization_CTJ2021_11x17_Digital.pdf https://www.healthit.gov/topic/2020-2025-federal-health-it-strategic-plan https://dvagov.sharepoint.com/:b:/r/sites/VHABA/Active%20Documents/VHA%20HISP%20Supplemental%20Information.pdf?csf=1&web=1

1.2 VETERAN BENEFITS FROM VHA’S HEALTH INFORMATION TECHNOLOGY

The three vignettes below are examples of how HIT helps our Nation’s Veterans. The VHA HISP defines VHA’s goals for the enhancement and use of HIT.

When Tom first got out of the U.S. Army, he wasn’t sure how much of his medical history he would have to write down for the VHA. When he arrived for his first visit to VHA, Tom discovered that, not only did VHA have his complete medical record from his time in the service, but the doctor immediately had a refill for a prescription he had been taking. The doctor also saw a trend suggesting Tom might be on a path toward developing diabetes.

Since Tom lives in an area where there isn’t a local VA outpatient clinic, VHA sent Tom to a local physician for treatment (community care provider). The physician made notes in the electronic health record (EHR) system and Tom has periodic follow-ups with VHA providers. VHA providers have all those notes thanks to the Nationwide Health Information Network efforts. This integrated medical record from the DoD to VHA and community providers allows Tom and his doctors to manage his health and lower his long-term health risks.

When Mary retired after 22 years in the service, she and her family re-located to a rural area located 200 miles from the nearest VA Medical Center (VAMC).

Mary was faced with treacherous weather and dangerous driving conditions to see her provider in the Women’s Comprehensive Primary Care Clinic. As a result, she doubted that she would be able to seek care through VHA. After contacting her assigned Women Veterans Program Manager, Mary discovered that her provider would be able to “see” her at a VHA partner telehealth access station located only 20 minutes from her house at the local Walmart.

Mary had some doubts about using telehealth to “see” a provider; however, she decided to go for at least one appointment. After arriving at the telehealth access station, Mary was screened by her assigned station volunteer who walked her through what she could expect from the appointment. She then met with her provider via Total Exam equipment for her comprehensive physical. Mary was amazed that she was able to discuss her medical conditions with her provider as if they were in the same room together. The entire experience provided Mary with a great sense of relief knowing that she could receive comprehensive care without traveling extremely long distances. Mary now meets with her provider every few months through telehealth and is thrilled with the outstanding care she receives using modern technologies.

John suffered traumatic brain injury while serving in Operation Enduring Freedom. After receiving initial rehabilitation, he was allowed to return home outside of Lewiston, MT with his wife, Sally. Rather than constantly driving to the Fort Harrison (MT) VAMC for long-term rehabilitation, they use a tablet to identify available VA providers, initiate virtual care visits, and communicate with the patient care team. The built-in camera allows for face-to-face discussions with his therapists. The team sends visual and fine motor skill practice to the tablet and can monitor John’s long-term progress. Also, with a VHA outpatient clinic in Lewiston, seeing a physician in person is far more convenient, and the clinic has all the telemedicine facilities necessary to work with the Fort Harrison VAMC specialists. Sally wouldn’t be able to help John in his recovery without these tools. By being home, and Sally feeling empowered and capable, their marriage is more stable, and John doesn’t suffer increased stress over the possibility of losing his wife.

2 VHA STRATEGIC DRIVERS FOR THE FUTURE OF VHA HEALTHCARE

VHA conducts continuous environmental scans of the health information environment to identify strategic drivers that may influence VHA HIT strategy and help prioritize VHA IT investments. The environmental scans look for changes relative to the following categories:

1. Technology Trends – Expected HIT advancements with a potential to disrupt VHA business practices and processes and contribute to healthcare transformation through incorporation of emerging health best practices, security, and privacy enhancements, sharing clinical knowledge and workflows, and accommodation of clinical decision support (CDS) at the point of care.

2. Healthcare Industry Business Trends – The healthcare industry faces significant changes in the foreseeable future. VHA must adapt based on these changes to be able to function effectively as a key player in the healthcare industry.

3. Veteran Demographics and Needs – Demographic trends play an important role in the evolution of HIT in VHA. Predictive analyses of demographics, social factors, and specific healthcare requirements help identify evolving trends in VHA demographics. This allows VHA to anticipate the volume of care needed in certain specialties.

4. Laws, Regulations and Policies/Standards – As a government department, key legislative changes are expected to impact VA and the services it provides, including healthcare and related IT solutions.

5. VHA Performance Gaps/Improvement Opportunities – Areas where it is critical for VHA to improve its clinical or business performance, as identified through assessment of performance measures, product effectiveness analyses, external and internal inspection, Lean-based continuous improvement projects, and innovation efforts.

Figure 2 depicts the current VHA strategic drivers for each category. Additional details, including a description of the strategic driver and its possible impacts to VHA, are available in Appendix A.

Figure 2 – VHA Strategic Drivers Influence the VHA HIT Strategy

3 VHA HIT GOALS AND OBJECTIVES

The future VHA HIT environment will have the following characteristics:

• Advanced EHR capabilities (e.g., EHR Modernization (EHRM)/Cerner solution)

• Clinical decision support (CDS) that leverages Big Data, including Veteran genomic data and patient generated data from wearable devices and sensors

• Enterprise-wide data and information standardization

• Interoperability between VHA, DoD, and community providers

• Secure information exchange

• Efficient and cost-effective care delivery leveraging an array of innovative technologies to provide convenient access to care, including telehealth (i.e., virtual care) and mobile health services

• Operate as a High Reliability Organization (HRO), including the creation of a learning organization

• Value based and outcome driven

• Agile and able to meet the healthcare needs of a diverse Veteran population

This will facilitate lowering the overall cost of healthcare delivery, along with positive improvements in health outcomes and Veteran and provider experiences with VHA, as it redefines the boundaries of where, how, and when care is provided. Additionally, these enhancements will assist with attracting and retaining employees and encourage Veterans to make VHA their healthcare provider of choice, in line with the ChooseVA campaign.

Based on the mission, vision, and strategies of both VA and VHA, VHA developed four long-term goals to provide a roadmap to attaining the future HIT environment. In FY2021, the Health ITSSC collaborated with relevant stakeholders to refresh the VHA HIT Goals and ensure they reflect the revised VHA Long Range Plan goals developed by the VHA Chief Strategy Office in FY2020. The VHA HIT Goals directly align to the overarching VHA goals, as depicted in Figure 3.

Figure 3 – Direct Relationship Between VHA and HIT Goals

The HIT Goals are also reflective of the three priorities communicated by VHA leadership. A mapping showing the alignment of the HIT Goals to the VHA priorities is included in the VHA HISP Supplemental Information document. The priorities are:

1. Restoring trust in VHA by ensuring that when Veterans come to see us, we are delivering top-quality service and highly reliable care that improves Veterans' health and prevents harm.

2. Creating a learning organization in which science and informatics, Veteran-clinician partnerships, incentives, and culture are aligned to promote and enable continuous and real-time improvement in both the effectiveness and efficiency of care.

3. Modernizing VHA’s structure, culture, governance, and systems.1

The HIT Goals, and their related objectives, are described in the following sub-sections. The descriptions expound on current and/or planned VHA initiatives to attain the HIT Goals, as well as provide a glimpse of the desired future state for VHA HIT relative to each goal. Performance measures were also identified to track progress towards achieving the HIT Goals and Objectives.

3.1 HIT GOAL 1

Goal 1 Modernize VHA HIT capabilities to support Veterans in making VHA their provider and care coordinator of choice.

HIT Goal 1 focuses on optimizing access to healthcare services and information and providing Veterans with informed choices of where, how, when, and from whom they receive care. For VHA, this will involve expanding VHA’s care network to allow Veterans to receive care from a greater range of community providers, as well as providing alternate forms of access through telehealth (i.e., virtual care) and mobile care programs. Adoption of innovative healthcare technologies, such as mobile applications, wearable sensors, secure messaging, and online patient portals, will provide measurable benefits to Veterans and VHA personnel by providing timely and convenient access to health information and services, which will in turn improve quality, safety, and health outcomes.

3.1.1 Objective 1.1: Improve Veterans' access to healthcare services by expanding telehealth to alternative healthcare settings such as home-based and mobile or telehealth clinics at partner locations (e.g., community providers, commercial partners/Walmart, and Veteran Service Organizations).

VHA has and will continue to implement innovative IT practices to improve Veterans’ access to healthcare, such as telehealth and mobile clinics, to provide care to all Veterans when and where they need it.

Telehealth utilizes information and telecommunication technologies to provide healthcare services when the patient and practitioner are separated by geographical distance. In FY2020, VHA provided more than

5.6 million episodes of telehealth care across three modalities (home telehealth, clinical video telehealth, and store-and-forward telehealth) to over 1.6 million Veterans. 2 Many of these Veterans lived in rural areas and may otherwise have had limited access to VHA healthcare. Error! Reference source not found.

shows where various telehealth services are provided.

1 VHA Plan for Modernization, March 21, 2019, pg. 2.

2 VHA Office of Connected Care, VHA Connected Care Strategic Plan 2021-2025, pg. 2.

Performance Measures

Increase in the percentage of the Veteran population utilizing telehealth services and mobile health applications.

https://dvagov.sharepoint.com/:b:/r/sites/VHABA/Active%20Documents/VHA%20HISP%20Supplemental%20Information.pdf?csf=1&web=1 https://dvagov.sharepoint.com/:b:/r/sites/VHABA/Active%20Documents/VHA%20HISP%20Supplemental%20Information.pdf?csf=1&web=1 _Ref34825433 _Ref34825433

Figure 4 – Where VA Telehealth Occurs3

The use of telehealth and related technologies, including video conferencing at clinics or partner retail pharmacies (e.g., CVS and Walmart), store-and-forward imaging, and home telehealth devices (e.g., remote monitoring), aims to improve the health of Veterans by expanding clinical care beyond the traditional office visit, provides cutting-edge specialty care in sparsely populated areas, and improves coordination between Veterans and their care teams. This supports the concept of health equity by ensuring all Veterans have the opportunity to receive the same high-quality VHA healthcare no matter where they reside. Telehealth can also be used to provide care during national emergencies (e.g., natural disaster, pandemic, etc.). VHA is dedicated to providing the most up-to-date technologies to enhance patient experiences and will continue to optimize access to care via IT advancements in telehealth, mobile, or online healthcare services.

3.1.2 Objective 1.2: Leverage innovative solutions, including mobile applications, personal devices, and wearable sensors, to gather patient generated health data and provide secure, timely exchange of that data between Veterans and providers to inform care decisions.

In order to provide the best care to Veterans, VHA must leverage technologies that allow Veterans to actively engage in their healthcare and assist with exchanging reliable, up to date health information. This may include VA-developed mobile applications for smart phones or tablets and wearable sensors or healthcare monitoring devices (e.g., remote glucose or heart monitors) provided by VHA, as well as commercially developed mobile applications or devices (e.g., Fitbit and Apple Health). The goal is to seamlessly integrate with VHA systems to import patient-generated health data from any device into the electronic health record in a format that allows that data to support clinical care through monitoring and tracking, as well as to inform analysis and care decisions. Eventually, VHA providers will be able to prescribe these connected technologies to Veterans as part of their care plans.

These applications and devices will assist Veterans by providing self-care services to meet their personal health goals and the information gathered can be leveraged by their care team when developing care plans. For example, VHA will develop mobile applications that provide health care education and coaching specific to a Veteran’s healthcare needs or an automated text messaging program that can be tailored to interactively offer Veteran-specific recommendations. Through these options, Veterans will be able to manage their own health records, health data, and health recommendations within the context of their daily lives.4 Additionally, integration of patient generated health data into the electronic health record means VHA providers will be able to monitor specific metrics between visits and have accurate, real world data they can use to monitor effectiveness of treatments or inform diagnosis and/or care decisions to ultimately improve health outcomes.

3 Evans, Dr. Neil, VHA Office of Connected Care, Telehealth Strategic Vision briefing to ITSSC, August 24, 2021.

4 VHA Office of Connected Care, VHA Connected Care Strategic Plan 2021-2025, pg. 2.

3.1.3 Objective 1.3: Enhance patient portal capabilities to provide secure messaging, online scheduling, and availability of patient health records and care/medication instructions, to improve access to information and coordination between Veterans and their care teams.

VHA will continue to enhance online patient portal capabilities to provide an easy-to-use platform where Veterans can access their health information. Veterans will be able to view their health record, research preventive health recommendations, schedule appointments, request prescription refills, and securely message their providers. My HealtheVet is VA’s current online Personal Health Record for Veterans, active duty service members, their dependents, and caregivers, which provides some of these services. The goal is to build and expand on these capabilities to provide a cohesive experience that provides enriched resources and tools that Veterans can utilize at any time to be more informed and better engage in their care and wellness. For example, Veterans will be able to locate on-demand services like tele-urgent care and join telehealth appointments directly from the platform. Additionally, Veterans will be able to initiate communication with their care team 24/7 through secure messaging, text chat, or video session.

Through a single, easily accessible platform, Veterans will be able to navigate to the services and information they need and to enhance the personalization, engagement, convenience, and experience of accessing VHA healthcare services. A robust online patient portal enhances engagement and communication between Veterans and their providers, streamlines administrative tasks like registration and scheduling, provides greater focus on Veteran care, and improves clinical outcomes through encouraging Veteran compliance with clinical recommendations like referrals and prescriptions.

3.1.4 Objective 1.4: Integrate and harmonize VA’s public-facing web technologies to act as a single "digital front door" for accessing all VA-related services and to inspire communication and a sense of community among VA, Veterans, and their dependents.

VA previously initiated an effort to launch a revamped VA.gov website to serve as a unified portal for Veterans to access the full suite of VA services from all the administrations, including healthcare, benefits, and cemetery services. The main site acted as a hub to connect Veterans to the services and information they were seeking, while providing a seamless experience that minimized multiple logins and data entry redundancy. The “digital front door” takes this initial concept to the next level by further integrating access to VA’s services through implementation of a multi-channel engagement strategy.

The goal of the digital front door will be optimizing Veteran engagement at every major touchpoint in their journey by providing digital interactions leveraging technologies that Veterans have already adopted for everyday use. This means that Veterans will be able to interact with VA and its administrations using the communication channel that is convenient for them, whether it is a phone call, secure message, text chat, mobile application, website, or video session. From the VHA perspective, Veterans will have a single platform through which they can initiate communications to VA at any time; see their key health information; schedule or join their appointments; and securely message their providers.5 The focus will be on developing a common content management system and incorporating best practices to impose cross-agency governance of VA content and avoid duplication, conflict, and inconsistency to provide a common experience no matter what modality is utilized. This will make Veterans feel that VA is considerate of their time and preferences and is capable of meeting their needs, thus enhancing trust, and making VHA their provider of choice.

5 VHA Office of Connected Care, VHA Connected Care Strategic Plan 2021-2025, pg. 1.

3.2 HIT GOAL 2

Goal 2 Modernize VHA HIT capabilities to support delivery of comprehensive and integrated healthcare to Veterans providing transparency and value.

HIT Goal 2 focuses on providing comprehensive and integrated healthcare to Veterans that considers all factors relating to a Veteran’s well-being including healthcare, behavioral health, nutrition, environmental care, and spiritual care. This approach augments traditional clinical care by providing both complementary therapies (such as acupuncture, massage, and yoga) and self-care resources to help Veterans achieve complete, long-term wellness.6 VHA encourages and empowers Veterans to be active participants in their healthcare journey along with their families, caregivers, and other support systems to ensure integrated care and to improve health outcomes. VHA will achieve its mission of becoming the premier provider of choice for America’s Veterans through the delivery of timely and equitable quality healthcare regardless of where a Veteran resides or how a Veteran chooses to receive care. Helping Veterans build digital skills and employing devices (e.g., tablets and smartphones) that can be used and accessed easily, ensures Veterans are more actively involved in their healthcare journey and leads to improved health outcomes. Additionally, VHA established Integrated Clinical Communities (ICC), which are designed to create an enterprise-wide clinical framework that helps the exchange of best practice knowledge internally within the VHA.

3.2.1 Objective 2.1: Enable comprehensive, Veteran-centric healthcare through the implementation of VHA, DoD, and community provider integration and interoperability efforts (e.g., EHR interoperability, Veteran Health Information Exchange, and HL7 FHIR).

VA’s transformation into a high-performing, integrated delivery network (HPIDN) that focuses on the healthcare journey of each Veteran and a Veteran’s support system, will empower Veterans and establish partnerships to achieve their health and life goals. The HPIDN approach demonstrates VA’s commitment to safety and Veteran experience as well as to lifetime coordination and integration of healthcare delivery to our nation’s Veterans. VA and VHA have an extensive network of partners, allowing VA to expand care coverage to Veterans and innovate on virtual care delivery that helps to fast-track a shared journey to fully integrated and seamless access to care. Strategic partnerships increase access to care, broaden understanding of Veterans’ experiences, and facilitate the sharing of appropriate clinical and operational information for delivery of consistent, high-quality care to Veterans.

Veteran care is increasingly delivered across a broad and dynamic continuum and the ability for VHA to consume and share health information and knowledge, coordinate care processes, and conduct clinical quality management across tiers and institutions of care (e.g., community providers, research partners, etc.) is essential to ensure Veterans receive high-quality, comprehensive, and integrated care. To facilitate data sharing, VHA is implementing enterprise-wide data standardization that aligns with required and emerging health industry standards and best practices for the ethical use and sharing of clinical knowledge, clinical workflows, and Veteran data in a timely manner. The HPIDN model is Veteran-centric, founded in VA’s strategic priorities, incorporates industry best practices, and adopts new platforms and technologies to deliver the most effective healthcare for Veterans. The network maintains VA care at the forefront, with support from federal, academic, and community partners.

6 VHA Vision Plan, December 2020, pg. 4.

Performance Measures

Increase in the percentage of external providers with whom VHA can bi-directionally exchange health records/information.

VHA will leverage open data, transport, and other standards endorsed by the Office of the National Coordinator for Health IT (ONC) and adhere to key open architecture tenets, such as open transport formats (e.g., Health Level Seven (HL7) messaging), open interface specifications, and design patterns to enable open and scalable solutions. Additionally, VHA will adopt Fast Healthcare Interoperability Resources (FHIR) standards, which describe data formats and elements and is an Application Programming Interface (API) for exchanging EHRs. Care coordination, CDS, quality measurement, research, public health, and operational planning could all benefit from the adoption of national clinical data standards.

3.2.2 Objective 2.2: Enhance coordination, transparency, and continuity of care through collaborative partnerships and support systems to achieve integrated healthcare.

Community care remains a key component of VHA’s Veteran-centric healthcare delivery strategy. VHA has been delivering care through community providers for decades, but the programs have grown in number and complexity. The VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act consolidates VA’s community care programs into a new program that is easier to navigate for Veterans, community providers, and VA employees. Veterans who access community care can expect a familiar process with several improvements through a new urgent care benefit, expanded eligibility criteria, and improved quality of care. Community providers can expect their interaction with VA will get easier with new IT systems, better communications, and more timely payments.7 Additional information on community care efforts is available in the VHA HISP Supplemental Information document, and the latest updates related to the VA MISSION Act are available on the VA MISSION Act SharePoint site. The market assessments required by the MISSION Act are designed to ensure that VA’s infrastructure and resources are balanced to meet Veterans’ needs and will help VA align supply and demand of care to improve the access, timeliness, and quality of healthcare. The MISSION Act also directs VA to review the access standards defining when a Veteran can elect to receive community care every three years to ensure VA continues to meet Veteran needs. Additionally, research and education (e.g., academic) partnerships strive to directly improve the care that providers give to Veterans. The ability to work with and share research data with partners provides significant opportunities to improve both Veteran and public health.

3.2.3 Objective 2.3: Leverage predictive analytics, genomic and precision medicine, bioinformatics, and artificial intelligence/machine learning to analyze and interpret patient-specific data to inform clinical care decisions, improve health outcomes, and support reporting.

VHA must also implement innovative Veteran-centric healthcare techniques, such as the use of predictive analytics and the implementation of genomics to support precision (or personalized) medicine, into its HIT capabilities to inform clinical decision-making and improve Veteran health outcomes. Healthcare analytics provide immense value, improve quality of care, and offer a better patient experience through more personalized health care. VHA will leverage data, health informatics, and evidence to understand and improve outcomes. Additionally, VHA will pursue advanced healthcare research and analysis capabilities, with capacity to channel research-driven innovation into clinical or operational practices (e.g., integrating CDS into clinical processes), and share research information with external partners and the public. Shifts in how information is accessed and used by providers and Veterans present VHA with the opportunity to find new ways to improve the experience of Veterans and their families, building transparency and value into the services offered by VHA.

7 “MISSION Act 101,” VAntage Point Blog, February 11, 2019, https://www.blogs.va.gov/VAntage/56414/mission-act-101-how-the-law-will-improve-vas-ability-to-deliver-health-care-to-veterans/ https://dvagov.sharepoint.com/:b:/r/sites/VHABA/Active%20Documents/VHA%20HISP%20Supplemental%20Information.pdf?csf=1&web=1 https://vaww.vashare.vha.va.gov/sites/LIT/MISSION_Act/SitePages/Homepage.aspx https://vaww.vashare.vha.va.gov/sites/LIT/MISSION_Act/SitePages/Homepage.aspx https://www.blogs.va.gov/VAntage/56414/mission-act-101-how-the-law-will-improve-vas-ability-to-deliver-health-care-to-veterans/ https://www.blogs.va.gov/VAntage/56414/mission-act-101-how-the-law-will-improve-vas-ability-to-deliver-health-care-to-veterans/

3.3 HIT GOAL 3

Goal 3 Modernize VHA HIT capabilities to support and enhance innovation, making VHA a high-reliability learning and teaching organization.

HIT Goal 3 focuses on VHA modernizing its HIT capabilities to transform VHA into a High Reliability Organization (HRO). HROs experience fewer than anticipated accidents or events of harm, despite operating in highly complex, high-risk environments.8 Figure 5 depicts the three pillars of HRO change, and HIT should be used to better enable these changes:

leadership engagement and commitment, a culture of safety, and continuous process improvements.

Figure 5 – Three HRO Pillars of Change9

3.3.1 Objective 3.1: Implement performance measurement capabilities to monitor and drive a culture of quality and safety and provide an accessible mechanism for accurate reporting.

VHA’s HIT should enable VHA and community providers to provide a single standard of care and a common Veteran experience. Providers should be held to the same high standards no matter where they are and are expected to conform to all VA enterprise policies and procedures, specifically those related to safety and quality of care. To support this, VHA must implement IT capabilities that monitor and measure defined performance measures, for both VHA and community providers. The ability to accurately report on these defined performance measures in a timely manner, will provide the basis to monitor adherence to VHA quality and safety standards and initiate corrective actions when needed. HIT should enable root cause analysis to be performed, risks to be anticipated, and focus to be placed on front line staff and their care processes which will lead to learning, inquiring, and improving clinical and business operations.

8 VHA High Reliability Organization (HRO) Reference Guide, March 2021, Page 2, https://dvagov.sharepoint.com/sites/OHT-

PMO/high-reliability/Documents/VHA%20HRO%20Reference%20Guide.pdf 9 VHA High Reliability Organization (HRO) Reference Guide, March 2021, Page 6, https://dvagov.sharepoint.com/sites/OHT-

PMO/high-reliability/Documents/VHA%20HRO%20Reference%20Guide.pdf

Performance Measures

Decrease in the number of reported safety events causing harm.

https://dvagov.sharepoint.com/sites/OHT-PMO/high-reliability/Documents/VHA%20HRO%20Reference%20Guide.pdf https://dvagov.sharepoint.com/sites/OHT-PMO/high-reliability/Documents/VHA%20HRO%20Reference%20Guide.pdf https://dvagov.sharepoint.com/sites/OHT-PMO/high-reliability/Documents/VHA%20HRO%20Reference%20Guide.pdf https://dvagov.sharepoint.com/sites/OHT-PMO/high-reliability/Documents/VHA%20HRO%20Reference%20Guide.pdf

3.3.2 Objective 3.2: Enable Corporate and regional analytics that further our understanding of utilization, quality of care, and comparative effectiveness, and use that knowledge to support continuous healthcare improvement.

VHA will focus on the expansion of corporate and regional analytics to interpret data and report on a multitude of metrics including, but not limited to, utilization rates, quality of care, safety measures, response time, clinical outcomes, etc. Correlating this information from across the enterprise in a format that allows for comparison will allow VHA to identify areas of success and areas for further improvement.

For example, VHA has established regional and enterprise data governance boards and leverages them to gather IT-related needs to support enterprise and field-level reporting and analytics. The goal is to generate knowledge and best practices related to reporting, analytics, and business intelligence, and disseminate that information to healthcare providers and public health entities to inform clinical decision-making.

3.3.3 Objective 3.3: Adhere to VHA’s enterprise privacy, security, and identity management policies to mitigate the risk to data at rest or in transit to maintain trust with Veterans.

As VHA becomes more interoperable with internal and external organizations, and as Veterans are increasingly accessing and exchanging their health information through various modes of technology, this increases concerns and issues related to Veteran privacy and security of information. VHA needs to maintain trust with Veterans and employees by working to identify, document, and disseminate standardized and secure design interfaces and processes to access authoritative data.10 For example, VHA was bound by various laws and regulations that limit the type of sensitive clinical data (e.g., sickle cell, AIDS, etc.) that could be transferred to community providers. As a result, VHA had to attain consent from Veterans which was difficult and time consuming and led to a significant backlog in responding to health information requests. To make this process more efficient, the VA MISSION Act changes the consent process from “opt in” to “opt out” and VHA is investing in IT solutions to help automate the response process. This is an example of how HIT can support efforts that ultimately enhance VHA outcomes, services, and transparency, and provide value to Veterans.

3.3.4 Objective 3.4: Support information management and IT capability needs for healthcare research (e.g., registries, databases, and queries) to enhance both Veteran and public health.

VHA’s continued transformation into a learning organization, or Learning Health System (LHS), to provide exceptional service to Veterans and an engaging environment for employees is a must. A LHS is a system in which science, informatics, incentives, and culture are aligned for innovation, with best practices seamlessly embedded in the care process, Veterans and families are active participants in all elements, and new knowledge is captured as an integral by-product of the care experience.11 Information is central to the LHS concept. VHA’s HIT should enable integration and extraction of data from researchers, practitioners, Artificial Intelligence (AI)/Machine Learning (ML) devices, registries, and information within databases so that results from scientific research and best practices can be put into practice, both organizationally and clinically to enhance Veteran and public health.

10 Department of Veterans Affairs Office of Information and Technology Information Resource Management FY2020-2022 IT

(IRM) Strategic Plan, Page 14.

11 Friedman CP, Rubin JC, Sullivan KJ. Toward an Information Infrastructure for Global Health Improvement. IMIA Yearbook.

3.4 HIT GOAL 4

Goal 4 Modernize VHA HIT capabilities to support efficient and effective use of enterprise resources for Veterans and VHA employees.

HIT Goal 4 focuses on delivering transformation initiatives that enable VHA to realize efficiencies in clinical and business workflows; assessing and prioritizing capabilities to allow VHA to provide the highest quality of healthcare services where VHA is a recognized leader; and improving the Veteran’s digital experience through innovative approaches (e.g., clinical mobile applications, VA-issued or Veteran-owned devices for telehealth, Veteran portal via VA.gov) while protecting private health information to offer a wide array of connected services.

3.4.1 Objective 4.1: Optimize health information technology value to Veterans and VHA employees by enabling seamless systems modernization (e.g., EHRM, FMBT, Supply Chain, and Contact Center) that meet workflow and usability needs.

The EHRM effort to modernize the outdated EHR portion of Veterans Health Information Systems and Technology Architecture (VistA) to Cerner Millennium will continue to move forward to transition to an advanced, commercial-off-the-shelf (COTS) EHR solution. Until the VistA EHR system is fully phased out, VA will need to maintain two EHR systems simultaneously, as well as support IT capabilities such as the Computerized Patient Record System (CPRS). The Cerner EHR solution implementation will continue to impact the VHA organization from medical center sites all the way up to Central Office and will be a catalyst for fundamental change in the way VHA delivers Veteran-focused, provider friendly care.12

Operational change management and continuity of operations during change impacts will be informed by leadership from the VHA Office of the Functional Champion who serves as the voice of the clinical and business end user and provides a decision-making model to identify and mitigate negative impacts from system transformation changes encountered during the EHR implementation. 13 All VISN, VAMC, and Consolidated Patient Account Center leaders will also in turn supply appropriate subject matter expertise to support the Functional Champion team.14 Additionally, program-level governance forums between VA, DoD, and partner organizations should improve data interoperability, facilitate data-driven decisions among key stakeholders, and support a joint decision-making model to manage EHRM goals and objectives.

Concurrently, the VA is undertaking additional priority IT initiatives that will also significantly impact VHA operations and provide more efficient and interoperable systems: Financial Management Business Transformation (FMBT) and supply chain transformation. FMBT will replace the current financial management system with Integrated Financial Acquisition Management System (iFAMS), a COTS product, which will increase transparency, accuracy, timeliness, and reliability of financial information across VA.

For supply chain transformation, the Veterans Affairs Logistics Redesign (VALOR) Program Office will partner with the DoD to implement DoD’s Defense Medical Logistics Standard Support (DMLSS), and its

12 U.S. Department of Veterans Affairs, Office of Information and Technology. (January 2, 2020). FY 2018-2024 U.S. Department of Veterans Affairs Enterprise Roadmap Executive Summary [Internal document] 13 U.S. Department of Veterans Affairs, Veterans Health Administration. (April 23, 2021). Functional Champion and EHR

Implementation Focus Areas – Final Report [Internal document] 14 Ibid.

Performance Measures

Reduced cycle time to record information in an advanced EHR during care delivery and improved operational metrics on workflow stabilization.

Cloud-based successor LogiCole, to modernize the logistics system to enable streamlined processes and business efficiencies, regulatory compliance, and collaboration.

The Enterprise Contact Center Modernization will deliver an easy and more effective customer experience as Veterans interact with VA through all communication channels (e.g., voice, chat, text, video).15 Enterprise Contact Center Modernization involves consolidating the existing network of contact centers and implementing emerging technologies and common user interfaces.16 State-of-the-art IT capabilities such as these will help VHA attract and retain high-quality healthcare providers and compete with alternate healthcare systems at the local level to attract Veterans and improve the overarching reputation of VHA as a high-quality healthcare provider.

3.4.2 Objective 4.2: Support delivery of Veteran-centered care in VA facilities and among community partners by effectively managing resources through continuous improvements in health IT governance decision support and data management standards and processes.

As VHA HIT looks across all points of care including hospitals, clinics, and home and community-based care settings, a must-have for healthcare analytics is an interoperable framework for VHA healthcare systems and community partners. The robust HIT infrastructure today is made possible by a project-centric IT service delivery model covering multiple business portfolios delivering care and other services to Veterans.17 Future HIT investment strategy decisions will require continuous alignment on VHA IT policies and processes to manage new requirements, solution analysis and design, execution, and the capability to measure critical metrics against directives. VHA HIT includes systems, applications, and capabilities that enable the interoperability of Veteran data between non-VA providers and VA, as well as between VistA and the Cerner EHR to ensure Veterans’ EHRs remain current across providers.18 Additionally, continuous analysis and business intelligence on comprehensive data sets is being conducted in the areas of medical research, education, and population health to improve healthcare for all Veterans.19

Electronic health information management presents interoperability challenges for both technologists and informatics specialists to ensure that VHA remains an effective steward of Veteran data. Managing large amounts of data of different data types, with different sets of provenances and different data ownership/stewardship requirements, serves as an additional driver for medical research, education, and population health modernization.20 As VHA continues to implement the MISSION Act and transitions from VistA to the Cerner EHR over the next 10 years, it will be increasingly important to ensure that each Veteran’s EHR is up to date, complete, and not fragmented while multiple EHR systems are in operation at the same time.21 To manage the change impacts, the VA and DoD will apply a joint data ethics framework to leverage common strengths, identify an approach to manage unique data variation requirements, and integrate the data ethics framework into data steward processes.22

15 U.S. Department of Veterans Affairs, Office of Information and Technology. (March 31, 2020). Digital Transformation –

FY2020 – 2026 VA Enterprise Roadmap [Internal document] 16 Ibid.

17 U.S. Department of Veterans Affairs, Office of Information and Technology. (January 2, 2020). FY 2018-2024 U.S. Department of Veterans Affairs Enterprise Roadmap Executive Summary [Internal document] 18 Ibid.

19 U.S. Department of Veterans Affairs, Office of Information and Technology. (March 31, 2020). Digital Transformation –

FY2020 – 2026 VA Enterprise Roadmap [Internal document] 20 Ibid.

21 Ibid.

22 U.S. Department of Veterans Affairs and Department of Defense, Joint Executive Committee. (July, 2021). VA-DoD Joint Data and Analytics Strategy Plan of Action [Internal document]

3.4.3 Objective 4.3: Ensure that healthcare delivery to Veterans aligns with industry standards for digital connectivity and actively participate in the development of those standards.

Evolving healthcare technology delivery via the cloud as VHA moves forward will require greater demand for a uniform technology platform to minimize risks of exposure, and application credentialing to manage endpoints that may or may not reside on the network. For example, IT upgrades and further expansion in cloud computing during the pandemic allowed VHA to accommodate a significant spike in demand for telehealth support. Initiatives that continue to move toward a fully deployed hybrid cloud environment with improved wireless and mobile connectivity will expand opportunities to scale VHA HIT architecture.23 To better deliver Veterans choice in virtual care technologies and shape the development of future virtual care platforms, the VA Enterprise Cloud will represent a culmination of all mobile applications.24 Utilizing the VA Robotic Process Automation (RPA) Platform, there are many opportunities for digital assistants to improve the level of service for Veterans performing tasks such as appointment scheduling, eligibility determination to access services from local health care providers, and specialist referrals which include a review of pre-care requirements.25 AI-based RPA will become increasingly relevant to eliminating manual tasks in both the Veteran and customer service agent experience.26 AI and ML approaches should be utilized to discover customer patterns, predict or anticipate customer needs, and augment customer, employee, and customer service agent tasks.27

With the EHR implementation, collected patient data will automatically transfer to Veterans’ EHRs and subsequently support clinicians to more effectively measure Veteran response to care and treatment effectiveness while achieving data standardization.28 VA will also strive to empower Veterans with access to their own health record by implementing standards-based health data APIs that allow Veterans to access their joint VA/DoD record through a variety of approved third-party health applications.29 Efforts to increase patient understanding of data usage will need to include awareness-building of potential secondary uses of data, how to control and safely access electronic health information, and how to make informed decisions concerning consent for data exchange.30 To enable Veterans to be in control of their vital information, patient choice technologies should be employed for consent management to establish their participation in information exchanges and to dynamically maintain access and usage preferences.

As both legacy technologies and modernization initiatives are addressed across portfolios, the Federal Information Technology Acquisition Reform Act, the Data Center Optimization Initiative, and federal Cloud policies will guide standardization efforts.31 A multitude of technology advancements such as open APIs, SMART on FHIR applications, health information exchanges, partnering with digital and retail

23 U.S. Department of Veterans Affairs, Office of Information and Technology. (January 2, 2020). FY 2018-2024 U.S. Department

24 U.S. Department of Veterans Affairs, Office of Information and Technology. (March 31, 2020). Digital Transformation –

FY2020 – 2026 VA Enterprise Roadmap [Internal document] 25 U.S. Department of Veterans Affairs, Office of Information and Technology. (August 13, 2021). What is Robotic Process

Automation? DigitalVA.