VA118-17-R-2324-004.pdf

Office of Informatics and Information Governance Strategic Investment Management Requirements Development and Management

VA EHRM Functional Requirements i August 2017

VA Electronic Health Record Modernization (EHRM) Functional Requirements

Business Requirements Report

August 2017

VA EHRM Functional Requirements ii August 2017

Table of Contents

1. Manage Appointments Across All Care Settings

2. Provide Patient Assessments

3. Provide Patient Screening

4. Manage Patient Referrals

5. Provide Patient Tracking

6. Manage Admission, Discharge, and Transfer

7. Manage Orders

8. Manage Consults

9. Capture Informed Consent

10. Provide Treatment

11. Provide Laboratory and Pathology Services

12. Provide Dental Care Services

13. Provide Mental Health Services

14. Provide Radiology and Nuclear Medicine Services

15. Provide Pharmacy Services

16. Provide Emergency Health Care

17. Provide Homeless Veterans Access to Health Care

18. Provide Social Work Services

19. Manage Clinical Documentation

20. Provide Care Coordination

21. Provide Care Management

22. Provide Team-Based Care

23. Manage Remote Care

24. Manage Extended Care

25. Manage Medication Administration

26. Provide Clinical Decision Support

27. Provide Patient Care Education

28. Patient Self-Management of Health Information

29. Provide Blood Services

30. Provide Positive Patient Identification (Bar Code Management) 16

31. Manage Data

VA EHRM Functional Requirements iii August 2017

32. Provide Information Security (HIPAA, Privacy, etc.)

33. Outcome Monitoring and Quality Improvement Activities

34. Provide Enterprise Reporting

35. Manage Health Care Resources

36. Manage Clinical Occupational Health

37. Facilitate Patient Safety Activities

38. Manage Public Health (Population Health Surveillance/Registries, etc.)

39. Conduct Health Care Research, Education, and Innovation

40. Perform Inventory Management/Supply Chain Operations

41. Manage Revenue Operations

42. Determine Eligibility

43. Perform Enrollment

44. Determine Allowable Services

45. Communicate Process Appeal and/or Notice of Disagreement .. 24

46. Provide Compensation & Pension Services

47. Manage Credentialing and Privileging of Providers

48. Manage Community Care (Non-VA)

49. Enterprise Services

50. Non-Functional Requirements

Appendix A: Glossary of Terms

Appendix B: References

VA EHRM Functional Requirements 1 August 2017

1. Manage Appointments Across All Care Settings Provides for the scheduling, cancelling, coordinating, and viewing of face-to-face and telehealth appointments. This may include initial and follow-up appointments and all consultations or referrals as required for comprehensive and seamless care. It also includes managing and monitoring patients on the Electronic Wait List to ensure they receive care based on established guidelines. Another business activity included is patient check-in for appointment, which precedes delivery of care by identifying the patient and staging the patient for an encounter with a provider.

a. Includes the ability to manage scheduling for Department of Veterans Affairs (VA) Outpatient Services while also accounting for appointment wait times

b. Includes the ability to manage scheduling for VA Inpatient care and services

c. Includes the ability to manage scheduling for other VA services such as Vet Centers

d. Includes procedural-based scheduling notating procedure(s), prerequisite orders/labs, imaging, advanced imaging, necessary supplies, and implantable devices in addition to regular encounter requirements

e. Includes the ability to schedule and track dental appointments using the enterprise scheduling solution linking all medical appointments, pending consults, and appointment requests to coordinate scheduling of the Veteran

f. Includes the ability to find patient in system by name, unique identifier (e.g., integration control number [ICN] or data file number [DFN]), date of birth, team, ward, appointment, pending consults, or other search criteria

g. Includes the ability to manage the scheduling of patient activities and procedure-specific equipment and supplies including case cart preparation from all locations within the Electronic Health Record (EHR) and capture/preserve original and revised timestamps (e.g., to inform clinic wait times)

h. Includes the ability for all scheduling activities to automatically become part of the medical record system

i. Includes the ability to manage Scheduling System Business Operations to facilitate administrative oversight and reporting

j. Includes scheduling for Community Care Appointment Management (includes Eligibility, Referrals), and Authorization Management (Payer Management)

k. Includes the ability to schedule compensation and pension and disability evaluation examinations

l. Includes the ability to integrate identity of the primary provider/team (primary care or mental health) appropriately in the appointing process

2. Provide Patient Assessments Includes conducting an assessment to analyze problem(s) that the patient is presenting or the provider uncovers during the encounter. The assessment considers the age, gender, self-identified gender identity (SIGI), military history (including Military Occupation Specialties [MOS]), functional status, medical and behavioral condition of the patient, such as social determinants of health, caregiver status, and disease specific assessments.

VA EHRM Functional Requirements 2 August 2017

a. Includes support for patient care assessment accessible within clinical workflows, using standardized tools /instruments and clinical results/patient data and demographics as specific considerations for directing completion of assessments

b. Includes pre-procedure assessments customizable by exam type and modality for all services

c. Includes admission assessments customizable by exam type and modality for all applicable services (e.g., Visual Impairment Services Team (VIST) screen for Blind Rehab admission)

d. Includes the ability to replicate/extract assessment data downstream into other assessments, reporting, or other uses in the EHR

e. Includes access/integration of results of assessments completed in stand-alone systems (Resident Assessment Instrument/Minimum Data Set [RAI/MDS], Outcome and Assessment Information Set [OASIS]), Care Management Tracking and Reporting Application (CMTRA), State prescription drug monitoring programs

3. Provide Patient Screening Involves the ability to conduct screening activities to analyze problem(s) that the patient is at risk for presenting with, recommended to receive based on demographic or other factors, or which the provider uncovers during the episode of care. Examples include but are not limited to preventive screenings, clinical reminders, suicide risk screening, eye health screening, and mammography.

a. Includes managing patient screenings when they present for care (e.g., targeted user, timeframe for occurrence/reoccurrence, resolution, etc.)

b. Includes performing screenings using standardized pre-formatted questionnaires for routine or primary care (e.g., Weight Management, Tobacco screening and cessation), specialty services or high risk events mandated by VA policy (e.g., suicide risk screening, Intimate Partner Violence, Military Sexual Trauma)

c. Includes ability to manage interdisciplinary care patient screenings

d. Includes verifying/reviewing relevant referral/patient information at the time of screening

e. Includes utilizing standardized tools/checklists to facilitate patient, family and caregiver discussions for pre discharge and discharge planning

f. Includes the ability to provide guidance based on screening results to the correct service of care with recommendations for treatment

g. Includes an alert system for clusters and trends outside of recommended treatment thresholds identified by the assessment

h. Includes the ability to determine if screenings have already been performed at other

VA facilities (depending on policy) and include those findings in the current visit

4. Manage Patient Referrals Involves managing patient referrals across all care settings. It addresses enabling the origination, the documentation and tracking of referrals between care providers, home care agencies, hospice agencies, or healthcare organizations, including clinical and administrative details of the referral, and the consents and authorizations for disclosures as required.

VA EHRM Functional Requirements 3 August 2017

a. Includes managing all referrals for internal and external providers (Non-VA and Department of Defense [DoD]) as well as multiple pathways to access services

b. Includes the ability for a VA user to send information to a community provider with standardized format and language consistent with specialty specific requirements if applicable

c. Manage referrals from the Veterans Crisis Line to refer a caller to a facility suicide prevention coordinate and capture a note of the referral process

5. Provide Patient Tracking Includes following a patient’s progress through the continuum of care to ensure the patient is receiving all necessary screening, treatment, and follow-up while receiving care. Includes the activities to maintain an up-to-date account of the location of a patient within or between medical treatment facilities whether VA, DoD, or Non-VA clinical settings.

a. Includes the ability to track ongoing progress of patient through all phases of care for all services, including ancillary

b. Includes determining patient progress when undergoing procedures/tests

c. Includes determining patient and staff physical locations throughout a healthcare facility through alerts, tracking boards, and real-time locator systems

d. Includes the ability to track medical devices and instruments

e. Includes the ability to document patient visit including coding, consult completion

6. Manage Admission, Discharge, and Transfer Includes activities required to assume the responsibility of a patient's whereabouts while receiving inpatient treatment. Admit Patient represents the activities that allow a patient to occupy a bed, to receive treatment and be monitored by clinical staff. It also includes documenting a patient’s acceptance into a medical facility for receiving treatment. Discharge Patient includes the process activities for releasing a patient from a medical facility after treatment is completed. Transfer includes the process and activities for moving a patient from one medical facility to another medical facility (VA, DoD, or non-VA) and/or within a medical center from one level of care to another.

a. Includes capturing and reconciling comprehensive documentation/communication/tracking information for all Admission, Discharge, and Transfer (ADT) activity

b. Includes electronic exchange of information to facilitate admission, discharge and transfer of care (e.g., patient transfers to another location within the hospital, to Community Living Center [CLC], another VA hospital, or an outside hospital)

c. Includes analyzing, controlling, and optimizing bed management activities

d. Includes the ability for patients to register themselves, including remote registration

e. Includes communication back to the care team about patient’s

Admission/Discharge/Transfer status

VA EHRM Functional Requirements 4 August 2017

7. Manage Orders Supports enterprise-wide ordering functionality for all types of orders across the care setting to support inpatient, outpatient, and prescription scenarios. Supports order portability across VA, Non-VA and DoD entities. Examples include, but are not limited to, nutrition and food service, medications, laboratory, nursing, radiology, consult and referral orders, prosthetics, etc.

a. Includes the ability to manage orders from VA staff and community partners as needed for medications, consults, procedures, supplies, labs tests, Social Work and Nursing by role, etc.

b. Includes support for ordering and acquiring dental images to review with ability to document image findings in a structured format

c. Includes the ability to manage standardized order sets across the enterprise and complex order sets

d. Includes Clinical Decision Support and medication order checking at order entry

e. Includes the ability to write orders that will not become active until after a specified event occurs (delayed orders) for ADT (e.g., transfer to different level of care or admission) and orders upon discharge

f. Includes allowing personal preferences to be established and saved for viewing all available orders across all statuses

g. Includes the ability to flag orders that require clarification/further explanation

8. Manage Consults Supports the management, requesting, and tracking of consults (including e-consults) from order entry to consult completion across all care settings and specialty areas.

a. Includes the ability to electronically order and sign VA consultations as needed to VA and Non-VA providers and services

b. Includes alerting provider, tracking, scheduling, completion, communication back to ordering provider, user feedback, and outcomes of consults

c. Includes the ability to complete consults within scope of practice

d. Includes pre-formatted questions/suggestions for pre-work to ensure patient is a candidate for consult and to prepare consultant to meet with patient (e.g., labs and other tests, precautions, history, etc.)

e. Includes preparing a patient in the Emergency Department (ED) for a surgery procedure in an OR by following established policies

9. Capture Informed Consent Involves the ability to capture a patient’s oral or signature informed consent for treatment, services, permissions and information sharing.

a. Includes the ability to manage and track Health Care Consents within the end-user’s workflow in all appropriate settings (including but not limited to managing permissions, authorize care/treatment decisions and sharing of personally identifiable information (PII)); managing advance directives; integration with other patient self-

VA EHRM Functional Requirements 5 August 2017 reports and teleconsultations before, during, and after a Veteran’s visit and medical consultations; and processing and displaying consents and authorizations

10. Provide Treatment Supports the provision of treatment, procedures, episodes of care and post visit procedures across all care settings, as well as document treatment plans based on a patient’s diagnosis.

Encompasses all foundational services, specialty care, and ancillary services.

a. Includes provision of Primary Care, Specialty Care and Ancillary Services in both inpatient and outpatient settings

b. Includes provision of Nutrition and Food Services which includes managing food or stock items, recipes, menus, food or stock inventory, patient preferences and allergies, tray tickets, room service, forecasting, etc.

c. Includes the ability to provide the full range of rehabilitative care including Physical Medicine and Rehabilitation, Polytrauma, Traumatic Brain Injury, Blind Rehabilitation, Audiology and Speech Pathology, and Recreation Therapy

d. Includes the ability to provide Nursing Services which integrates a wide array of services, encompassing patient care (assess, plan, implement and evaluate care), clinical practice, education, research and administration

e. Includes automated workflows and documentation to enhance efficiency and standardize communications among care team members across the continuum of care.

f. Includes the ability to perform surgery and invasive procedures (inpatient or outpatient)

g. Includes tools to support acute care of the elderly, care provided in Geriatric and Evaluation Units, inpatient hospice and palliative care, Gero-Psych Unit care

h. Includes provision of Women’s Health Services to include women’s health primary care, gynecological care, and maternity care across care settings as well as management of gender-specific procedures and tests (e.g., pap smear, mammogram, transgender care)

i. Includes support for managing ophthalmic treatment to include physical eye exams and visual rehabilitation and mobility

j. Includes the use of medical devices while treating the patient, Vital Signs (VS) machines, Intravenous (IV) pumps, electronic patient education, unit tracking boards, bed management systems; physiological devices, sitter monitoring, remote telemetry

k. Includes managing equipment used within Operating Rooms (OR) with standard temperature and humidity controls (e.g., workstations must be fully operational in an environment that is between 17 and 37 degrees Celsius (62 – 98 degrees Fahrenheit) and up to 50% humidity)

l. Includes provisions for Operating Room (OR) surgical devices that can generate unacceptable electronic interference/artifact in concurrently used susceptible equipment

m. Includes ordering and managing chemotherapy

VA EHRM Functional Requirements 6 August 2017

11. Provide Laboratory and Pathology Services Includes provision of laboratory and pathology services in such areas as chemistry, microbiology, genomics, histology and cytogenetics, anatomic pathology, clinical pathology, electron microscopy, surgical pathology, toxicology, cytopathology, and autopsy. This includes setting the standards for quality, test methods, and procedures as well as diagnosis of disease based on the gross, microscopic, chemical, immunologic, and molecular examination of organs, tissues, and whole bodies.

a. Includes managing the acquiring, receiving, storing, controlling, distributing, maintaining, preparing, and disposing of biologic products including blood and implants

b. Includes automated workflows, to include Radio Frequency Identification tracking, to support enhancing efficiency, positive identification tasks and sharing of lab data across the enterprise

c. Includes managing the collection and accessioning of specimens

d. Includes capturing processing and analysis of lab tests and procedures and the location (appropriate department or work area)

e. Includes review and verification of results

f. Includes reporting of results and/or diagnosis for clinical health treatment

g. Includes analyzing administrative and efficiency data

h. Includes managing accreditation by regulating bodies and agencies

i. Includes support for the execution, operations and expansion of VA virtual molecular/genetics laboratory- Huntington LSRP and Helix.

12. Provide Dental Care Services Facilitates the provision of comprehensive dental care that adhere to the highest standards of hygiene and infection control. A full range of services is offered to eligible patients including:

regularly scheduled cleaning and X-rays, restorative procedures such as fillings, crowns, and bridges, dentures, oral surgery, and implantology services, access to oral and facial reconstruction surgery resulting from trauma or serious illness. This function also includes providing dental care services to homeless Veterans through the Homeless Veterans Dental Program.

a. Includes maintaining consistency of operations, to include meeting the expectation that dental providers will use the same enterprise capabilities as their medical colleagues (e.g. scheduling, orders, alerts, progress note tools, etc.) and the dental capability will support and enhance, not supplant this workflow

b. Includes the ability for seamless bidirectional integration of the dental and medical components of the EHR

c. Includes the ability to export existing patient data from previously established VA records dental/medical into new systems

d. Includes the ability to alert providers to essential required interventions based on patient’s data within their electronic health record

e. Includes capture and verification of dental eligibility, case status, and assigned dental team members including primary and secondary providers

VA EHRM Functional Requirements 7 August 2017

f. Includes support to order, acquire, archive, retrieve, view, report, and close out orders of dental images, 2D/3D scans, and other digital dental sources (i.e., DICOM, STL data) linked to a patient

g. Includes capturing and tracking in a standardized, computable format the longitudinal oral health status

13. Provide Mental Health Services Delivers coordinated, interdisciplinary provision of medical, nursing, psychosocial, and allied health services to mental health patients in both an inpatient and outpatient setting. Services included but are not limited to Mental Health Primary Care Services, Individual / Group Psychiatry Services, Post-Traumatic Stress Disorder (PTSD), Residential Rehabilitation Treatment, Substance Abuse, and Suicide Prevention. Includes tools that support Veterans’ mental health concerns in full recovery in all settings and elimination of suicide.

a. Includes a fully integrated behavioral health system that facilitates the following critical elements: interdisciplinary comprehensive care planning, coordination, and case management across all specialty areas that influence behavioral healthcare within and without the VA

b. Includes support of self-administered medications and Suicide Prevention to mental health patients in inpatient, outpatient, and residential treatment setting

c. Includes integration of substance abuse services

d. Includes facilitating involuntary commitments along with uploading legal documents into the EHR

e. Includes capturing advanced directive (medical and mental health) and Next of Kin

(NOK)/fiduciary or guardian information

f. Includes supporting Measurement Based Care Activities

g. Includes capturing and managing Military Sexual Trauma (MST) activities including special provisions unique to this population (e.g., provision of only MST care to active duty service members not eligible for other VA care, not sharing records with external entities)

h. Includes tools to support full spectrum of Suicide Prevention care in the management of High-risk Mental Health (MH) Patients, manage Veteran Crisis Line (VCL) information to include referrals from the crisis line to the facility, REACH Vet predictive analytics/Strategic Tool for Opioid Risk Mitigation (STORM)

i. Includes managing Vet Centers and Readjustment Counseling Service to include maintaining a separate system of records for Veterans that is not accessible to clinicians caring for the Veteran, ensure client records are viewable to all Vet Center staff, automated scheduling for appointments, staff access to Veteran's clinical record, and mobile technology

14. Provide Radiology and Nuclear Medicine Services Involves the interpretation of medical images to diagnose ailments, as well as the use of ionizing and nonionizing radiation to treat disease.

a. Includes support for all imaging exam types

VA EHRM Functional Requirements 8 August 2017

b. Includes capturing (to include MRI, CT, Ultrasound, X-rays, photos, etc.), storing, viewing, and transmitting of medical images from one location to another for clinical analysis, diagnosis, and medical intervention

c. Includes automated workflows and processes providing the capture, storage, access and sharing of imaging data and multimedia across the enterprise and between the VA and Community Care providers

d. Includes reviewing and analyzing images to determine a disposition and/or diagnosis

e. Includes communicating interpretations to the ordering provider

f. Includes managing the use of radiation therapy or Nuclear Medicines for the treatment of disease including the ability to document radiation dose and interface with third party radiation dose capturing systems

g. Includes the ability to provide a procedure risk calculation

h. Includes seamless integration with medical imaging technologies for access to images from multiple modalities (e.g., Picture Archiving and Communications Systems [PACS] systems)

i. Includes an electronic interface to import a snapshot of the radiation treatment plan or other documentation

15. Provide Pharmacy Services Enhances the clinical outcomes and improves the health of Veteran patients through the appropriate use of pharmaceuticals.1 Includes supporting the provision of Inpatient Pharmacy Services and the handling and dispensing of drugs and supplies to outpatients (including via consolidated mail outpatient service). Includes Pharmacy Benefits Management (PBM) Systems Oversights. Includes managing medication orders and billing, medication reconciliation, direct and indirect patient medication counseling and education, drug and supply dispensing services, clinical pharmacist activities as a component of the interdisciplinary health care team, and arranging for emergency prescription services through a community pharmacy or the Fee Basis program.

a. Includes supporting the provision of Consolidated Mail Outpatient Pharmacy (CMOP) Services to dispense via mail

b. Includes supporting the operational oversight to the information systems used by the PBM and all pharmacy operations nationwide to include enhancing pharmacy data exchange and integrating clinical documentation capabilities

c. Includes managing national formulary information for dispensing Over the Counter (OTC) medications and medical supplies

d. Includes managing pharmacy copayment adjudication

e. Includes managing recalled medications through pharmacy inventory and automation with appropriate action (e.g., notification, replacement, and enterprise wide documentation)

f. Includes managing a data store of information (e.g., identify potential Adverse Drug Events [ADEs]) for medications, immunizations, and supplements

1 A complete list of required Pharmacy Interfaces can be found in Appendix B: References

VA EHRM Functional Requirements 9 August 2017

g. Includes managing prior authorizations, requests for internal quality control of order, review patient’s record of current drugs, and review patient’s laboratory results

h. Includes intervention execution to include but not limited to reviewing patient and or order specific information, adjudicating issues, describing issues, reviewing responses, documenting resolutions, notifying appropriate parties

i. Includes the ability to mark available quantity for fill, place in partial fill status, and process increment transactions

16. Provide Emergency Health Care Includes providing rapid and varied medical services for patients stricken with sudden and acute illness and require immediate access to healthcare. This function includes triage services and acuity determination.

a. Includes immediate management of procedures and tests in a manner that minimizes the need for manual data entry

b. Includes management of communications of emergent test results that require verbal confirmation, and communication of results outside of standard business hours

c. Includes performing procedures, with and without sedation, in non-operating room locations

17. Provide Homeless Veterans Access to Health Care Supports VA social workers and other mental health clinicians in assisting homeless Veterans who are eligible for VA health care and other benefits. This function also provides a mechanism to contract with providers for community-based residential treatment for homeless Veterans.

a. Includes Management of Homeless Veteran Populations to include determining eligibility for services from field based remote locations (e.g., HINQ, eligibility office, etc.), displaying and managing Homeless Veteran Information (e.g., Veteran demographics, locality, date of service, disposition information, contact information, etc.), capturing and managing community outreach and intervention information (if patient is not eligible, provide a process to hand off to community provider; if patient is eligible, complete full HOMES assessment), Support Mobile Functionality (e.g., outreach, telehealth, transportation, housing, etc.) to improve efficiencies

b. Includes Managing Referrals from National VA Call Centers (e.g. Homeless,) to include support for bi-directional data sharing among community partners for assessments, display relevant homeless information from other entities, integration between the patient record and HOMES software

c. Includes Specialty Reporting functionality supporting Homeless Case Management

18. Provide Social Work Services Supports developing and implementing treatment approaches that address individual social problems and work with acute and chronic medical conditions, dying patients, and bereaved families. This includes ensuring continuity of care through the admission, evaluation, treatment, and follow-up processes. Activities also include coordinating discharge planning and providing

VA EHRM Functional Requirements 10 August 2017 case management services based on the patient’s clinical and community health and social services resources.

a. Includes the ability to conduct and record spiritual assessments and care interventions within the EHR

b. Includes the ability to provide access to Chaplain Services (e.g., counseling, funerals/memorials, etc.)

c. Includes managing clinical social work interventions

d. Includes integration with Veterans Benefit Administration (VBA) system and the ability to integrate fiduciary information into the EHR, and allow claim status information to be integrated as “read” only in the EHR

e. Includes managing documentation for post 9/11 Veteran/Active Duty Service Members

f. Includes the ability to facilitate involuntary commitments along with uploading legal documents into the EHR

g. Includes information exchange to facilitate referrals to social work resources both VA and Non-VA resources including community provider with transmission confirmation

h. Includes the ability to provide notifications to Veteran and Veteran acknowledgment regarding access to Social Work support

i. Facilitates the social work consult with the following information: determinants of health; housing; finance; well-being; and community resources/programs

j. Supports access to existing crisis response teams

19. Manage Clinical Documentation Includes the ability to create, modify, authenticate, and retire (archive), as needed, transcribed or directly-entered clinical documentation and notes to capture patient/provider episodes of care and the results of ancillary actions.

a. Includes support for managing patient health records, including incomplete, longitudinal, and point of care records

b. Includes support for managing Patient Summary Record of Care, historical summary of patient care and procedures, and relevant health conditions of family members

c. Includes support for managing Patient Care Encounter information and data capture/documentation

d. Includes support for managing Patient Summary Lists over the course of a visit or the lifetime of the patient

e. Includes support for managing and monitoring Patient Clinical Measurements, test results, medications, and immunizations

f. Includes support for health information management through adherence to established VA and federal policies, guidelines, regulations, and standards regarding the collection, storage, dissemination, and destruction of health information

g. Includes support for reminders/notifications/follow-ups to clinical workforce to ensure clinical tasks/activities

h. Includes the ability to provide support for online shared advanced directives

i. Includes capturing critical concerns in a highly visible manner for providers of all services

VA EHRM Functional Requirements 11 August 2017

j. Includes the ability to capture and integrate health care information into scripted/automated progress notes

k. Includes the ability to upload graphs, color images, and drawings that are viewable in the EHR and integrated with applications to support comparison of examination findings over time

l. Include the ability to link scanned or other electronic documents to a specific document in the health record

m. Includes capturing VA and Non VA Community Based Services

n. Includes the ability to capture, review and sign all treatment and procedure notes by all licensed, independent providers

o. Includes the ability to trigger co-signature of all treatment and procedure notes when required by an attending per policy

20. Provide Care Coordination Describes the coordination of patient care activities between participants involved in a patient's care within VA, and between VA and external providers, to facilitate the appropriate delivery of health care services. It involves coordinating personnel and other resources needed to carry out, document, and track all required patient care activities. It also involves the timely exchange of information among participants responsible for different aspects of care.

a. Includes capturing and supporting care team activities and workload

b. Includes maintaining care/medical team staff assignments

c. Includes a tracking and notification system for normal and abnormal findings and the services required to address the findings

d. Includes providing secure, reliable, real-time access to VA and community partners’ patient health record information where and when it is needed to support care and to reconcile and incorporate community data, as appropriate

e. Includes managing patient follow-up and support transition between transitions of care

f. Includes interfacing and integrating information from VBA with the EHR

g. Includes capturing planned treatment with internal and external providers

21. Provide Care Management Supports individualized, issue-focused plans of care that facilitates the appropriate level of care and resources to ensure timely and high quality services and cost-effective outcomes. This may include support for care management, case management, wellness, goal setting, and disease management strategies.

a. Includes creation and management of health care plans and patient goals across all care settings including access to relevant, historical, patient specific health care information

b. Supports management of care plans in collaboration with community partners including the ability to integrate, analyze and display health care data

c. Includes the ability for the provider to create, edit, and sign a patient care plan

d. Includes the ability for a patient to review and e-sign a patient care plan

VA EHRM Functional Requirements 12 August 2017

e. Includes managing and capturing patient care services for Other-Than-Honorable Discharge patients including tracking period of eligibility and supporting clinician request for extension of eligibility period

f. Includes supporting sharing of diagnostic information with another provider involved in care for the same patient

g. Includes the ability to provide reminders regarding clinical goals/tasks in the plan of care

22. Provide Team-Based Care Supports team-based, role-driven delivery of health services to individuals and/or their families by at least two health providers who work collaboratively with patients and their caregivers, to the extent preferred by each patient, to accomplish shared goals within and across the full continuum of care to include both federal and community partners. This includes collaborative documentation capabilities, interdisciplinary goal setting tools, and capture of outcomes within the workflow. Team-based care supports group visits/shared visits and co-treatment and helps to determine the appropriate mix of staff and skillsets required for care teams and delivery of team-based healthcare. The assignment of tasks is determined by health care needs, prioritization, and provider availability in a dynamic environment.

a. Includes a team management capability that allows users to define, construct, and manage teams, and to manage role-based activities

b. Includes the ability to document patient-specific barriers, patient educational needs, and patient capabilities and preferences

c. Includes the collaborative, interdisciplinary evaluation, planning, tracking, and documenting patient care and goals over time

d. Includes coordination of patient-centric care plans across VA and non-VA facilities

e. Includes capturing nontraditional work load such as drive times, documentation times, and care management times for multiple disciplines providing team care

f. Includes the capture of integrated inter-professional notes that allow different disciplines to enter content at different times into a unified comprehensive care plan note

g. Includes initiating inter-professional plan of care for patient admission and tracking of services to be rendered during an inpatient stay

h. Includes the capability to support synchronous communication to facilitate real-time communication among a distributed team utilizing multiple communication modalities

i. Includes the capability to capture and document patient flow to facilitate team-based care

j. Includes monitoring and evaluation tools that allow care teams to assess and evaluate effectiveness, identity, escalate, and remediate issues

23. Manage Remote Care Provides the ability to interact with patients and providers, provide care, treatment, and education to the patient population unable to physically present at a VA medical facility. Includes the ability to support coordinated, bi-directional patient /provider and provider/provider

VA EHRM Functional Requirements 13 August 2017 communications electronically in a secure manner. Includes connected care modalities of telehealth, remote home monitoring, point of service kiosks, mobile applications/tools.

a. Includes automated workflows and documentation needed to provide efficient and accurate non-institutional care services

b. Includes the ability to provide a single patient portal or a single consolidated view for patients

c. Includes the ability to customize the patient portal and associated mobile applications with VA-specific content, branding and transactional services such as healthcare enrollment application, Veteran profile update, claim status and other VA services

d. Includes self-assessments and patient report outcome measures completed remotely by patients

e. Includes the ability to view images and video remotely

f. Supports 24/7 response to issues/concerns to call centers, crisis line operations, and online peer support opportunities

g. Includes the ability to support and/or directly integrate with in-home health care delivery devices/technologies

h. Includes the ability to use patient location contact to display local emergency numbers, pharmacy numbers, and maps, so remote provider can initiate emergency response, call in prescriptions, etc.

i. Includes the ability to manage and coordinate transportation for patients who require transportation to or from facilities and other locations for examination, treatment or care

j. Includes the ability to provide self-management of health information/patient portal functionality via desktop browsers, mobile browsers, and native mobile applications.

k. Includes the ability to expose transactional read/write APIs for patient portal functionality (including Messaging, Prescription Refills, Scheduling, Lab Results, Health Record downloads and other patient portal functionality), so that other VA products may integrate with these patient-facing capabilities

24. Manage Extended Care Provides efficient records management allowing for comprehensive integrated care spanning all extended care settings provided by the VA or authorized in the community. This comprehensive communication and integration is essential for quality care to chronically ill and disabled Veterans of all ages needing extended care services, through an integrated interdisciplinary clinical care programs.

a. Includes tools and templates to support interdisciplinary care delivered in Community Living Centers (CLC), community nursing home, and State Veteran Homes, clinic (GeriPACT) Home Based Primary Care (HBPC), community home care, adult day health care, homemaker/home health aide; home respite, home hospice, home telehealth, Caregiver Support Program, Medical Foster Home, and Geriatric Research, Education and Clinical Centers (GRECC)

VA EHRM Functional Requirements 14 August 2017

25. Manage Medication Administration Includes the ability to ensure medications are tracked, delivered, and administered appropriately to the correct patient and support management of medication reconciliation. Includes medications (both prescription and non-prescription) provided by both VA and Non-VA providers.

a. Includes providing CMOP Services for management of prescriptions throughout the lifecycle of the prescription that allow a single prescription to be filled locally or by CMOP, and allow Veterans, providers and the local VA pharmacy to change, track, and monitor CMOP prescriptions; includes bidirectional communications between the EHR to the designated CMOP accounting for sending and receiving patient and prescription data.

b. Includes managing and monitoring patients receiving medications that require clinical oversight in compliance with FDA regulations

c. Includes support for patient self-administration of medication

d. Includes the ability to obtain, collect, track, document, and communicate medication information from Patient, Family, and/or Caregiver

e. Includes managing radiation and contrast dose tracking and dose trends locally and nationally

f. Includes management of communication to and from all state’s Prescription Drug

Monitoring Program

g. Includes the ability to manage medications using bar code administration and mediation delivery systems

26. Provide Clinical Decision Support Augments clinical decision-making by providing health care professionals with knowledge-enriched, disease-specific recommendations for treatments, tests, and referrals based on individual patient profiles. Explicit but adaptable to allow accurate capture of what processes were followed and allow the clinicians to adapt to changing conditions and information.

a. Includes the ability to seamlessly integrate with decision support tools

b. Includes the ability to identify specific health related issues in the patient’s record

c. Includes generating alerts for preventive care, wellness care, medication administration, or other activities at the time of the encounter that are based on national protocols

d. Includes the ability to perform pharmacy medication order checks, check for flags, check for adverse interactions using First Databank, review order checks associated with the medication or prescription order, review clinical screening and/or provider override comments

e. Includes the ability to incorporate community data into clinical decision making

f. Includes picture identification of the patient within the chart to minimize the risk of mistaken identity and mistaken orders

g. Includes the ability to personalize (create and save) the user experience for all data elements in the health record

VA EHRM Functional Requirements 15 August 2017

h. Includes the ability to easily identify/view new orders, verified results, new results, and alerts for critical values per personal preferences

i. Includes the ability to view results in same location where orders have been submitted, worksheets and graphs to display information over time, and results in logical formats instead of just alphabetical, and images and report for both local and remote studies

j. Includes automatic reconciliation of outpatient and inpatient medications during provider sign-off

k. Includes real-time Medication Administration Record with bar code scanning

l. Includes retrievable information for patients (e.g., printable handout)

m. Includes suggested procedures that are generated contextually from dental diagnostic findings creating procedural specific plan that includes associated supporting diagnosis

n. Includes interacting with interventions related to patient goals using decision support tools that guide the user through scenario based goals/interventions processing

27. Provide Patient Care Education Supports the provision of appropriate, personalized education on matters involving the patient's condition, medications, risks, and instructions for self-care and self-management to patients, caregivers, and staff. Multiple modalities may be utilized in providing reliable information regarding wellness, preventive care, disease management, treatments, peer support groups, and other relevant information.

o. Includes the ability to provide and document patient/caregiver education and counseling across all services

p. Includes ability to generate printable materials that auto-populate patient specific content for patient education

q. Includes links to on-line tools with automated documentation of education

28. Patient Self-Management of Health Information Provide patients, caregivers, and staff, as authorized, the ability to access and self-manage health information to include pre-appointment surveys, recommended services, preferences, med refills, view educational materials, etc.

a. Includes the ability to provide self-management of health information/patient portal functionality via browsers and mobile devices

b. Includes a built-in comprehensive directory of Health Information Exchange recipients for patient use

c. Includes the ability to automatically send the patient care summary and patient instructions, at the end of an encounter, to the patient’s portal of choice in standards based format

d. Includes the ability to capture and track patient designations of persons involved in their care

VA EHRM Functional Requirements 16 August 2017

29. Provide Blood Services Supports management of acquiring, receiving, storing, controlling, distributing, maintaining, preparing, and disposing of blood, blood products and transfusion services. This includes obtaining products from external blood banks.

a. Includes ability to document transfusion reactions, linked to specific unit received, and provide a lookback when the blood bank notifies us that a received donor unit was positive for some pathogen

b. Includes the ability for electronic verification and capture of patient transfusion event data in the patient’s electronic health record that utilizes automated processes and bar code scanning

c. Supports the administrative oversight and auditing of transfusions

30. Provide Positive Patient Identification (Bar Code Management)

Supports Positive Patient Identification, decreases in patient misidentification, enhanced efficiencies, and reduce vulnerabilities in health care delivery to include but not be limited to labeling of blood and laboratory specimens.

a. Includes the ability to utilize barcodes to prevent human errors in the distribution and/or dispensing of medications

b. Includes the ability to utilize barcodes to electronically validate and document medication administration

c. Includes the ability to provide prompts that guide the user to the next step

d. Includes the ability to display a selected patient's medication profile

e. Includes the ability to formulate medication administration information into reports

f. Includes the ability to allow authorized users to access an alternative to the standard medication order processing in emergent situations

g. Includes the ability to utilize bar codes for management of specimen collection and tracking the specimen through to order completion

31. Manage Data Includes capturing data and documentation from sources internal and external to VA including patient generated data, clinical, administrative, and financial information systems, other EHR systems, Personal Health Record (PHR) systems, and data received through Health Information Exchange (HIE) networks. Includes management of patient health records, including computable longitudinal and point of care records available across all time zones to support around-the-clock clinical care and across the full range of VA health operations based on roles and location-based security.

a. Includes the ability to utilize standardized data and coding terminology systems for VA, DoD, and Community providers that are consistent with VA and industry standards for workload reporting and decision support

b. Includes the ability to utilize government endorsed messaging and content standards for interoperability with systems external to VA

VA EHRM Functional Requirements 17 August 2017

c. Includes the ability to leverage EHR data to manage operations within a clinical setting

d. Includes management of patient identity across data from VA, DoD, and non-VA providers to ensure one unique identifier across all care episodes to include role-based masking of SSN and non-veteran employee Date of Birth

e. Includes the ability to segregate information based on user role, health condition (e.g., MST), or employee status

f. Includes the ability to manage data elements from various entry points (e.g., internal/external/medical devices/patient generated) as appropriate for continuity of care, workload capture, administrative, and analytical purposes

g. Includes the ability to manage data elements that are standardized, accessible, and editable by various internal/external users, based on predetermined user access roles across all services

h. Includes the ability to manage data created from multiple modes of entry (e.g., free text, scanned images, other imports, etc.)

i. Includes the ability to disseminate nationally-directed database or template changes to all facilities throughout the enterprise based on predetermined user access roles

j. Includes the ability to manage Release of Information requests and Accounting of Disclosures

k. Includes the ability to audit/track all actions (e.g., entries, edits, deletions, etc.) made in the EHR

l. Includes the ability to accommodate and record accurate date/time zone information (e.g., International Date Line)

m. Includes ensuring episodic care data are broken down longitudinally and by clinics

n. Includes integration of natural language processing (NLP) tools

o. Includes metrics for training and systems improvement

p. The system shall comply with VA Directives, Policies and Regulatory Requirements

q. Includes capture of right data, right format, and right time for automated data collection from medical devices

32. Provide Information Security (HIPAA, Privacy, etc.)

Involves all functions pertaining to the protection of information and information systems from unauthorized access, use, disclosure, disruptions, modification, or destruction.