Achieving Interoperability from the Ground Up

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1 Achieving Interoperability from the Ground Up Presented by: Amir Ismail, Director of Installation and Support

2 About Document Storage Systems, Inc. (DSS) «DSS is a leading health information technology (HIT) software development and systems integration company «DSS has provided technical and service integration expertise with the VistA system for more than 20 years «DSS released vxvista to meet the needs of hospitals, clinics, long-term care facilities and physician practices. «DSS empowers health systems and hospitals to enhance patient care by adopting and/or enhancing VistA-based EHR solutions that enable interoperability, improve healthcare quality, enhance revenue cycles and reduce cost. «This presentation will focus on the inherent Architecture of Interoperability within VistA and how to leverage that innate functionality for truly integrated EHR systems

3 Introduction vxvista Interoperability Image courtesy of SRS soft

4 Architecture of Interoperability Baked In «VistA--Built to Scale Up in the VA «New Integrated Modules «Modernization/Future Growth part of the VistA DNA from Day 1 «vxvista Central Data Repository/EHR Backbone «Integration & Interfaces to Legacy Systems «Interfaces to External Systems «Interfaces to Best of Breed Systems «Interoperability & Interfaces = on-going services «Development «Testing «Data-warehouse/Analytics «Health Information Exchange

5 Interface Toolkit Multiple Options Native HL-7 Support Interface Engines/ESB InterSystems Ensemble Mirth Cloverleaf SOA/SOAP Architecture Flat File Conversion InterSystems Cache FM to SQL tool NHIN & HIE Standards InterSystems HealthShare Foundation Scripted Data Migration

6 Anyface Interface the Right Tool for the Job vxvista in Action a longitudinal health record system that can communicate with outside systems with a variety of interface tools, ability to plug in new extensions & modules, and readiness to engage in health information exchange

7 DSS Supports Interoperability within the VA DSS Innovates and Supports Interoperability in the Department of Veteran s Affairs

8 Why are Interfaces Critical for vxvista? «No longer a closed loop many more inputs and outputs in non-va deployments «Legacy Systems «Legacy Data «Current On-Going Contracts «New Contracts/Best-of-Breed Solutions «Proprietary «Open Source «Health Data Exchange «Personal Health Records

9 DSS Supports Interoperability in Non-VA Deployments VistA is an acronym for Veterans Information System Technology Architecture. Is a comprehensive system developed by the Department of Veterans Affairs. VistA is a patient centric, longitudinal health record system used by 163 hospitals, 135 nursing homes, 850 community outpatient clinics, and 180,000+ health care professionals VistA was built on a model of outcomes tracking, continuity of care, reporting, and research. Funded by tax payers and designed from clinician requirements it is the most used EHR in the world today. vxvista-open Source is FOIA VistA that has been modified and enhanced by DSS, Inc. for over 5 years to work in non-va healthcare delivery settings. It was released to the world as an Open Source Project in January Key Enhancements Prescription writing and printing Laboratory Interfaces and Order Sheet printing Pediatrics Enhanced Women s Health (OB/GYN) Patient Medical Record Numbers Provider Alternate ID Numbers Redaction of many VA-isms in GUIs and commonly used options VistA and vxvista power can be increased by adding Compatible Extensions. A list of available extensions is available at The VistA Extension Hub (www.thevxhub.org). DSS, Inc. has many years of experience developing additional extensions to the VistA System. Some of the Available Extensions are: Mental Health Suite (MHS) Dental Record Manager Plus (vxdrm+) Patient Search Tool (Open Source) Release of Information (ROI) Fee Basis Claims System (FBCS) Insurance Capture Buffer (ICB) vxdocmanager (DocMan)

10 Challenges to Interoperability «Inconsistent or lack of Standardized Data Terminology «Multiple Data Standards «While some inroads toward achieving standards-based interoperability for EHRs exist, industry-wide adoption of a completely uniform set of standards has yet to occur «Closed systems and closed vendors who make interoperability more costly & more complex

11 Lesson Learned: Data is in the Details and Mapping is a Must «Data mapping enables disparate databases to communicate and is a critical component of EHR interoperability «Functional Team members who understand what the data means must work hand-in-hand with the technical team to translate, transform, and talk meaningfully «Mapping and normalizing data provides the ability to integrate disparate systems and query information as a single data set

12 Lesson Learned: The Importance of Organizational Buy-in «To create an environment of Interoperability, first build consensus «Details drive development and priorities must be established by collaboration between functional and technical stakeholders «Solutions cannot be one-size-fits-all tailoring and customization is necessary because no two environments or client sites are identical

13 Lesson Learned: Most Requested vxvista Interfaces «Practice management systems «ADT «Scheduling «Billing systems «External Laboratory Systems «Legacy Data Migration «ARRA Required Interfaces

14 Future of VistA Interfaces/Interoperability «Health Information Exchange «Public Health Data Sharing «Personal Health Records

15 DSS--More Information «Active member and supporter of the OSEHRA organization «Founder and supporter of: a forum for discussion and best practices among worldwide vxvista and VistA EHR users. «For more information, please visit

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