A nursing information model process for interoperability.

The ability to share nursing data across organizations and electronic health records is a key component of improving care coordination and quality outcomes. Currently, substantial organizational and technical barriers limit the ability to share and compare essential patient data that inform nursing care. Nursing leaders at Kaiser Permanente and the U.S. Department of Veterans Affairs collaborated on the development of an evidence-based information model driven by nursing practice to enable data capture, re-use, and sharing between organizations and disparate electronic health records. This article describes a framework with repeatable steps and processes to enable the semantic interoperability of relevant and contextual nursing data. Hospital-acquired pressure ulcer prevention was selected as the prototype nurse-sensitive quality measure to develop and test the model. In a Health 2.0 Developer Challenge program from the Office of the National Coordinator for Health, mobile applications implemented the model to help nurses assess the risk of hospital-acquired pressure ulcers and reduce their severity. The common information model can be applied to other nurse-sensitive measures to enable data standardization supporting patient transitions between care settings, quality reporting, and research.

The Department of Veterans Affairs' (VA) implementation of the Virtual Lifetime Electronic Record (VLER): findings and lessons learned from Health Information Exchange at 12 sites.

PURPOSE: We describe the Department of Veterans Affairs' (VA) Virtual Lifetime Health Electronic Record (VLER) pilot phase in 12 communities to exchange health information with private sector health care organizations and the Department of Defense (DoD), key findings, lessons, and implications for advancing Health Information Exchanges (HIE), nationally. METHODS: A mixed methods approach was used to monitor and evaluate the status of VLER Health Exchange pilot phase implementation from December 2009 through October 2012. Selected accomplishments, contributions, challenges, and early lessons that are relevant to the growth of nationwide HIE are discussed. RESULTS: Veteran patient and provider acceptance, trust, and perceived value of VLER Health Exchange are found to be high, and usage by providers is steadily growing. Challenges and opportunities to improve provider use are identified, such as better data quality and integration with workflow. Key findings and lessons for advancing HIE are identified. CONCLUSIONS: VLER Health Exchange has made great strides in advancing HIE nationally by addressing important technical and policy issues that have impeded scalability, and by increasing trust and confidence in the value and accuracy of HIE among users. VLER Health Exchange has advanced HIE interoperability standards and patient consent policies nationally. Policy, programmatic, technology, and health Information Technology (IT) standards implications to advance HIE for improved delivery and coordination of health care are discussed. The pilot phase success led to VA-wide deployment of this data sharing capability in 2013.

Translating standards into practice: experience and lessons learned at the Department of Veterans Affairs.

The increased need for interoperable electronic health records in health care organizations underscores the importance of standards. The US Department of Veterans Affairs (VA) has a long history of developing and adopting various types of health care data standards. The authors present in detail their experience in this domain. A formal organization within VA is responsible for helping to develop and implement standards. This group has produced a Standards Life Cycle (SLC) process endorsed by VA key business and information technology (IT) stakeholders. It coordinates the identification, description, and implementation of standards aligned with VA business requirements. In this paper, we review the adoption of four standards in the categories of security and privacy, terminology, health information exchange, and modeling tools; emphasizing the implementation approach used in each. In our experience, adoption is facilitated by internal staff with expertise in standards development and adoption. Use of processes such as an SLC and tools such as an enterprise requirement repository help formally track and ensure that IT development and acquisition incorporate these standards. An organization should adopt standards that are aligned with its business priorities and favor those that are more readily implementable. To assist with this final point, we offer a standard "Likelihood of Adoption Scale," which changes as standards specifications evolve from PDF documents only, to PDF documents with construction and testing tools, to fully functional reference implementations.

Toward a Virtual Lifetime Electronic Record: the Department of Veterans Affairs experience with the Nationwide Health Information Network.

Health information exchange is expected of all electronic health records (EHRs) in order to ensure safe, quality care coordination. The U.S. Department of Veterans Affairs (VA) has a long history of information exchange across VA facilities and with the U.S. Department of Defense (DoD). However, since a majority of VA and DoD patients receive a portion of their health care from the private sector, it is essential that both agencies enable health information exchange with private sector providers. This has been made possible by the use of the specifications and trust agreement developed by the Nationwide Health Information Network (NwHIN) initiative. Currently, VA has 12 medical centers exchanging information with the private sector and is evaluating the value of the exchange. The authors report on the success of these pilots as well as on the challenges, which include stricter technical specifications and a more efficient approach to patient identification (ID) matching and consent management.

The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente Nationwide Health Information Network exchange in San Diego: patient selection, consent, and identity matching.

The Nationwide Health Information Network allow for the secure exchange of Electronic Health Records over the Internet. The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente, participated in an implementation of the NwHIN specifications in San Diego, California. This paper focuses primarily on patient involvement. Specifically, it describes how the shared patients were identified, were invited to participate and to provide consent for disclosing parts of their medical record, and were matched across organizations. A total 1,144 were identified as shared patients. Invitation letters containing consent forms were mailed and resulted in 42% participation. Invalid consent forms were a significant issue (25%). Initially, the identity matching algorithms yielded low success rate (5%). However, elimination of certain traits and abbreviations and probabilistic algorithms have significantly increased matching rate. Access to information from external sources better informs providers, improves decisions and efficiency, and helps meet the meaningful use criteria.

U.S. Department of Veterans Affairs Enterprise Reference Terminology strategic overview.

The Veterans Health Affairs (VHA) branch of the Department of Veterans Affairs has undertaken an Enterprise Reference Terminology (ERT). VHA, arguably the largest integrated healthcare provider in the United States, has completely computerized virtually all clinical transactions, including physician orders and documentation. The VA is now integrating its clinical records across hundreds of sites of care by means of a Health Data Repository (HDR) project. ERT has been designed to provide a terminology development environment, terminology services, and maintenance services for the clinical and business content in HDR and other VHA applications. Drug, laboratory observations, and clinical document title files have been developed, and the ERT will encompass all HDR domains by 2008. Commercial tools are used to host the VHA's ERT terminology development and server environments. We will select and adopt both open-source and licensable terminology systems to provide ERT content, as well as reuse existing VA-specific terminology content.