VHA Requires Compliance
ATTEMPTING TO EASE IT VENDOR INTEGRATION woes, a national healthcare purchasing organization has added clinical information standards to its purview. VHA Inc., based in Irving, Texas, is leading an effort to integrate disparate information systems based on the Health Level Seven (HL7) interoperability standard.
"None of the vendors have a business plan to tackle integration," says Scott Decker, VHA’s senior director of development for the information systems group. The new interface project will provide VHA membership organizations a best-of-breed healthcare IT solution, he says. "It’s easy and adds a lot of value to our members quickly." To ensure compliance from vendors, VHA is requiring all of its healthcare IT business partners to comply with the integration.
VHA also announced it is endorsing the CCOW (clinical context object workgroup) desktop integration protocol that was demonstrated for the first time at Microsoft’s Healthcare Users Group last September. CCOW is an objects-based, front-end interface that allows a user to view a different patient’s record on one application without manually changing that patient’s record for every application running on the desktop. When one application is changed to show a different record, the others, operating in the background, follow suit.
Five healthcare IT vendors will demonstrate the "proof of concept" integration at VHA’s annual membership conference April 14-17 in Nashville, Tenn. Atlanta-based Eclipsys is contributing its recently acquired Continuum 2000 inpatient electronic medical records system; MedicaLogic, Beaverton, Ore., is providing its outpatient electronic medical records system; Oacis Healthcare Systems, Greenbrae, Calif., is providing the clinical data repository and enterprise master patient index; Per-Se Technologies, Atlanta, is supplying the scheduling software; and Healthdyne Information Enterprises, Marietta, Ga., is responsible for linking it all together with its interface engine.
Is there a need for additional healthcare IT integration protocols? Yes, says Jerry Malone, vice president of North American sales for Healthdyne. "Even though we have a standard, the vendors don’t necessarily conform."
VHA’s recent interest in healthcare IT integration is purely for the benefit of its provider members. Nonetheless, it represents efforts that are beneficial to HL7 and the entire industry, says Mayo Clinic’s George Beeler, chairman of HL7. "We need groups like this to specify the standard."
HL7 requires at least a 95 percent affirmative ballot for approval. As with any standard, he says, it’s written with many options to satisfy multiple requirements.
VHA is seeking document imaging, managed care, home healthcare and disease management software developers to join the integration efforts.
A Government CPR Takes Off
THE DEPARTMENT OF DEFENSE, VETERANS administration, Indian Health Service and Louisiana State University Medical Center announced development plans for the government computer-based patient record, highlighting a new phase in military healthcare. Designed to track health status and medical encounters of all military personnel over their lifetime, the G-CPR will be the foundation of the Composite Health Care System (CHCS) II, the forthcoming upgrade to the congressionally-mandated medical information system that serves 650 military hospitals and clinics worldwide.
The project commenced in December 1997 under the authority of Kenneth Kaiser, undersecretary for health of Veterans Affairs, and Edward Martin, acting assistant secretary of defense for health affairs, following a statement issued by President Bill Clinton on the Gulf War veterans’ illness. Clinton charged the Department of Defense and Veterans Affairs with the task of creating a new Force Health Protection Program that will provide all military personnel with a longitudinal medical record.
The current system, CHCS, is comprised of more than 60 information systems that contain medical records of military personnel. In many cases, the data is not portable among medical facilities, let alone each branch of the DoD. "We are migrating all these applications into one system," says USAF Col. Lynn Ray, CHCS II program manager.
Development of the G-CPR will be the responsibility of a single contractor charged with fully integrating various off-the-shelf and custom built applications in a militarywide system. The system is expected to take about four years to develop and could reach costs of $1 billion, says David Brooks, group senior vice president for SAIC, developers of the CHCS system. Brooks named SAIC, American Management Systems, EDS, IBM and Computer Sciences Corp. as leading candidates for the G-CPR that is scheduled to be awarded by October 1, 1998.
The DoD recognizes the monumental task of building a G-CPR. "There are several problems to overcome," Ray says. For example: How will a single MPI be constructed? What standards will be used? To buffer questions from the IT industry, the government held a G-CPR Industry Day Conference on January 28.
Since the conference, the DoD has drafted a statement of objectives for the G-CPR. Topping the list of requirements is a system that incorporates various best-of-breed, open architecture applications. "We want a components-based approach," says Richard Ferrans, chief of medical informatics and telemedicine at Louisiana State University Medical Center. "A big turn key solution may not be the best option."
Some of the specific requirements include compatibility with the Windows NT 4.0 operating system, support for the Informix Universal server, support for HL7 version 2.3 messaging and DICOM version 2.0 imaging standards--and it must be browser-enabled. The G-CPR will also have the capability to store and read medical information from personal information carriers, or PICs. "Like dog tags with a computer chip," Ray says.
Until CHCS II is operable and patient data is rolled into the G-CPR, which is still five to 10 years away, CHCS will continue to operate as DoD’s health information system. Veterans Health Affairs, comprised of 173 hospitals and 500 ambulatory care centers in 22 integrated service networks across the country, is in the process of upgrading its in-house clinical information system with a graphical user interface. It is the last upgrade for VA, says Robert Kolodner, associate chief information officer for VA. Once the G-CPR is in place, VA, like the DoD, will acquire commercial information systems under the G-CPR contract.
Louisiana State University Medical Center and the Indian Health Service became involved with the G-CPR as a result of previous associations with the VA and DoD.
LSUMC in Baton Rouge joined the project because its vision of the CPR is very close to what the VA and DoD wants to accomplish, Ferrans says. Consisting of 10 public hospitals and about 500 clinics throughout the state, LSUMC has leveraged leading edge technologies, including a clinical data repository based on ActiveX, through its network. "If this can work at the state level, it can work at the national level, too," he says.
Indian Health Services in Rockville, Md., which operates 50 hospitals and 200 ambulatory care centers on or near reservations in 34 states, has worked closely with both the VA and DoD on information systems development in the past, and was a natural to collaborate on the G-CPR project, Kolodner says. "As far as the current information systems are concerned, they’re all very much related."
--J.E. / P.S.