The Georgia Institute of Technology led a proof-of-concept demonstration for a digital health platform (DHP) for the Department of Veterans Affairs and Veterans Health Administration as part of the VA’s plan to advance electronic health record (EHR) interoperability, data exchange and data integration for veteran care.
A team of public-private health care technology collaborators established by the VA and VHA launched an open-source project that supports the clinical and operational policy and program transformation plans needed to address expected changes in veteran populations, service needs and care delivery models, according to a Georgia Tech press release about the project.
For example, the DHP demonstration included the capability to obtain patient data from disparate military and commercial electronic records systems, and accept information from a broad range of ancillary services and consumer medical devices.
The system was demonstrated to VA and VHA officials in September and October 2016.
The public-private collaboration, established in partnership with the VA’s Office of Information and Technology, included the VHA, Office of the National Coordinator for Health Information Technology (ONC), the Georgia Institute of Technology and private-sector companies providing services in analytics, customer relationship management, and application program interfaces. Georgia Tech served as the project’s lead architect and provided overall project management.
“If you can liberate the data from deep inside a system and securely move it to the cloud and manage its movement through well-designed application programming interfaces (APIs), that gives you a lot of options for reorganizing work flows and processes,” Steve Rushing, senior strategic adviser in Georgia Tech’s Health Extension Services, said in a prepared statement. “We are doing for health care what has already been done for other industries that have used interoperability standards as the foundation for APIs to exchange information among different systems.”
The team – including partner organizations Salesforce, Mulesoft, Apervita and UCB—conducted its first demonstration just six weeks after the contract with the VA was signed. Using Fast Healthcare Interoperability Resources (FHIR), a standard describing health data formats and elements, and a REST API transport protocol, the team built an API gateway surrounding VistA and Georgia Tech’s testing and teaching electronic health record system, known as GTonFHIR. The project used anonymous patient data.
The overall project created 21 system APIs, which control how specific types of data flow into and out of the DHP. This included data exchanges with the Cerner EHR (representing the Department of Defense and a community hospital), Duke University Medical Center (Epic) as an academic medical provider, DocSnap personal health record (connecting to a Navy medicine pilot project), and personal health monitoring devices via Apple Healthkit and Validic.
“The DHP leverages the power of public-private partnerships,” LaVerne Council, who was the VA’s chief information officer at the time the project was conducted, said in a statement. “We brought together some of the brightest engineers and health informaticists from some of the most innovative companies and assembled them at Georgia Tech. There, over a period of eight weeks, we established an API gateway, the cornerstone of the digital health platform, consisting of 21 APIs that connected to three different EHR systems including our own, VistA, a class leading customer relationship management system, Georgia Tech’s Fast Healthcare Interoperability Resources (FHIR) server, and a real time analytics system. We also developed a veteran-facing mobile app. We integrated low-cost, high-quality video communication into the fabric of the veteran experience, and we integrated internet-connected health devices that track activities and vitals including blood pressure, weight and blood glucose.”
By keeping much of the original VistA system accessible via the API gateway, the strategy protects the investment in and could accelerate the deployment of the agency’s existing health information technology innovations across the VHA system during the period of full DHP component acquisition and deployment, Rushing said in the press release.
“In electronic health records, like almost any other major enterprise application, about 60 percent of the code is tied to routine workflow needed on a day-to-day basis. Changing these doesn’t add strategic value because the new programming will look much like the old,” Rushing said. “The important strategic implementation is done at the edges of the system, and that’s where the VA wanted us to focus our interoperability engineering and demonstrate the power of liberating the data. By using an architecture that is API-driven, we addressed the interoperability requirement, kept what works and added new VHA-created and private industry innovations where needed.”
Among the innovations is an analytics layer. By studying the health records of service members transitioning from active duty to veteran status, the analytics layer makes recommendations about care, such as enrollment in specialized services for veterans suffering from traumatic brain injury (TBI).
“This is basically doing the same thing – with a different intent – that happens every time you sign into Facebook or Amazon,” Rushing said. “The system learns about you from your records to help health professionals precisely meet your personal needs. Rather than wait until a veteran has a seizure because of a service-related injury, the system would use the analytics to recommend a protocol for proactively managing the problem.”
The demonstration addressed the specific challenges of three groups of former service members: Iraq war veterans with traumatic brain injuries, women veterans who need gender-specific services not traditionally provided by the VA, and Vietnam-era veterans who are now suffering age-related illnesses such as diabetes and congestive heart failure. TBIs alone affect some 87,000 veterans.
“The VA is looking for a flexible, future-focused health platform and architecture focused on a services-based model,” Jon Duke, M.D., director of Georgia Tech’s Center for Health Analytics and Informatics, said in a statement. “They are taking a really ambitious approach to it, and this could have a tremendous impact on care for veterans as well as on health systems more broadly.”
The impetus for the project was VHA strategic planning, started in the spring of 2016, on developing a successor to VistA, which has served the agency for 40 years. The strategic planning scope was expanded beyond replacement of VistA as a single EHR application system to include best practices driving enterprise information technology modernization across other industries. This included the move to a platform of interoperable cloud-based application system components, according to university officials.