REPORT TO THE PRESIDENT
B. Adoption of Common Standards and Terminologies
VA and DoD have achieved the common adoption of an initial set of standards through the Consolidated Health Informatics (CHI) initiative. See Table 3. In partnership with HHS, VA and DoD are lead partners in the CHI project, one of the 24 eGov initiatives supporting the President’s Management Agenda. The goal of the CHI initiative is to establish Federal health information interoperability standards as the basis for electronic health data transfer in Federal health activities and projects.
DoD and VA have established an initial joint strategy for data standards which focuses on maximizing the utilization of the CHI standards in future systems development and
acquisitions and influencing Standards Development Organizations (SDOs) in further standards work. The Target List of VA/DoD standards is attached at Appendix B. This Federal government effort has the potential to catalyze industry to adopt common terminologies and standards, thereby reducing software development costs and producing more affordable electronic health record technologies.
Table 3 Approved and Adopted CHI Standards Standard Description
HL7 2.4 and
higher XML Health Level 7 messaging standards to ensure that each Federal agency can share information that will improve coordinated care for patients such as entries of orders, scheduling appointments and tests and better coordination of the admittance, discharge and transfer of patients.
Health Level & vocabulary standards for demographic information, units of measure, immunizations, and clinical encounter and HL7 Clinical Document Architecture standard for text base reports.
NCDCP
Scripts Certain National Council on Prescription Drug Programs (NCDCP) standards for ordering drugs from retail pharmacies to standardize information between health care providers and the pharmacies. These standards already have been adopted under the Health Insurance Portability and Accountability Act (HIPAA) of 1996, and will be adopted in the three Federal departments that aren't covered by HIPAA will also use the same standards.
IEEE1073 The Institute of Electrical and Electronics Engineers 1073 (IEEE1073) series of standards that allow for health care providers to plug medical devices into information and computer systems that allow health care providers to monitor information from an ICU or through telehealth services on Indian reservations, and in other circumstances.
LOINC Laboratory Logical Observation Identifier Name Codes (LOINC) to standardize the electronic exchange of clinical laboratory results.
DICOM Digital Imaging Communications in Medicine (DICOM) standards that enable images and associated diagnostic information to be retrieved and transferred from various manufacturers' devices as well as medical staff workstations.
SNOMED-CT The College of American Pathologists Systematized Nomenclature Medicine Clinical Terms (SNOMED-CT) for laboratory results contents, non-laboratory interventions and procedures, anatomy, diagnosis and problems, and nursing.
HIPAA The Health Insurance Portability and Accountability Act (HIPAA) transactions and code sets for electronic exchange of health related information to perform billing and administrative functions. These are the same standards now required under HIPAA for health plans, health clearinghouses and those health care providers who engage in certain electronic transactions.
Standard Description Federal
Terminologies
A set of Federal terminologies related to medications, including the Food and Drug Administration’s names and codes for ingredients, manufactured dosage forms, drug products and medication packages the National Library of Medicine’s RxNORM for describing clinical drugs and the VA’s National Drug File Reference Terminology (NDF- RT) for specific drug classifications.
HUGN The Human Gene Nomenclature (HUGN) for exchanging information regarding the role of genes in biomedical research in the federal sector.
EPA Substance Abuse Registry System
The Environmental Protection Agency’s Substance Registry System for non-medicinal chemicals of importance to health care.
VA and DoD work with the American National Standards Institute’s (ANSI) and Healthcare Informatics Standards Board (HISB) to influence the adoption and
implementation of nationally and internationally approved standards. Both VA and DoD participate on the Health Level Seven (HL7), an ANSI-accredited SDO that is working across the industry to establish a set of standard functions for electronic records. A VA nurse informaticist co-chairs the HL7 Electronic Health Record work group. VA and DoD representatives jointly chair the Governmental Projects Special Interest Group. VA representatives also co-chair the Conformance Special Interest Group, the Patient Administration Technical Committee, and Process Improvement.
VA and DoD also participate in the National Health Information Infrastructure (NHII) Taskforce.
The focus of the taskforce is on activities to help the health care industry create and adopt a national health information infrastructure. The purpose is to create a
comprehensive knowledge-based network of interoperable systems capable of
providing information for sound decision support available anywhere and at any time it is needed.
The benefits of NHII would be:
• Improved patient safety;
• Improved quality of care;
• Effectively shared decision support;
• Better understanding of health care costs;
• Monitored and protected pubic health; and
• Better informed health care consumers.
VA and DoD are working to define Department enterprise architectures that will fully align with the lines of business within each organization, including the delivery of health
care. VA and DoD are working closely to ensure that both enterprise architectures support health data interoperability as well as optimal information management to support shared care delivery.
Recognizing the value that coordinated delivery of health care would bring to our Nation, VA and DoD are actively engaged with HHS in the Federal Health Architecture (FHA) initiative. As co-leads of the electronic health record FHA subgroup, the
Departments ensure that FHA activities are closely tied to Federal EHR initiatives. The FHA initiative has as its goals: 1) improved coordination and collaboration on
government health IT solutions and investments; and 2) improved efficiency, standardization, reliability, and availability of comprehensive health information solutions. Part of this work includes identifying relevant data and technical industry standards, including those set by the private sector, that would support identified Federal business requirements.
The Departments’ independent and collaborative efforts toward standards and architecture could serve as a model for local or regional architecture efforts in
communities, and between private sector health care providers. Further, as is identified by the FHA initiative, a published Federal architecture based on common standards could induce private sector technology firms to reduce software development costs.
This savings would then be passed on to health care providers across all settings, including those settings that necessarily rely on government (e.g., Federal, local or state) funding and assistance.
In addition to the joint work in this area conducted by VA and DoD, VA works with other Federal partners to promote the shared use of standards and terminologies. These efforts are represented in Appendix C. Through the above mentioned areas and
participation in other varied professional and standards development organizations, VA and DoD seek to influence local, state, and national agencies as well as private industry to cooperate in adopting and implementing common standards.
C. TeleHealth Technologies Used for Long Distance Consultations and Distance