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Georgia Tech Furthers VA Vision for EHR Interoperability

A recent proof-of-concept definition by Georgia Tech is the latest step in the VA plan to advance EHR interoperability, data exchange, and data integration for veteran care.

VA DHP.

Source: Thinkstock.

- The Department of Veterans Affairs and Veterans Health Administration scored a victory for its patient-centered EHR interoperability solution, the Digital Health Platform (DHP), as part of a proof-of-concept demonstration led by the Georgia Institute of Technology. 

A team of public-private health care technology collaborators launched an open-source project supporting clinical and operational policy and program reconfiguration plans useful for handling changes in veteran populations, service needs, and care delivery models, the university announced earlier this week.

Collaborators in the project include the VA Office of Information and Technology, Office of the National Coordinator for Health Information Technology (ONC), and several private-sector companies that aided with analytics, customer relationship management, and application program interfaces (APIs) — Salesforce, Mulesoft, Apervita, and UCB.

 “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,” said Steve Rushing, Senior Strategic Adviser at Georgia Tech’s Health Extension Services. “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 demonstration took place six weeks after the VA officially greenlighted the project. With the help of the health IT standard and API Fast Healthcare Interoperability Resources (FHIR), collaborators designed an API gateway surrounding the VA EHR technology VistA and Georgia Tech’s testing and teaching EHR system using anonymous patient data.

The project produced 21 system APIs controlling how types of data flow into and out of the DHP. Data exchanges involved in the project include Cerner EHR and Epic EHR.

 “The DHP leverages the power of public-private partnerships. We brought together some of the brightest engineers and health informaticists from some of the most innovative companies and assembled them at Georgia Tech,” VA CIO LaVerne Council said in an interview with 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,” she continued. “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.”

The proof-of-concept should accommodate future developments by connecting to outside web services, apps, devices, and EHR systems that use FHIR or other leading industry open standards.

 “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,” Rushing added.

“Changing these doesn’t add strategic value because the new programming will look much like the old,” he went on to say. “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.”

An additional advantage of the DHP is analytical insight gained through studying the EHRs of military personnel making the transition from active duty to veteran status. The analytics aspect of the technology generates recommendations for care including enrollment in specialized services for veterans suffering a traumatic brain injury.

The project started in the spring of 2016 when the VA began making plans to improve EHR interoperability using HL7 and cloud-based technologies to present a comprehensive picture of veterans’ electronic medical records and allow this information to follow veterans wherever they go.

The proof-of-concept demonstrated that while VistA is still a part of the project, it is one EHR technology of many used by providers. DHP is agnostic toward commercial EHR systems and VistA, allowing for increased interoperability through the use of open-source API gateway connections. 

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