Health IT Strategic Framework

Attachment 3

Appendix A - Definitions

Medically Underserved Areas (MUA) may be a whole county or a group of contiguous counties, a group of county or civil divisions or a group of urban census tracts in which residents have a shortage of personal health services.

Health Professional Shortage Areas (HPSAs) may have shortages of primary medical care, dental or mental health providers and may be urban or rural areas, population groups or medical or other public facilities.

Medically Underserved Populations (MUPs) may include groups of persons who face economic, cultural or linguistic barriers to healthcare.

Appendix B - Target DoD Standards Profile

Appendix C - VA/DoD Telehealth Projects

• VA-DoD Imaging Subgroup: This working group was established under the joint Military Health System (MHS) and VA Clinical Data Repository-Health Data Repository (CHDR) Working Integrated Product Team to develop a strategy for sharing medical and dental digital images associated with beneficiary electronic healthcare records. Comprised of functional and technical experts from each agency, the Imaging Subgroup has recognized that interoperability of digital images depends on utilization of a common standard called Digital Imaging Communications in Medicine (DICOM). The group has drafted a joint document identifying the DICOM conformance requirements that image acquisition vendors must meet in order to be recommended for purchase. Once approved for release to the field, this collaborative statement will provide greater influence on the marketplace than either agency could achieve alone. The benefit will be improved interoperability between DoD and VA digital imaging information systems.

• Teleradiology:

• The Army's Southeast Regional Medical Command is working with the VA to support ongoing local initiatives specific to Teleradiology between the following:

• Eisenhower Army Medical Center and the Augusta VA Hospital in Georgia,

• Ft. Campbell and the VA in Kentucky, and

• Ft. Jackson and the Columbia SC, VA (specific to CT Scans whereby Ft. Jackson sends images over a 100MB fiber link to the VA)

• The "I-25 Corridor Working Group" has begun connecting together the USAF Academy Hospital (USAFA), clinics at Buckley, Schriever, Peterson, Malmstrom, and FE Warren AFBs, the hospital at Ft. Carson, VA medical clinics in La Junta and Pueblo CO, and VA Medical Centers in Denver CO and Cheyenne WY, to enable exchanging digital radiographs and MRIs, thus allowing workload sharing and rapid provision of remote specialist interpretation. VA Denver, USAFA, Peterson, and Carson have already starting exchanging images.

• Sacramento VA Medical Center (old Mather AFB, CA) sends Emergency Room after-hours and weekend x-ray and CT images to Travis AFB's David Grant Medical Center (DGMC) over a point-to-point T1 line using dynamic compression technology. Radiology residents at DGMC make preliminary review and fax results back to the VA. Final interpretations and dictations are performed by VA radiologists. This helps maintain workload requirements for Travis radiology residency program and improves quality of life for understaffed VA Medical and Regional Office Center (VAMC) radiologists who have limited on-call responsibilities.

• Madigan Army Medical Center is planning Teleradiology with the Seattle VA once both sites have updated their systems and have established connectivity

• Telepsychiatry: Weed Army Community Hospital (Ft. Irwin, CA) is working with the Los Angeles VA Regional Office to establish a VA/DoD sharing agreement to perform Compensation and Pension examinations, utilizing telemedicine for psychiatric examinations on persons separating/retiring at Fort Irwin who require such evaluation.

• Hawaii Integrated Federal Healthcare Partnership: The Pacific Telehealth and Technology Hui was established in 1999 as a joint partnership of the VAMC Honolulu and Tripler Army Medical Center (TAMC) to manage joint Telehealth projects involving research, development, prototype, evaluation and technology transfer. These efforts include:

• Two projects developed under a joint initiative with the Joslin Diabetes Center, one of the world's leading research centers for diabetes. It is further described below in Case Management. The first project, the Joslin Vision Network (JVN), provides a platform for assessing the severity of diabetic retinopathy using a highly sophisticated digital camera to capture and transmit an image of the retina to a reading station for remote evaluation. The second, the joint Hui-Joslin initiative called the Holopono program, demonstrates the use of Internet technology to manage follow-up care for patients with diabetes.

• A project that permits electronic transmission of pharmacy orders between TAMC and VAMC Honolulu for dispensing. This interface allows pharmacy orders written at the DoD facility to be transmitted electronically and filled at the VA pharmacy.

• Janus, a project that allows DoD providers to retrieve patient data from the VA's VistA patient record system. It provides a single Graphical User Interface (GUI) front end that links to a web application to pull data from VistA to provide end-users on TAMC's Composite Healthcare System (CHCS) with VistA patient record information.

• Alaska Federal Healthcare Access Network: This initiative of the Alaska Federal Healthcare Partnership is comprised of DoD, VA, Indian Health Service (IHS), the US Coast Guard and other state and federal agencies. Its goal is to use new telecommunications and telemedicine technology to extend and improve access to healthcare service and information for over 200,000 federal beneficiaries. The project has linked 235 federal and state healthcare sites into a statewide telemedicine system. Using state-of-the-art technology and equipment, member organizations have begun to send medical images, health information, and voice data to regional hospitals for remote diagnosis and consulting.

• Case Management (Diabetes): The Joslin Vision Network (JVN) is a telemedicine application focused on increasing access of diabetic patients into appropriate eye care and represents a collaborative effort between the DoD, VA and Joslin Diabetes Center in Boston. The original proof-of-concept JVN system has evolved into a second-generation system using non-proprietary Microsoft hardware and software, which leverages the established Patient Archiving and Communications System infrastructure and implements the Comprehensive Diabetes Management Program (CDMP) proposed in the Chronic Care Model developed by Edward Wagner, M.D. Its six components are: (1) Coordination with community resources (2) Strategic commitment of the organization (3) Support of patient self-management (4) Redesign of delivery system (5) Clinical decision support and (6) Clinical information systems. The JVN eye care system:

• Is currently deployed in 32 active remote imaging sites with six established and certified reading centers distributed across ten different states from Hawaii to New England,

• Represents participating sites associated with the DoD, the Veterans Health Affairs and the IHS,

• Has allowed access to over 12,000 patients into the JVN eye care system since September 2001,

• JVN CDMP application is currently live at the Joslin Diabetes Center and Walter Reed Army Medical Center,

• Provides significant opportunity, when leveraged with deployed teleconsultation systems, to realize substantial cost savings for treating chronic disease.

• e-Learning: The Adult Nurse Practitioner Post Master's Program is a collaborative effort between the VA and the Graduate School of School of Nursing, Uniformed Services University for the Health Sciences (USUHS), which provides a Nurse Practitioner Distance Learning educational curriculum for VA and DoD nurses. It demonstrated that students and teachers, separated by geographic distance, can participate fully in an effective and meaningful educational process using electronic technology for communication. USUHS enables distance learning in support of the doctoral Nursing Science program for DoD and VA nurses. USUHS is also in the process of building a distance learning component to their Master's in Public Health program that could be utilized by DoD and VA providers.

Appendix D - Benefits of Telehealth

The benefits of telehealth are varied and impressive. Though some are difficult to quantify as they are concerned with quality of care or military troop readiness, the following list highlights benefits that already have been demonstrated in a multitude of pilot projects throughout the world, not just in the military:

• Biosurveillance, and thus Homeland Defense capabilities, are enhanced by providing data feeds from electronic and telephone triage systems and teleconsultations.

• Travel costs associated with transportation to distant specialty providers is reduced.

• Scarce medical specialty and sub-specialty resources can be leveraged beyond the "brick and mortar" construct of medical care.

• On-duty time and medical readiness is increased as a result of reduction in time spent to obtain specialty medical care.

• Access to care is enhanced, especially where travel distances represent a significant barrier.

• Unnecessary medical evacuations are reduced.

• Health services in the home and community-based care locations are augmented.

• Mortality and intensive-care bed days are reduced through utilization of electronic critical/intensive care monitoring (as shown in commercial studies).

• Costs of emergency care and inpatient hospital stays are decreased through more effective case management utilizing electronic home-health monitoring systems.

• For VA and DoD, the amount of specialty care provided to beneficiaries by the private sector is reduced, providing cost savings.

• The quality of residency teaching via an e-Learning platform enables gathering of relevant specialty cases for review and dramatically enhances provider education.

What's New

• Third Nationwide Health Information Network Forum: Prototypes and Business Models, January 25-26, 2007.
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• Emergency Responder Electronic Health Record Detailed Use Case
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• HHS Announces State Alliance for e-Health
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• State Privacy and Security Subcontract Opportunities Announced Under Expanded HHS Contract with RTI
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• Click here to find out more about the American Health Information Community workgroup meetings.



• HHS Enters Into Agreements to Support Digital Health Recovery for the Gulf Coast
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• HHS Announces Award of NHIN Prototype Contracts
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• ONC and AHIMA release two anti-fraud project reports
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• Health IT (HIT) Adoption Initiative Announced
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• Health IT Contracts Awarded Stemming from RFPs
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