The Future of Digital Health for Veterans
Healthcare is in the midst of a digital revolution, and for the Department of Veterans Affairs (VA), the Digital Health Platform (DHP) is part of the next logical step beyond the traditional Electronic Health Record (EHR) system to further advance the industry movement towards digital health.
The DHP will bridge the gaps in episodic clinical data in the EHR with other “untapped” data sources such as clinical data collected through mobile apps, patient portals, third party repositories, consumer health and tracking devices. Doing so in an intelligent manner will provide a more complete understanding of patient health and the environmental and situational conditions that lead to adverse health events. The following diagram shows the breadth of the digital health landscape and illustrates the potential for utilizing new or untapped data for clinical decision making. The diagram also hints at the likelihood of data fragmentation that exists across all the sub-elements of the digital health landscape.
The VA has indicated their desire to move “beyond the EHR to a digital health platform that better supports Veterans throughout the health continuum.“ And according to a report on health IT Interoperability, “the primary goal of DHP is to ensure that all available health data on a veteran—from personal devices and wearables to provider-generated data at annual physicals—is available in one easily-accessible digital location that can follow that individual anywhere.”
To achieve this goal, the DHP should be an extension of the existing health IT infrastructure and not a replacement. As a cloud-hosted, highly secured data integration and data management platform, the DHP augments and bridges the data gaps between VA systems as well as provides access to the clinical data from mobile apps and devices that are not currently available to VA systems. It builds on top of the EHR and other business systems through standards-based data APIs (with emphasis on HL7 FHIR), which has the dual benefits of extending the data/evidence base for medical decision making and integrating with existing systems in an abstracted and non-proprietary way to avoid tight coupling with any particular brand of EHR.
The evolving technology landscape impacting the VA demands that a DHP integrate through standards-based APIs and abstraction to ensure future success. Doing so helps future-proof the DHP and separate the DHP from the underlying systems and architectures that it integrates with. This in turn allows the VA to migrate and change legacy solutions without negatively impacting the DHP itself or the business community that will benefit from its capabilities.
This is critical given some of the uncertainties facing future direction of the VA health IT ecosystem, which currently operates using the Veterans Information Systems and Technology Architecture (VistA). The VA has indicated several potential scenarios for their future IT ecosystem:
- Leave VistA in place (either in VA Medical Centers or Regional Data Centers), virtualize it, and leverage it as part of the VistA Evolution and eHMP strategy
- Replace VistA with a COTS EHR
- Consolidate VistA into a national, standard instance
These three scenarios are just some of the VA initiatives in planning stages or already underway that demonstrate the options the VA is considering as well as some of the challenges they face in determining the optimal path towards a less complex, more homogeneous system with reduced operating costs and an improved user experience that meets new business needs. While the plan laying out how all the VA initiatives fit together is still evolving, the only certainty is change. The distributed VistA EHR environment used at the VA today will undoubtedly morph into something different in the future. To achieve the benefits of the DHP despite the changes to the underlying VA systems requires abstraction to ensure that the DHP can operate against different and emerging architectures. This further highlights the importance of building a DHP that as an extension to existing digital health infrastructure instead of a replacement.
To prepare for this, HPE and partner QuintilesIMS are building our internal DHP capability incrementally. We have identified and stood up a highly extensible platform hosted in the cloud that meets stringent security requirements out of the gate (AppNucleus is FIPS 140-2 and NIST 800-88 compliant) and comes with standards-based APIs, a mobile SDK for rapid mobile app development and native Bluetooth integration with wearables and other Internet of Things (IoT) devices.
We are building on top of this platform incrementally to align our evolving DHP to known VA use cases and business problems. This starts with loosely coupled integration with VistA through standards-based APIs. Our first prototype focuses on clinical studies and specifically the Millions Vets Program. By integrating our base DHP with VistA and a workflow manager, we have stood up a prototype capable of streamlining the Veteran engagement processes for enrolling Veterans into clinical studies and retaining their interest through a dynamic Veteran engagement platform.
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