Interoperability Modernization StrategyNote that the title of this strategy focuses on interoperability, but the vision is about seamless care and benefits. Whereas interoperability is the ability of technologies to exchange and use information, seamless care and benefits is the experience of human beings that interoperability enables. The care experience from encounter to encounter is seamless when beneficiaries and providers easily make decisions and smoothly execute management plans based on comprehensive beneficiary data.Federal Electronic Health Record Modernization Program OfficeFEHRM_ab9ff24e-0d79-11eb-a754-843cfe82ea00The Federal Electronic Health Record Modernization (FEHRM) program office was chartered by the Department of Defense and Department of Veterans Affairs deputy secretaries on December 4, 2019, with the goal to implement a single, common federal electronic health record (EHR) to enhance patient care and provider effectiveness, regardless of the location of care. A modern, secure, interoperable EHR enhances integrated, patient-centered care delivery across the continuum of care. Advancing interoperability across the federal and private sectors space is one of the FEHRM’s chartered objectives.Dr. Neil C. EvansInterim Director, Federal Electronic Health Record Modernization Program OfficeDepartment of DefenseThe Department of Defense (DOD) and Department of Veterans Affairs (VA), referred to as the Departments, share a unique beneficiary population that relies on both Departments for their care and benefits. Today’s active-duty Service member is tomorrow’s Veteran, not to mention the other eligible beneficiaries, caregivers, and survivors that both Departments serve. DOD and VA, supported by the Federal Electronic Health Record Modernization (FEHRM) program office, collaborate to optimize the interoperability of the information systems they each use to support the care of their beneficiaries. They strive to deliver systems that can exchange health and benefits data between them, and with private sector providers in local communities across the country, with a goal of using that data to provide health care and benefits to support the overall health and wellbeing of beneficiaries and to ease the transition from military Service member to Veteran. Supported by interoperable systems, health and benefits teams are able to more efficiently and effectively conduct their work to provide a seamless experience for the beneficiary wherever they seek care and services. Department of Veterans AffairsEvery day, DOD and VA are working to align systems, software platforms, security procedures and data repositories to increase interoperability to better serve their beneficiaries and manage resources. The Joint Longitudinal Viewer enables DOD and VA health care providers to view a patient’s health record across both Departments. Joint health information exchange (HIE) allows data from participating community partners and health systems who treat DOD and VA beneficiaries to be integrated into the EHR. DOD and VA’s current modernization efforts include the implementation of a single, common EHR. These advancements are built upon a shared vision of the health care and benefits ecosystem and a high degree of collaboration and coordination to achieve the vision. This Interoperability Modernization Strategy reflects the collaborative effort of leaders and subject matter experts across DOD and VA who provided their insights into clinical and technical capabilities, operational business practices and ethical and policy considerations required to achieve interoperability. Health Care Professional SocietiesHealth care professional societies and standards development organizations, such as the Healthcare Information and Management Systems Society, Institute of Electrical and Electronics Engineers (IEEE) and Health Level Seven® International, have established definitions for interoperability. Title 4 of the 21st Century Cures Act and Section 715 of the National Defense Authorization Act for Fiscal Year 2020 (NDAA FY2020) also include definitions. At their core, they all define interoperability as the ability of technologies to exchange and use data in a meaningful way. This Interoperability Modernization Strategy uses the IEEE definition: the ability of two or more systems or components to exchange information and to use the information that has been exchanged. Standards Development OrganizationsHealthcare Information and Management Systems SocietyInstitute of Electrical and Electronics EngineersHealth Level Seven® InternationalOffice of the National Coordinator for Health Information TechnologyThe Office of the National Coordinator for Health Information Technology (ONC), part of the Department of Health and Human Services, provides national leadership on health information technology (IT) and is responsible for implementing several provisions of the 21st Century Cures Act related to enhancing interoperability and electronic health information exchange. This strategy adopts the goals of the ONC 2020–2025 Federal Health IT Strategic Plan, aligning it with national health IT priorities. With these Federal Health IT goals as a framework, DOD and VA leaders and subject matter experts, supported by the FEHRM, defined objectives that will guide the Departments in achieving their vision of providing a seamless health care and benefits experience for beneficiaries and those who serve them, while addressing legislative requirements. In addition, the FEHRM’s ongoing collaboration with ONC will ensure continued alignment with national priorities. Service MembersDOD and VA serve a range of beneficiaries, including Service members, beneficiaries and Veterans, as well as caregivers and survivors. For all beneficiaries, accessing and managing their health care and benefits is seamless whether they: * Seek care or benefits at a DOD or VA facility or with a member of the health care and benefits partner continuum * See a health and benefits team member in person, have a phone consultation or access care and services via digital solutions * Manage their health and benefits by computer, on their smart phone or by visiting a facilityVeteransCaregiversSurvivorsA seamless health care and benefits experience for beneficiaries and those who serve them_ab9ff406-0d79-11eb-a754-843cfe82ea00To establish interoperability modernization goals and objectives_ab9ff578-0d79-11eb-a754-843cfe82ea00Seamless CareThe experience of seamless care and benefits is the north star of this interoperability modernization strategy.InformationSeamless care requires exchange and use of information. Seams often occur in the fabric of health care and benefits between encounters or tasks, even within the same health care system using the same EHR.InteroperabilitySeamless care involves three human-computer operations: gathering data to understand what is going on, interpreting what is going on to decide on the management plan and coordinating work to execute the plan.DataTo reiterate: gathering pertinent data, making sense of the data and coordinating action; when these three operations are gapless, easy and orderly, the fabric of care becomes seamless. The following strategic framework, goals and objectives require the full spectrum of human-computer operations related to interoperability.Sense MakingCoordinationEthicsAll efforts to improve health care and benefits through interoperability modernization and use of beneficiary data are guided by the highest ethical standards to ensure appropriate and secure use of beneficiary data, prioritize privacy and access and promote beneficiary and public trust in the people, technology and systems of DOD, VA and their health care partners. HealthPromote Health and Wellness_ab9ff6ae-0d79-11eb-a754-843cfe82ea001DODVADOD and VA are committed to helping their beneficiaries optimize their health and wellness at every stage of their lives. The Departments aim to do this by integrating data from their health, benefits and other systems to provide a full picture of each individual that is available to the beneficiary and to their health and benefits team based on the beneficiary’s preferences. Beneficiaries maintain ownership and control of their data, and both they and team members have access to the necessary components of the records, including information on the social determinants of health, to promote early, proactive engagement. Working in partnership with beneficiaries, team members help to ensure beneficiaries are aware of and have access to the full range of care and services available to improve their overall health and wellness. WellnessBeneficiaries are empowered to manage their health and wellness_ab9ff7f8-0d79-11eb-a754-843cfe82ea001ABeneficiariesEmpowering beneficiaries means that they maintain ownership and control of their health, benefits and other data and have access to information to help them understand and use that data to improve their health and wellness. Beneficiary preferences determine how their data is accessed, managed and shared to manage health and wellness. BenefitsBeneficiaries are empowered to manage their health care and benefits_ab9ff942-0d79-11eb-a754-843cfe82ea001BBeneficiariesBeneficiaries have access to their health, benefits and related data as they work in partnership with their health and benefits team to manage their treatment and other health care services and their benefits. They have input into their care plan and, via a portal, can view their record, schedule appointments, review reports and communicate with their team members to actively participate in the management of their care and benefits. This objective also encompasses the support beneficiaries receive through status transitions (active duty, Reserve, Veteran and survivor) to help ensure access to appropriate care and benefits (included in Objective 2.1. Military to Civilian Transition in the Department of Veterans Affairs and Department of Defense Joint Executive Committee Joint Strategic Plan Fiscal Years 2019–2021). Data & CommunicationHealth and benefits team members and public health organizations are able to access and analyze data and communicate findings and recommendations to improve individual- and population-level health and wellness_ab9ffae6-0d79-11eb-a754-843cfe82ea001CHealth Team MembersBenefits Team MembersPublic Health OrganizationsWhen appropriate, members of the health and benefits team and public health organizations are able to access, query and analyze DOD and VA’s store of beneficiary data. This enables them to uncover new ways to improve individual- and population-level health and wellness, respond to urgent health events (including epidemics) and lessen health disparities identified in segments of the population. Team members can leverage data that enables them to easily and efficiently design, implement and evaluate interventions. Efficiency & EffectivenessBenefits and service providers deliver effective and efficient benefits and services_ab9ffc58-0d79-11eb-a754-843cfe82ea001DBenefits ProvidersService ProvidersThrough interoperable systems, benefits and service providers within DOD, VA and the health care and benefits partner continuum are able to view, interact with and analyze health, benefits and other relevant beneficiary data that enables them to work in partnership with the beneficiary to help ensure they receive the benefits and services that meet their needs and maximize their health and wellness. CareEnhance the Delivery and Experience of Care_ab9ffdac-0d79-11eb-a754-843cfe82ea002BeneficiariesHealth Team MembersBenefits Team MembersWherever, whenever and however a beneficiary receives care and benefits, the experience will be seamless. Beneficiaries will have access to their complete health and benefits data, and that information will be available for authorized use to every health and benefits team member they encounter within the DOD, VA or health care and benefits partner continuum. This will remove the burden on the beneficiary to repeat information and optimize their time with team members, while increasing overall efficiency in the health and benefits systems. Additionally, DOD and VA are committed to addressing the health impacts of beneficiaries who experienced exposure events during their Service through tailored health care and benefits. AccessBeneficiaries access health care and benefits regardless of location_ab9fff1e-0d79-11eb-a754-843cfe82ea002ABeneficiariesHealth Team MembersBenefits Team MembersMilitary Treatment FacilitiesVA Medical CenterHealth Care PartnersBenefits PartnersDOD and VA’s efforts to enhance interoperability are dedicated to improving the beneficiary experience. Interoperable EHR and benefits systems enable every beneficiary to access the most up-to-date data and to receive care and benefits regardless of location or method of access. This includes in-person access at a military treatment facility, VA medical center or facility in the health care and benefits partner continuum, or access by phone, video or digital solutions such as telehealth, portal technology, personal health records and smart phone apps. Increasingly, patient-generated data from home monitoring and other systems that beneficiaries collect can also be incorporated into the EHR. Ease of access enables the beneficiary and team members to work together to establish goals for care and services that make the maximum use of health care and benefits to improve beneficiary health and wellness, as well as beneficiary satisfaction. It also enables team members to collaborate on beneficiary care in real time or asynchronously, while remaining fully up to date, and can simplify transitions when beneficiaries move between care settings. This objective also encompasses the work being done to establish and incorporate into the EHR an Individual Longitudinal Exposure Record to track beneficiaries who experience hazard exposure events during their Service to provide them with tailored health care and benefits (included in Objective 1.2. Individual Longitudinal Exposure Record [ILER] in the Department of Veterans Affairs and Department of Defense Joint Executive Committee Joint Strategic Plan Fiscal Years 2019–2021).InformationBeneficiaries have access to information to make informed choices about their health care providers and insurers_aba00086-0d79-11eb-a754-843cfe82ea002BBeneficiariesHealth Care ProvidersHealth Care InsurersFor beneficiaries to actively participate in and manage their care and benefits, they must have access to information. Interoperable health and benefits systems and supporting technology provide beneficiaries the ability to view and analyze their data along with relevant cost and quality information and to use that data to determine the provider or insurer that best meets their needs.LocationHealth and benefits team members provide care wherever the beneficiary is located_aba001ee-0d79-11eb-a754-843cfe82ea002CHealth Team MembersBenefits Team MembersMilitary Treatment FacilitiesVA Medical CentersHealth Care PartnersBenefits PartnersWhether seeking care at a military treatment facility, VA medical center or facility in the health care and benefits partner continuum or accessing care by phone, video or digital solutions such as telehealth, the beneficiary experience should be seamless. The goal of interoperable EHR and benefits systems is to enable every member of the health and benefits team appropriate access to the most up-to-date beneficiary data to deliver appropriate care and benefits. Ease of access enables team members to collaborate on beneficiary care in real time and at intervals, while remaining fully up to date. It can also simplify transitions between care settings when beneficiaries must move from one facility to another.Safety & EffectivenessHealth and benefits team members practice safe and effective beneficiary-centered care_aba0039c-0d79-11eb-a754-843cfe82ea002DHealth Team MembersBenefits Team MembersInteroperable systems provide relevant data at the point of care that enable team members to provide safe, effective, beneficiary-centered care. Health care team members are supported by appropriate evidence-based alerts, decision support tools, clinical workflows and technologies to enable the selection of the most appropriate clinical decisions. DODand VA-approved clinical practice guidelines and relevant standards and terminologies are embedded within the EHR and support clinical practice, data exchange, continuity of care, coordination of care and measurable outcomes. Interoperable systems further enable benefits team members to provide effective and efficient services to beneficiaries. Appropriate, accurate data are available and easy to use to enable beneficiary and benefits team members to easily communicate about and transact the full range of eligible services. Beneficiary empowerment and satisfaction are prioritized, and barriers that impede access, usability and transparency are eliminated.Administrative BurdenHealth and benefits team members experience reduced administrative burden and focus their time on beneficiaries_aba0052c-0d79-11eb-a754-843cfe82ea002EHealth Team MembersBenefits Team MembersHealth and benefits team members, in collaboration with the beneficiary, manage a vast array of health and benefits decisions on a regular basis. The complexity and number of these decisions are made more complex when systems are not seamlessly connected. Interoperable systems will enable the capture of beneficiary information once, with the underlying data then available for multiple purposes and future treatment. Seamlessly connected systems eliminate the need for repeated data entry in multiple systems, removing that burden from health and benefits team members and enhancing data quality. Interoperable systems that exchange complete, accurate and timely data return valuable time to focus on beneficiary concerns and needs. Beneficiary satisfaction and confidence in their care and benefits system improve when team members can communicate and confirm accurate information across both Departments.ITHealth and benefits team members are supported by information technology that meets their workflow and usability needs_aba006bc-0d79-11eb-a754-843cfe82ea002FHealth Team MembersBenefits Team MembersDOD and VA acquire and implement best-in-class IT capabilities that enable health and benefits team members to deliver a seamless health care and benefits experience to beneficiaries. IT capabilities must enable frontline users to perform their required or desired actions, whether it is a beneficiary accessing their health data via an app on their smart phone, a health care provider providing a new prescription, a benefits administrator processing a claim or a population health professional running a report to monitor a health issue in a portion of the beneficiary population. Capabilities must deliver value and integrate human-centered design principles and an understanding of workflows and how the product is used by the end user. Where possible, usability testing should be conducted in the environment where the capability will be used. Additionally, DOD and VA maintain exclusive control over beneficiary health data. Adverse EventsPatient safety and population health professionals identify, predict, monitor and prevent adverse events_aba0086a-0d79-11eb-a754-843cfe82ea002GPatientsPatient Safety ProfessionalsPopulation Health ProfessionalsThrough interoperable systems, public safety and population health professionals should have the ability to appropriately interact with and analyze DOD and VA beneficiary data and analyze automated reports on adverse events that will help them identify and predict these events, monitor their impact and ultimately prevent them. Information SharingDOD, VA and members of the health care and benefits partner continuum promote sharing of health and benefits information among other federal, state and local entities in accordance with applicable laws and patient preferences_aba00a04-0d79-11eb-a754-843cfe82ea002HDODVAHealth Care PartnersBenefits PartnersFederal EntitiesState EntitiesLocal EntitiesPublic Health ProfessionalsOpportunities exist for increased data sharing among federal, state and local entities that respects beneficiary preferences and safeguards their security and privacy. For example, to support population health, sharing immunization data among states would allow public health professionals to track nationwide immunity and identify potential areas for outbreaks. In addition, the VA may need to share up-to-date disability rating information on Veterans with state tax authorities to ensure Veterans can receive appropriate property tax relief in accordance with state law. Another example is that DOD routinely sends records for transitioning Service members to both VA and the Social Security Administration to facilitate disability evaluation and benefits eligibility review. In each of these examples, the ability of health and benefits team members to support beneficiaries requires that 1) systems are interoperable, 2) current policies, procedures and legal requirements are embedded in workflows to aid in decision making and 3) beneficiary preferences are captured and used to help ensure that the most appropriate, beneficiary-centric solutions can be provided while ensuring Departmental compliance.EcosystemBuild a Secure, Data-Driven Ecosystem to Accelerate Research and Innovation_aba00d4c-0d79-11eb-a754-843cfe82ea003The increasing level of interoperability between DOD and VA and with the health care and benefits partner continuum provides opportunities for the Departments to continually advance their dynamic ecosystem that supports research and innovation to improve care and benefits and advance human knowledge. Consistent with the Institute of Medicine and 21st Century Cures Act, the Departments align with the key tenants of a highly reliable learning health system. They leverage research, informatics and innovation for continuous improvement with best practices seamlessly embedded in the delivery process and new knowledge captured as a by-product of the delivery experience. An ethical framework underpins all research and innovation initiatives to help ensure the appropriate and secure use of data and prioritize beneficiary privacy. DataBeneficiaries have the choice to contribute their data to research initiatives_aba00f22-0d79-11eb-a754-843cfe82ea003ABeneficiaries have the choice to contribute their data to research initiatives within the parameters of existing law and organizational policies and based on their personal preferences. Health and benefits team members present opportunities to beneficiaries to participate in large-scale studies to accelerate health research to produce new medical treatments to benefit individuals and the wider population.InteroperabilityResearchers and IT professionals advance interoperability to better facilitate research and innovation_aba010b2-0d79-11eb-a754-843cfe82ea003BResearchersIT ProfessionalsResearchers need easy access to data across multiple systems to enable studies and clinical trials that will lead to new treatments and interventions and to drive innovation in the health and benefits systems. They also work in collaboration with the IT professionals across the enterprise to study the best IT solutions, such as application program interfaces, machine learning and artificial intelligence, to continually improve interoperability and facilitate research and innovation. ONC’s Cures Act Final Rule, published March 9, 2020, addresses improvements to research and innovation in the interoperability space.SystemsResearchers and innovators leverage data and information technologies to build information systems that are evidence-based to advance health, health care delivery and provision of benefits_aba01256-0d79-11eb-a754-843cfe82ea003CResearchersInnovatorsTo support the continuing development of an interoperable, data-driven ecosystem, researchers and innovators must have an evidence base that enables current technologies to be studied and evaluated to determine how they can be used and improved to deliver maximum value. This evidence base also facilitates the evaluation of potential new information technologies to ensure they will meet the Departments’ current and future needs and deliver value across the ecosystem.DataConnect Health Care and Health Data_aba013fa-0d79-11eb-a754-843cfe82ea004DOD and VA are committed to securely connecting health data through an interoperable health IT infrastructure, while safeguarding the privacy of beneficiary data and ensuring its appropriate use. The Departments are implementing a single, common EHR and ensuring interoperability with other systems to facilitate seamless care and benefits delivery to beneficiaries. The Departments continue to improve interoperability with members of the health care and benefits partner continuum through a joint HIE, which maximizes appropriate and timely data sharing. DOD and VA participate in the federal health IT architecture arena and collaborate with standards development organizations. In addition, they participate in the IT marketplace by evaluating new products and adopting the products that best meet their requirements to continually improve interoperability. The Departments also ensure technical requirements and contract specifications maximize open architecture, standards and data sharing within organizational frameworks and policies for appropriate data access and use.ITLeadership in health and benefits delivery, finance and technology optimize the value of information technology_aba015a8-0d79-11eb-a754-843cfe82ea004ALeadership in health and benefits delivery, finance and technology collaborate closely to shepherd the organizations through governance processes to help ensure the value and benefit of the infrastructure meets the financial, operational and business needs of the Departments, while prioritizing interoperability within organizational standards for data access and use. Close collaboration and tightly integrated evaluation processes of IT solutions help ensure interoperability is enacted in the broadest possible terms—technical, architecture, process, workflow and policy— resulting in outstanding user experiences, cost efficiencies and reduced technical sustainment burdens. This objective aligns with the 21st Century Cures Act Section 3022 that defines information blocking (except as required by law or covered by an exception) as any act that is likely to interfere with (includes “prevent” and “materially discourage”) access, exchange or use of electronic health information included in the United States Core Data Sets for Interoperability standard adopted in 170.213.IntegrationLeadership in technology and information enable seamless integration between systems to support health care and related benefits_aba01760-0d79-11eb-a754-843cfe82ea004BLeadership in technology and information ensure architecture, standards, terminologies and application interfaces accelerate interoperability by enabling data to be accessed and shared appropriately and securely across the complete spectrum of care and benefits, within all applicable settings and with relevant stakeholders, including the beneficiary. They also procure systems and devices that comply with DOD and VA’s interoperability goals. These IT systems and devices are accompanied by robust privacy and cybersecurity policies that operate in the background and make it easy for users to guard privacy and security. 2020-10-13https://fcw.com/-/media/gig/edit_shared/documents/2020/october/dod_va_interoperability_modernization_strategy_20200924.pdfOwenAmburOwen.Ambur@verizon.net