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_bec336d8-0d79-11eb-8f70-d241fe82ea00The Federal Electronic Health Record Modernization (FEHRM) program office was chartered by the Department ofDefense and Department of Veterans Affairs deputy secretaries on December 4, 2019, with the goal to implementa 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-centeredcare delivery across the continuum of care. Advancing interoperability across the federal and private sectors spaceis 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’sactive-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 ElectronicHealth Record Modernization (FEHRM) program office, collaborate to optimize the interoperability ofthe information systems they each use to support the care of their beneficiaries. They strive to deliversystems that can exchange health and benefits data between them, and with private sector providers inlocal communities across the country, with a goal of using that data to provide health care and benefitsto support the overall health and wellbeing of beneficiaries and to ease the transition from militaryService member to Veteran. Supported by interoperable systems, health and benefits teams are able tomore efficiently and effectively conduct their work to provide a seamless experience for the beneficiarywherever they seek care and services. Department of Veterans AffairsEvery day, DOD and VA are working to align systems, softwareplatforms, security procedures and data repositories to increaseinteroperability to better serve their beneficiaries and manageresources. The Joint Longitudinal Viewer enables DOD and VAhealth care providers to view a patient’s health record acrossboth Departments. Joint health information exchange (HIE)allows data from participating community partners and healthsystems who treat DOD and VA beneficiaries to be integrated intothe EHR. DOD and VA’s current modernization efforts include theimplementation of a single, common EHR. These advancementsare built upon a shared vision of the health care and benefitsecosystem and a high degree of collaboration and coordinationto achieve the vision. This Interoperability ModernizationStrategy reflects the collaborative effort of leaders and subjectmatter experts across DOD and VA who provided their insightsinto clinical and technical capabilities, operational businesspractices and ethical and policy considerations required toachieve interoperability. Health Care Professional SocietiesHealth care professional societies and standards developmentorganizations, such as the Healthcare Information andManagement Systems Society, Institute of Electrical andElectronics Engineers (IEEE) and Health Level Seven®International, have established definitions for interoperability.Title 4 of the 21st Century Cures Act and Section 715 of theNational Defense Authorization Act for Fiscal Year 2020 (NDAAFY2020) also include definitions. At their core, they all defineinteroperability as the ability of technologies to exchange anduse data in a meaningful way. This Interoperability ModernizationStrategy uses the IEEE definition: the ability of two or moresystems or components to exchange information and to usethe 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 HumanServices, provides national leadership on health information technology (IT) and is responsible for implementing severalprovisions of the 21st Century Cures Act related to enhancing interoperability and electronic health information exchange. Thisstrategy 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 benefitsexperience for beneficiaries and those who serve them, while addressing legislative requirements. In addition, the FEHRM’songoing 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 andsurvivors. 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_bec33944-0d79-11eb-8f70-d241fe82ea00To establish interoperability modernization goals and objectives_bec33aa2-0d79-11eb-8f70-d241fe82ea00Seamless 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_bec33bf6-0d79-11eb-8f70-d241fe82ea001DODVADOD and VA are committed to helping their beneficiaries optimize their health and wellness at every stage of theirlives. The Departments aim to do this by integrating data from their health, benefits and other systems to providea full picture of each individual that is available to the beneficiary and to their health and benefits team based onthe beneficiary’s preferences. Beneficiaries maintain ownership and control of their data, and both they and teammembers have access to the necessary components of the records, including information on the social determinantsof health, to promote early, proactive engagement. Working in partnership with beneficiaries, team members help toensure beneficiaries are aware of and have access to the full range of care and services available to improve theiroverall health and wellness. WellnessBeneficiaries are empowered to manage their health and wellness_bec33d36-0d79-11eb-8f70-d241fe82ea001ABeneficiariesEmpowering beneficiaries means that they maintain ownership and control of their health, benefits and other data andhave access to information to help them understand and use that data to improve their health and wellness. Beneficiarypreferences determine how their data is accessed, managed and shared to manage health and wellness. BenefitsBeneficiaries are empowered to manage their health care and benefits_bec33e6c-0d79-11eb-8f70-d241fe82ea001BBeneficiariesBeneficiaries have access to their health, benefits and related data as they work in partnership with their health andbenefits team to manage their treatment and other health care services and their benefits. They have input into theircare plan and, via a portal, can view their record, schedule appointments, review reports and communicate with theirteam 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 toCivilian Transition in the Department of Veterans Affairs and Department of Defense Joint Executive Committee JointStrategic 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_bec33fb6-0d79-11eb-8f70-d241fe82ea001CHealth Team MembersBenefits Team MembersPublic Health OrganizationsWhen appropriate, members of the health and benefits team and public health organizations are able to access, query andanalyze 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 insegments of the population. Team members can leverage data that enables them to easily and efficiently design, implementand evaluate interventions. Efficiency & EffectivenessBenefits and service providers deliver effective and efficient benefits and services_bec34114-0d79-11eb-8f70-d241fe82ea001DBenefits ProvidersService ProvidersThrough interoperable systems, benefits andservice providers within DOD, VA and thehealth care and benefits partner continuum areable to view, interact with and analyze health,benefits and other relevant beneficiary datathat enables them to work in partnership withthe beneficiary to help ensure they receive thebenefits and services that meet their needsand maximize their health and wellness. CareEnhance the Delivery and Experience of Care_bec34272-0d79-11eb-8f70-d241fe82ea002BeneficiariesHealth 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_bec34448-0d79-11eb-8f70-d241fe82ea002ABeneficiariesHealth 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 solutionssuch 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_bec345a6-0d79-11eb-8f70-d241fe82ea002BBeneficiariesHealth 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_bec34736-0d79-11eb-8f70-d241fe82ea002CHealth 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_bec348d0-0d79-11eb-8f70-d241fe82ea002DHealth 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, decisionsupport 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 andsupport 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 easilycommunicate about and transact the full range of eligible services. Beneficiary empowerment and satisfaction areprioritized, 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_bec34a56-0d79-11eb-8f70-d241fe82ea002EHealth 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_bec34bd2-0d79-11eb-8f70-d241fe82ea002FHealth 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_bec34f1a-0d79-11eb-8f70-d241fe82ea002GPatientsPatient 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_bec350aa-0d79-11eb-8f70-d241fe82ea002HDODVAHealth 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 routinelysends 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_bec35258-0d79-11eb-8f70-d241fe82ea003The increasing level of interoperability between DOD and VA and with the health care and benefits partner continuumprovides opportunities for the Departments to continually advance their dynamic ecosystem that supports researchand innovation to improve care and benefits and advance human knowledge. Consistent with the Institute of Medicineand 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 seamlesslyembedded in the delivery process and new knowledge captured as a by-product of the delivery experience. Anethical framework underpins all research and innovation initiatives to help ensure the appropriate and secure useof data and prioritize beneficiary privacy. DataBeneficiaries have the choice to contribute their data to research initiatives_bec3542e-0d79-11eb-8f70-d241fe82ea003ABeneficiaries have the choice to contribute their data to research initiatives within the parameters of existing lawand organizational policies and based on their personal preferences. Health and benefits team members presentopportunities to beneficiaries to participate in large-scale studies to accelerate health research to produce new medicaltreatments to benefit individuals and the wider population.InteroperabilityResearchers and IT professionals advance interoperability to better facilitate research and innovation_bec356a4-0d79-11eb-8f70-d241fe82ea003BResearchersIT ProfessionalsResearchers need easy access to data across multiple systems to enable studies and clinical trials that will lead to newtreatments and interventions and to drive innovation in the health and benefits systems. They also work in collaboration withthe IT professionals across the enterprise to study the best IT solutions, such as application program interfaces, machinelearning and artificial intelligence, to continually improve interoperability and facilitate research and innovation. ONC’s CuresAct 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_bec3585c-0d79-11eb-8f70-d241fe82ea003CResearchersInnovatorsTo support the continuing development of an interoperable, data-driven ecosystem, researchers and innovators must havean evidence base that enables current technologies to be studied and evaluated to determine how they can be usedand improved to deliver maximum value. This evidence base also facilitates the evaluation of potential new informationtechnologies to ensure they will meet the Departments’ current and future needs and deliver value across the ecosystem.DataConnect Health Care and Health Data_bec35a0a-0d79-11eb-8f70-d241fe82ea004DOD and VA are committed to securely connecting health data through an interoperable health IT infrastructure, whilesafeguarding the privacy of beneficiary data and ensuring its appropriate use. The Departments are implementinga single, common EHR and ensuring interoperability with other systems to facilitate seamless care and benefitsdelivery to beneficiaries. The Departments continue to improve interoperability with members of the health care andbenefits partner continuum through a joint HIE, which maximizes appropriate and timely data sharing. DOD and VAparticipate in the federal health IT architecture arena and collaborate with standards development organizations. Inaddition, they participate in the IT marketplace by evaluating new products and adopting the products that best meettheir requirements to continually improve interoperability. The Departments also ensure technical requirements andcontract specifications maximize open architecture, standards and data sharing within organizational frameworksand policies for appropriate data access and use.ITLeadership in health and benefits delivery, finance and technology optimize the value of information technology_bec35bae-0d79-11eb-8f70-d241fe82ea004ALeadership in health and benefits delivery, finance and technology collaborate closely to shepherd the organizationsthrough 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 standardsfor data access and use. Close collaboration and tightly integrated evaluation processes of IT solutions help ensureinteroperability 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 asrequired by law or covered by an exception) as any act that is likely to interfere with (includes “prevent” and “materiallydiscourage”) access, exchange or use of electronic health information included in the United States Core Data Setsfor Interoperability standard adopted in 170.213.IntegrationLeadership in technology and information enable seamless integration between systems to support health care and related benefits_bec35d48-0d79-11eb-8f70-d241fe82ea004BLeadership 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